Polycystic liver in two adult llamas

Polycystic liver is usually considered an incidental finding in human and veterinary medicine. Two unrelated adult llamas ( Lama glama) with a history of marked anorexia and weight loss were received for autopsy and diagnostic workup. The main gross change in the liver of both animals was multiple variably sized cysts randomly distributed throughout the parenchyma. Histologically, the cysts compressed the adjacent parenchyma and were lined by a single layer of cuboidal-to-columnar epithelium, surrounded by a fibrous collagen capsule. The lumen of the cysts contained finely granular-to-homogeneous basophilic material. The lining epithelium displayed strong immunoreactivity for pancytokeratin AE1/AE3 and cytokeratins 7, 8, 8/18, and 19, and was negative for vimentin, confirming the biliary epithelial origin of the cysts. No parasitic or infectious agents, or neoplastic changes, were detected. All other laboratory tests performed in both llamas were negative or non-diagnostic, suggesting that the congenital hepatic cysts described may have been at least partly responsible for clinical disease in both animals.

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Cystic thymic degeneration with pseudoepitheliomatous hyperplasia in a Beagle puppy: an idiopathic lesion?

Journal of Veterinary Diagnostic Investigation ◽

10.1177/1040638720914570 ◽

2020 ◽

Vol 32 (3) ◽

pp. 435-439

Author(s):

Giulia Moretti ◽

Monica Sforna ◽

Domenico Caivano ◽

Luca Mechelli ◽

Antonello Bufalari ◽

...

Keyword(s):

Pleural Effusion ◽

Laboratory Tests ◽

Incidental Finding ◽

Cystic Degeneration ◽

Cystic Lesions ◽

Coagulation Disorders ◽

Pseudoepitheliomatous Hyperplasia ◽

Computed Tomographic ◽

Anticoagulant Drug ◽

History Of

A 6-mo-old female Beagle dog was inappetent and depressed. The radiographic, ultrasonographic, and computed tomographic examination of the chest revealed a 10 × 7 cm multicystic mediastinal structure interpreted as altered thymus, in association with moderate pleural effusion that laboratory tests confirmed as hemothorax. No history of trauma or anticoagulant drug intoxication was reported, and no coagulation disorders were detected. Afterward, medial cranial sternotomy was performed to remove the altered tissue. Histologically, this tissue was compatible with a thymic remnant, characterized by numerous cystic lesions, mostly blood filled and lined by flattened-to-cuboidal epithelial cells, occasionally projecting into the surrounding stroma, and forming cytokeratin-positive ribbons, trabeculae, and papillae. Lymphocytes were scant, and numerous areas of congestion and hemorrhage were present throughout the samples. This case of idiopathic thymic hemorrhage with cystic degeneration of the thymus and pseudoepitheliomatous hyperplasia was an incidental finding; the dog recovered from surgery uneventfully.

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Parenchymal mucinous cystadenoma of the kidney: a case report and literature review

African Journal of Urology ◽

10.1186/s12301-021-00203-4 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Mahmoudreza Kalantari ◽

Shakiba Kalantari ◽

Mahdi Mottaghi ◽

Atena Aghaee ◽

Salman Soltani ◽

...

Keyword(s):

Renal Cyst ◽

Left Kidney ◽

Previous History ◽

Mucinous Cystadenoma ◽

Single Layer ◽

Renal Cysts ◽

Cystic Mass ◽

Flank Pain ◽

History Of

Abstract Background Mucinous cystadenoma (MC) of the kidney is exceedingly rare. We found 22 similar cases in the literature. These masses are underdiagnosed due to radiologic similarities with simple renal cysts. Case presentation A 66-year-old man with a previous history of hypertension and anxiety was referred to our tertiary clinic with left flank pain. Ultrasound revealed a 60 mm-sized, complex cystic mass with irregular septa in the lower pole of the left kidney (different from last year's sonographic findings of a simple benign cyst with delicate septa). CT scan showed the same results plus calcification. Due to suspected renal cell carcinoma, a radical nephrectomy was performed. Postoperative histopathologic examination revealed a cyst lined by a single layer of columnar mucin-producing cells with small foci of pseudo-stratification, consistent with the MC’s diagnosis. The first follow-up visit showed normal blood pressure without medication and no flank pain and anxiety after a month. Conclusion It is quite challenging to distinguish the primary MC of the kidney from a simple renal cyst based on clinical and imaging findings. The radiologic features of these entities overlap significantly. Thus, complex renal cyst and renal cysts with mural nodules should be followed closely to detect malignancy earlier.

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Hypercalcaemia due to ovarian small cell carcinoma of the hypercalcaemic type

BMJ Case Reports ◽

10.1136/bcr-2021-243571 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243571

Author(s):

Annalisa Montebello ◽

Mark Gruppetta

Keyword(s):

Cell Carcinoma ◽

Small Cell Carcinoma ◽

Incidental Finding ◽

Lower Abdominal Pain ◽

Ovarian Tumour ◽

Small Cell ◽

Pelvic Radiotherapy ◽

Wide Range ◽

History Of ◽

Parathyroid Hormone Related Peptide

A 37-year-old woman presented with a few days’ history of lower abdominal pain and an incidental finding of hypercalcaemia. A thorough workup ensued, and the cause was found to be an exceptionally rare ovarian tumour—ovarian small cell carcinoma of the hypercalcaemic type. Acute treatment of hypercalcaemia consisted of aggressive intravenous fluids and bisphosphonates. She underwent surgery to remove the tumour and is currently receiving systemic platinum/etoposide chemotherapy combination to be followed by pelvic radiotherapy. This case highlights the wide range of differential diagnosis for hypercalcaemia and the importance of a stepwise and thorough approach during investigations. We discuss the pathophysiology of malignancy-related hypercalcaemia, focusing especially on parathyroid hormone-related peptide-associated hypercalcaemia.

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CAT SCRATCH SYNDROME

PEDIATRICS ◽

10.1542/peds.10.3.311 ◽

1952 ◽

Vol 10 (3) ◽

pp. 311-318

Author(s):

WILLIAM J. WATERS ◽

SEYMOUR S. KALTER ◽

JOHN T. PRIOR

Keyword(s):

Skin Test ◽

Laboratory Tests ◽

Complement Fixation Test ◽

Complement Fixation ◽

Clinical Laboratory ◽

Clinical Course ◽

Diagnostic Value ◽

Clinical Findings ◽

Pathologic Findings ◽

History Of

The clinical, laboratory and pathologic findings of a series of cases of cat scratch syndrome have been reviewed. In spite of a variable clinical course, certain features associated with a selected group of laboratory tests appear to be constant enough to be of diagnostic value. A history of contact with a cat and/or scratch which is usually associated with a peripheral skin lesion, lack of lymphangitis, presence of regional lymphadenopathy with tenderness to palpation are the most constant clinical findings. Fever, so frequently emphasized as a characteristic clinical sign, may be extremely variable in type and duration or entirely absent. A skin test with cat scratch antigen has been positive in all cases. Lacking this antigen, a negative Frei skin test in conjunction with a positive complement fixation test (Lygranum C. F.) is suggestive evidence for the diagnosis. With positive evidence from the above data, biopsy of an affected gland with its relatively nonspecific pathologic picture is not considered essential for the establishment of the diagnosis of cat scratch syndrome.

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Hoarseness of Voice as a Rare Presentation of Tuberculosis: A Case Report Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.817 ◽

2019 ◽

Vol 7 (19) ◽

pp. 3262-3264

Author(s):

Taher Felemban ◽

Abdullah Ashi ◽

Abdullah Sindi ◽

Mohannad Rajab ◽

Zuhair Al Jehani

Keyword(s):

Laryngeal Carcinoma ◽

Incidental Finding ◽

Chain Reaction ◽

Rare Presentation ◽

Case Presentation ◽

X Ray ◽

History Of ◽

Chest X Ray ◽

Polymerase Chain ◽

Laryngeal Tuberculosis

BACKGROUND: Having hoarseness of voice as the first clinical manifestation of tuberculosis is rare. This atypical presentation causes some confusion since other more common conditions, such as laryngeal carcinoma, present similarly and might require more invasive tests to confirm the diagnosis. CASE PRESENTATION: A 38-year-old male presented to the otorhinolaryngology clinic with a four-month history of change in voice. Laryngoscopy demonstrated a right glottic mass, raising suspicion of laryngeal cancer. The computed tomography showed a mass and incidental finding of opacities in lung apices. Chest x-ray demonstrated findings suggestive of tuberculosis. Polymerase chain reaction and culture of sputum samples confirmed the diagnosis and the patient was started on anti-tuberculosis treatment. CONCLUSION: Despite accounting for only 1% of pulmonary tuberculosis cases and having a similar presentation to laryngeal carcinoma, we recommend considering laryngeal tuberculosis when evaluating hoarseness of voice in endemic areas.

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Incidental Finding of an Undiagnosed Coarctation of the Aorta Causing Dilated Cardiomyopathy in an Adult

Case Reports in Cardiology ◽

10.1155/2017/6129073 ◽

2017 ◽

Vol 2017 ◽

pp. 1-2

Author(s):

Abdalla Ibrahim ◽

Zahir Satti ◽

Ronan Curtin

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Incidental Finding ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Descending Aorta ◽

Arm Pain ◽

Left Ventricular Dilation ◽

History Of

31-year-old male with no past medical history apart from high blood pressure noted by GP one week prior to admission presented with a three-week history of a flu-like illness and symptoms of heart failure with severe global left ventricular dilation and dysfunction on Transthoracic Echocardiography (TTE). Two weeks following admission he complained of left arm pain and CT upper limb confirmed embolic occlusion of the left brachial artery and incidental severe coarctation of the proximal descending aorta after the origin of the left subclavian artery. Follow-up TTE suggested the presence of coarctation of the aorta on a suprasternal view which was not performed at the time of his first TTE. His heart failure and blood pressure responded very well to medical therapy and he has been referred for surgical correction of his aortic coarctation.

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Bouveret syndrome: a rare form of gallstone ileus

BMJ Case Reports ◽

10.1136/bcr-2020-238126 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238126

Author(s):

Don Haering ◽

Mattie Murphy ◽

John Craig ◽

Gavin A Falk

Keyword(s):

Clinical Evidence ◽

Incidental Finding ◽

Gallstone Ileus ◽

Definitive Treatment ◽

Abdominal Radiograph ◽

Quadrant Pain ◽

Abdominal Ct Scan ◽

History Of ◽

Bouveret Syndrome ◽

High Index Of Suspicion

A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.

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Abstract 158: Magnetic Resonance Digital Subtraction Angiography Identifies Impaired Drainage in Arteriovenous Malformations With History of Rupture

Stroke ◽

10.1161/str.45.suppl_1.158 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Justin E Vranic ◽

Parmede Vakil ◽

Sameer A Ansari ◽

Hunt H Batjer ◽

Bernard R Bendok ◽

...

Keyword(s):

Digital Subtraction Angiography ◽

Arteriovenous Malformations ◽

Incidental Finding ◽

Whole Body ◽

Digital Subtraction ◽

Focal Neurological Deficit ◽

History Of ◽

Vein Yellow ◽

The Mean ◽

Time Density

BACKGROUND: Cerebral digital subtraction angiography (DSA) has established impaired hemodynamic drainage of intracranial arteriovenous malformations (iAVM) as a risk factor for iAVM hemorrhage. Unlike conventional DSA, MR-DSA offers a noninvasive means of characterizing iAVM hemodynamics. We hypothesize that MR-DSA will demonstrate impaired drainage in iAVMs with history of rupture when compared to iAVMs without history of rupture. METHODS: Consecutive patients with untreated, DSA-confirmed iAVM underwent MR-DSA on a 3T Whole-body MR-scanner. For each iAVM, regions of interest (ROI) were drawn on all feeder arteries and draining veins. Time-density curves were constructed for each ROI. The arteriovenous malformation transit time (ATT) was defined for each ROI as the time between contrast arrival and peak intravascular contrast density on the MR time-density curve. The drainage of each iAVM was characterized by the ratio of the draining vein ATT to the mean feeder artery ATT. The ATT ratio was compared between iAVMs with history of hemorrhage and those without. Statistical analysis was performed using a Student’s unpaired t-test with p <0.05 defined as statistically significant. RESULTS: From May 2011 to April 2012, 13 patients (7M:6F, 40.6±13.8 years old) were enrolled in our study, with 3 patients presenting with history of hemorrhage and the remainder presenting with history of seizure, focal neurological deficit, headache, or as an incidental finding. The ATT ratio was significantly higher in iAVMs with history of hemorrhage than in those without (1.17±0.06 vs 0.95±0.02, p <2.9E-7). CONCLUSION: MR-DSA identifies impaired drainage in iAVMs with history of rupture without exposing patients to the procedural risks and ionizing radiation associated with cerebral DSA. FIGURE A: MR-DSA with feeder artery (red) and draining vein (yellow) labeled. FIGURE B: Time-density curves of the artery (red) and vein (yellow) from which vessel ATTs were derived.

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Consultation with the specialist

Pediatrics in Review ◽

10.1542/pir.13.7.273 ◽

1992 ◽

Vol 13 (7) ◽

pp. 273-274

Author(s):

Frederick H. Lovejoy

Keyword(s):

Physical Examination ◽

Case History ◽

Laboratory Tests ◽

Deep Inspiration ◽

Deep Breathing ◽

Logical Sequence ◽

History Of ◽

Difficult Challenge ◽

Diagnostic Trial ◽

Rapid Laboratory

Diagnosing poisoning by an unknown agent can be a difficult challenge. Five strategies of assessment may be used in logical sequence, however, to arrive at a diagnosis: (a) history, (b) physical examination, (c) rapid laboratory tests, (d) diagnostic trial, and (e) screening for toxins. This is illustrated by a case history, followed by discussion of a recommended approach and the utilization of these principles to arrive at a diagnosis in the case. Initial Case History A 41/2-year-old boy, with a history of onset of deep breathing following supper, is brought to your office by his mother. He had been alert and well all day, without fever, fully oriented, and without vomiting or diarrhea. He had been playing both in the house and garage in the morning and had spent the afternoon watching television. His temperature is 37.6°C, respiratory rate is 60 breaths per minute with deep inspiration and expiration, and pulse is 100 beats per minute and regular. He is without cyanosis. His pupils are midpoint, his lungs are clear, and his breath has no noticeable odor. What would you ask the mother in an effort to establish a diagnosis? History An unknown agent often can be suspected by history alone. The location of ingestion, if known, can offer clues.

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P1344 Right ventricular mass: multimodality diagnostic approach to an incidental finding

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.781 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

J Ambrozic ◽

A Kovac ◽

R Zbacnik ◽

S Ponorac ◽

P Kogoj ◽

...

Keyword(s):

Right Ventricular ◽

Incidental Finding ◽

Contrast Echocardiography ◽

Interventricular Septum ◽

Percutaneous Biopsy ◽

Intracardiac Echocardiography ◽

Diagnostic Approach ◽

Right Ventricular Mass ◽

History Of ◽

The Right

Abstract Background Cardiac masses are rare entities and often diagnostically challenging. When incidentally found multimodality diagnostic approach is warranted for further characterization and evaluation of its contribution to the patient’s symptoms. Case report 62-year-old male, smoker, with a history of non-Hodgkin lymphoma treated with radiation and chemotherapy 10 years ago, was admitted due to subacute myocardial infarction. Coronary angiogram showed subacute occlusion of partly collateralized RCA, subsequently treated with dilatation and stenting. Echocardiography revealed signs of dilated cardiomyopathy with severely reduced left ventricular ejection fraction (EF 20%), that could be due to chemotherapy-related cardiotoxicity. On admission CTA was performed to exclude aortic dissection since the patient presented with very severe chest pain radiating to the back. It showed a heterogeneous formation within the right ventricle (RV) extending along the interventricular septum from the apex towards the tricuspid annulus, appearing to involve interventricular septum as well. According to the imaging characteristics the mass was suspected to be a liposarcoma (Figure A). With contrast echocardiography hypoechogenic formation in the RV on parasternal long-axis view could be visualized (Figure B). Due to previous history of malignancy PET scan was performed that revealed hypometabolic RV mass, suggesting a benign tumor, without any sign of metastasis. We decided for percutaneous biopsy that was done under intracardiac echocardiography (ICE) guidance using the view from the RV towards RV outflow tract (Figure C). Histology revealed proliferation of mature adipocytes, either orthotopic or multiplied (Figure D). To exclude well-differentiated liposarcoma FISH (fluorescent in situ hybridization) with amplification of MDM2 gene was undertaken, confirming benign lesion, most probably cardiac lipoma. It was concluded that the mass was an incidental finding, not related to the patient’s symptoms and not causing any functional disturbances; therefore surgical therapy could be avoided. Conclusion While echocardiography remains the first-line imaging modality, multimodality diagnostic approach is mandatory for evaluation and treatment decision of a newly-discovered cardiac mass. Histology provides definitive diagnosis and ICE could be helpful for guiding percutaneous biopsy, thus avoiding invasive open-heart procedures. Figure. Cardiac CTA (A), contrast echocardiography (B), intracardiac echocardiography (C) and histologic specimen (D) of the right ventricular mass (arrows). Abstract P1344 Figure.

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