A case of delayed diagnosis of Necrolytic Migratory Erythema

Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.

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DELAYED DIAGNOSIS OF CONVULSIVE SYNCOPE FROM PACEMAKER LEAD FRACTURE IN A PATIENT WITH HISTORY OF SEIZURE DISORDER

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03461-6 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2105

Author(s):

Keneil Shah ◽

Najdat Bazarbashi ◽

Daniel Nguyen ◽

Vincent See

Keyword(s):

Delayed Diagnosis ◽

Seizure Disorder ◽

Pacemaker Lead ◽

Lead Fracture ◽

History Of ◽

Convulsive Syncope

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Hand tumors: A review of 186 patients at a single institute

Journal of Orthopaedic Surgery ◽

10.1177/2309499021993994 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199399

Author(s):

Taketsugu Fujibuchi ◽

Hiroshi Imai ◽

Joji Miyawaki ◽

Teruki Kidani ◽

Hiroshi Kiyomatsu ◽

...

Keyword(s):

Soft Tissue ◽

Clinical Features ◽

Malignant Tumors ◽

Proximal Phalanx ◽

Delayed Diagnosis ◽

Ring Finger ◽

Soft Tissue Tumors ◽

Body Parts ◽

Maximal Diameter ◽

Benign Soft Tissue Tumors

Purpose: The spectrum of diagnoses and clinical features of hand tumors differ from those of tumors in other body parts. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study aimed to elucidate the diagnostic distribution and the clinical features of hand tumors undergone surgery in our institute. Patients and methods: A total of 235 lesions in 186 patients diagnosed with hand tumors between 1978 and 2020 were reviewed. Age at surgery, gender, chief complaint, tumor location, and pathological diagnosis were analyzed. Results: There were 121 benign bone tumors, 98 benign soft tissue tumors, and 16 malignant tumors. Chondroma and tenosynovial giant cell tumor were common benign bone and soft tissue tumors at the proximal phalanx of the ring finger and the palm, respectively. Meanwhile, chondrosarcoma and synovial sarcoma were common malignant tumors at the dorsal part of the hand. Local pain and painless mass were the chief complaints in patients with benign bone and soft tissue tumors, respectively. Most patients with malignant tumors were referred after unplanned resection. When patients were classified into two categories by tumor size according to maximal diameter, tumors larger than 19 mm had a significantly higher risk of malignant ( p = 0.031) despite being smaller than other tumors in different body parts. Conclusion: When a tumor malignancy is suspected, the patient should be referred to a specialist to avoid unplanned resection or delayed diagnosis due to misdiagnosis. Knowing the distribution and clinical features should help in diagnosing hand tumors.

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AB0450 PERIPHERAL MACROVASCULAR INVOLVEMENT IN SYSTEMIC SCLEROSIS AS COMPARED WITH HEALTHY CONTROLS: A SMALL COHORT STUDY BY COLOR AND SPECTRAL DOPPLER ULTRASONOGRAPHY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3481 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1252.2-1252

Author(s):

R. D’alessandro ◽

E. Garcia Gonzales ◽

P. Falsetti ◽

C. Baldi ◽

F. Bellisai ◽

...

Keyword(s):

Systemic Sclerosis ◽

Clinical Features ◽

Doppler Ultrasonography ◽

Power Doppler ◽

Ulnar Artery ◽

Artery Occlusion ◽

Power Doppler Ultrasonography ◽

Digital Ulcers ◽

Healthy Controls ◽

History Of

Background:Together with autoimmune-inflammation and fibrosis, microvasculopathy is a hallmark of SSc. However, also macrovascular changes may occur including peripheral proliferative vasculopathy. Whether this changes may represent a specific SSc marker with a predictive value remains a matter of debate.[1,2,3]Objectives:To study peripheral macrovascular involvement by color doppler ultrasound (CDUS) with spectral wave analysis (SWA) in a cohort of 40 SSc patients as compared to healthy controls. To further analyze any differences among the SSc population.Methods:Forty SSc patients and 36 healthy controls were examined by CDUS with SWA of both hands. Macrovascular involvement was assessed by measuring the resistivity index (RI) of distal ulnar and radial arteries. Examinations were performed with an Esaote MyLab Twice machine equipped with a linear 10-22 MHz probe. Ultrasound examination was carried out by two independent rheumatologists blinded to clinical conditions of the patients. Statistical analysis was performed by using MaxStat software.Results:The RI index resulted increased in the SSc cohort as compared with healthy controls (left ulnar RI 0.977 vs 0.715; right ulnar RI 0.996 vs 0.699; left radial RI 0.988 vs 0.706; right radial RI 0.999 vs 0.688; p<0.001). SSc patients with an increased RI in one artery were more probable to have an increased RI in the other vessels too (r 2 = 0.35; p<0.01). In addition, 8 out of 40 SSc patients presented left ulnar artery occlusion (UAO) and 7 out of 40 SSc patients presented right UAO, of which 6 presented bilateral UAO. Awaiting to enlarge the cohort for further analysis, descriptive data regarding increased RI at CDUS/SWA and clinical features, including years from onset of the disease, subtype of SSc, mRSS, history of digital ulcers, interstitial lung disease and PAH are described in Table 1.Conclusion:Peripheral macrovascular involvement was observed in SSc patients as compared with healthy controls. Further studies will determine whether this feature may have specificity for diagnosis/prognosis in SSc.References:[1]Lescoat A, Yelnik CM, Coiffier G et al. Ulnar Artery Occlusion and Severity Markers of Vasculopathy in Systemic Sclerosis: A Multicenter Cross-Sectional Study. Arthritis Rheumatol. 2019;71:983-990.[2]Lescoat A, Coiffier G, Rouil A et al. Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study. Arthritis Care Res (Hoboken). 2017;69:543-551.[3]Schioppo T, Orenti A, Boracchi P, De Lucia O, Murgo A, Ingegnoli F. Evidence of macro- and micro-angiopathy in scleroderma: An integrated approach combining 22-MHz power Doppler ultrasonography and video-capillaroscopy. Microvasc Res. 2019;122:125-130.Table 1.Main clinical features of the SSc cohort (n=40) studied by CDUS for macrovascular involvement.SSc cohort (n = 40)Years from onsetrange (35 y – 0 y)mean = 10.5 yAutoantibodiesACA 13/40Anti-TopoI 14/40Other 13/40mRSSrange (0 -30)mean = 3ILD17/40PAH7/40Capillaroscopy patternEarly 10/40Active 11/40Late 6/40History of digital ulcers16/40Left ulnar IR0.977Left radial IR0.988Right ulnar IR0.996Right radial IR0.999Disclosure of Interests:None declared.

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History of Diabetes, Clinical Features of Prostate Cancer, and Prostate Cancer Recurrence-Data from CaPSURETM (United States)

Cancer Causes & Control ◽

10.1007/s10552-005-3301-z ◽

2005 ◽

Vol 16 (7) ◽

pp. 789-797 ◽

Cited By ~ 39

Author(s):

J.M. Chan ◽

D.M. Latini ◽

J. Cowan ◽

J. DuChane ◽

P.R. Carroll

Keyword(s):

Prostate Cancer ◽

United States ◽

Clinical Features ◽

Cancer Recurrence ◽

Prostate Cancer Recurrence ◽

History Of

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Posterior Fossa Arachnoid Cyst Masking a Delayed Diagnosis of Hyperparathyroidism in a Child

Case Reports in Endocrinology ◽

10.1155/2012/931371 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

B. Dhamija ◽

D. Kombogiorgas ◽

I. Hussain ◽

G. A. Solanki

Keyword(s):

Differential Diagnosis ◽

Primary Hyperparathyroidism ◽

Posterior Fossa ◽

Arachnoid Cyst ◽

Hospital Admissions ◽

Delayed Diagnosis ◽

Visual Disturbance ◽

Organ Damage ◽

Presenting Symptoms ◽

History Of

Background. Primary hyperparathyroidism in childhood is a very rare entity, often being diagnosed late after the onset of its presenting symptoms. It most commonly affects patients in their fourth decade of life and beyond. The inclusion of primary hyperparathyroidism in the differential diagnosis is necessary when evaluating patients presenting with nonspecific symptoms such as polyuria, fatigue, weight loss, abdominal pain, nausea, and vomiting.Methods. We report the case of an eleven-year-old girl presenting with three years history of headaches, visual disturbance, along with episodes of emotional lability. Neuroimaging confirmed a large posterior fossa arachnoid cyst. It was decided to manage this lesion conservatively with surveillance. Only after further hospital admissions with recurrent loss of consciousness, dizziness, and nausea to add to her already existing symptoms, a full biochemical and endocrine assessment was performed to look for more specific causes for her presentation. These pointed to a diagnosis of primary hyperparathyroidism.Conclusions. The inclusion of primary hyperparathyroidism in the differential diagnosis should be considered when evaluating paediatric patients presenting with nonspecific (neurological, gastrointestinal, and renal) symptoms in order to establish a prompt diagnosis of the disorder and to avoid severe complications of prolonged hypercalcaemia and end-organ damage.

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Case of second primary breast cancer in ectopic breast tissue and review of the literature

BMJ Case Reports ◽

10.1136/bcr-2020-241361 ◽

2021 ◽

Vol 14 (4) ◽

pp. e241361

Author(s):

Jamin Kweku Addae ◽

Thomas Genuit ◽

Joseph Colletta ◽

Kathy Schilling

Keyword(s):

Breast Cancer ◽

Primary Breast Cancer ◽

Breast Tissue ◽

Delayed Diagnosis ◽

Left Breast ◽

Second Primary ◽

Female Population ◽

Accessory Breast ◽

History Of ◽

High Index Of Suspicion

Accessory breast tissue (ABT) is found in approximately 2%–6% of the female population and are subject to most of the physiological and pathological changes that occur in pectoral breast. Primary breast cancer occurring in ABT is a rare occurrence and a second primary breast cancer occurring in an accessory breast has never been reported. We report the case of a 60-year-old woman with a history of mastectomy for left breast cancer 5 years prior to presentation, who presented with an enlarging right axilla mass found to be a second primary breast cancer in an accessory tissue on biopsy. Many physicians are unfamiliar with the clinical presentation of accessory breast cancer due to the rarity of the condition and this ultimately results in delayed diagnosis and advanced disease at presentation. It is therefore prudent that physicians have a high index of suspicion when patients present with axillary masses.

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Psoas Abscess: Diagnosis and Treatment

Acute Medicine Journal ◽

10.52964/amja.0118 ◽

2006 ◽

Vol 5 (1) ◽

pp. 13-16

Author(s):

Raj Kandasamy ◽

◽

Asha Srikanth ◽

SM Rutter ◽

CJ Butcher ◽

...

Keyword(s):

Clinical Features ◽

Case History ◽

Diagnostic Tests ◽

Psoas Abscess ◽

Diagnosis And Treatment ◽

Uncommon Presentation ◽

Appropriate Treatment ◽

History Of

Psoas abscess is an uncommon presentation on the acute medical take. However recognition and appropriate treatment is essential. This review is designed to highlight the clinical features, microbiology, diagnostic tests and treatment for this condition. In order to illustrate some of the pitfalls and complexities in the management of psoas abscess we have included a case history of a patient who was recently treated in our department.

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