scholarly journals Large multicystic spinal lesion in a young African migrant: a problem of differential diagnosis

2021 ◽  
Vol 14 (7) ◽  
pp. e242690
Author(s):  
Tamara Ursini ◽  
Paola Rodari ◽  
Geraldo Badona Monteiro ◽  
Valeria Barresi ◽  
Carmelo Cicciò ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cystic Echinococcosis ◽  
Bone Cyst ◽  
Spinal Tuberculosis ◽  
Final Diagnosis ◽  
Lower Limbs ◽  
Migration Flow ◽  
Spinal Lesion ◽  
African Migrant ◽  
Expansive Lesion

We describe a rare case of large, fully cystic spinal schwannoma in a young adult from The Gambia. The initial clinical suspicion was spinal cystic echinococcosis. He came to our attention reporting progressive walking impairment and neurological symptoms in the lower limbs. An expansive lesion extending from L2 to S1 was shown by imaging (ie, CT scan and MRI). Differential diagnoses included aneurysmal bone cyst and spinal tuberculosis and abscess; the initial suggested diagnosis of spinal cystic echinococcosis was discarded based on contrast enhancement results. The final diagnosis of cystic schwannoma was obtained by histopathology of the excised mass. Cystic spinal lesions are rare and their differential diagnosis is challenging. Awareness of autochthonous and tropical infectious diseases is important, especially in countries experiencing consistent migration flow; however, it must be kept in mind that migrants may also present with ‘non-tropical’ pathologies.

scholarly journals Intramedullary Tuberculoma of the Spinal Cord: A Case Report

2020 ◽  
Vol 13 ◽  
pp. 300-303
Author(s):  
Kelsey Knobbe ◽  
Melissa Gaines
Keyword(s):  
Spinal Cord ◽  
Differential Diagnosis ◽  
Case Report ◽  
Treatment Guidelines ◽  
Clinical Course ◽  
Spinal Tuberculosis ◽  
Spot Test ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spinal Lesion

Intramedullary tuberculoma (IMT) is a form of spinal tuberculosis which provides a challenge to the internist because there lacks clear diagnostic and treatment guidelines to date. Although rare, it should be included on the differential diagnosis of any patient who presents with progressively worsening symptoms of radiculopathy and a new spinal lesion on imaging. Traditional methods for detection of tuberculosis including tuberculosis spot test and the Ziehl-Neelsen stain have limited utility in diagnosing IMT. In this report, we describe the clinical course, diagnosis and treatment regimen of an adult male with intramedullary tuberculoma of the thoracic spinal cord

scholarly journals Primary extraosseous dural chondrosarcoma: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Francis Garay Buitron ◽  
Albert Pons-Escoda ◽  
Noemí Vidal ◽  
Alberto Torres ◽  
Angels Camins
Keyword(s):  
Differential Diagnosis ◽  
Brain Mri ◽  
Final Diagnosis ◽  
Imaging Features ◽  
Cartilaginous Tissue ◽  
Total Resection ◽  
Case Presentation ◽  
Tertiary Center ◽  
Fibrous Tumor ◽  
Expansive Lesion

Abstract Background Dural chondrosarcoma is a very rare intracranial tumor, given that meninges do not normally contain cartilaginous tissue from which it can originate. We present a case of primary extraosseous dural chondrosarcoma. Case presentation A 48-year-old woman presented to our tertiary center neurosurgery consultation with progressive headache, vomiting, vertigo, and gait instability of 5 months’ duration. An initial brain CT revealed a large parietal mass with gross calcifications and subtle hyperostosis of the inner table. Subsequent brain MRI showed a heterogeneous expansive lesion with a honey-comb enhancement. Discussion of intra- or extra-axial location was warranted, and finally, initial presurgical suspicion of meningioma arose although some atypical imaging features were detected. The differential diagnosis included solitary fibrous tumor–hemangiopericytoma and dural metastasis. Total resection of the lesion was performed, extra-axial origin was confirmed, and pathology resulted in a primary dural chondrosarcoma. Conclusion The importance of this case presentation lies in the unusual nature of the final diagnosis, the brief literature review and differential diagnosis with emphasis on imaging pearls, as well as the useful reminder for physicians to consider less frequent diseases when key findings do not unambiguously lead to the usual suspects.

The Significance of “Fractional Excretion of Urea” in The Differential Diagnosis of Acute Kidney Injury in Cirrhotic Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sameh Mohamed Ghaly ◽  
Moataz Serry Seyam ◽  
Mohamed Osama Aly ◽  
Ahmed Mohamed Hesham Abdelfattah ◽  
Ahmed R. Mashaal
Keyword(s):  
Acute Kidney Injury ◽  
Differential Diagnosis ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Final Diagnosis ◽  
Good Alternative ◽  
Decompensated Cirrhosis ◽  
Eligibility Criteria ◽  
Significant Difference ◽  
Cirrhotic Patients

Abstract Background Patients with cirrhosis are more susceptible to develop AKI than the non-cirrhotic individuals. AKI has an estimated prevalence of approximately 20% to 50% among hospitalized patients with cirrhosis. Physicians caring for patients with cirrhosis should recognize the acute or chronic character of renal disease, the causes of renal injury, the clinical conditions leading concomitantly to AKI and liver dysfunction, and the prognostic factors associated with the progression of AKI. Hypovolemia (due to diuretics, hemorrhage and diarrhea), acute tubular necrosis (ATN), sepsis, nephrotoxic agents (such as nonsteroidal anti-inflammatory drugs, aminoglycosides and/or radiological contrasts) and hepatorenal syndrome (HRS)-type 1 are the most common causes of AKI in cirrhotic patients. Objective To evaluate the sensitivity of fractional excretion of urea (FEUrea) vas a diagnostic biomarker for different causes of acute kidney injury in liver cirrhosis. Patients and Methods This study was conducted in co-operation between Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between July 2019 to January 2020. It included 70 adult Egyptian patients admitted for treatment of complications of cirrhosis who fulfilled the eligibility criteria and compared to 10 cirrhotic patients without renal impairment. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations, Child-Pugh score was calculated for admission and urine samples were collected for urinary urea and creatinine levels to calculate FEUrea. Results Concerning the gender distribution in this study, male to female percent was 40 (57.10%) males and 30 (42.90%) females for gender, respectively. As regards to the causes of AKI, there were 24 (34.30%) PRA, 7 (10.00%) HRS and 39 (55.70%) ATN for final diagnosis. In the current study, there was significant difference (P = 0.0001; P < 0.05) in FE urea % among PRA, HRS and ATN groups (26.28±2.89, 11.76±3.44, and 47.37±10.53, respectively). Findings showed a higher FEUrea cut-off for ATN (>33%) compared to lower cut-off values for PRA (<33% and >21%) and HRS (<21%). Conclusion FEUrea was found to be an excellent simple tool for the differential diagnosis of AKI in patients with decompensated cirrhosis and ascites. FEUrea has also proven to be a useful “tubular injury” marker by differentiating ATN from non-ATN with high diagnostic accuracy (Sensitivity and Specificity exceeding >90%). FEUrea was found to be a good alternative and noninvasive tool for differentiating causes of AKI in cirrhotic patients instead of other non-available or expensive markers.

scholarly journals Somatically derived Yolk Sac tumor of the urinary bladder: A case report and differential diagnosis

2020 ◽  
Author(s):  
Nadia Espejo-Herrera ◽  
Enric Condom Mundó
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Final Diagnosis ◽  
Yolk Sac ◽  
Yolk Sac Tumor ◽  
High Grade ◽  
Yolk Sac Tumors ◽  
Urinary Bladder Tumor

Abstract Background: Yolk sac tumor is a germ cell neoplasm that arises predominantly in the gonads, but can also derive from somatic neoplasms in extragonadal locations. These cases have been denominated recently as “somatically derived Yolk sac tumors”, and have been documented in several locations, although reports from the urinary tract are scarce. To our knowledge, this is the first report of a Yolk sac tumor derived from urothelial carcinoma. Case presentation: We present a unique case of a 76-year-old man with a recurrent urinary bladder tumor, initially interpreted as a high grade urothelial carcinoma with glandular differentiation. In the recurrent tumor, diverse histological patterns were identified, including glandular, hepatoid and sarcomatoid. This tumor showed positivity for AFP, GLP3 and SALL4, and negativity for CK7 and EMA. Fluorescent in situ hybridization study showed a polysomic pattern of chromosome 12. All these findings led to the final diagnosis of a Yolk sac tumor derived from urothelial carcinoma. Conclusions: Somatically derived Yolk Sac tumors should be considered in the differential diagnosis of a high grade urothelial carcinoma, particularly when glandular and other unusual patterns are observed. Key words: Yolk sac tumor, somatically derived, urothelial carcinoma, urinary bladder, case report.

scholarly journals Cystic pancreatic lesions: MR imaging findings and management

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Giovanni Morana ◽  
Pierluigi Ciet ◽  
Silvia Venturini
Keyword(s):  
Differential Diagnosis ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Main Pancreatic Duct ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Morphological Findings ◽  
History Of ◽  
Cystic Pancreatic Lesions ◽  
Radiological Examinations

AbstractCystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.

scholarly journals Active Unicameral Bone Cysts in the Upper Limb are at Greater Risk of Fracture

2009 ◽  
Vol 17 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Inn Kuang Tey ◽  
Arjandas Mahadev ◽  
Kevin Boon Leong Lim ◽  
Eng Hin Lee ◽  
Saminathan Suresh Nathan
Keyword(s):  
Growth Plate ◽  
Lower Limb ◽  
Pathological Fracture ◽  
Bone Cyst ◽  
Lower Limbs ◽  
Unicameral Bone Cyst ◽  
Pathological Fractures ◽  
Risk Of Fracture ◽  
History Of ◽  
Index 2

Purpose. To elucidate the natural history of unicameral bone cyst (UBC) and risk factors for pathological fracture. Methods. 14 males and 8 females (mean age, 9 years) diagnosed with UBC were reviewed. Cyst location, symptoms, and whether there was any fracture or surgery were recorded. Cyst parameters were measured on radiographs, and included (1) the cyst index, (2) the ratio of the widest cyst diameter to the growth plate diameter, and (3) the adjusted distance of the cyst border from the growth plate. Results. There were 11 upper- and 11 lower-limb cysts. 13 patients had pathological fractures and 9 did not. 20 patients were treated conservatively with limb immobilisation; 2 underwent curettage and bone grafting (one resolved and one did not). Seven cysts resolved (5 had fractures and 2 did not). The risk of fracture was higher in the upper than lower limbs (100% vs 18%, p<0.001). Fractured cysts were larger than unfractured cysts (mean cyst index, 4.5 vs. 2.2, p=0.07). Active cysts were more likely to fracture. Conclusion. Conservative management had a 30% resolution rate. Surgery should be considered for large active cysts in the upper limbs in order to minimise the fracture risk.

Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers

Dermatology ◽  
2018 ◽  
Vol 234 (5-6) ◽  
pp. 194-197
Author(s):  
Jean-Benoît Monfort ◽  
Karine Cury ◽  
Philippe Moguelet ◽  
François Chasset ◽  
Claude Bachmeyer ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Retrospective Study ◽  
Skin Biopsy ◽  
Leg Ulcer ◽  
Lower Limbs ◽  
Leg Ulcers ◽  
Independent Factor ◽  
Histological Characteristic

Background: The histological characteristic of hypertensive leg ulcers (HLU) is the presence of “arteriolosclerosis.” The pertinence of performing a skin biopsy to diagnose HLU is questionable, as cutaneous arteriolosclerosis may be related to patient comorbidities. The objective here was to evaluate the frequency of arteriolosclerosis in skin leg biopsies performed in patients without ulcer and in control patients with HLU. Methods: We performed a retrospective study between January 2013 and July 2014. Patients were included if they had undergone a deep skin biopsy on the lower limbs, in the absence of any leg ulcer. Controls were patients with typical HLU. Results: Fifty-eight patients and 6 controls were included. Hypertension was present in 25 patients (43%). Arteriolosclerosis, defined as fibrous endarteritis, was present in 35 out of 58 patients (60%) and in all of the controls. No hyalinosis or hyperplastic proliferative arteriolosclerosis was observed in the patients or controls. Only age was an independent factor associated with the presence of cutaneous arteriolosclerosis (p &x#3c; 0.0001). Conclusion: Cutaneous arteriolosclerosis is significantly and independently associated with age. Thus, skin biopsy seems not to be necessary for the diagnosis of HLU but only for a differential diagnosis.

scholarly journals Simple bone cyst in a 7-year-old child

2017 ◽  
Vol 65 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Heitor ALBERGONI DA SILVEIRA ◽  
Camila LOPES CARDOSO ◽  
Mariane PEXE ◽  
Rafael ZETEHAKU ARAUJO ◽  
Anthony BENITES CONDEZO ◽  
...  
Keyword(s):  
Clinical Case ◽  
Bone Cyst ◽  
Radiographic Examination ◽  
Simple Bone Cyst ◽  
Presumptive Diagnosis ◽  
Surgical Exploration ◽  
Tooth Roots ◽  
Expansive Lesion ◽  
Exploratory Surgery

ABSTRACT The simple bone cyst,or traumatic bone cyst, solitary or idiopathic bone cavity is an intraosseous pseudocyst discovered through a panoramic radiographic examination. Commonly, the SBC is presented as an asymptomatic lesion, radiolucent, unilocular, without cortical expansion, with margins adorning vital tooth roots of the affected region. The literature has recommended that clinical and radiographic aspects of simple bone cyst are quite convincing as to diagnosis, so follow-up through clinical and radiographic examination has been suggested. This case illustrates an exuberant clinical case of simple bone cyst, which was presented as multilocular and expansive lesion in a 7-year-old patient. Surgical exploration was performed because her parents were anxious about the presumptive diagnosis of other more aggressive lesions. The diagnosis of SBC was confirmed. The case was monitored and, after three years, total bone remodeling of the affected area was observed. In conclusion, asymptomatic radiolucent lesions that suggest a strong presumptive diagnosis of a simple bone cyst can be clinically and radiographically monitored. However, clinical variations, as in the present clinical case, require confirmation of the diagnosis, which is performed through exploratory surgery. The establishment of the diagnosis affords the safest approach for both the professional and the patient.

scholarly journals Orbital pseudotumor: a differential diagnosis of Graves' ophthalmopathy

2011 ◽  
Vol 55 (1) ◽  
pp. 85-88 ◽  
Author(s):  
Luciana Souza Cruz Caminha ◽  
Elisa Rebelo Pinto ◽  
Priscila Alves Medeiros de Sousa ◽  
Ricardo Andrade Oliveira ◽  
Flavia Lucia Conceiçao ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Inflammatory Disease ◽  
Final Diagnosis ◽  
Response To Therapy ◽  
Orbital Pseudotumor ◽  
Graves Ophthalmopathy

The objective of this study is to report and discuss a rare and inflammatory cause of exophthalmos. This report describes a patient with exophthalmos, who was initially diagnosed with euthyroid Graves' with good response to therapy. After 8 years of follow-up, she had recurrence of symptoms and a new evaluation revealed the final diagnosis of orbital pseudotumor. Orbital pseudotumor is an uncommon disorder that both radiologically and clinically mimics a malignant process or other inflammatory disease, such as Graves' ophthalmopathy.

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