BICIPITAL TUBEROSITY OSTEOCHONDROMA CAUSING PAINFUL CLICKING AROUND THE WRIST: CASE REPORT AND LITERATURE REVIEW

Hand Surgery ◽  
2012 ◽  
Vol 17 (02) ◽  
pp. 229-232 ◽  
Author(s):  
Abdulrahman Alsawadi ◽  
Mustafa Abbas ◽  
Jeremy Stanton
Keyword(s):  
Diagnostic Challenge ◽  
Presenting Symptoms ◽  
Image Intensification ◽  
Mri Scans ◽  
History Of ◽  
Benign Tumours ◽  
High Index Of Suspicion ◽  
Radial Tuberosity ◽  
Radiological Studies ◽  
Bicipital Tuberosity

Osteochondromatas of bicipital tuberosity are rare, most commonly occurring as metaphyseal benign tumours of the long bones. The usual presenting symptoms are pain and reduced rotation of the elbow. A painful clunk in the wrist as a presenting symptom has not been described before. We present a young lady with a two-year history of a painful clunk in her wrist. Her case presented a diagnostic challenge, as the pain and the click originated from her elbow and radiated down her forearm to the wrist. She underwent several radiological studies, and examination under anaesthesia confirmed the diagnosis. Excision was performed resulting in complete resolution of her symptoms. Along with painful clunk in the wrist originating from the elbow, an enlarged radial tuberosity should raise a high index of suspicion, and MRI scans and examination under image intensification can aid in the diagnosis of radial tuberosity osteochondroma.

scholarly journals Pompe Disease: Cyanosed Hypotonic Infant with Normal Respiratory Rate

2017 ◽  
Vol 13 (2) ◽  
pp. 172-174 ◽  
Author(s):  
S. Koirala ◽  
A. Poudel ◽  
R. Basnet ◽  
K. Subedi
Keyword(s):  
Respiratory Rate ◽  
Pompe Disease ◽  
Clinical Findings ◽  
Diagnostic Challenge ◽  
Floppy Infant ◽  
History Of ◽  
Infantile Pompe Disease ◽  
High Index Of Suspicion ◽  
To Receive ◽  
Remote Part

Infantile hypotonia or floppy infant is a diagnostic challenge when it presents with other presenting complaints such as fever, cough or diarrhea. Many times the hypotonia goes unnoticed when other symptom covers the hypotonia and child continues to receive the treatment for other symptoms. We report a rare case from Nepal of infantile Pompe disease who presented with the history of fever and cough in the recent earthquake disaster camp at remote part of Sindhupalchowk, Nepal. He was being treated as a case of pneumonia.Pompe disease can be diagnosed clinically by taking detailed history and correlating the clinical findings during the presentation with other symptoms. In our case the normal respiratory rate, reduced Spo2 and presence of crackles dominated the hypotonia and was mistreated as pneumonia. High index of suspicion is necessary in diagnosing Pompe disease.

scholarly journals Diffuse infiltrating retinoblastoma: A diagnostic conundrum

2021 ◽  
Vol 7 (2) ◽  
pp. 204-206
Author(s):  
Harsha Bhattacharjee ◽  
Aditi Mehta ◽  
Dipankar Das ◽  
Kasturi Bhattacharjee ◽  
Manabjyoti Barman ◽  
...  
Keyword(s):  
Family History ◽  
Multimodal Imaging ◽  
Positive Family History ◽  
Neovascular Glaucoma ◽  
Exudative Retinal Detachment ◽  
Imaging Features ◽  
Diagnostic Challenge ◽  
Progressive Loss ◽  
History Of ◽  
High Index Of Suspicion

Diffuse infiltrating retinoblastoma (DIR) is characterized by absence of intraocular mass, lack of calcification. It may mimic inflammatory uveitis or exudative retinopathy. An eight-years-old boy presented with progressive loss of vision in left eye. Clinical evaluation revealed neovascular glaucoma with a yellow–gray fundal glow, exudative retinal detachment, subretinal exudation and telangiectatic vessels. The presentation was consistent with exudative retinopathy (Coat’s disease) but for the presence of a family history of retinoblastoma in the younger sibling. Despite the absence of an intraocular mass or calcification on multimodal imaging, the enucleation was done on the basis of clinical suspicion of retinoblastoma. Histopathology confirmed a diagnosis of DIR.: DIR can pose a diagnostic challenge due to its non-characteristic clinical and imaging features and atypical presentation. A high index of suspicion along with a positive family history was key to diagnosis in our case; histopathology was confirmatory.

scholarly journals Metastatic Prostate Cancer to the Left Temporal Bone: A Case Report and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Erynne A. Faucett ◽  
Hal Richins ◽  
Rihan Khan ◽  
Abraham Jacob
Keyword(s):  
Prostate Cancer ◽  
Hearing Loss ◽  
Temporal Bone ◽  
Metastatic Prostate Cancer ◽  
Prior History ◽  
Presenting Symptoms ◽  
Radiologic Findings ◽  
Cranial Nerve Palsies ◽  
History Of ◽  
High Index Of Suspicion

Breast, lung, and prostate cancers are the three most common malignancies to metastasize to the temporal bone. Still, metastatic prostate cancer of the temporal bone is a rare finding, with approximately 21 cases reported in the literature and only 2 cases discovered more than 10 years after initial treatment of the primary. This disease may be asymptomatic and discovered incidentally; however, hearing loss, otalgia, cranial nerve palsies, and visual changes can all be presenting symptoms. We present the case of a 95-year-old man with history of primary prostate cancer treated 12 years earlier that was seen for new-onset asymmetric hearing loss and otalgia. The tympanic membranes and middle ears were normal; however, based on radiologic findings and eventual biopsy, the patient was diagnosed with extensive metastatic prostate cancer to the left temporal bone. This case (1) demonstrates that a high index of suspicion for unusual etiologies of seemingly benign symptoms must be maintained in elderly patients having prior history of cancer and (2) substantiates the value of temporal bone imaging when diagnosis may be unclear from history and physical exam.

scholarly journals Metastatic Uterine Leiomyosarcoma in a Nullipara with Primary Infertility: A Case Report

2019 ◽  
Vol 4 (11) ◽  
Author(s):  
Okechukwu B. Anozie ◽  
Johnbosco I. Nwafor ◽  
Chidi U. Esike ◽  
Chukwuemeka I. Ukaegbe ◽  
Richard L. Ewah ◽  
...  
Keyword(s):  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Leiomyosarcoma ◽  
Presenting Symptoms ◽  
Primary Infertility ◽  
History Of ◽  
Uterine Cancers ◽  
Operative Findings ◽  
High Index Of Suspicion ◽  
Lost To Follow Up

Uterine leiomyosarcoma accounts for 1-2% of uterine cancers. It is an extremely aggressive malignancy associated with a poor prognosis. Women affected may vary in age, but are most common between 4th and 7th decades of life. Presenting symptoms mimic uterine leiomyoma. Preoperative diagnosis of uterine leiomyosarcoma is difficult and often made at time of surgical resection. We report a case of Mrs A.E, a 40 year old nullipara with history of primary infertility of 20 years duration, who presented with abdominal swelling of 3 years and vaginal bleeding of 7 weeks duration. Abdominopelvic ultra-sonography done at presentation was suggestive of leiomyoma. She was scheduled for myomectomy and subsequently had total abdominal hysterectomy and omentectomy following intra-operative findings of features suggestive of leiomyosarcoma with evidence of metastasis to omentum. These findings were confirmed on histology of the specimen. She received one cycle of combination chemotherapy but was lost to follow up. Uterine LMS is an aggressive tumour, therefore, a high index of suspicion is needed especially for huge uterine nodules and such patients must be closely monitored for adequate management.

scholarly journals Case of Metastatic Malignant Melanoma Simulating Granuloma Annulare

2021 ◽  
Vol 5 (3) ◽  
pp. 289-292
Author(s):  
Haley Danielle Heibel ◽  
Parneet Dhaliwal ◽  
Etan Marks ◽  
Clay J. Cockerell
Keyword(s):  
Malignant Melanoma ◽  
Metastatic Melanoma ◽  
Immunohistochemical Staining ◽  
Previous History ◽  
Metastatic Malignant Melanoma ◽  
Granuloma Annulare ◽  
Diagnostic Challenge ◽  
Clinical Presentations ◽  
History Of ◽  
High Index Of Suspicion

Malignant melanoma and particularly metastatic melanoma represent a diagnostic challenge due to the wide variety of histologic patterns, resemblance to benign entities, and extensive range of clinical presentations.  A high index of suspicion for melanoma is important for accurate diagnosis, especially when there is a previous history of malignancy.  Here, we present a patient with a history of melanoma and locally metastatic melanoma, who subsequently developed a nodule on his right forearm near the site of his previous melanoma excision.  Histologically, the melanoma appeared as granuloma annulare (GA) with benign cytologic features, but was identified as metastatic melanoma using SOX-10 immunohistochemical staining.  Other malignancies, including lymphomas, leukemias, sarcomas, and cutaneous metastases of internal malignancies, have mimicked GA and interstitial granulomatous processes.  Therefore, further immunohistochemical staining should be performed to assess for metastatic disease in the setting of a histological pattern that resembles a benign granulomatous process in a patient with a history of malignancy, including malignant melanoma.

scholarly journals Fever of Unknown Origin - A Child With an Unusual Case of Juvenile Idiopathic Arthritis

2020 ◽  
Vol 4 (1) ◽  
pp. 459-461
Author(s):  
Purnima Gyawali ◽  
Deepika Gyawali ◽  
Sharda Acharya
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Fever Of Unknown Origin ◽  
Pediatric Population ◽  
Unknown Origin ◽  
Diagnostic Challenge ◽  
Laboratory Assessment ◽  
Medical College ◽  
Unexplained Fever ◽  
History Of ◽  
High Index Of Suspicion

Fever of unknown origin in the pediatric population is fever >38.3°C (101°F) of at least seven days' duration, in which no diagnosis is apparent after initial outpatient or hospital evaluation that includes a careful history and physical examination and initial laboratory assessment. Fever of unknown origin is a diagnostic challenge, with a broad spectrum of causes classified as infectious, malignant/neoplastic, rheumatic/inflammatory, and miscellaneous disorders. A high index of suspicion should be kept for juvenile idiopathic arthritis in children presenting with unexplained fever and joint symptoms and should be appropriately managed. The case described here is of a 13-year-old female from Nepal, who presented to the Pediatric outpatient department of KIST Medical College and Teaching Hospital with a history of fever and arthralgia for three months.

scholarly journals Silent primary ovarian ectopic pregnancy following ovulation induction: diagnostic dilemma

2021 ◽  
Vol 10 (9) ◽  
pp. 3654
Author(s):  
Kalyani Saidhandapani ◽  
Yashaswi Pandey ◽  
Priya Shaunthini
Keyword(s):  
Ovulation Induction ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Ovarian Pregnancy ◽  
Threatening Condition ◽  
Reproductive Techniques ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Urine Pregnancy Test

Early diagnosis of an ovarian pregnancy, of all the diagnoses relating to extrauterine gestations, is perhaps a diagnostic challenge faced by an obstetrician and a radiologist. About 0.5% of extrauterine implantations occur in the ovary. Recent studies have demonstrated infertility and Assisted reproductive techniques (ARTs), multiparity, use of intrauterine devices as risk factors for ovarian ectopic. Knowledge pertaining to ovulation induction and risk of ovarian ectopic is even more scant. In this article, we report a case report of ovarian pregnancy following ovulation induction with letrozole. Patient visited with history of missed menstrual period, mild abdominal pain and a weakly positive urine pregnancy test. Provisional diagnosis of right tubal ectopic was made. Diagnosis of ruptured ovarian ectopic was made on explorative laparoscopy which was later confirmed histopathologically. Patient had normal intra and post-operative course. An ovarian ectopic can present as a life-threatening condition and a high index of suspicion can prevent morbidity as well as mortality. Ovarian pregnancy in a primigravida with ovulation induction without an alarming sign, as in this case, is the rarest entity came across till date.

scholarly journals Osteoid Osteoma of the Trapezium: Case Report of an Unusual Tumor Location Presenting a Diagnostic Challenge

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
S. E. Roberts ◽  
M. N. Mirzabeigi ◽  
A. Naik ◽  
C. Preciado ◽  
B. Chang
Keyword(s):  
Case Report ◽  
Osteoid Osteoma ◽  
Bone Tumor ◽  
Bone Tumors ◽  
Tumor Location ◽  
Benign Bone Tumor ◽  
Diagnostic Challenge ◽  
Benign Bone Tumors ◽  
Presenting Symptoms ◽  
High Index Of Suspicion

Osteoid osteoma is a benign bone tumor, which represents approximately 10% of all benign bone tumors. When localized to the carpus, osteoid osteomas are most often seen in the scaphoid and capitate. Rarely, these tumors can also be observed in the trapezium. Given the infrequency with which osteomas are located in the trapezium and often nonspecific presenting symptoms, diagnosis of this tumor can be challenging and requires a high index of suspicion.

scholarly journals A case report of visceral leishmaniasis and malaria co-infection with pancytopenia and splenomegaly - a diagnostic challenge

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Pragya Gautam Ghimire ◽  
Prasanna Ghimire ◽  
Jyoti Adhikari ◽  
Anurag Chapagain
Keyword(s):  
Case Report ◽  
Visceral Leishmaniasis ◽  
World Population ◽  
Risk Of Infection ◽  
Diagnostic Challenge ◽  
Endemic Region ◽  
Case Presentation ◽  
The World ◽  
History Of ◽  
High Index Of Suspicion

Abstract Background Leishmaniasis and malaria are tropical diseases with more than half of the world population at risk of infection resulting in significant morbidity and mortality. Co-infection of Leishmaniasis and malaria pose a great challenge in the diagnosis as well as overall management. Case presentation In this case report, we present a rare case of a 5 years old child hailing from non-endemic region of Nepal with history of fever for a period of 3 months who was diagnosed as co-infection of malaria due to Plasmodium vivax and visceral Leishmaniasis with pancytopenia that subsequently improved after a course of treatment. Conclusions A high index of suspicion for a possibility of co-infection with Leishmaniasis and malaria should be borne in mind when an individual hailing from or having history of travel to endemic countries presents with prolonged fever.

scholarly journals Paraplegia and acute aortic dissection: a diagnostic challenge for physicians in the emergency situation

2019 ◽  
Vol 12 (7) ◽  
pp. e230561
Author(s):  
Waqas Memon ◽  
Zobia Aijaz ◽  
Rmaah Memon
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Surgical Repair ◽  
Emergency Situation ◽  
Diagnostic Challenge ◽  
Type A Aortic Dissection ◽  
Presenting Symptoms ◽  
Paravertebral Abscess ◽  
History Of ◽  
Severe Back Pain

Acute aortic dissection presenting neurological symptoms is rare and entails significant diagnostic challenges. We present a case of 45-year-old woman with a medical history of essential hypertension and smoking, admitted with lobar pneumonia. During her inpatient treatment, she developed severe back pain and numbness below the level of the umbilicus. Due to her presenting symptoms considered differential diagnoses were paravertebral abscess and acute stroke. CT scan of the head did not reveal any ischaemic changes. Further investigation with MRI (with and without contrast) raised concerns for possible aortic dissection. CT angiography of thorax, abdomen and pelvis displayed extensive aortic dissection extending from aortic root to left iliac artery limiting flow to right carotid artery causing stenosis. The patient was diagnosed with Stanford type A aortic dissection. The patient was referred to the cardiothoracic surgery team for surgical repair. The patient made a good recovery after a prolonged course of hospitalisation, followed by cardiac rehabilitation and physical therapy.

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