EXTENSIVE MAXILLOFACIAL LYMPHANGIOMA WITH SUPPURATION IN THE LATE POSTNATAL PERIOD OF A CHILD

Lymphangiomas have a dysontogenetic origin, that is, they occur during the development of the fetus and are treated as an abnormal development of the endothelium of proliferating lymphatic vessels and manifest clinically, most often immediately after the birth of a child or in infancy. According to data published earlier by the staff of our department, among benign tumors of soft tissues of maxillofacial area, dermoid cysts (32.6%) take first place. The second place is given to hemangiomas (26.0%); lymphangiosis of such localization are quite rare, accounting for only 3% of the total number of tumors of soft tissues of the face and neck, which causes certain features of tactical approaches to choice and scope of diagnostic measures. In general, lymphangioma, a malformation of the lymphatic system, accounts for 9% of all soft tissue germline tumors and is diagnosed immediately after birth in 65-85% of children, with their superficial location. When they are located in the maxillofacial region, aesthetic deficiencies or functional impairments can be quite pronounced. The features of their topographic-anatomical location in deep fiber spaces and in the area of the floor of the oral cavity cause considerable difficulties in the conduct of diagnostics, the choice of tactical operating techniques and methods of treatment, because the postoperative period is accompanied by a high probability of complications. The presented content of the medical history indicates that the diagnosis of deep-seated and bulky lymphangiomas in young children is rather difficult. Especially, when it comes to festering and combined with acute infectious somatic diseases, it can provoke the occurrence of the inflammatory process directly in the lymphangioma. Attention is drawn to the fact that the frequency of diagnostic errors at the prehospital stage is 75%. Basically, the children were sent to hospital with an incorrect diagnosis, although they were under the supervision of district pediatricians for a long time and repeatedly looked around at a pediatric surgeon. The purpose of our study was to study the peculiarities of clinical manifestations and the diagnosis of volumetric, deep-seated lymphangiomis of the maxillofacial focal infiltration in a child of infancy. Routine diagnostic methods, such as needle biopsy and modern computed tomography, make it possible to unify the diagnostic process to a great extent and decide on the optimal option for operative access and the volume of surgical intervention. There are also certain difficulties in the choice of pharmacological drugs and their dosage when it comes to the combination of a diffuse purulent process with acute manifestations of the pathology of infectious origin. This category of children is subject to dynamic observation to exclude the possibility of recurrence of lymphangioma in conditions of its incomplete necrotization with timely involvement of measures.

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Difficulties of radiological diagnosis оf small breast cancers

Уральский медицинский журнал ◽

10.52420/2071-5943-2021-20-2-49-53 ◽

2021 ◽

Vol 20 (2) ◽

pp. 49-53

Author(s):

Т. N. Leikht ◽

G. I. Bratnikova ◽

Р. S. Gomina ◽

N. S. Kosolapova ◽

К. A. Tihaya ◽

...

Keyword(s):

Breast Cancer ◽

Soft Tissues ◽

Correct Diagnosis ◽

Screening Mammography ◽

Diagnostic Methods ◽

Benign Tumors ◽

Breast Cancers ◽

Vertical Orientation ◽

Small Breast ◽

Ultrasound Scanner

Introduction. Breast cancer in the structure of malignancies in women takes the 1st place. There has been an annual increase in morbidity, including due to improvements in diagnostic interventions and screening. Mammography and ultrasound of the breasts is mandatory when diagnosing breast cancer. The difficulties of diagnosis are revealed in small tumors.Methods. Breast ultrasounds were performed on the ultrasound machines of the expert class TOSHIBA APLIO 500, PHILIPS EPIQ 5 and PHILIPS EPIQ 7. Mammography and tomosynthesis were performed on mammogram MAMMOMAT INSPITATION PRIME. Core-biopsia under ultrasound control was carried out on the Logiq9 ultrasound scanner. Eighty women were selected with suspected cancer after breast core-biopsy with the category BI-RADS 3, 4 and 5. The size of the node according to ultrasound data was 6-10 mm.Results. According to core-biopsia has been identified cancer, histologically and immunohystochemically confirmed in 50 cases. In 30 women benign tumors were identified. The most informative mammograms of breast cancer were high tumor density, ray of radiibility and local deformity of soft tissues. Among the characteristic ultrasonic signs of the cancer more often noted vertical orientation, reduced echogenicity, uneven contour, other signs were not so character for the cancer.Conclusion. You can't focus on a separate sign of education! Only a combination of traits, different diagnostic methods contribute to the correct diagnosis.

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Differential diagnosis and treatment of Morton’s neuroma in ambulatory surgical practice

Ambulatory surgery hospital-replacing technologies ◽

10.21518/1995-1477-2020-1-2-89-94 ◽

2020 ◽

pp. 89-94

Author(s):

V. N. Korobkov ◽

V. A. Filippov

Keyword(s):

Differential Diagnosis ◽

Plantar Fasciitis ◽

Soft Tissues ◽

Diagnostic Errors ◽

Metatarsophalangeal Joint ◽

Diagnostic Methods ◽

Differential Diagnostics ◽

Foot Pain ◽

Morton’S Neuroma ◽

Morton's Neuroma

Introduction. Diagnosis of Mortoan neuroma in some cases does not cause much difficulty and is based on typical signs, but in some cases it presents certain difficulties. Therapeutic tactics for this disease involves the use of conservative or surgical treatment.Aim. Study of the results of differential diagnosis of Morton’s neuroma in the practice of an outpatient surgeon.Material and methods. A study of the results of diagnostics and differential diagnostics in 15 patients with chronic foot pain at the age of 28 to 46 years was conducted. Among them, there were 14 women and 1 man. Differential diagnostics for foot pain syndromes allowed us to distinguish three groups of patients. The first group included 7 patients with Morton’s neuroma. The second group included 4 patients with plantar fasciitis and the third group-4 patients with arthritis, synoviitis of the metatarsophalangeal joints. To conduct differential diagnostics, we used anamnesis, physical examination, and data from instrumental diagnostic methods.Results. Diagnosis of Morton’s neuroma was based on the use of standard research methods (anamnesis, data from a physical instrumental examination of the foot). It should be noted the importance of ultrasound examination of the soft tissues of the foot on the plantar surface for the diagnosis of Morton’s neuroma. This allows for differential diagnosis with foot diseases such as plantar fasciitis and metatarsophalangeal joint synovitis, which may show similar symptoms.Conclusion. Morton’s neuroma is not a rare disease of the foot, which in the initial stages of the disease has a blurred clinical picture, similar to other diseases of the foot. This can lead to diagnostic errors, but the use of modern diagnostic methods, including sonographic methods, allows in most cases to establish an accurate diagnosis and choose an appropriate treatment strategy.

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Infectious Alertness in Removal Benign Neoplasms in the Maxillofacial Area

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs05.05.236 ◽

2020 ◽

Vol 5 (5) ◽

pp. 236-241

Author(s):

V. N. Yadchenko ◽

◽

I. O. Pohodenko-Chudakova ◽

E. S. Yadchenko ◽

◽

...

Keyword(s):

Differential Diagnosis ◽

Soft Tissues ◽

Subcutaneous Tissue ◽

Clinical Manifestations ◽

Diagnostic Methods ◽

Benign Neoplasms ◽

Humid Climate ◽

Maxillofacial Region ◽

European Continent ◽

Surgical Interventions

Human dirofilariasis is a parasitic disease, transmissible helminthiasis caused by parasitizing nematodes of the genus Dirofilaria, most often D. repens and D. immitis which occurs with a predominant lesion of the skin (63%), conjunctiva (50%), mucous membranes, subcutaneous tissue and less often – internal organs. The most frequent incidence of dirofilariasis is observed in regions with a warm, humid climate, and at temperatures below 14℃, dirofilariae stop developing. Human cutaneous dirofilariasis on the European continent is most often diagnosed in representatives of southern and eastern Europe. There are confirmed cases of dirofilariasis on the territory of the Republic of Belarus and neighboring countries. Quite often, this disease affects the maxillofacial region. The purpose of the work was to initiate infectious alertness when planning operations for the removal of benign neoplasms in the maxillofacial region and inform medical specialists about the possibility of developing dirofilariasis of the specified localization, its clinical manifestations and objective diagnostic methods. Material and methods. The object of observation was a 34-year-old female patient R. with maxillofacial dirofilariasis. The subject of the study is the medical record of an inpatient patient R. Results and discussion. At the pre-hospital stage, patient R. underwent a general clinical examination. All indicators of the tests were within the age norm. According to the results of radiation examination methods, no data confirming the parasitic etiology of the disease was obtained. Taking into account the presence of a rounded formation about 1.0-1.2 cm in diameter which is slightly displaced relative to the underlying and surrounding soft tissues, the patient was offered surgical treatment. During the operation, a rounded self-moving helminth was extracted from the formation, about 11.0 cm long and 0.15 cm in diameter. After the helminth was identified, the patient was diagnosed with dirofilariasis. This should be taken into account in the diagnostic and therapeutic aspects when working with patients who have tumor processes in the maxillofacial region. Conclusion. The presented clinical observation shows that in the practice of a dental surgeon and a maxillofacial surgeon, it is increasingly possible to deal with the localization of helminth in the maxillofacial region which simulates a neoplasm which must be taken into account when conducting diagnostics, differential diagnosis and preoperative preparation. The results of the described case are aimed at developing infectious alertness when planning surgical interventions to remove benign neoplasms in the maxillofacial region, developing a rational diagnostic scheme and differential diagnosis for patients with suspected dirofilariasis and other parasitic lesions of the maxillofacial region

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Clinical-anamnestic analysis of the course and treatment of benign and borderline epithelial ovarian tumors

HEALTH OF WOMAN ◽

10.15574/hw.2016.115.86 ◽

2016 ◽

pp. 86-93

Author(s):

M.Yu. Yegorov ◽

◽

A.A. Sukhanova ◽

Keyword(s):

Varicose Veins ◽

Clinical Manifestations ◽

Abnormal Uterine Bleeding ◽

Abdominal Distension ◽

Ovarian Tumors ◽

Lower Limbs ◽

Benign Tumors ◽

Age Group ◽

Venous Disorders ◽

Serous Tumors

The objective: study the features of gynecological, physical history, diagnosis and treatment of patients with benign epithelial ovarian tumors (BeEOT) and borderline epithelial ovarian tumors (BEOT), determining the frequency of recurrence of ovarian tumors in the postoperative period. Patients and methods. According to a retrospective analysis of case histories of 112 women with epithelial ovarian tumors (EOT) underwent conservative or radical surgical treatment in a hospital, two groups were formed: I group – patients with benign epithelial ovarian tumors (BeEOT), which amounted to 85 (75.9%) women, and group II – patients with borderline epithelial ovarian tumors (BEOT), which amounted to 27 (24.1%) women. It was found that the main complaints of patients with EOT were pain (49.1%), abdominal distension (17%), and abnormal uterine bleeding (12.5%). The highest incidence of BeEOT (31.8%) observed in the age group of 41–50 years, while the peak incidence of BEOT (44.4%) corresponds to the age group of 51–60 years. Results. In BEOT endocrine pathology occurs significantly more frequently (p<0.05) than in BeEOT – 25.9% vs. 9.4%, respectively. Pathology of pancreatic-hepatobiliary system occurs significantly more frequently (p<0.05) in patients with BEOT compared with BeEOT – 81.5% versus 57.6%, respectively. Venous disorders (varicose veins of the pelvic organs, lower limbs, haemorrhoids) observed in BEOT significantly more frequently (p<0.05) than in BeEOT – 18.5% vs. 5.9%, respectively. EOT most often diagnosed in the period from 1 to 6 months after the first clinical manifestations with an average uptake of medical care 4.6±0.57 months. In assessing of peritoneal exudate cytogram the mesothelium cells are significantly more common for BeEOT (p<0.01) than BEOT – 79.4% versus 40.9%, respectively. Cervicitis is more likely significantly to occur in BeEOT (p<0.01) than in BEOT – 29.4% vs. 7.4%, respectively. The most common histological type among the benign tumors of the ovaries are endometriomas, which occurred in 48.2% of all BeEOT cases, and among the borderline tumors – serous tumors, which accounted for 59.3% of all BEOTs. Conclusion. The use of organ sparing surgery in EOT increases the risk of recurrence, especially in the case of endometrial histology or borderline variant of tumor. Key words: benign and borderline epithelial ovarian tumors, clinical-anamnestic analysis, diagnosis, treatment.

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Imaging Features of Primary Tumors of the Hand

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616999200817173154 ◽

2020 ◽

Vol 16 ◽

Author(s):

Filippo Boriani ◽

Edoardo Raposio ◽

Costantino Errani

Keyword(s):

Soft Tissue ◽

Soft Tissues ◽

Epithelioid Sarcoma ◽

Case Series ◽

Malignant Neoplasm ◽

Benign Tumors ◽

Imaging Features ◽

Primary Tumors ◽

Therapeutic Decisions ◽

Tumors Of The Hand

: Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis prognosis and therapy.The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.

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Application of electronic trigger tools to identify targets for improving diagnostic safety

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-008086 ◽

2018 ◽

Vol 28 (2) ◽

pp. 151-159 ◽

Cited By ~ 21

Author(s):

Daniel R Murphy ◽

Ashley ND Meyer ◽

Dean F Sittig ◽

Derek W Meeks ◽

Eric J Thomas ◽

...

Keyword(s):

Adverse Event ◽

Patient Safety ◽

High Risk ◽

Health Systems ◽

Language Processing ◽

Diagnostic Errors ◽

Diagnostic Process ◽

Future Research ◽

Implementation Challenges ◽

Preventable Harm

Progress in reducing diagnostic errors remains slow partly due to poorly defined methods to identify errors, high-risk situations, and adverse events. Electronic trigger (e-trigger) tools, which mine vast amounts of patient data to identify signals indicative of a likely error or adverse event, offer a promising method to efficiently identify errors. The increasing amounts of longitudinal electronic data and maturing data warehousing techniques and infrastructure offer an unprecedented opportunity to implement new types of e-trigger tools that use algorithms to identify risks and events related to the diagnostic process. We present a knowledge discovery framework, the Safer Dx Trigger Tools Framework, that enables health systems to develop and implement e-trigger tools to identify and measure diagnostic errors using comprehensive electronic health record (EHR) data. Safer Dx e-trigger tools detect potential diagnostic events, allowing health systems to monitor event rates, study contributory factors and identify targets for improving diagnostic safety. In addition to promoting organisational learning, some e-triggers can monitor data prospectively and help identify patients at high-risk for a future adverse event, enabling clinicians, patients or safety personnel to take preventive actions proactively. Successful application of electronic algorithms requires health systems to invest in clinical informaticists, information technology professionals, patient safety professionals and clinicians, all of who work closely together to overcome development and implementation challenges. We outline key future research, including advances in natural language processing and machine learning, needed to improve effectiveness of e-triggers. Integrating diagnostic safety e-triggers in institutional patient safety strategies can accelerate progress in reducing preventable harm from diagnostic errors.

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Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-011593 ◽

2021 ◽

pp. bmjqs-2020-011593

Author(s):

Traber D Giardina ◽

Saritha Korukonda ◽

Umber Shahid ◽

Viralkumar Vaghani ◽

Divvy K Upadhyay ◽

...

Keyword(s):

Medical Record ◽

Clinical Care ◽

Diagnostic Testing ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Diagnostic Process ◽

Healthcare Organisation ◽

Safety Concerns ◽

Patient Complaints ◽

Malpractice Claims

BackgroundPatient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.ObjectiveTo systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.MethodsWe reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.ResultsIn cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.ConclusionsAnalysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.

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Dermoscopic aspect of verrucous epidermal nevi: New findings

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1811-27 ◽

2019 ◽

Author(s):

ÖMER FARUK ELMAS ◽

NECMETTİN AKDENİZ

Keyword(s):

Polarized Light ◽

Diagnostic Methods ◽

The Other ◽

Diagnostic Process ◽

Fine Scale ◽

Epidermal Nevus ◽

Clinical Interpretation ◽

New Findings ◽

Clinical Variants ◽

Histopathological Investigation

Background and Aim: Verrucous epidermal nevi are cutaneous hamartomas having many clinical variants. Dermoscopic features of verrucous epidermal nevus have rarely been investigated. We aimed to identify dermoscopic findings of the entity which will facilitate the diagnostic process by reducing the use of invasive diagnostic methods. Material and Methods: The study included the patients with histopathologically approved verrucous epidermal nevus. Clinical, dermoscopic and histopathological features of the patients were retrospectively reviewed and the findings identified were recorded. Dermoscopic examination was performed with a polarized-light handheld dermoscope with 10-fold magnification. Results: The most common dermoscopic features were thick brown circles, thick brown branched lines and terminal hairs. The most common vessel pattern was dotted vessels. Branched thick brown lines, brown globules, brown dots forming lines, serpiginous brown dots, white and brown exophytic papillary structures, fine scale, thick adherent scale and cerebriform structures were the other findings. Conclusion: We observed many vascular and non-vascular dermoscopic findings which have not been described previously for the entity. Dermoscopic examination of the verrucous epidermal nevi may lead more reliable clinical interpretation and thus it may reduce the need for histopathological investigation. Keywords: dermoscopy, large brown circles, verrucous epidermal nevus

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Congenital intestinal lymphangiectasia

Vojnosanitetski pregled ◽

10.2298/vsp1103270p ◽

2011 ◽

Vol 68 (3) ◽

pp. 270-273

Author(s):

Dusan Popovic ◽

Milan Spuran ◽

Tamara Alempijevic ◽

Miodrag Krstic ◽

Srdjan Djuranovic ◽

...

Keyword(s):

Early Recognition ◽

Clinical Manifestations ◽

Lymphatic Vessels ◽

High Protein Diet ◽

Intestinal Wall ◽

Intestinal Biopsy ◽

Intestinal Lymphangiectasia ◽

Laboratory Assessment ◽

Protein Losing Enteropathy ◽

Adequate Treatment

Background. Congenital intestinal lymphangiectasia is a disease which leads to protein losing enteropathy. Tortous, dilated lymphatic vessels in the intestinal wall and mesenterium are typical features of the disease. Clinical manifestations include malabsorption, diarrhea, steatorrhea, edema and effusions. Specific diet and medication are required for disease control. Case report. A 19-year old male patient was hospitalized due to diarrhea, abdominal swelling, weariness and fatigue. Physical examination revealed growth impairment, ascites, and lymphedema of the right hand and forearm. Laboratory assessment indicated iron deficiency anaemia, lymphopenia, malabsorption, inflammatory syndrome, and urinary infection. Enteroscopy and video capsule endoscopy demonstrated dilated lymphatic vessels in the small intestine. The diagnosis was confirmed by intestinal biopsy. The patient was put on high-protein diet containing medium-chain fatty acids, somatotropin and suportive therapy. Conclusion. Congenital intestinal lymphangiectasia is a rare disease, usually diagnosed in childhood. Early recognition of the disease and adequate treatment can prevent development of various complications.

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Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error

Diagnosis ◽

10.1515/dx-2019-0108 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Martin A. Schaller-Paule ◽

Helmuth Steinmetz ◽

Friederike S. Vollmer ◽

Melissa Plesac ◽

Felix Wicke ◽

...

Keyword(s):

Patient Safety ◽

Clinical Reasoning ◽

Data Gathering ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Care Physician ◽

Diagnostic Process ◽

Myasthenic Crisis ◽

Hospital Organization ◽

Substantial Impact

Abstract Objectives Errors in clinical reasoning are a major factor for delayed or flawed diagnoses and put patient safety at risk. The diagnostic process is highly dependent on dynamic team factors, local hospital organization structure and culture, and cognitive factors. In everyday decision-making, physicians engage that challenge partly by relying on heuristics – subconscious mental short-cuts that are based on intuition and experience. Without structural corrective mechanisms, clinical judgement under time pressure creates space for harms resulting from systems and cognitive errors. Based on a case-example, we outline different pitfalls and provide strategies aimed at reducing diagnostic errors in health care. Case presentation A 67-year-old male patient was referred to the neurology department by his primary-care physician with the diagnosis of exacerbation of known myasthenia gravis. He reported shortness of breath and generalized weakness, but no other symptoms. Diagnosis of respiratory distress due to a myasthenic crisis was made and immunosuppressive therapy and pyridostigmine were given and plasmapheresis was performed without clinical improvement. Two weeks into the hospital stay, the patient’s dyspnea worsened. A CT scan revealed extensive segmental and subsegmental pulmonary emboli. Conclusions Faulty data gathering and flawed data synthesis are major drivers of diagnostic errors. While there is limited evidence for individual debiasing strategies, improving team factors and structural conditions can have substantial impact on the extent of diagnostic errors. Healthcare organizations should provide the structural supports to address errors and promote a constructive culture of patient safety.

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