scholarly journals Pyrexia of Unknown Origin: An Atypical Presentation of Hepatic Hemangioma

2020 ◽  
Vol 06 (04) ◽  
pp. e180-e184
Author(s):  
Gunjan Desai ◽  
Dattaraj Budkule ◽  
Prasad Pande ◽  
Prasad Wagle
Keyword(s):  
Unknown Origin ◽  
Uneventful Recovery ◽  
Hepatic Hemangioma ◽  
Diagnostic Challenge ◽  
Abdominal Ultrasonography ◽  
Algorithmic Approach ◽  
Pyrexia Of Unknown Origin ◽  
Right Lobe ◽  
Sudden Decrease ◽  
Vague Abdominal Pain

AbstractPyrexia of unknown origin (PUO) has been a diagnostic challenge for decades. Hepatic hemangioma (HH) is not a common differential diagnosis of PUO. It is the most common benign hepatic tumor, commonly asymptomatic and incidentally detected, or can present with vague abdominal pain. PUO is a rare presenting feature. We describe a case of 38-year-old lady presenting with PUO. With no other identifiable source of fever despite exhaustive investigations, a giant hemangioma in right lobe of liver detected on abdominal ultrasonography was deemed to be the cause of PUO. The patient had sudden decrease in hemoglobin while undergoing workup, which on imaging showed a bleeding hemangioma and right hepatectomy was performed. Patient had an uneventful recovery and her PUO also resolved after surgery. HH should be considered a rare diagnosis of exclusion for PUO after a standard algorithmic approach does not reveal any other cause.

Case 31

2020 ◽  
pp. 211-217
Author(s):  
Andrew Woodhouse
Keyword(s):  
Unknown Origin ◽  
Modern Medicine ◽  
Initial Evaluation ◽  
Substantial Proportion ◽  
Diagnostic Challenge ◽  
Specific Patient ◽  
Pyrexia Of Unknown Origin ◽  
Patient Groups ◽  
Definition Of ◽  
Targeted Approach

Fever for which there is no obvious cause after initial evaluation and which persists remains a diagnostic challenge even for modern medicine with its plethora of investigative tools. The classical definition of pyrexia of unknown origin (PUO) is still useful but more recent modifications take into account specific patient groups and the changes in the way in which patients are evaluated, with less emphasis on in-patient investigation. While infection remains an important underlying cause of PUO, a substantial proportion of patients have other conditions, particularly malignancy and inflammatory and autoimmune diseases. Approaching a patient with PUO in a systematic way and gathering information from history, examination, and initial investigations allow a targeted approach to investigations which will reveal a diagnosis in a majority of patients.

scholarly journals Splenic Tuberculosis: A Cause of Pyrexia of Unknown Origin Report of Two Cases

2013 ◽  
Vol 14 (1) ◽  
pp. 88-90
Author(s):  
Ahmedul Kabir ◽  
Aparna Das ◽  
Mahmudul Hassan Banna ◽  
Baharul Minnat ◽  
H A M Nazmul Ahasan
Keyword(s):  
Laboratory Data ◽  
Unknown Origin ◽  
Clinical Entity ◽  
Specific Information ◽  
Rare Clinical Entity ◽  
Abdominal Ultrasonography ◽  
Pyrexia Of Unknown Origin ◽  
Splenic Tuberculosis ◽  
Diagnostic Difficulties ◽  
Microbiological Confirmation

Tuberculosis of spleen is an extremely rare clinical entity. It often poses diagnostic difficulties as microbiological confirmation of diagnosis is not easy. We encountered two casas who presented with prolong fever but no other symptoms. Laboratory data provided no specific information for diagnosis. Abdominal ultrasonography revealed splenomegaly with multiple small hypoechoic lesions within the spleen. A diagnosis of isolated splenic tuberculosis was confirmed after a splenic puncture and histopathological examination.DOI: http://dx.doi.org/10.3329/jom.v14i1.14586 J MEDICINE 2013; 14 : 88-90

scholarly journals Imaging Characteristics and Management of Infected Hepatic Hemangioma: Case-in Discussion

2021 ◽  
Author(s):  
Karolin Ginting ◽  
Anisha Tailor ◽  
Timothy Braverman ◽  
Ajay Agarwal ◽  
Shyam Allamaneni
Keyword(s):  
Liver Tumors ◽  
Hepatic Hemangioma ◽  
Liver Mass ◽  
Diagnostic Challenge ◽  
Intentional Weight Loss ◽  
Cancer Management ◽  
Imaging Characteristics ◽  
Right Lobe ◽  
Systemic Symptoms ◽  
Hepatic Hemangiomas

AbstractHepatic hemangiomas are the most common type of benign liver tumors. We present a case of an infected hepatic hemangioma, which posed a diagnostic challenge. A 43-year-old female presented with right upper quadrant pain after blunt force trauma and intentional weight loss. CT and MRI were done, showing a posterior right lobe liver mass. Imaging characteristics were thought to be suggestive of metastatic disease, with a differential diagnosis of abscess. Drainage and biopsy of the mass revealed Streptococcus sp. infection, and pathology showed a cavernous hemangioma with inflammation. Patients presenting with systemic symptoms and an indeterminate liver mass on imaging should be evaluated for infected hepatic hemangiomas. Biopsy may be needed to rule out cancer. Management may include surgical resection; however, antibiotics and percutaneous drainage can suffice, as in this case.

Super-mesenteric-vein-expia-thrombosis, the clinical sequelae can be quite atrocious

2016 ◽  
Vol 28 (4) ◽  
pp. 445-449 ◽  
Author(s):  
Benjamin Howell Lole Harris ◽  
Jason Leo Walsh ◽  
Sarfraz A. Nazir
Keyword(s):  
Elevated Serum ◽  
Unknown Origin ◽  
Mesenteric Vein ◽  
Pyrexia Of Unknown Origin ◽  
Presenting Symptoms ◽  
Contrast Enhanced ◽  
Life Threatening ◽  
Intra Abdominal Infection ◽  
Enhanced Computed Tomography ◽  
Vague Abdominal Pain

Abstract Superior mesenteric vein (SMV) thrombosis is a rare, potentially life-threatening complication of intra-abdominal infection. Here we present a case of massive SMV thrombosis secondary to appendicitis in a 13-year-old boy. He presented with vague abdominal pain and associated symptoms, persistently elevated serum inflammatory markers and a pyrexia of unknown origin. Sonography proved inconclusive, and a definitive diagnosis was made by abdominal contrast-enhanced computed tomography. He was treated with antibiotics and anticoagulation before interval elective laparoscopic appendectomy. The non-specific nature of the presenting symptoms makes SMV thrombosis an important differential to consider when dealing with such patients.

scholarly journals High diagnostic yield of splenic core biopsy in patients with pyrexia of unknown origin

2021 ◽  
Author(s):  
Yee Ting Nicole Yim ◽  
Gabriel Wallis ◽  
Jawad Saeed ◽  
Stefan Voo ◽  
Irfan Kayani ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Diagnostic Yield ◽  
Unknown Origin ◽  
Pyrexia Of Unknown Origin ◽  
High Diagnostic Yield

ANTERIOR ABDOMINAL WALL ABSCESS A RARE PRESENTATION OF LEFT SIDED COLONIC CARCINOMA: A DIAGNOSTIC CHALLENGE FOR A GENERAL SURGEON

2021 ◽  
pp. 26-28
Author(s):  
Sukanta Sikdar ◽  
Mala Mistri ◽  
Subhabrata Das ◽  
Dibyendu Chatterjee
Keyword(s):  
Abscess Formation ◽  
Colonic Carcinoma ◽  
Uneventful Recovery ◽  
General Surgeon ◽  
Bowel Habit ◽  
Abdominal Abscess ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Carcinoma Of The Colon ◽  
History Of

Background: The various presentations of carcinoma of the colon are well known. Abscess formation occurs in 0.3 to 0.4% and is the second most common complication of perforated lesions. Perforation and penetration of adjacent organs with intra-abdominal abscess formation as the initial presentation is uncommon. It is difcult to make an accurate diagnosis of abscess formation as the rst evidence of colonic carcinoma preoperatively. A 68 yrs old female who presented to the ED with acute onset of left lower abdominal f Case presentation: ullness, pain and local redness for 15 days. She denied any history of vomiting, fever, anorexia but history of altered bowel habit. Clinically she had a palpable lump (20 x15) cm in left lumber region .The lump was parietal with local raise of temperature , redness and tenderness can be elicited . So our initial impression was parietal wall abscess and we underwent emergency drainage of abscess. She had uneventful recovery and discharged after 2 weeks. She was admitted with similar presentation in previous location 30 days after discharge. Now we investigate thoroughly, a CECT scan of whole abdomen which conrms radio-logically as carcinoma of descending colon with abscess extending into the parietal wall .We underwent an exploratory laparotomy and HPE proven as adenocarcinoma of the colon. Post op she developed SSI which was managed with regular dressing and she was discharged in post-op day 20. We report this case because of an unusual Conclusion: presentation of left sided colonic Ca. The accurate preoperative diagnosis of these conditions extremely complicated because of the fuzzy clinical presentation. The CT scan can diagnose malignancy pre-operatively, even if the denitive diagnosis of colonic perforated neoplasia may be evident only during surgery. So early diagnosis and prompted intervention can save the patient to developed sepsis and to reduce signicantly the morbidity and mortality. The importance is to focus on the differential diagnosis and keep in mind that a colon carcinoma can present with abdominal abscess. Surgeons should be aware of this differential because it is easily ignored pre-operatively.

scholarly journals Leptospirosis presenting as severe cardiogenic shock: A case report

2018 ◽  
Vol 19 (4) ◽  
pp. 351-353
Author(s):  
E Forbat ◽  
MJ Rouhani ◽  
C Pavitt ◽  
S Patel ◽  
R Handslip ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiogenic Shock ◽  
Social History ◽  
Rare Case ◽  
Clinical Course ◽  
Unknown Origin ◽  
Case Presentation ◽  
Pyrexia Of Unknown Origin ◽  
Severe Cardiogenic Shock ◽  
Infectious Illness

Background Leptospirosis is a rare infectious illness caused by the Spirochaete Leptospira. It has a wide-varying spectrum of presentation. We present a rare case of severe cardiogenic shock secondary to leptospirosis, in the absence of its common clinical features. Case presentation A 36-year-old woman presented to our unit with severe cardiogenic shock and subsequent multi-organ failure. Her clinical course was characterised by ongoing pyrexia of unknown origin with concurrent cardiac failure. She was initially managed with broad-spectrum antibiotics and inotropes. Percutaneous cardiac biopsy excluded major causes of myocarditis. On day 21 after presentation, she was found to be IgM-positive for leptospirosis. Conclusions This is a rare case of severe cardiogenic shock secondary to leptospirosis infection. The case also highlights the importance of obtaining a thorough social history when assessing a patient with an unusual presentation, as clues can often be missed.

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