Liu Yang

Rationale: Isolated hepatic involvement of Langerhans cell histiocytosis (LCH) in the pediatric population is an exceedingly rare condition. Its clinical presentation is nonspecific, and its imaging features frequently overlap with those of other hepatic focal lesions, rendering preoperative diagnosis particularly challenging. Patient concerns: An 11-year-old girl presented with a chief complaint of intermittent abdominal pain. Diagnoses: Enhanced computed tomography and magnetic resonance imaging revealed multiple liver nodules. A characteristic imaging pattern was observed: during the portal venous and delayed phases, the periphery of the lesions exhibited a “wash-in and wash-out” enhancement pattern, while the central areas remained non-enhancing throughout all phases. This imaging finding provided a crucial diagnostic clue. The diagnosis of LCH was ultimately confirmed by liver biopsy, supplemented by electron microscopy and immunohistochemistry. Systemic evaluation verified isolated hepatic involvement. Interventions: The patient received immunosuppressant therapy combined with prednisone and vindesine-based combination chemotherapy. Outcomes: The patient was treated with immunosuppressant therapy and combination chemotherapy. Follow-up at 6 months indicated a favorable recovery. Lessons: This case illustrates that contrast-enhanced ultrasound can effectively delineate the unique hemodynamic characteristics of hepatic LCH lesions, serving as a valuable supplement to conventional cross-sectional imaging. In the differential diagnosis of focal liver lesions in children, particularly when there is clinical suspicion for LCH, increased recognition of these specific contrast-enhanced ultrasound features is crucial. This awareness can help prevent diagnostic delays and guide targeted pathological sampling.

Rationale: Duplication of gallbladder is a rare anomaly in humans, as it is very rare for a duplication of gallbladder to be missed during the first cholecystectomy and thus require a second cholecystectomy. Patient concerns: A 42-year-old man came to our hospital with paroxysmal right upper abdominal pain for 10 days. In addition to the pain, he also had transient jaundice. He had undergone laparoscopic cholecystectomy (LC) 1 year ago. Magnetic resonance cholangiopancreatography showed gallstones, intrahepatic bile duct stones with cholangitis, no dilatation of the common bile duct, and a cystic structure was visible in the upper part of common bile duct. The patient underwent LC again, and the intraoperative diagnosis was duplication of gallbladder. Diagnosis: The patient was diagnosed with duplication of gallbladder during surgery. Interventions: The patient underwent LC again. Outcomes: The patient underwent LC again, and was diagnosed with duplicated gallbladder during the operation. The operation was successful and the patient was discharged on the 5th day after the operation without other complications. Lessons: Our case and literature review showed that there are no specific signs of duplicated gallbladders, and ultrasound has a low sensitivity for the diagnosis of double gallbladders, so double gallbladders are easily missed. Patients with double gallbladders may have multiple missed diagnoses during diagnosis and treatment, as in this case. When patients experience upper abdominal pain again after gallbladder removal, we should be alert and consider the possibility of duplicated gallbladders.

Background: Medial epicondyle fractures are one of the more common humerus fractures, but humeral medial condyle fracture (HMCF) is rare. Nonunion of medial humeral condyle fractures due to functional exercise is less common. Case presentation: We report a 5-year-old patient with a nonunion HMCF due to excessive functional exercise, who bruised the elbow 1 year ago and had no positive findings on all imaging studies. On this physical examination, there was a snapping and palpable lump in the elbow joint during movement, but the patient did not feel any discomfort and the range of motion of the joint was normal. X rays and computed tomography (CT) showed that the left HMCF was discontinuous, the broken ends were dislocated, and the joint alignment was poor. Open reduction (OR) and screw fixation was used during the operation, and the patient recovered well at 3-month follow-up. Conclusions: The rarity and low radiographic appearance of displaced HMCF are easily overlooked and can eventually lead to nonunion HMCF, especially when radiographically difficult to visualize before age 5 years. Therefore, regardless of whether there are signs or imaging abnormalities in the growth process of adolescents, they should be vigilant, shorten the time interval for re-examination, and early detection and timely treatment can avoid some complications caused by this.