scholarly journals Aggressive primary urethral malignancy masquerading as stricture urethra: Unusual presentation of a rare malignancy

2021 ◽  
pp. 449-451
Author(s):  
Sridhar Parnandi ◽  
Ravindra G Varma ◽  
Amit Saple
Keyword(s):  
Delayed Diagnosis ◽  
Outlet Obstruction ◽  
High Index ◽  
Elderly Male ◽  
Stricture Urethra ◽  
Urinary Tract Symptoms ◽  
Retrograde Urethrogram ◽  
Diagnostic Modalities ◽  
Rare Malignancy ◽  
High Index Of Suspicion

Bladder outlet obstruction in an elderly male patient is most of the time diagnosed as prostatomegaly or stricture urethra unless there is a high index of suspicion for other differential diagnoses. Rare tumors like urethral malignancy may be misdiagnosed due to their varied and delayed mode of presentation. Here, we present a case of a patient who presented with acute urinary retention and was suspected to be a stricture urethra which ultimately turned out to be an aggressive urethral tumor. Investigations such as retrograde urethrogram, ultrasound, or cystoscopy which are the most common diagnostic modalities in a patient with lower urinary tract symptoms may not diagnose urethral tumors. Delayed diagnosis is common in these tumors resulting in a lesser chance for curative treatment. A high index of suspicion with a lesser threshold for investigations like MRI is pivotal for early diagnosis in these patients.

An elderly male with lower urinary tract symptoms during COVID-19 pandemic: Extraperitoneal perforation of bladder diverticulum

2021 ◽  
pp. 039156032110229
Author(s):  
Amit Sharma ◽  
Deepak Biswal ◽  
Satyadeo Sharma ◽  
Siddhant Roy
Keyword(s):  
Bladder Outlet Obstruction ◽  
Outlet Obstruction ◽  
Transurethral Resection Of Prostate ◽  
Bladder Diverticulum ◽  
Elderly Male ◽  
Bladder Drainage ◽  
Intravenous Antibiotics ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Case: We present a case of spontaneous extra-peritoneal rupture of an acquired diverticulum an elderly male with symptoms of bladder outlet obstruction who presented in emergency with acute abdomen. Outcome: The acute phase was managed conservatively with bladder drainage and intravenous antibiotics. He recently underwent Transurethral Resection of Prostate. He is asymptomatic on follow-up. Conclusions: Acquired bladder diverticulum are rare in adults and are mostly seen in patients with high pressure bladder due to bladder outlet obstruction. Atraumatic extraperitoneal ruptures of diverticulum are uncommonly reported.

Nodular melanoma presenting as an exophytic subungual mass

2018 ◽  
Vol 63 (1) ◽  
pp. 32-34 ◽  
Author(s):  
B Finlay ◽  
T Ramachandren ◽  
K Hussey ◽  
S Parkyn ◽  
K Meyer ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Interesting Case ◽  
High Index ◽  
Nodular Melanoma ◽  
Diagnostic Pitfall ◽  
One Year ◽  
High Index Of Suspicion ◽  
Subungual Melanoma

Despite being recognised and reported in the literature for decades, subungual melanoma of the foot remains a diagnostic pitfall, with it commonly being mistaken for benign conditions. We present an interesting case of delayed diagnosis of subungual melanoma of the hallux that was misdiagnosed in the community for over one year. With melanoma being the fourth most commonly diagnosed cancer in Australia in 2013, this case serves as a reminder to all clinicians about the importance of maintaining a high index of suspicion for melanoma of the foot.

scholarly journals An insight into the management of urinary bladder diverticulum: a retrospective observational study

2020 ◽  
Vol 7 (12) ◽  
pp. 1820
Author(s):  
Soumish Sengupta ◽  
Supriya Basu ◽  
Saurabh Gupta
Keyword(s):  
Urinary Bladder ◽  
Outlet Obstruction ◽  
Voiding Cystourethrogram ◽  
Bladder Diverticulum ◽  
Large Size ◽  
Stricture Urethra ◽  
Urinary Tract Symptoms ◽  
Clean Intermittent Catheterisation ◽  
Insight Into ◽  
Lower Urinary

Background: The aim of the study is to retrospectively analyse the best mode of treatment for patients presenting with urinary bladder diverticulum. Methods: This study includes 46 patients who presented to the outpatient department between January of 2018 to March of 2020. They had lower urinary tract symptoms (LUTS) and were later found on investigations with imaging like ultrasound and voiding cystourethrogram (VCUG) as having bladder diverticulum with some cases associated with bladder outlet obstruction. Secondary causes were treated surgically or conservatively with clean intermittent catheterisation (CIC). Diverticulum was addressed with diverticulectomy when conservative management failed with recurrent LUTS or if the diverticulum was of a large size with significant post void residual urine. Results: Most of the patients with diverticulum associated with prostatomegaly or stricture urethra fared well after treatment of the underlying cause except one who underwent subsequent diverticulectomy. Four out of 5 patients with neurogenic bladder did well with CIC alone barring one who underwent diverticulectomy for a large sized diverticulum and refractory LUTS. Two patients with bladder growth involving the neck of diverticulum underwent partial cystectomy along with diverticulectomy. Four out of the remaining 8 patients with primary diverticulum were taken up for diverticulectomy directly and one underwent subsequent diverticulectomy for failed CIC. Conclusions: Not all urinary bladder diverticulum required surgical management per se. Most fared well with treatment of the underlying cause. So only those with large size, recurrent LUTS and failed management with CIC should be considered for diverticulectomy.

Lead encephalopathy secondary to petrol inhalation

1999 ◽  
Vol 16 (4) ◽  
pp. 149-150
Author(s):  
Maria Morgan ◽  
John Owens ◽  
Prega Pillay
Keyword(s):  
Environmental Exposure ◽  
Chelating Agents ◽  
Medical Condition ◽  
Delayed Diagnosis ◽  
High Index ◽  
Lead Encephalopathy ◽  
High Index Of Suspicion

AbstractLead encephalopathy is a relatively rare medical condition. It can present with multiple seizures, delirium, blindness, aphasia and dementia. Usually it is due to environmental exposure. This paper describes a case of delayed diagnosis of lead encephalopathy secondary to petrol sniffing which responded to chelating agents therapy. A high index of suspicion must be maintained to diagnose this treatable cause of encephalopathy.

scholarly journals Salmonella Aortitis in an Elderly Male, a Rare but Deadly Cause of Abdominal Pain: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 242-245
Author(s):  
Kevin Yanushefski ◽  
Sukhdip Kaur ◽  
Mary Eberhardt
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Surgical Intervention ◽  
Rare Condition ◽  
Vascular Reconstruction ◽  
Elderly Male ◽  
Abdominal Ct ◽  
Diagnostic Modalities ◽  
High Level ◽  
High Index Of Suspicion

Introduction: Infectious aortitis is a rare condition with mortality rates approaching 100% without surgical intervention. Symptoms and findings may be vague. Computed tomography (CT) with intravenous (IV) contrast, once the gold standard of diagnosis, may only show subtle findings. More recently, CT angiography (CTA) and magnetic resonance angiography have become the diagnostic modalities of choice. Case Report: A 58-year-old diabetic male presented to our emergency department with nausea, vomiting, diarrhea, fevers, and abdominal pain of two weeks duration. The patient had been seen just days before at another facility with the same complaints. He received an abdominal CT with IV contrast that was reported as negative and discharged with the diagnosis of gastroenteritis. He failed to improve and presented to our facility. On presentation, the patient was diaphoretic and uncomfortable. A repeat abdominal CT with IV contrast revealed a mantle of low density around the aorta. The patient was started on IV antibiotics, and a follow-up CTA of the abdomen and pelvis showed an irregular saccular aneurysm. Vascular surgery was consulted, and the patient underwent vascular reconstruction. Conclusion: Because of the high level of mortality seen in infectious aortitis and improvement in patient outcomes with surgical intervention, a high index of suspicion needs to be maintained in patients presenting with fever and chest, abdominal, and back pain, especially in the setting of risk factors and bacteremia. The clinician should be aware that the usual modality for the evaluation of abdominal pain, CT with IV contrast, may not be adequate to make the diagnosis.

scholarly journals Coronavirus Infection of the Urinary Bladder and Lower Urinary Tract: A Review and Update

2021 ◽  
Vol 4 (2) ◽  
pp. 01-11
Author(s):  
Anthony Kodzo-Grey Venyo
Keyword(s):  
Urinary Tract ◽  
Urinary Bladder ◽  
Respiratory Tract ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
De Novo ◽  
High Index ◽  
Urinary Tract Symptoms ◽  
High Index Of Suspicion ◽  
Lower Urinary

COVID-19 infection does affect males and females. Even though the commonest manifestations of COVID-19 infection tend to be related to symptoms associated with the respiratory tract, many other organs of the body also tend to be affected and COVID-19 infection of these other organs could manifest contemporaneously with symptoms of the respiratory tract system in addition to symptoms of the affected organs. At times COVID-19 may initially manifest solely related to non-respiratory tract organs and because the symptoms are non-specific without a high index of suspicion, the diagnosis of COVID-19 infection may be missed initially or there may be delay in the diagnosis which would tend to lead to spreading of the disease. Some of the manifestations of COVID-19 infection of the urinary bladder may include: Lower urinary tract symptoms of urinary frequency, and or urinary urgency, and or nocturia, and or urinary incontinence, or on rare occasions non-visible or visible haematuria, or acute retention of urine. The aforementioned symptoms may occur as De novo (new-onset) symptoms alone or they may be associated with or without fever, with or without respiratory tract symptoms. Some individuals who already have lower urinary tract symptoms could experience worsening of their previous lower urinary tract symptoms and if the clinician does not have a high index of suspicion for the possible development of COVID-19 infection, and the clinician does blame the symptoms on benign prostatic hyperplasia then the diagnosis could be missed or delayed. If the COVID-19 cystitis is associated with COVID-19 infection of the male genital tract then some of the patients could experience scrotal discomfort, swelling of the scrotum, erythema of the scrotum, or low-flow priapism or clinical and radiology imaging features of acute orchitis, or acute epididymitis, or acute epididymo-orchitis. However, if the lower urinary tract symptoms are associated with respiratory tract symptoms all clinicians globally are aware of the fact that a high index of suspicion for COVID-19 infection should be exercised. What is important is that every clinician and every individual should be made aware of the fact that the development of De novo lower urinary tract symptoms or sudden onset of worsening lower urinary tract symptoms should be regarded as possibly due to COVID-19 infection and appropriate tests should be undertaken to confirm or negate the diagnosis of COVID-19 infection quickly. Diagnosis of COVID-19 infection of the urinary bladder can be confirmed the undertaking of various COVID-19 infection tests but COVID-19 PCR test has tended to be a common test that most people use globally.

Neurobrucellosis associated with feral swine hunting in the southern United States

2020 ◽  
Vol 13 (12) ◽  
pp. e238216
Author(s):  
Harry Ross Powers ◽  
Jared R Nelson ◽  
Salvador Alvarez ◽  
Julio C Mendez
Keyword(s):  
United States ◽  
At Risk ◽  
High Index ◽  
Southern United States ◽  
Endemic Country ◽  
Feral Swine ◽  
Neurological Sequelae ◽  
Initial Symptoms ◽  
The Usa ◽  
High Index Of Suspicion

Although uncommon, Brucella infection can occur outside the areas of high endemicity, such as the USA. In the southern USA, hunters of wild swine are at risk for brucellosis. We present a case of a patient with fever, headache and constitutional symptoms that were ongoing for 11 months. He was diagnosed with neurobrucellosis. The patient was treated successfully with intravenous ceftriaxone, oral doxycycline and oral rifampin therapy. He had persistent neurological sequelae after completing treatment. This case illustrates the high index of suspicion needed to diagnose neurobrucellosis in a non-endemic country because initial symptoms can be subtle. The disease can be treated successfully, but long-lasting neurological sequelae are common.

Mycobacterium Fortuitum Infections of the Hand

1992 ◽  
Vol 17 (6) ◽  
pp. 675-677 ◽  
Author(s):  
F. K. IP ◽  
S. P. CHOW
Keyword(s):  
Correct Diagnosis ◽  
High Index ◽  
Mycobacterium Fortuitum ◽  
High Index Of Suspicion

Five cases are reported of infection due to Mycobactenum fortuitum involving the hand following contaminated injection or traumatic wounds. Synovectomy, debridement, or amputation together with prolonged chemotherapy using kanamycin or amikacin were required. Doxycycline and sulphamethoxasole also seemed to be the effective antibiotics for this organism. A high index of suspicion is important in order to obtain the correct diagnosis.

scholarly journals Acute permethrin neurotoxicity: Variable presentations, high index of suspicion

2014 ◽  
Vol 1 ◽  
pp. 1026-1028 ◽  
Author(s):  
Bonny Drago ◽  
Namrata S. Shah ◽  
Samir H. Shah
Keyword(s):  
High Index ◽  
High Index Of Suspicion
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