scholarly journals Tarlov Cysts Misdiagnosed as Adnexal Masses in Pelvic Sonography: A Literature Review

2020 ◽  
Vol 7 ◽  
Author(s):  
Shengshu Kim ◽  
Ho jun Lee ◽  
Joong Hyun Park ◽  
Taeyeon Kim ◽  
Kiyeun Nam
Keyword(s):  
Cerebrospinal Fluid ◽  
Conservative Treatment ◽  
Adnexal Mass ◽  
Cauda Equina ◽  
Tarlov Cyst ◽  
Adnexal Masses ◽  
Perineural Cyst ◽  
Asymptomatic Patients ◽  
Pelvic Masses ◽  
Average Patient

Introduction: A Tarlov cyst (TC) is a perineural cyst filled with cerebrospinal fluid that originates from the dorsal ganglion or the spinal posterior nerve root. TCs are usually asymptomatic and incidentally found in the sacral region. Endopelvic extension of TCs is uncommon and can be misdiagnosed as an adnexal mass on gynecological ultrasound imaging.Methods: We performed a search for all clinical studies of TCs that mimicked adnexal masses that had been published through October 12, 2020. We placed no restrictions on language or year of publication in our search, and we performed searches with the following keywords: perineural cyst, Tarlov cyst, sclerotherapy, management, and prognosis. We included all misdiagnosed cases or cases considered as adnexal masses on pelvic sonography.Results: We identified 21 cases of TCs mimicking adnexal masses and conducted a comprehensive analysis of these 21 cases to assess the epidemiology, symptoms, initial diagnoses, provisional ultrasound diagnoses, confirmative modalities, sizes, locations, treatments, and outcomes. The 21 cases included 16 symptomatic cases (76%) and 5 cases with incidental findings (24%), and the average patient age was 41.3 years. The initial diagnosis was performed with ultrasonography in all cases. The most frequent misdiagnosis was unspecified adnexal mass. Confirmative diagnostic modalities were MRI only (67%), CT only (5%), and both MRI and CT (28%). Treatments were surgery (33%), conservative treatment (19%), percutaneous intervention (5%), and alcohol sclerotherapy (5%). In two symptomatic cases misdiagnosed as pelvic masses, cystectomy was performed and leakage of cerebrospinal fluid occurred, necessitating repair of the leak. In one of the asymptomatic patients, cauda equina syndrome occurred after alcohol sclerotherapy for misdiagnosed TC. However, the patient improved with no neurologic deficit after 18 months of conservative treatment.Conclusion: The possibility of large TCs should be considered when assessing adnexal masses in sonography. Since TCs can masquerade as pelvic masses, they should be considered if the mass appears tubular/cystic or multilocular/multiseptate, does not move with respiration, and originates from the sacrum in sonography with or without neurologic symptoms. Accurate diagnosis can prevent medical mismanagement and reduce patient discomfort.

Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study

2019 ◽  
Vol 31 (2) ◽  
pp. 271-278 ◽  
Author(s):  
Narihito Nagoshi ◽  
Osahiko Tsuji ◽  
Daisuke Nakashima ◽  
Ayano Takeuchi ◽  
Kaori Kameyama ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Surgical Intervention ◽  
Lesion Size ◽  
Sudden Onset ◽  
Neurological Function ◽  
Neurological Injury ◽  
Prognostic Indicators ◽  
Asymptomatic Patients ◽  
Surgical Data ◽  
Unstable Gait

OBJECTIVEIntramedullary cavernous hemangioma (CH) is a rare vascular lesion that is mainly characterized by the sudden onset of hemorrhage in young, asymptomatic patients, who then experience serious neurological deterioration. Despite the severity of this condition, the therapeutic approach and timing of intervention for CH remain matters of debate. The aim of this study was to evaluate the clinical characteristics of CH patients before and after surgery and to identify prognostic indicators that affect neurological function in these patients.METHODSThis single-center retrospective study included 66 patients who were treated for intramedullary CH. Among them, 57 underwent surgery and 9 patients received conservative treatment. The authors collected demographic, symptomology, imaging, neurological, and surgical data. Univariate and multivariate logistic regression analyses were performed to identify the prognostic indicators for neurological function.RESULTSWhen comparing patients with stable and unstable gait prior to surgery, patients with unstable gait had a higher frequency of hemorrhagic episodes (52.4% vs 19.4%, p = 0.010), as assessed by the modified McCormick Scale. The lesion was significantly smaller in patients who underwent conservative treatment compared with surgery (2.5 ± 1.5 mm vs 5.9 ± 4.1 mm, respectively; p = 0.024). Overall, the patients experienced significant neurological recovery after surgery, but a worse preoperative neurological status was identified as an indicator affecting surgical outcomes by multivariate analysis (OR 10.77, 95% CI 2.88–40.36, p < 0.001). In addition, a larger lesion size was significantly associated with poor functional recovery in patients who had an unstable gait prior to surgery (8.6 ± 4.5 mm vs 3.5 ± 1.6 mm, p = 0.011).CONCLUSIONSOnce a hemorrhage occurs, surgical intervention should be considered to avoid recurrence of the bleeding and further neurological injury. In contrast, if the patients with larger lesion presented with worse preoperative functional status, surgical intervention could have a risk for aggravating the functional deficiencies by damaging the thinning cord parenchyma. Conservative treatment may be selected if the lesion is small, but regular neurological examination by MRI is needed for assessment of a change in lesion size and for detection of functional deterioration.

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.

Subdural hemorrhage of the cauda equina. A rare complication of cerebrospinal fluid shunt. Case report

1996 ◽  
Vol 19 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Gabriele Wurm ◽  
Peter Pogady ◽  
Karin Lungenschmid ◽  
Johannes Fischer
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Rare Complication ◽  
Cauda Equina ◽  
Subdural Hemorrhage ◽  
Cerebrospinal Fluid Shunt

scholarly journals May-Thurner Syndrome Is Aggravated by Pregnancy

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 222
Author(s):  
Kuntharee Traisrisilp ◽  
Manatsawee Manopunya ◽  
Tanop Srisuwan ◽  
Wisit Chankhunaphas ◽  
Theera Tongsong
Keyword(s):  
Conservative Treatment ◽  
Renal Agenesis ◽  
Iliac Vein ◽  
Vein Thrombosis ◽  
Left Lower Extremity ◽  
Asymptomatic Patients ◽  
Pregnancy And Postpartum ◽  
Anticoagulant Prophylaxis ◽  
The Right ◽  
Deep Vein

This study aims to emphasize that asymptomatic patients with undiagnosed and asymptomatic May-Thurner syndrome (MTS) may firstly develop severe compression during pregnancy. A 40-year-old woman, G1P0, at 22 weeks of twin gestation presented with left lower extremity edema and pain. One twin was structurally normal while the other had bilateral renal agenesis with oligohydramnios. Magnetic resonance venography (MRV) revealed severe compression of the left iliac vein by the right iliac artery without evidence of deep vein thrombosis (DVT). Conservative treatment with anticoagulant prophylaxis was instituted throughout the rest of pregnancy and postpartum period. She was also complicated with severe pre-eclampsia, a cesarean section was performed due to a prolapsed cord at 27 weeks of gestation, and she gave birth to a surviving baby weighing 1100 g. In conclusion, this case report provides evidence that pregnancy can disclose a subtle May-Thurner anatomy to be symptomatic without DVT. Successful pregnancy outcomes could be achieved with conservative treatment and anticoagulant prophylaxis.

Evaluation of Adnexal Masses-Correlation of Clinical, Sonological and Histological Findings in Adnexal Masses

2020 ◽  
Vol 22 (4) ◽  
pp. 199-202
Author(s):  
Manisha Acharya ◽  
P Kumar ◽  
BB Shrestha ◽  
S Shrestha ◽  
R Amatya ◽  
...  
Keyword(s):  
Predictive Value ◽  
Adnexal Mass ◽  
Diagnostic Value ◽  
Mean Value ◽  
Ca 125 ◽  
Histopathological Diagnosis ◽  
Adnexal Masses ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Clinical Records

Adnexal mass is a common clinical finding in gynaecological practice. The study aims to find out the diagnostic value of clinical examination, ultrasonography and Ca-125 and its correlation, using Risk of Malignancy Index with histopathological diagnosis in adnexal masses. Clinical records were retrieved of women who had surgical management for adnexal mass in the last 2 years duration. Based on the data, Risk of Malignancy Index values were calculated. It was then compared with histopathological diagnosis. Out of 66 patients, 56 patients had benign tumor and 10 patients had malignancy. The Risk of Malignancy Index values of each patient was calculated which ranged from 8 to 2205 with mean value of 425.52 (SD±41.8). Risk of Malignancy Index sensitivity was 70%, specificity was 96.42%, positive predictive value was 77.78%, and negative predictive value was 95.83%. Risk of Malignancy Index is a reliable diagnostic tool in differentiating benign from malignant adnexal masses.

When infection mimics cauda equina syndrome: a cautionary tale

2021 ◽  
Vol 103 (6) ◽  
pp. e181-e183
Author(s):  
R Shah ◽  
N Jayakumar ◽  
S Athar ◽  
N Ashwood
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Varicella Zoster Virus ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Lessons Learned ◽  
Resonance Imaging ◽  
Varicella Zoster ◽  
Elsberg Syndrome

A 63-year-old man presented to the emergency department with low back pain, perineal and genital numbness, together with bilateral lower limb paraesthesia and urinary retention. He was admitted under the orthopaedic service for investigation of suspected cauda equina syndrome. Magnetic resonance imaging of his spine did not reveal any evidence of cauda equina compression. Magnetic resonance imaging of his brain demonstrated nonspecific multiple hyperintensities in the right frontotemporal and left temporo-occipital regions. Computed tomography of his chest, abdomen, and pelvis did not identify any evidence of malignancy. Cerebrospinal fluid from a lumbar puncture showed a high leucocyte count (predominantly lymphocytes). Viral cerebrospinal fluid polymerase chain reaction was positive for varicella zoster virus. A diagnosis of varicella zoster virus myeloradiculitis (Elsberg syndrome) was established and the patient was treated with intravenous aciclovir. Unfortunately, the patient succumbed to a devastating intracerebral haemorrhage during his inpatient stay, probably due to vasculopathy from the underlying varicella zoster virus infection. This case describes a rare infectious mimic of cauda equina syndrome. Elsberg syndrome is an infectious syndrome characterised by bilateral lumbosacral myeloradiculitis, with varicella zoster virus being a well-recognised aetiological agent. We discuss the relevant literature in detail and identify the key, cautionary lessons learned from this case.

Perineural cyst with intracystic cerebrospinal fluid leakage by traction of nerve root -a case report

2021 ◽  
Author(s):  
Shusuke Hagihara ◽  
Hideki Ohta ◽  
Jun Tanaka ◽  
Teruaki Shiokawa ◽  
Yoshiyuki Matsumoto ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Nerve Root ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Perineural Cyst

Rapid-Onset Weakness and Numbness in a Patient With Systemic Lupus Erythematosus

2021 ◽  
pp. 120-121
Author(s):  
Floranne C. Ernste
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cerebrospinal Fluid ◽  
Lupus Erythematosus ◽  
White Blood Cells ◽  
Cauda Equina ◽  
Transverse Myelitis ◽  
Lower Extremities ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestation ◽  
Fluid Analysis

A 33-year-old woman with systemic lupus erythematosus, diagnosed 2 years prior and treated with hydroxychloroquine, sought care for a 4-week history of pain and paresthesias in her low back and lower extremities. She described a bandlike sensation of numbness starting in her midback which descended to both legs. Her symptoms progressed to constipation and inability to urinate adequately. She reported difficulty with ambulation. Over the course of 1 week of hospitalization, urinary and fecal incontinence developed. On examination, she was alert and appropriately oriented. She had a malar rash and swelling of the metacarpophalangeal joints consistent with bilateral hand synovitis. Neurologic examination indicated hyperreflexia with brisk patellar and Achilles tendon reflexes bilaterally. She had trace motor weakness of the hip flexors, quadriceps, and hamstrings. She had loss of pinprick and temperature sensation in the lower extremities, extending beyond the saddle area to the T12 dermatome. Vibration perception and proprioception were preserved. She had a positive Babinski sign in the left foot. Her cerebellar examination showed slowing of rapid alternating movements in the left hand. Magnetic resonance imaging of the lumbosacral spine indicated subtle T2 signal change of the intramedullary conus and enhancement of the cauda equina nerve roots. Cerebrospinal fluid analysis showed an increased protein concentration. Two white blood cells/µL were found in the cerebrospinal fluid. The serum antinuclear antibody was strongly positive, and the anti–double-stranded DNA antibody level was greater than 1,000 IU/mL. The serum complement levels were low. Lupus anticoagulant, beta-2 glycoprotein antibodies, and antiphospholipid antibodies were increased, at greater than twice the upper limits of normal. Electromyography indicated multiple sacral radiculopathies. The patient was diagnosed with autoimmune myeloradiculitis as a neuropsychiatric manifestation of systemic lupus erythematosus (neuropsychiatric systemic lupus erythematosus). The patient received methylprednisolone followed by prednisone, with a gradual taper. Her hospital course was complicated by the development of deep venous thromboses in the bilateral lower extremities. She was started on heparin and transitioned to warfarin therapy. She started mycophenolate mofetil. Hydroxychloroquine was continued. At a 24-month follow-up visit, the patient remained in neurologic remission. Neuropsychiatric systemic lupus erythematosus events consist of a heterogeneous array of neurologic and psychiatric disorders including intractable headaches, cognitive dysfunction, psychosis, seizure disorders, transverse myelitis, aseptic meningitis, cranial neuropathies, and acute inflammatory demyelinating polyneuropathy.

scholarly journals Magnetic Resonance Evaluation of Pelvic Mass Lesions in Females with Histopathological Correlation: An Institutional Experience

2019 ◽  
Vol 05 (02) ◽  
pp. 044-049
Author(s):  
Reddy Ravikanth
Keyword(s):  
Magnetic Resonance ◽  
Pelvic Mass ◽  
Distant Metastases ◽  
Cervical Region ◽  
Care Hospital ◽  
Cervical Lesions ◽  
Adnexal Masses ◽  
Pelvic Masses ◽  
Peritoneal Implant ◽  
Mass Lesions

Abstract Introduction Magnetic resonance imaging (MRI) is often used in the detection and staging of large pelvic masses. Many large masses in the female pelvis arise from the reproductive organs. These pelvic masses most commonly arise from the uterus, cervix, ovaries, and fallopian tubes. Objective This study was aimed to assess the role of MRI in female pelvic mass lesions. Also, it presents a pictorial review of MRI images of such pelvic masses. Materials and Methods This study was conducted on 50 female patients with clinically suspected pelvic masses at physical examination and referred for MRI at a tertiary care hospital over a 2-year period between July 2017 and June 2019. Results Most common lesions evaluated on imaging were benign uterine lesions (15 cases, 34.09%), benign adnexal lesions (13 cases, 29.54%), malignant adnexal (10 cases, 22.73%), malignant uterine cervical lesions (6 cases, 13.64%); two cases had indeterminate type lesions, two lesions proved to be normal bowel loops on MRI, and in two cases MRI could not be performed. Cystic lesions were commonly seen in adnexa (15 out 21) while solid lesions were common in uterine cervical region (18 out 23). Out of these, 14 were complex cystic adnexal masses and 10 were malignant. Uterine cervical lesions were carcinoma cervix. Better assessment with improved imaging capability was possible on MRI for invasion of surrounding structures in 10 cases, lymphadenopathy in 3 cases, ascites in 13 cases, peritoneal implant in 6 cases, encasement in 1 case, and distant metastases in 1 case. Conclusion In conclusion, pelvic mass lesions in females are more common above the age of 45 years. Adnexal masses are usually cystic, while the uterine masses are solid in texture. As the complexity and size of the cystic adnexal masses increases, there are increased chances of malignancy. Pretreatment staging and assessment of malignancy, invasion of surrounding structures, encasement, invasion of vessels or assessment of lymphadenopathy, peritoneal implant, ascites, and distant metastases are better appreciated by MRI.

scholarly journals Adnexal mass: a clinicopathological study at a tertiary care centre in Assam, India

2019 ◽  
Vol 8 (4) ◽  
pp. 1457
Author(s):  
Mukut Jyoti Das ◽  
Pranay Phukan
Keyword(s):  
Clinical Examination ◽  
Adnexal Mass ◽  
Histopathological Examination ◽  
Color Doppler ◽  
Tertiary Care ◽  
Broad Ligament ◽  
Reproductive Age ◽  
Transvaginal Sonography ◽  
Age Group ◽  
Adnexal Masses

Background: An adnexal mass may be found in females of all ages with significantly variable prevalence, but more common among women of reproductive age. Adnexal masses pose a special dilemma to the attending gynaecologist because the diagnosis is often difficult and differential diagnosis is vast. Clinical examination is the first step in evaluation of patients with adnexal mass. Pelvic masses which are undetected or overlooked on physical examination can be identified by Ultrasonography. The aims and objectives of the study were to: to find out different types of adnexal pathology clinically, correlation of clinical finding with histopathology, correlation of ultrasonography finding with histopathology.Methods: The present study was carried in the Department of Obstetrics and Gynecology, Assam medical college and hospital, Dibrugarh from 1st July 2017 to 30th June 2018. This study was a hospital based observational study which included 145 patients of adnexal mass attending the GOPD who required admission and operative intervention. All cases underwent an abdominal ultrasound examination with color Doppler. Transvaginal sonography was done wherever feasible. Following surgery, specimens were sent for histopathological examination and the reports were correlated with pre-operative clinical and ultrasonography findings.Results: The most common site of origin of adnexal mass was ovary (92.41%) followed by fallopian tube (6.20%) and broad ligament (1.39%). Majority (79.31%) were non neoplastic or benign adnexal masses. All cases of adnexal malignancy were of ovarian origin. The sensitivity and specificity of clinical examination for diagnosis and discriminating benign and malignant ovarian neoplasms were 70% and 86.6% and that of ultrasonography was 86.67% and 96.65% respectively.Conclusions: Adnexal mass in reproductive age group were mostly non neoplastic and benign, whereas malignancy was mostly seen in peri and post-menopausal age group. Ultrasonography is a useful adjunct to clinical examination for diagnosis and proper management of patients with adnexal mass in low resource setup.

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