Differential diagnosis of a calcified cyst found in an 18th century female burial site at St. Nicholas Church cemetery (Libkovice, Czechia)

During archaeological excavations in burial sites, sometimes stoned organic objects are found, in addition to human remains. Those objects might be of a different origin, depending on various factors influencing members of a community (i.e. diseases, trauma), which provides information about their living conditions. The St. Nicholas Church archaeological site (Libkovice, Czechia) in the 18th century horizon of the cemetery, yielded a maturus-senilis female skeleton with a stone object in the left iliac fossa. This object was an oviform cyst-like rough structure, measuring 54 mm in length, 35 mm in maximum diameter and 0.2–0.7 mm shell thickness. Within the object there were small fetal bones (long bones, i.e. femur and two tibias, two scapulas, three ribs, vertebrae and other tiny bone fragments). Methods utilized to analyze the outer and inner surface morphology of the cyst and its inside, included: X-ray, CT imaging, SEM, histological staining and EDS. The EDS analysis revealed the presence of primarily oxygen, calcium and phosphorus in bone samples, and oxygen and silicon, in stone shell. Based on the length of the femur (20.2 mm) and tibia (16 mm) shafts, the fetal age was determined as being in the 15–18 week of pregnancy. The differential diagnosis was conducted, including for the three most probable cases: fetiform teratoma (FT), fetus-in-fetu (FIF) and lithopedion. The possibility of fetiform teratoma was discounted due to the presence of an anatomically correct spine, long bones and the proportions of the find. Although the low calcium content in the shell (2.3% atom mass), the lack of skull bones and the better developed lower limbs indicate fetus-in-fetu rather than lithopedion, the analyses results are unable to conclusively identify the object under one of these two categories since there are insufficient such cases in excavation material with which to draw comparison.

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Tubocutaneous Fistula due to Endometriosis – A Differential Diagnosis in Cutaneous Fistulas with Cyclic Secretion

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0036-1597754 ◽

2017 ◽

Vol 39 (01) ◽

pp. 31-34

Author(s):

Edinari Lopes ◽

Lia Damásio ◽

Laio Passos

Keyword(s):

Differential Diagnosis ◽

Surgical Intervention ◽

Rare Complication ◽

Iliac Fossa ◽

Main Diagnosis ◽

Significant Morbidity ◽

Cutaneous Fistula ◽

Left Iliac Fossa ◽

Surgical Scar ◽

Hormonal Therapies

The development of a tubocutaneous fistula due to endometriosis in a post-cesarean section surgical scar is a rare complication that generates significant morbidity in the affected women. Surgery is the treatment of choice in these cases. Hormonal therapies may lead to an improvement in symptoms, but do not eradicate such lesions. In this report, we present a 34-year-old patient with a cutaneous fistula in the left iliac fossa with cyclic secretion. Anamnesis, a physical examination, and supplementary tests led us to suggest endometriosis as the main diagnosis, which was confirmed after surgical intervention.

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An unusual differential diagnosis of a left iliac fossa mass

BMJ Case Reports ◽

10.1136/bcr.01.2009.1431 ◽

2009 ◽

Vol 2009 (mar08 1) ◽

pp. bcr0120091431-bcr0120091431

Author(s):

R. Lee ◽

S. Liptrot ◽

A. Shaw ◽

N. Hurst

Keyword(s):

Differential Diagnosis ◽

Iliac Fossa ◽

Left Iliac Fossa

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Giant cell tumor in long bones: The significance of marginal sclerosis for the differential diagnosis

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1993.29.2.307 ◽

1993 ◽

Vol 29 (2) ◽

pp. 307

Author(s):

Hee Jin Kim ◽

Jin Suck Suh ◽

Chang Yun Park

Keyword(s):

Differential Diagnosis ◽

Giant Cell Tumor ◽

Giant Cell ◽

Cell Tumor ◽

Long Bones

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Abdominal apoplexy during pregnancy

BMJ Case Reports ◽

10.1136/bcr-2020-235946 ◽

2020 ◽

Vol 13 (10) ◽

pp. e235946

Author(s):

Jasmeet Kumari ◽

Rosemary Harkin

Keyword(s):

Iliac Fossa ◽

Unknown Origin ◽

Breech Presentation ◽

Sudden Onset ◽

Left Iliac Fossa ◽

Safe Delivery ◽

Uterine Contractions ◽

Early Labour ◽

Increased Risk ◽

High Index Of Suspicion

We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. ‘Abdominal apoplexy’ (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.

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

BMJ Case Reports ◽

10.1136/bcr-2021-242690 ◽

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.

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Imperforate hymen mimicking acute appendicitis in an adolescent woman: a rare presentation

BMJ Case Reports ◽

10.1136/bcr-2020-238547 ◽

2021 ◽

Vol 14 (3) ◽

pp. e238547

Author(s):

Victoria Rose Russell ◽

Mohamed Ibrahim ◽

Georgina Phillips ◽

Tom Setchell ◽

Sanjay Purkayastha

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Iliac Fossa ◽

Female Genital Tract ◽

Delayed Diagnosis ◽

Rare Presentation ◽

Left Iliac Fossa ◽

Imperforate Hymen ◽

Retrograde Menstruation ◽

Low Incidence

Imperforate hymen is a rare congenital malformation of the female genital tract. The condition poses several diagnostic challenges owing to its low incidence and often atypical presentation. Classical symptoms include amenorrhoea and cyclical abdominal pain. Delayed diagnosis leads to potentially irreversible and lifechanging sequelae including infertility, endometriosis and renal failure. A premenarchal 13-year-old girl with a background of chronic constipation presented with symptoms mimicking acute appendicitis. The underlying cause was imperforate hymen and retrograde menstruation. The diagnosis was made during diagnostic laparoscopy. As with this patient, pre-existing symptoms are often troublesome long before the true diagnosis is made. This case report highlights the importance of recognising imperforate hymen as a potential cause of acute abdominal pain in premenarchal adolescent girls. The clinical picture may present as right or left iliac fossa pain. Early identification reduces the risk of adverse complications and avoids unnecessary and potentially harmful interventions.

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Ultrasonic elastography and conventional ultrasound in the diagnosis of thyroid micro-nodules

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.6.777 ◽

2019 ◽

Vol 35 (6) ◽

Author(s):

Jinming Wang ◽

Wenbing Wei ◽

Rui Guo

Keyword(s):

Differential Diagnosis ◽

Roc Curve ◽

Thyroid Nodules ◽

Ultrasound Elastography ◽

Surgical Pathology ◽

Maximum Diameter ◽

Clinical Value ◽

Conventional Ultrasound ◽

Missed Diagnosis ◽

The Difference

Objective: To investigate the clinical value of conventional ultrasound, ultrasound elastography and conventional ultrasound combined with ultrasound elastography in differential diagnosis of benign and malignant thyroid micro-nodules. Methods: Eighty-six patients who were found with thyroid micro-nodules with the maximum diameter no more than 10 mm in the physical examination in our hospital from June 2015 to December 2017 were selected, and 102 nodules were included. All patients were confirmed with thyroid micro-nodules by puncture or surgical pathology and underwent conventional ultrasound and ultrasound elastography. Taking the surgical pathological results as a control, the value of conventional ultrasound, ultrasound elastography and conventional ultrasound combined with ultrasound elastography in differential diagnosis of benign and malignant thyroid micro-nodules were compared. A receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve was calculated. Results: One hundred and two thyroid nodules were detected by surgical pathology, including 75 benign nodules (73.53%) and 27 malignant nodules (26.47%). The sensitivity and diagnostic accordance rate of ultrasound elastography were significantly higher than those of conventional ultrasound in the diagnosis of thyroid microcarcinoma, and the missed diagnosis rate of ultrasound elastography was significantly lower than that of conventional ultrasound; the difference was statistically significant (P<0.05). However, the difference between the two methods was not statistically significant in terms of diagnostic specificity and misdiagnosis rate (P>0.05). The areas under the ROC curve in the diagnosis of benign and malignant thyroid nodules by conventional ultrasound and ultrasound elastography were 0.735 and 0.743 respectively. Conclusion: Conventional ultrasound can be used as a routine examination technique in differential diagnosis of benign and malignant thyroid nodules, while ultrasound elastography can improve the sensitivity and diagnostic rate in the diagnosis of thyroid micro carcinoma. It can help to reduce the clinical missed diagnosis, which also can be be used as an effective supplement for conventional ultrasound. doi: https://doi.org/10.12669/pjms.35.6.777 How to cite this:Wang J, Wei W, Guo R. Ultrasonic elastography and conventional ultrasound in the diagnosis of thyroid micro-nodules. Pak J Med Sci. 2019;35(6):1526-1531. doi: https://doi.org/10.12669/pjms.35.6.777 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers

Dermatology ◽

10.1159/000492669 ◽

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.

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A case of successful surgical management of primary retroperitoneal mucinous cystadenoma

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa045 ◽

2020 ◽

Vol 2020 (3) ◽

Author(s):

Zeeshan Afzal ◽

Weronika Stupalkowska ◽

Maria B Mahler-Araujo ◽

David Bowden ◽

Richard J Davies

Keyword(s):

Iliac Fossa ◽

Mucinous Cystadenoma ◽

Surgical Excision ◽

Mass Effect ◽

Rare Tumour ◽

Left Iliac Fossa ◽

Female Population ◽

Midline Laparotomy ◽

Complete Surgical Excision ◽

Primary Retroperitoneal

Abstract Primary retroperitoneal mucinous cystadenoma (PRMC) is a rare tumour. It was first reported in 1965, and since then, less than 100 cases have been reported. It is cystic in nature and most commonly affects the female population. It becomes symptomatic in later stages due to its mass effect, making the diagnosis challenging in its early asymptomatic stage. We report a case of a 32-year-old female who presented with abdominal pain and a mass in left iliac fossa. Diagnostic imaging revealed a large cystic lesion in retroperitoneum. A midline laparotomy was performed, and a complete surgical excision was accomplished without any spillage. Surgical histology confirmed the diagnosis of PRMC. The patient was discharged on postoperative day 2. There was no evidence of tumour recurrence on repeat imaging at 90-day follow-up. Surgical approach, with complete resection and without any spillage, remains the most effective and appropriate treatment for this tumour.

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