Substernal goitre presenting with upper and lower extremity oedema

2021 ◽  
Vol 14 (11) ◽  
pp. e245036
Author(s):  
Rebekah LeAnn Bennett Daggett ◽  
Daniel Farishta ◽  
Hugo Cuellar ◽  
Cherie-Ann O Nathan
Keyword(s):  
Lower Extremity ◽  
Initial Assessment ◽  
Uneventful Recovery ◽  
Surgical Removal ◽  
Extensive Literature ◽  
Rare Presentation ◽  
Clinical Presentations ◽  
Left Innominate Vein ◽  
Home Placement ◽  
Work Up

Substernal goitre is characterised by compressive symptoms of the airway and oesophagus. Chronic, progressive symptoms usually result in surgical removal. We report a rare presentation of substernal goitre in a male in his early 70s who suffered from severe bilateral lower extremity (LE) lymphoedema, resulting in immobility and nursing home placement, and left upper extremity lymphoedema. Our initial assessment led to a filariasis work-up, which was negative, due to the patient’s prior 2-year residence in India and service overseas. Chest CT scan revealed an incidental substernal goitre extending posterior to the left innominate vein and aortic arch to the level of the left mainstem bronchus. The patient underwent a left hemithyroidectomy via cervical excision and sternotomy and had an uneventful recovery with resolution of lymphoedema and mobility. Despite extensive literature regarding clinical presentations of substernal goitre, severe lymphoedema of the LE is not a well-established association.

scholarly journals Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease

2021 ◽  
Vol 07 (03) ◽  
pp. e132-e137
Author(s):  
Mohammed Alagha ◽  
Thomas M. Aherne ◽  
Ahmed Hassanin ◽  
Adeel S. Zafar ◽  
Doireann P. Joyce ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Sensitivity And Specificity ◽  
False Negative ◽  
Arterial Disease ◽  
Initial Assessment ◽  
Reference Standard ◽  
Lower Extremity Arterial Disease ◽  
Negative Results ◽  
Positive Results ◽  
Arterial Imaging

Abstract Introduction Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark. Methods In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard. Results Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively. Conclusion ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.

scholarly journals French recommendations for the management of Behçet’s disease

2021 ◽  
Vol 16 (S1) ◽  
Author(s):  
Isabelle Kone-Paut ◽  
◽  
Stéphane Barete ◽  
Bahram Bodaghi ◽  
Kumaran Deiva ◽  
...  
Keyword(s):  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Initial Assessment ◽  
Diagnostic Process ◽  
Behcet's Disease ◽  
Therapeutic Modalities ◽  
Clinical Presentations ◽  
Key Points

AbstractBehçet’s disease (BD) is a systemic variable vessel vasculitis that involves the skin, mucosa, joints, eyes, arteries, veins, nervous system and gastrointestinal system, presenting with remissions and exacerbations. It is a multifactorial disease, and several triggering factors including oral cavity infections and viruses may induce inflammatory attacks in genetically susceptible individuals. BD vasculitis involves different vessel types and sizes of the vascular tree with mixed-cellular perivascular infiltrates and is often complicated by recurrent thrombosis, particularly in the venous compartment. Several new therapeutic modalities with different mechanisms of action have been studied in patients with BD. A substantial amount of new data have been published on the management of BD, especially with biologics, over the last years. These important therapeutic advances in BD have led us to propose French recommendations for the management of Behçet’s disease [Protocole National de Diagnostic et de Soins de la maladie de Behçet (PNDS)]. These recommendations are divided into two parts: (1) the diagnostic process and initial assessment; (2) the therapeutic management. Thirty key points summarize the essence of the recommendations. We highlighted the main differential diagnosis of BD according to the type of clinical involvement; the role of genetics is also discussed, and we indicate the clinical presentations that must lead to the search for a genetic cause.

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 Rare presentation of Limb Body Wall Complex in a Neonate: Case report and review of literature

2022 ◽  
Author(s):  
Omoloro Adeleke ◽  
Farrukh Gill ◽  
Ramesh Krishnan
Keyword(s):  
Body Wall ◽  
Anorectal Malformations ◽  
Epidemiologic Studies ◽  
Normal Male ◽  
Rare Occurrence ◽  
Pathological Findings ◽  
Review Of Literature ◽  
Rare Presentation ◽  
Case Presentation ◽  
Clinical Presentations

The Limb Body Wall Complex (LBWC) aka. Body Stalk Syndrome is an uncommon congenital disorder characterized by severe malformations of limb, thorax, and abdomen, characterized by the presence of thoracoschisis, abdominoschisis, limb defects, and exencephaly. This condition is extremely rare with an incidence of 1 per 14,000 and 1 per 31,000 pregnancies in large epidemiologic studies. Majority of these malformed fetuses end up with spontaneous abortions. We present this rare case with occurrence in a preterm infant of 35 weeks gestation. Our report highlights majority of the clinical presentations as reported in previous literature, but the significant pathological findings of absent genitalia and malformed genitourinary, anorectal malformations make this case presentation an even more rare occurrence. Infant karyotyping was normal male and there is no specific underlying genetic correlation in this condition which has fatal prognosis.

scholarly journals Rare presentation of incomplete male urethral duplication: A case report and review of literature

2021 ◽  
Vol 9 (1) ◽  
pp. 292-296
Author(s):  
Orgeness J Mbwambo ◽  
Alex Mremi ◽  
Mohamed Mbarouk ◽  
Jasper Mbwambo ◽  
Frank Bright ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Case Report ◽  
Postoperative Period ◽  
Surgical Removal ◽  
Urethral Duplication ◽  
Review Of Literature ◽  
Rare Presentation ◽  
Rare Congenital Anomaly ◽  
Accessory Urethra

Urethral duplication is a rare congenital anomaly affecting mainly males. Here, we report a case of urethral duplication in a 19 years old male presented as a scrotal sinus discharging pus for 1 year. Surgical removal of accessory urethra was done and postoperative period was uneventful.

scholarly journals Untypical autoimmune pancreatitis and pancreatic cancer: differential diagnosis experiences extracted from misdiagnose of two cases

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Gaopeng Li ◽  
Ting Liu ◽  
Jian Zheng ◽  
Wenqin Kang ◽  
Jun Xu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Autoimmune Pancreatitis ◽  
Diagnostic Value ◽  
Warning Signs ◽  
Clear Cut ◽  
Clinical Presentations ◽  
Pet Ct ◽  
Serum Igg4 ◽  
Work Up ◽  
Rare Diagnosis

Abstract Background Differentiation between pancreatic cancer (PC) and focal form of autoimmune pancreatitis (AIP) is very challenging, with similar clinical presentations, laboratory results and morphologic imagings of US, CT, EUS, MRI, ERCP, PET-CT. Even serum IgG4 and biopsy sometimes cannot give clear-cut differential accurate diagnostis. Considering the totally different management strategy of the two diseases, accurate diagnostic value is urgently needed to remind the clinicians of the rare diagnosis of untypical AIP among frequent PC-suspected patients. Results We present 2 laparotomy cases of AIP that had a high similar characteristic to PC and retrospectively extracted the warning signs that may help select untypical AIP in PC-suspected patients. Conclusions We find that mild fluctuating jaundice with abdominal pain, young age, tumor marker of TPS, TPA and diverse results between variable radiological tests can help to differentiate AIP mass from PC, through retrospectively analyzing work-up process of AIP in two patients who underwent laparotomy for suspected PC.

Carcinosarcoma of the Pancreas Arising in a Mucinous Cystic Neoplasm

2006 ◽  
Vol 72 (4) ◽  
pp. 351-355 ◽  
Author(s):  
Mark Bloomston ◽  
Jose Chanona-Vilchis ◽  
E. Christopher Ellison ◽  
Nilsa C. Ramirez ◽  
Wendy L. Frankel
Keyword(s):  
Mucinous Cystic Neoplasm ◽  
Nodal Metastasis ◽  
Uneventful Recovery ◽  
Cystic Neoplasm ◽  
Painless Jaundice ◽  
Head Of The Pancreas ◽  
Poorly Differentiated ◽  
Well Differentiated ◽  
Immunohistochemical Studies ◽  
Work Up

We report a carcinosarcoma of the pancreas in a 67-year-old woman who presented with nausea, vomiting, and painless jaundice. A work-up demonstrated a well-circumscribed mass in the head of the pancreas. After pylorus-preserving pancreaticoduodenectomy, the tumor was found to be grossly yellow, and it compressed the common bile duct and pancreatic duct. Histological examination of the neoplasm showed a 4.0 x 4.0 x 3.0-cm mucinous cystadenocarcinoma with invasive poorly differentiated carcinoma, well-differentiated squamous cell carcinoma, and sarcomatous stroma invading into the duodenum. There was no evidence of nodal metastasis (pT3N0M0). Immunohistochemical studies showed that the epithelial cells stained positive for cytokeratin 7, cytokeratin AE1/3, cytokeratin monoclonal antibody 5.2, epithelial membrane antigen, M-carcinoembryonic antigen, and low-molecular-weight kininogen, and the sarcomatous component was immunoreactive with vimentin. The patient had an uneventful recovery, but died 4 months later of rapidly progressive metastatic disease to the liver and peritoneum. To the best of our knowledge, this is the second case of carcinosarcoma with invasive epithelial and sarcomatous areas in the background of a mucinous cystic neoplasm of the pancreas.

Lytic lesion of skull: a rare presentation of chronic granulomatous disease

2020 ◽  
Vol 13 (9) ◽  
pp. e235423
Author(s):  
Gurinder Kumar
Keyword(s):  
Chronic Granulomatous Disease ◽  
Serratia Marcescens ◽  
Gene Mutation ◽  
Lytic Lesion ◽  
Granulomatous Disease ◽  
Case Scenario ◽  
Rare Presentation ◽  
History Of ◽  
Work Up

An 18-month-old boy presented with lytic lesion of skull and recurrent abscesses with Serratia marcescens. The extensive work up revealed a gene mutation confirming the diagnosis of chronic granulomatous disease (CGD). This case scenario underscores the importance of exploring the possibility of immunodeficiency if there is a history of recurrent abscesses with atypical organism. The case also demonstrates that CGD can present as lytic lesion of skull.

scholarly journals A case report of cardiac amyloidosis presenting with chronic pericardial effusion and conduction block

2019 ◽  
Vol 3 (4) ◽  
pp. 1-7
Author(s):  
Kevin John John ◽  
Ajay Kumar Mishra ◽  
Ramya Iyyadurai
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Amyloidosis ◽  
Conduction Block ◽  
Vital Signs ◽  
Permanent Pacemaker ◽  
Rare Presentation ◽  
Amyloid Deposits ◽  
Clinical Presentations ◽  
Chest X Ray ◽  
Pacemaker Insertion

Abstract Background Amyloidosis is caused by the deposition of abnormal proteins in the extracellular space of various organs. The clinical features of amyloidosis depend on the type of amyloid protein and the organ system involved. Case summary A 51-year-old woman developed complete heart block which warranted a permanent pacemaker insertion. She was referred for evaluation of chronic pericardial effusion. The patient had stable vital signs and muffled heart sounds on examination of the cardiovascular system. Her chest X-ray film showed a permanent pacemaker in situ, and echocardiogram showed a chronic pericardial effusion without features of tamponade. On further evaluation, she was found to have an M band on serum electrophoresis, elevated free light chain ratio and amyloid deposits in bone marrow biopsy. Technetium pyrophosphate (Tc-PYP) scintigraphy was consistent with cardiac amyloidosis. Discussion Cardiac amyloidosis can have diverse clinical presentations. Chronic pericardial effusion and conduction block can be a rare presentation of cardiac amyloidosis and needs to be considered while evaluating the same. Cardiac magnetic resonance imaging and Tc-PYP imaging can be used in establishing the diagnosis of cardiac amyloidosis, if endomyocardial biopsy is not feasible.

scholarly journals Psychotic disorders in late life: a narrative review

2019 ◽  
Vol 9 ◽  
pp. 204512531988279 ◽  
Author(s):  
Rajesh R. Tampi ◽  
Juan Young ◽  
Rakin Hoq ◽  
Kyle Resnick ◽  
Deena J. Tampi
Keyword(s):  
Psychotic Disorders ◽  
Adult Population ◽  
Management Strategies ◽  
Late Life ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Antipsychotic Medications ◽  
Clinical Presentations ◽  
Older Adult Population ◽  
Work Up

Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.

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