Artery of Percheron infarct: a diagnostic challenge

2021 ◽  
Vol 14 (4) ◽  
pp. e236189
Author(s):  
Joana Morais ◽  
Ana Andrade Oliveira ◽  
Inês Burmester ◽  
Olga Pires
Keyword(s):  
Anatomical Variation ◽  
Sudden Change ◽  
Rare Event ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Diagnostic Challenge ◽  
Cranial Ct ◽  
Artery Of Percheron ◽  
Ischaemic Lesion ◽  
Change Of Consciousness

The artery of Percheron is a rare anatomical variation that supplies thalamus and the midbrain. A stroke in this area is a rare event. The presentation varies widely, with some bizarre disturbances, like transient episodic loss of consciousness similar to coma, somnolence, cognition and memory impairment and psychosis. We report a case of a patient who presented at the emergency department with a sudden change of consciousness. During the observation, she oscillated reactive state of consciousness with obnubilation similar to coma. The first exams were normal, which include a cranial CT of the brain, and so the patient was kept under observation. The final diagnosis was only possible 24 hours later with cranial CT where an ischaemic lesion on the Percheron territory was identified. This case highlights an unusual clinic and a difficult neuroimaging stroke diagnosis of a rare condition, that is unknown to most of the physicians.

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

Plasmablastic Myeloma Versus Plasmablastic Lymphoma; Is MYC Rearrangement Helpful Towards A Precise Diagnosis?

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S105-S105
Author(s):  
M Khedr ◽  
Y Yusuf ◽  
L Aftab
Keyword(s):  
Reference Range ◽  
Final Diagnosis ◽  
Plasmablastic Lymphoma ◽  
Bone Lesions ◽  
Molecular Testing ◽  
Diagnostic Challenge ◽  
Plasma Cell Neoplasm ◽  
Hiv Antibodies ◽  
Precise Diagnosis ◽  
Diagnostic Work

Abstract Introduction/Objective Plasmablastic myeloma (PBM) is a rare and aggressive plasma cell neoplasm. Differentiating PBM from plasmablastic lymphoma (PBL) represents a diagnostic challenge, as both diseases have overlapping cytomorphologic and immunophenotypic features. Genetic mutations in MYC occur in a majority of PBL cases but rarely in PBM, thus can theoretically be used to differentiate between both neoplasms. Methods We report a case of a 53-year-old female who presented with a rapidly growing mass in her right mandible. Biopsy revealed circumscribed nodules of immunoblastic cells with moderate cytoplasm, large vesicular nuclei and large prominent nucleoli. Apoptotic debris and brisk mitoses were present. Molecular testing revealed a C-MYC rearrangement. The location of the neoplasm and the above described morphological features were suggestive of PBL, especially with a positive C-MYC rearrangement. The neoplastic cells were positive for CD138, MUM1,CD56 and kappa; and negative for CD45, CD20, PAX5, CD3, CD5, CD30, EBER-ISH, HHV8, ALK-1, Lambda, EMA, CD21, CD23, pancytokeratin, CK20, CK7, Cam5.2, chromogranin, synaptophysin, HMB45, S100, P16, P40. MIB-1 showed high positivity, approximately 95%. Results Patient underwent further diagnostic work up, her HIV antibodies result were negative however, she was found to be anemic (Hemoglobin 6.6 g/dl; reference range 12-16 g/dl) and hypercalcemic (Calcium 12.3 mg/dl; reference range 8.5-10.5 mg/dl). PET scan revealed multiple hypermetabolic lytic bone lesions. The bone marrow biopsy showed 80% cellularity with extensive involvement by atypical plasmacytic cells forming large clusters. The patient’s final diagnosis was PBM. Conclusion Differentiating PBM from PBL is essential as treatment is different. Although MYC rearrangement in PBM is not common, it has been demonstrated and therefore should not be used to exclude this diagnosis. Here, we highlight the importance of correlating detailed clinical, radiological, laboratory, histological and genetics data for reaching the final diagnosis.

Struma Ovarii: Clinico-Morphological Features and Therapeutic Experience of a Romanian Institution over 20 Years

2021 ◽  
Vol 11 (20) ◽  
pp. 9427
Author(s):  
Mihaela Camelia Tîrnovanu ◽  
Vlad Gabriel Tîrnovanu ◽  
Bogdan Florin Toma ◽  
Elena Cojocaru ◽  
Carmen Ungureanu ◽  
...  
Keyword(s):  
Rare Condition ◽  
Diagnostic Algorithm ◽  
Complete Information ◽  
Published Data ◽  
Struma Ovarii ◽  
Therapeutic Approaches ◽  
Diagnostic Challenge ◽  
Benign Ovarian Tumors ◽  
The Right ◽  
Clinical Conditions

Struma ovarii is a rare condition with scarce published data regarding clinical, morphological, and therapeutic approaches. This study reports the experience of 25 patients with struma ovarii who received surgical treatment in a gynecology department in Romania. The study was conducted from January 1999 to September 2021 and included patients with confirmed struma ovarii whose medical records were retrospectively reviewed and evaluated. Struma ovarii represented 2.8% of the total number of benign ovarian tumors treated by surgery. The age of the patients was between 24 and 71 years. The tumor was unilateral in 24 cases, 13 cases on the left ovary, 11 on the right side, and bilateral in 1 case. Tumor dimensions ranged between 1 cm and 20 cm. In two cases, the patients had symptoms of hyperthyroidism. The procedure was performed on four women for diagnoses other than an ovarian tumor. In another five situations, there was suspicion of ovarian malignancy. In addition, struma ovarii was associated with other clinical conditions in 22 cases. These lesions represent a diagnostic challenge with heterogeneous clinical and imaging manifestations. Complete information of clinical, morphologic, and surgical findings may improve the diagnostic algorithm and better predict patient outcomes.

scholarly journals The Frequency and Causes of Subepidermal Gaps or Blisters and the Compliance Rate Between Clinical Diagnosis and Pathology Reports from 2015 to 2019

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Abbas Darjani ◽  
Hojat Eftekhari ◽  
Seyedeh Rojin Amini Rad ◽  
Narges Alizadeh ◽  
Rana Rafiee ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Skin Diseases ◽  
Histopathological Examination ◽  
Compliance Rate ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Direct Immunofluorescence ◽  
Diagnostic Challenge ◽  
Cross Sectional ◽  
Pathology Reports

Background: Skin diseases are the fourth most common cause of human illness, and blisters with different clinical manifestations make a diagnostic challenge. Objectives: This study aimed to evaluate the frequency and causes of subepidermal gaps or blisters, as well as the compliance rate between the initial and final clinical diagnoses based on pathology reports. Methods: In this cross-sectional study, pathology reports of subepidermal blisters or gaps were evaluated in the patients referred to the Razi Laboratory of Rasht from 2015 to 2019. The samples were examined by a pathologist after hematoxylin and eosin staining. The reports included demographic information, clinical differential diagnoses, final diagnosis, direct immunofluorescence findings, and salt split results. Finally, the compliance rate of clinical diagnosis with pathology reports was determined. Results: A total of 183 pathology reports were evaluated, 170 of which contained the final diagnosis. Females were more frequently affected by the disease, and pemphigoid bolus and lichen planus were the most prevalent final diagnoses. The compliance rate between the initial and final diagnoses was 94%. About 37.2% of the reports lacked direct immunofluorescence (DIF) and salt split, and only 42.6% of the samples had undergone DIF examination, while 20.2% had both DIF and salt split. There was no significant association between the compliance rate of the final diagnosis with age, sex, and undergoing diagnostic tests. Conclusions: A high incidence of subepidermal gaps or blisters was seen in middle-aged individuals and females. The compliance rate of the initial clinical diagnosis with the final diagnosis based on pathological reports was high. Our findings emphasize the importance of histopathological examination and the complementary role of direct immunofluorescence and salt split in diagnosis.

scholarly journals An Incidental Finding of Situs Ambiguus with Polysplenia in an Asymptomatic 70-Year-Old Male

2021 ◽  
pp. 1-3
Author(s):  
Christopher Ambrogi ◽  
◽  
Madina Ndoye ◽  
Keyword(s):  
Prostate Cancer ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Incidental Finding ◽  
Anatomical Variation ◽  
Rare Condition ◽  
Situs Ambiguus ◽  
Abdominal Organs ◽  
The Right ◽  
Thoracic And Abdominal

The term “Situs ambiguus” describes the configuration when some, but not all thoracic and abdominal organs are abnormally positioned. It is commonly associated with polysplenia, or multiple spleens. 50-100% of situs ambiguus with polysplenia have associated cardiac malformations [1]. We present a 70 year old male who came to our hospital for complete, acute, urinary retention, and was found to have invasive prostate cancer. Incidentally, the liver was positioned on the left side, and the spleen was located on the right side. There were multiple perisplenic nodular formations with peripheral calcifications that had enhancement kinetics similar to those of the spleen, suggesting polysplenia. In low thoracic cuts, the tip of the heart was clearly on the left side. The presence of situs ambiguus with polysplenia in the absence of cardiac abnormalities makes this case a unique presentation of an already rare condition. Clinicians should regularly consider the possibilities of anatomical variation in their medical and surgical practices.

Capsule endoscopy in small bowel Crohn’s disease and Tuberculosis

2017 ◽  
Vol 47 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Surinder Singh Rana ◽  
Vishal Sharma ◽  
Ravi Sharma ◽  
Ritambhra Nada ◽  
Rajesh Gupta ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Ileocecal Valve ◽  
Final Diagnosis ◽  
Diagnostic Challenge ◽  
Large N ◽  
Aphthous Ulcers

Differentiation of small bowel tuberculosis (SBTB) from Crohn’s disease (CD) is a diagnostic challenge. We studied 52 patients with suspected SBTB or CD with terminal ileal involvement, who were prospectively enrolled. After confirming patency of the gastrointestinal tract, 26 patients underwent capsule endoscopy (CE). A final diagnosis of CD was found in 18 patients and SBTB in eight patients. All SBTB patients had involvment of the ileocecal valve (ICV) with large (n = 6) and aphthous (n = 2) ulcers in the ileal segment. In CD, ICV involvement was seen in five (33%) patients. Large and aphthous ulcers were observed in seven (47%) and 15 (100%) patients, respectively. On comparison with CD, patients with SBTB had increased frequency of ICV involvement ( P = 0.002) and lesser frequency of aphthous ulcers ( P = 0.007). CE can help in differentiating CD from SBTB by the position of its involvement and the type of ulcers present.

scholarly journals Successful Endovascular Treatment for Aortic Thrombosis Due to Primary Antiphospholipid Syndrome: A Case Report and Literature Review

2018 ◽  
Vol 53 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Yoshito Kadoya ◽  
Kan Zen ◽  
Yohei Oda ◽  
Satoaki Matoba
Keyword(s):  
Endovascular Treatment ◽  
Antiphospholipid Syndrome ◽  
Laboratory Data ◽  
Ankle Brachial Index ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Primary Antiphospholipid Syndrome ◽  
Aortic Thrombosis ◽  
Good Treatment Option ◽  
The Right

A 60-year-old man with a history of Raynaud’s phenomenon presented with bilateral intermittent claudication and an ulcer on his right toe. The ankle–brachial index of the right and left legs was 0.77 and 0.75, respectively. Laboratory data showed prolongation of the activated partial thromboplastin time and a positive result on the lupus anticoagulant test. Computed tomography angiography revealed isolated infrarenal aortic stenosis with irregular surface and noncalcified plaques. Intravascular ultrasonography examination demonstrated a noncalcified, irregular, and mobile plaque, suggestive of abdominal aortic thrombosis. In addition to anticoagulant and dual antiplatelet therapy, endovascular treatment was performed. A total of three 40-mm-long balloon-expandable stents were successfully implanted on a 15-mm balloon. The final angiography showed good results except for minimal plaque shifting in the terminal aorta. Three months later, the ulcer resolved and a final diagnosis of primary antiphospholipid syndrome (APS) was made. Clinicians should recognize that APS can affect the abdominal aorta, leading to aortic thrombosis. Endovascular treatment may be the one good treatment option for this rare condition.

scholarly journals Isolated Pancreatic Tuberculosis Mimicking Pancreatic Cancer: A Diagnostic Challenge

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Abhishek Bhurwal ◽  
Muhammad Masoodul Haq ◽  
Sunil Sapru ◽  
Matthew Tortora ◽  
Dhanasekaran Ramasamy
Keyword(s):  
Pancreatic Tumor ◽  
Extrapulmonary Tuberculosis ◽  
Rare Condition ◽  
Abdominal Tuberculosis ◽  
Needle Aspiration ◽  
Diagnostic Challenge ◽  
Prognostic Implication ◽  
Pancreatic Tuberculosis ◽  
Antituberculosis Therapy ◽  
Persistent Abdominal Pain

Isolated pancreatic tuberculosis is an exceedingly rare condition, even in areas of the world where the disease is highly prevalent. Abdominal tuberculosis is a common form of extrapulmonary tuberculosis but involvement of the pancreas is very rare. We report a case of isolated pancreatic tuberculosis presenting as a pancreatic mass in a patient with persistent abdominal pain and jaundice. Clinically and radiologically, the mass mimicked a malignant pancreatic tumor with a vastly different prognostic implication and therapeutic approach. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) can provide valuable diagnostic information in this scenario. After the tissue showed evidence of acid-fast bacilli and the cultures showed growth of Mycobacterium tuberculosis, antituberculosis therapy was initiated. Conservative management is usually successful in alleviating symptoms and leading to a cure. The excellent response to ATT makes it imperative that these patients are diagnosed early and managed appropriately to avoid unnecessary surgery and associated morbidity.

scholarly journals P1736 An unexpected cause of ventricular tachycardia in a young patient

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Tomoaia ◽  
R S Beyer ◽  
M Puiu ◽  
A Dadarlat ◽  
F I Fringu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Young Patient ◽  
Young Male ◽  
Rare Condition ◽  
Lateral Wall ◽  
Final Diagnosis ◽  
Reduced Ejection Fraction

Abstract Introduction Hypoplastic coronary artery disease (HCAD) refers to a congenital underdevelopment of one or more coronary arteries, which are greatly reduced in diameter or length. It is a rare congenital abnormality which has rarely been documented in living patients and which may lead to myocardial infarction (MI) and sudden cardiac death (SCD). This case describes an otherwise healthy young male, which was admitted in the emergency department (ED) for repeated sustained ventricular tachycardia (VT) and was thereby diagnosed with an isolated hypoplasia of the left circumflex coronary artery (CX). Investigations revealed scar-related tachycardia, due to a prior silent myocardial infarction caused by HCAD. These findings were suggested by echocardiography and coronary angiography and were later confirmed by magnetic resonance and 3D cardiac mapping. Case Report A 34-year-old male patient was admitted to the intensive care unit with recurrent sustained VT causing hemodynamic instability. After receiving two electric shocks and amiodarone in the ambulance, the patient became hemodynamically stable. There was no remarcable medical history besides a syncopal fall 5 years before and no symptoms prior to the current event. Initial physical examination, ECG and laboratory testing were normal. Echocardiography revealed a dilated left ventricle with akynesia of the lateral wall and a mildly reduced ejection fraction (EF = 45%), moderate mitral regurgitation due to restriction of the posterior mitral leaflet. A subsequent emergent coronary angiography was therefore performed, which showed no sign of atherosclerotic lesions, yet it revealed a hypoplastic CX, without compensatory collateral vessels supplying the lateral wall. Cardiac MR demonstrated delayed enhancement with transmural necrosis and no viability in the lateral wall of the LV, suggesting a long-standing MI. Therefore, the final diagnosis was scar-related VT, due to a prior silent MI caused by HCAD. The management of this patient included implantation of an ICD in the secondary prevention of SCD. Moreover, we performed an EPS, which identified a scar at the level of the lateral and inferolateral LV walls as a substrate for VT (electroanatomic 3D voltage mapping) and of the critical istmus (3D activation mapping). The next step was radiofrequency ablation of the critical isthmus, with no inducibility of the VT after the procedure. After 6-months follow-up, there was no recurrence of the VT. Conclusion Finding the cause of myocardial infarction in a young patient with VT can be very challenging. We emphasise the role of imaging for the diagnosis and management of these patients. HCAD is a rare congenital anomaly, which can lead to progressive fibrosis in the territory with poor blood supply, MI and SCD. Although it is a rare condition, it should be considered in young adults who present with MI and/or SCD. Abstract P1736 Figure. Investigations

scholarly journals Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Sohil Pothiawala ◽  
Fatimah Lateef
Keyword(s):  
Differential Diagnosis ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Rare Condition ◽  
Facial Nerve Paralysis ◽  
Diagnostic Challenge ◽  
Radiological Investigation ◽  
Diagnostic Dilemma ◽  
Nerve Paralysis

Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders.Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal.Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma.Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant.

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