scholarly journals Clinicopathological Conference: 54-year-old with Facial Swelling for One Month

2020 ◽  
Vol 4 (4) ◽  
pp. 638-641
Author(s):  
Justin Pile ◽  
Adam Dawson ◽  
Lynn Maxa
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Allergic Reaction ◽  
Early Treatment ◽  
Multidisciplinary Approach ◽  
Correct Diagnosis ◽  
Critical Importance ◽  
Correct Conclusion ◽  
Facial Swelling ◽  
Ed Visits

A 54-year-old female with facial swelling for one month who had repeatedly been treated for allergic reaction during multiple emergency department (ED) visits, presented to the ED for the same complaint of facial swelling. Maintaining a broad differential diagnosis was of critical importance to appropriately evaluating the patient and arriving at the correct conclusion for the etiology of the patient’s symptoms. Upon establishing the correct diagnosis, a multidisciplinary approach was used to intervene to provide early treatment without delay.

scholarly journals Pott’s Puffy Tumour: a rare but sinister cause of facial swelling

2021 ◽  
Vol 20 (2) ◽  
pp. 144-147
Author(s):  
S Birks ◽  
◽  
L Peart ◽  
Keyword(s):  
Emergency Department ◽  
Mr Imaging ◽  
Allergic Reaction ◽  
Epidural Space ◽  
Frontal Sinus ◽  
Surgical Intervention ◽  
Medical Team ◽  
Intravenous Antibiotics ◽  
Facial Swelling ◽  
Uncommon Condition

A 27 year old female presented to the emergency department with intermittent central forehead swelling over several months associated with a headache. She was admitted under the medical team as having had a suspected allergic reaction but the diagnosis of a Pott’s Puffy Tumour was quickly made and confirmed through CT and MR imaging. This uncommon condition is related to sinusitis leading to localised abscess formation with osteomyelitis and a subsequent swollen appearance over the affected facial sinus. This patient’s sinus abscess extended into the epidural space and caused destruction of the anterior and posterior walls of the frontal sinus. The patient was managed with intravenous antibiotics, analgesia and referral to the local ENT team for surgical intervention.

scholarly journals Food-dependent exercise-induced anaphylaxis

CJEM ◽  
2001 ◽  
Vol 3 (04) ◽  
pp. 315-317 ◽  
Author(s):  
Michael Y. Woo ◽  
A. Adam Cwinn ◽  
Garth Dickinson ◽  
William H. Yang
Keyword(s):  
Physical Activity ◽  
Emergency Department ◽  
Vigorous Physical Activity ◽  
Correct Diagnosis ◽  
Allergic Reactions ◽  
Repeated Events ◽  
Ed Visits ◽  
Exercise Induced ◽  
Careful History

ABSTRACT Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods within the preceding several hours. When patients present to the emergency department (ED) with allergic reactions, careful history regarding these 2 factors is required to establish the correct diagnosis. Correct diagnosis of FDEIA will allow patients to take control of their lifestyles and avert repeated events and ED visits. Two cases of FDEIA are presented, and the diagnosis, pathophysiology and therapy of food-dependent exercise-induced anaphylaxis are reviewed.

scholarly journals Diagnostic Implications of an Elevated Troponin in the Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Maame Yaa Yiadom ◽  
Petr Jarolim ◽  
Cathy Jenkins ◽  
Stacy E. F. Melanson ◽  
Michael Conrad ◽  
...  
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Medical Records ◽  
Screening Test ◽  
Myocardial Injury ◽  
Troponin I ◽  
Type I ◽  
Elevated Troponin ◽  
Hospital Medical ◽  
Ed Visits

Objective. To determine the proportion of initial troponin (cTn) elevations associated with Type I MI versus other cardiovascular and noncardiovascular diagnoses in an emergency department (ED) and whether or not a relationship exists between the cTn level and the likelihood of Type I MI.Background. In the ED, cTn is used as a screening test for myocardial injury. However, the differential diagnosis for an initial positive cTn result is not clear.Methods. Hospital medical records were retrospectively reviewed for visits associated with an initial positive troponin I-ultra (cTnI), ≥0.05 μg/L. Elevated cTnI levels were stratified into low (0.05–0.09), medium (0.1–0.99), or high (≥1.0). Discharge diagnoses were classified into 3 diagnostic groups (Type I MI, other cardiovascular, or noncardiovascular).Results. Of 23,731 ED visits, 4,928 (21%) had cTnI testing. Of those tested, 16.3% had initial cTnI ≥0.05. Among those with elevated cTn, 11% were classified as Type I MI, 34% had other cardiovascular diagnoses, and 55% had a noncardiovascular diagnosis. Type I MI was more common with high cTnI levels (41% incidence) than among subjects with medium (9%) or low (6%).Conclusion. A positive cTn is most likely a noncardiovascular diagnosis, but Type I MI is far more common with cTnI levels ≥1.0.

scholarly journals Ewing’s Sarcoma of the Kidney Complicated by a Wunderlich Syndrome

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Mihai Razvan Manescu ◽  
Achraf Sahyoun ◽  
Nicolas Froment ◽  
Nicolae Crisan ◽  
Vincent Girot
Keyword(s):  
Differential Diagnosis ◽  
Treatment Option ◽  
Metastatic Disease ◽  
Multidisciplinary Approach ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Correct Diagnosis ◽  
Clinical Findings ◽  
Renal Masses ◽  
Ct And Mri

The Wunderlich syndrome found after the rupture of primitive renal Ewing’s sarcoma is not a situation that we find often in everyday practice. The clinical findings are not specific, which is why the differential diagnosis must be made with a multitude of benign and malignant renal masses until the correct diagnosis can be made by the pathologist. The CT and MRI images are not characteristic. One treatment option is the multidisciplinary approach; however, the prognosis remains poor for patients with metastatic disease.

A 10-year-old child with acute torticollis due to polymicrobial deep neck infection

2022 ◽  
Vol 15 (1) ◽  
pp. e244331
Author(s):  
Alex Guri ◽  
Eric Scheier
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Point Of Care ◽  
Correct Diagnosis ◽  
Point Of Care Ultrasound ◽  
Deep Neck Infection ◽  
Eikenella Corrodens ◽  
Neck Infection ◽  
Streptococcus Constellatus ◽  
Early Use

Torticollis in children can be a sign of a potentially dangerous disease; the correct diagnosis is not always obvious on history and physical examination. The use of point-of-care ultrasound (POCUS) helps to limit the differential diagnosis and direct appropriate further laboratory and radiology-performed evaluation. We present a case of a 10-year-old child whose deep neck infection (DNI) was timely diagnosed in the paediatric emergency department by early use of POCUS and drained under POCUS guidance after admission to the hospital. The culture from the fluid grew Eikenella corrodens, Streptococcus constellatus and Prevotella buccae. This case demonstrates that DNIs occur in children with acute acquired torticollis, even without fever and demonstrates the importance of early use of POCUS in cases where DNI is a potential diagnosis. Moreover, this case emphasises the importance of microbiological identification of DNIs that can be the key to successful treatment.

scholarly journals Immunohistochemical Analysis of CD99 and PAX8 in a Series of 15 Molecularly Confirmed Cases of Ewing Sarcoma

Sarcoma ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
LM. Chinchilla-Tábora ◽  
J. Ortiz Rodríguez-Parets ◽  
I. González Morais ◽  
J. M. Sayagués ◽  
M. D. Ludeña de la Cruz
Keyword(s):  
Differential Diagnosis ◽  
Ewing Sarcoma ◽  
Multidisciplinary Approach ◽  
Correct Diagnosis ◽  
High Sensitivity ◽  
Immunohistochemical Analysis ◽  
Fusion Transcript ◽  
Malignant Neoplasms ◽  
Hematoxylin And Eosin

Ewing sarcomas are an uncommon group of malignant neoplasms. A multidisciplinary approach is highly recommended to reach a correct diagnosis, considering the clinical, radiological, and histopathological aspects. Since in up to 90% of cases, the translocation t (11; 22) (q24; q12) occurs resulting in a chimeric fusion transcript EWSR1-FLI-1. The pathologist has several tools in addition to conventional techniques (hematoxylin and eosin), such as immunohistochemistry, which plays a very important role in the differential diagnosis. We present a series of 15 cases of molecularly confirmed ES, in which we found a sensitivity of 100% for CD99 and 80% for PAX8 by immunohistochemistry. This indicates a high sensitivity; however, it is known that both CD99 and PAX8 are also expressed in other tumours. Therefore, molecular confirmation should be performed in all cases.

scholarly journals Serotonin Syndrome versus Cannabis Toxicity in the Emergency Department

2020 ◽  
Vol 4 (2) ◽  
pp. 171-173
Author(s):  
Jacob Baltz ◽  
Lamanh Le
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Serotonin Syndrome ◽  
Lower Extremities ◽  
Signs And Symptoms ◽  
Final Diagnosis ◽  
High Potency ◽  
Marijuana Abuse ◽  
Syndrome Diagnosis ◽  
Ed Visits

As more states legalize marijuana, the potential of marijuana abuse could lead to an increase in the number of emergency department (ED) visits. We describe two patients who presented to the ED with dilated pupils, rigidity in both lower extremities, and clonus in both feet after inhaling the vapor of a highly potent form of marijuana. Serotonin syndrome diagnosis was initially considered in the differential diagnosis. Ultimately, high-potency marijuana abuse was the final diagnosis. Therefore, marijuana toxicity should be considered in ED patients who present with signs and symptoms similar to that of serotonin syndrome.

scholarly journals The Tired Pregnant Woman

2021 ◽  
Vol 5 (4) ◽  
pp. 494-498
Author(s):  
Katie VanNatta ◽  
Nicole Yuzuk ◽  
David Trotter ◽  
Brandon Wisinski
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Pregnant Woman ◽  
Hyperemesis Gravidarum ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Pregnant Patient ◽  
Initial Assessment ◽  
Case Presentation ◽  
Intermittent Bleeding

Introduction: Many pregnant women develop hyperemesis gravidarum. There are numerous gastrointestinal, genitourinary, neurologic, and metabolic causes to consider in this patient population. Case Presentation: This clinicopathological case presentation details the initial assessment and management of an 18-year-old pregnant patient who presented to the emergency department with a complaint of nausea, vomiting, fatigue, and intermittent bleeding. Discussion: This case takes the reader through the differential diagnosis and evaluation of the patient and the signs and symptoms, including her agitation and tachycardia, that led us to the correct diagnosis.

Apparent Proteinuria as a Consequence of Sodium Bicarbonate Ingestion

PEDIATRICS ◽  
1990 ◽  
Vol 86 (2) ◽  
pp. 318-319
Author(s):  
DAN WECHSLER ◽  
LAURA IBSEN ◽  
PATRICIA FOSARELLI
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Difficult Problem ◽  
Screening Tests ◽  
History Taking ◽  
Laboratory Screening ◽  
Appropriate Treatment ◽  
Laboratory Results ◽  
Careful History

An infant who is brought to an emergency department with vague symptoms poses a difficult problem for the pediatrician. The presence of specific findings on laboratory screening tests often helps to narrow the differential diagnosis, enabling appropriate treatment. Unexpected laboratory results, however, may lead the physician astray in making the correct diagnosis. It is important to interpret laboratory results within the context of the entire clinical picture and to keep in mind the limitations of certain of these tests. We report a case of apparent proteinuria in a 7-week-old infant caused by the addition of baking soda to his formula, and point out that careful history-taking may help to avoid an extensive diagnostic workup.

Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

2016 ◽  
Vol 12 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Katie Ekberg ◽  
Markus Reuber
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Epileptic Seizures ◽  
Routine Clinical Setting ◽  
Choice Of Treatment ◽  
Transient Loss ◽  
Factual Content ◽  
Patient’S History ◽  
Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

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