scholarly journals Diffuse steatonecrosis - presenting as an obscure abdominal mass - a diagnostic dilemma

2017 ◽  
Vol 5 (2) ◽  
pp. 734
Author(s):  
Binay Kumar ◽  
Upasna Chachra ◽  
. Bhuvan
Keyword(s):  
Differential Diagnosis ◽  
Fatty Acid ◽  
Acute Abdomen ◽  
Clinical Setting ◽  
Pancreatic Necrosis ◽  
Abdominal Mass ◽  
Special Method ◽  
Fat Necrosis ◽  
Diagnostic Dilemma ◽  
Palpable Lump

Diffuse steatonecrosis secondary to acute / gangrenous pancreatitis presenting as vague abdominal mass is difficult to diagnose and requires special method / techniques for demonstration of fatty acid crystalloids. We report a case of acute abdomen with palpable lump. On emergency exploratory laprotomy a large thick jumbled up omental mass was revealed adhered to parietal wall along with complete pancreatic necrosis. Biopsy show diffuse fat necrosis of pericolic fat, omentum / mesentry with involvement of gut submucosa and birefringent saponified fatty acid crystalloids were demonstrated. Steatonecrosis may cause diagnostic dilemma and should be considered as differential diagnosis in appropriate clinical setting.

Diagnostic dilemma in a large choledochal cyst

2019 ◽  
Vol 22 (2) ◽  
pp. 38-40
Author(s):  
Tul Maya Gurung ◽  
Rabin Koirala ◽  
Amit Shrestha
Keyword(s):  
Differential Diagnosis ◽  
Choledochal Cyst ◽  
Congenital Anomalies ◽  
Biliary Drainage ◽  
Abdominal Mass ◽  
Choledochal Cysts ◽  
Diagnostic Dilemma ◽  
Variable Presentation

Choledochal cysts are rare congenital anomalies that have a variable presentation with occasional diagnostic and therapeutic dilemmas. Our case is a 14-year female presented with recurrent abdomen pain with confusing diagnostic findings, suggestive of a large choledochal cyst (22x29x17cm) initially managed by percutaneous tube biliary drainage and later underwent excision and HPE revealing non-malignant findings. The choledochal cyst should always be a differential diagnosis for any patient presenting with an abdominal mass and should be managed accordingly.

INDICATORS OF VOLATILE FATTY ACIDS IN DIFFERENTIAL DIAGNOSTICS OF INFECTED AND STERILE PANCREONECROSIS

2019 ◽  
Vol 64 (11) ◽  
pp. 644-648
Author(s):  
E. S. Akayzin ◽  
A. S. Metelev ◽  
A. E. Akayzina
Keyword(s):  
Fatty Acids ◽  
Differential Diagnosis ◽  
Fatty Acid ◽  
Volatile Fatty Acid ◽  
Volatile Fatty Acids ◽  
Pancreatic Necrosis ◽  
Capillary Column ◽  
Differential Diagnostics ◽  
Gas Chromatograph ◽  
Flame Ionization

The aim of the study was to assess the information content of volatile fatty acid parameters for the differential diagnosis of infected and sterile pancreatic necrosis. The work is based on the results of examination and treatment of 34 patients with pancreatic necrosis. The analysis of concentrations of volatile fatty acids: acetic, propionic, butyric and isovaleric was carried out on an automated gas chromatograph «Crystallux-4000» with a capillary column «HP-FFAP» and flame ionization detector. The indicators of acetic, propionic, butyric, isovaleric acid and the sum of volatile fatty acids are statistically significantly higher in patients with infected pancreatic necrosis compared with the indicators of volatile fatty acids in patients with sterile pancreatic necrosis. Volatile fatty acid values can be used for the differential diagnosis of infected and sterile pancreatic necrosis

Myocardial Metabolic Imaging in the Clinical Setting

2009 ◽  
Vol 5 (1) ◽  
pp. 15
Author(s):  
Nagara Tamaki ◽  
Yuji Kuge ◽  
Keiichiro Yoshinaga ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Fatty Acid ◽  
Clinical Setting ◽  
Photon Emission ◽  
Tca Cycle ◽  
Emission Tomography ◽  
Metabolic Imaging ◽  
Myocardial Uptake ◽  
Glucose Utilisation ◽  
Myocardial Metabolic Imaging

Glucose and free fatty acids are a major energy source in the myocardium. Metabolic imaging with single photon emission tomography (SPECT) and positron emission tomography (PET) have been widely used for the evaluation of the pathophysiology of coronary artery disease (CAD) and heart failure. 18F fluorodeoxyglucose (FDG) is a glucose analogue that is used to measure myocardial glucose utilisation. The myocardial uptake of a modified branched fatty acid, 15-(p-[iodine-123] iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP), reflects the activation of fatty-acid metabolism by co-enzyme A (CoA) and indirectly reflects cellular adenosine triphosphate (ATP) production. The turnover rate of the tricarboxylic acid (TCA) cycle reflects the rate of overall myocardial oxidative metabolism. 11C acetate is readily metabolised to CO2 almost exclusively through the TCA cycle. These three major agents have been most commonly used for probing myocardial energy metabolism in vivo. Such metabolic imaging has been used for assessing myocardial viability on the basis of persistent glucose utilisation in ischaemic but viable myocardium. BMIPP and FDG have been identified for locating a recent history of myocardial ischaemia. Furthermore, metabolic imaging is promising for the assessment of the pathophysiology of heart failure and the treatment effect of various drugs, as well as mechanical treatments. In this article we will provide an overview of the application of myocardial metabolic imaging in a clinical setting.

Non-Gynecologic Causes of Adnexal/Pelvic Masses

2018 ◽  
Vol 15 (1) ◽  
pp. 46-49
Author(s):  
Michelle L. Gainty ◽  
Christina Jones
Keyword(s):  
Differential Diagnosis ◽  
Female Patient ◽  
Diagnostic Dilemma ◽  
Adnexal Masses ◽  
Pelvic Masses

Pelvic masses can pose a diagnostic dilemma with a broad differential to include both gynecological and non-gynecologic etiologies. While the initial instinct may be to search for gynecologic causes for the female patient, non-gynecologic etiologies must be considered as well. The presentation can be similar amongst many different causes of pelvic masses and imaging is generally required for further assessment to determine if the mass is intra- or extraperitoneal. The etiology of adnexal masses covers several subspecialties: gynecology, urology, gastroenterology, neurology, and oncology. For this reason, it is important for all to be aware of the differential diagnosis for pelvic masses.

scholarly journals Large intraperitoneal lipoleiomyoma in a pre-menopausal woman: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara L. Schaefer ◽  
Amy L. Strong ◽  
Sheena Bahroloomi ◽  
Jichang Han ◽  
Michella K. Whisman ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Smooth Muscle ◽  
Case Report ◽  
Smooth Muscle Actin ◽  
Abdominal Mass ◽  
Histopathological Analysis ◽  
Menopausal Woman ◽  
En Bloc ◽  
Cross Sectional

Abstract Background Lipoleiomyoma is a rare, benign variant of the commonplace uterine leiomyoma. Unlike leiomyoma, these tumors are composed of smooth muscle cells admixed with mature adipose tissue. While rare, they are most frequently identified in the uterus, but even more infrequently have been described in extrauterine locations. Case presentation We describe a case report of a 45-year-old woman with a history of in vitro fertilization pregnancy presenting 6 years later with abdominal distention and weight loss found to have a 30-cm intra-abdominal lipoleiomyoma. While cross-sectional imaging can narrow the differential diagnosis, histopathological analysis with stains positive for smooth muscle actin, desmin, and estrogen receptor, but negative for HMB-45 confirms the diagnosis of lipoleiomyoma. The large encapsulated tumor was resected en bloc. The patients post-operative course was uneventful and her symptoms resolved. Conclusions Lipoleiomyoma should be considered on the differential diagnosis in a woman with a large intra-abdominal mass. While considered benign, resection should be considered if the mass is symptomatic, and the diagnosis is unclear or there is a concern for malignancy.

A Rare Cause of Mechanical Intestinal Obstruction: A Neoplastic Intra-Abdominal Testis

2016 ◽  
Vol 101 (3-4) ◽  
pp. 167-170
Author(s):  
Fatih Ciftci ◽  
Suat Benek ◽  
Cem Kezer
Keyword(s):  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Undescended Testis ◽  
Abdominal Mass ◽  
Relevant Literature ◽  
Large Diameter ◽  
Exploratory Laparotomy ◽  
Clinical Findings ◽  
Surgical Units ◽  
Mechanical Intestinal Obstruction

The acute abdomen has many etiologies frequently encountered in emergency surgical units. Approximately 20% of surgical admissions for acute abdominal conditions are for intestinal obstruction. Clinicians often overlook rarer causes. A 43-year-old man presented to the emergency ward with the clinical findings of ileus. Computed tomography revealed a heterogeneous necrotic 168 × 100-mm mass between the sigmoid colon and urinary bladder. Physical examination revealed a palpable intra-abdominal mass that was removed via exploratory laparotomy. On histopathologic examination, the mass was identified as a seminoma. The literature contains few reports of seminoma as a cause of acute abdomen and ileus, mostly seen between the ages of 30 and 40 years. We report a patient with seminoma arising in an undescended testis that presented as a palpable painful lower abdominal mass and mechanical intestinal obstruction, despite the large diameter of the mass, as well as review relevant literature.

scholarly journals Pneumatosis Intestinalis: A Case Report and Approach to Management

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sean Donovan ◽  
Joseph Cernigliaro ◽  
Nancy Dawson
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Bowel Wall ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Pneumatosis Intestinalis ◽  
Rapid Evaluation ◽  
Thought Process ◽  
Diagnostic Dilemma ◽  
Clinical Scenarios

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

The Diagnostic Dilemma of Myxedema and Madness, Axis I and Axis II: A Longitudinal Case Report

1989 ◽  
Vol 18 (3) ◽  
pp. 263-270 ◽  
Author(s):  
Denis F. Darko ◽  
Alice Krull ◽  
Mark Dickinson ◽  
J. Christian Gillin ◽  
S. Craig Risch
Keyword(s):  
Differential Diagnosis ◽  
Medical Diagnosis ◽  
Psychiatric Care ◽  
Paranoid Schizophrenia ◽  
Diagnostic Dilemma ◽  
Chronic Thyroiditis ◽  
Axis Ii ◽  
Probable Presence ◽  
Axis I ◽  
Primary Axis

A patient with presumed chronic paranoid schizophrenia had chronic thyroiditis and Grade I hypothyroidism. Psychosis cleared following treatment with thyroid replacement. The probable presence of two axis II disorders may have contributed to the missed medical diagnosis and the patient's eventual suicide. The personality disorders were a major problem in the patient's medical and psychiatric care. The differential diagnosis among hypothyroidism and primary axis I psychotic and depressive psychopathology has always been problematic. When axis II pathology is also present, the diagnostic dilemma is increased.

Sign in / Sign up

Export Citation Format

Share Document