scholarly journals A case of chronic ulcer due to subcutaneous arteriolosclerosis in an obese patient mimicking pyoderma gangrenosum

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Sezin Fıçıcıoğlu ◽  
Nuray Can ◽  
Busem Tutuğ
Keyword(s):  
Morbid Obesity ◽  
Differential Diagnosis ◽  
Renal Insufficiency ◽  
Pyoderma Gangrenosum ◽  
Tissue Perfusion ◽  
Chronic Ulcer ◽  
Diagnostic Challenge ◽  
Wide Range ◽  
Chronic Ulcers ◽  
Arteriolar Narrowing

The differential diagnosis of chronic ulcers covers a wide range of diseases and poses a diagnostic challenge. Subcutaneous ischemic arteriolosclerosis can lead to local ischaemia and ulceration as a result of arteriolar narrowing and reduction of tissue perfusion. This pathophysiological feature can be seen in eutrophication (nonuremic calciphylaxis) in morbid obesity, hypertensive ischemic leg ulcer (Martorell ulcer) and calciphylaxis in chronic renal insufficiency. All of the ulcers happened in this way can be wrongly diagnosed as pyoderma gangrenosum because of clinical similarity and inadequate biopsies. We report a case of chronic ulcer due to subcutaneous arteriolosclerosis in morbid obesity, wrongly diagnosed as pyoderma gangrenosum. It can be detrimental to misdiagnose the ulcers due to subcutaneous arteriolosclerosis as pyoderma gangrenosum since they need a diametrically different approach.

scholarly journals A Challenging Case of Metastatic Intra-Abdominal Synovial Sarcoma with Unusual Immunophenotype and Its Differential Diagnosis

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Yi-Che Changchien ◽  
Uhrin Katalin ◽  
János Fillinger ◽  
László Fónyad ◽  
Gergő Papp ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Tumor Cells ◽  
Synovial Sarcoma ◽  
Desmoid Tumor ◽  
Gold Standard ◽  
Fusion Gene ◽  
Rt Pcr ◽  
Diagnostic Challenge ◽  
Wide Range ◽  
Typical Morphology

The primary and metastatic gastrointestinal synovial sarcoma is rare with a wide differential diagnosis. It usually expresses cytokeratins EMA, BCL2 with an occasional CD99, and S100 positivity but not desmin. We present a case of metastatic synovial sarcoma with unusual immunophenotype causing diagnostic challenges. The tumor cells showed focal cytokeratin, EMA, and, unexpectedly, desmin positivity. Additional intranuclear TLE-1 positivity and negativity for CD34 and DOG-1 were also identified. A diagnosis of monophasic synovial sarcoma was confirmed by using FISH break-apart probe. RT-PCR revealed the SYT-SSX1 fusion gene. Intra-abdominal synovial sarcoma, either primary or metastatic, with unusual desmin positivity raises the diagnostic challenge, since a wide range of differential diagnoses could show a similar immunophenotype (leiomyosarcoma, desmoid tumor, myofibroblastic tumor, and rarely GIST etc.). Typical morphology and focal cytokeratin/EMA positivity should alert to this tumor, and FISH and RT-PCR remain the gold standard for the confirmation.

Pyoderma gangrenosum underrepresentation in non-dermatological literature

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Ashley M. Reese ◽  
Carter K. Haag ◽  
Enjae Jung ◽  
Allison C. Nauta ◽  
Robert A. Swerlick ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Differential Diagnosis ◽  
Pyoderma Gangrenosum ◽  
Trauma Surgery ◽  
Neutrophilic Dermatosis ◽  
Diagnostic Challenge ◽  
Review Articles ◽  
Necrotizing Soft Tissue Infections ◽  
The Many ◽  
Teaching Modules

AbstractBackgroundPyoderma gangrenosum (PG) is a chronic, ulcerative neutrophilic dermatosis. PG presents a diagnostic challenge, largely due to the many mimicking diseases, the lack of confirmatory laboratory or biological markers, and the absence of widely accepted diagnostic criteria. In particular, PG is often mistaken for necrotizing soft tissue infections (NSTI).MethodsWe reviewed four major textbooks each in general surgery, plastic surgery, trauma surgery, vascular surgery, emergency medicine, and dermatology. We also performed a search of review articles addressing NSTI and necrotizing fasciitis (NF).ResultsTen out of the 20 non-dermatology textbooks did not list PG anywhere, and only two listed a differential diagnosis for PG. None of the non-dermatology textbooks indicated PG in the NSTI differential diagnosis, while three of the dermatology textbooks included PG in the NSTI differential diagnosis. PG was listed in all of the dermatology textbooks. Only one of the NSTI and NF articles mentioned PG in the differential diagnosis.ConclusionsThere is an underrepresentation in major textbooks of surgery and emergency medicine and in NSTI and NF review articles when it comes to diagnosing PG. This might be leading to trainees and advanced providers in these fields being uninstructed on PG, and likely contributes to PG misdiagnosis and mismanagement. We recommend PG be included in the differential diagnosis of chronic ulcers and NSTI in non-dermatology textbooks. We also suggest adding identification and diagnosis of inflammatory mimickers of NSTI (e.g. PG) in teaching modules in surgical and emergency specialties to address this knowledge gap.

scholarly journals Differential Diagnosis and Surgical Management of Cerebellopontine Angle Cystic Lesions

2018 ◽  
Vol 22 (3) ◽  
pp. 110-115
Author(s):  
Tobias Alécio Mattei ◽  
Carlos R. Goulart ◽  
Julia Schemes De Lima ◽  
Ricardo Ramina
Keyword(s):  
Differential Diagnosis ◽  
Critical Review ◽  
Cerebellopontine Angle ◽  
Careful Consideration ◽  
Preoperative Imaging ◽  
Cystic Lesions ◽  
Diagnostic Challenge ◽  
Imaging Evaluation ◽  
Wide Range ◽  
Cystic Meningiomas

Cerebellopontine angle (CPA) tumors in adults are mainly  benign and extra-axial. Although the most common CPA lesion (vestibular schwannoma) is familiar to most neurosurgeons, cystic lesions of the CPA do pose an important diagnostic challenge demanding a careful consideration of a wide range of differential diagnosis including: epidermoid cysts, arachnoid cysts, cystic schwannomas, cystic meningiomas as well as other rare entities such as vascular and malignant tumoral lesions. The authors present a critical review of the current literature on cystic CPA lesions, providing an overview about possible differentials as well as guidelines for preoperative imaging evaluation of a cystic CPA lesion. 

Gap of knowledge in diagnosis of pyoderma gangrenosum in clinical specialties education

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Katherine M. Erickson ◽  
Ashley M. Reese ◽  
Alex G. Ortega-Loayza
Keyword(s):  
Pyoderma Gangrenosum ◽  
Educational Resources ◽  
Online Resources ◽  
Neutrophilic Dermatosis ◽  
Soft Tissue Infections ◽  
Diagnostic Challenge ◽  
Included Review ◽  
Necrotizing Soft Tissue Infections ◽  
Chronic Ulcers ◽  
Disease Specific

Abstract Objectives Pyoderma gangrenosum (PG) is a chronic ulcerative neutrophilic dermatosis. It presents a diagnostic challenge due to the absence of disease-specific markers or histopathology, lack of universally accepted diagnostic criteria, and many mimicking diseases including necrotizing soft tissue infections (NSTI). PG cases often present first to specialties other than dermatology. We reviewed major educational resources in internal medicine, family medicine, and infectious disease for their coverage of PG. Content For each specialty, we reviewed five major textbooks, five prominent journals, and any commonly used online resources. Twelve of 15 textbooks mentioned PG, only three of which included a differential, with none including NSTI in the differential. Only two of 13 journals included review articles about PG, and none of these including NSTI in their differential. Interestingly, online resources tended to be the most complete; six of nine contained PG articles, nearly all including a differential and three listing NSTI within it. Summary We found an underrepresentation of PG among major textbooks and journals in clinical specialties, especially in differentiating PG from its mimickers. While online resources may help fill this gap in knowledge, texts and journals remain essential. Misdiagnosis and resultant mismanagement of PG can lead to disastrous outcomes. Outlook We recommend that PG be added to the differential diagnoses of chronic ulcers in educational resources. We also suggest the addition of identification and differentiation of PG to learning materials and lectures for providers in specialties who may encounter PG, NSTI, or similarly presenting diseases to address this gap.

DIAGNOSTIC VALUE OF SPECIFIC ANTIBODY SYNTHESIS IN BRAIN OF PATIENTS WITH NEUROINFECTIONS

2019 ◽  
Vol 72 (8) ◽  
pp. 1437-1441
Author(s):  
Pavel Dyachenko ◽  
Igor Filchakov ◽  
Anatoly Dyachenko ◽  
Victoria Kurhanskaya
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Manifestations ◽  
Diagnostic Value ◽  
Diagnostic Challenge ◽  
Specific Antibodies ◽  
Intrathecal Synthesis ◽  
Varicella Zoster ◽  
Mrz Reaction ◽  
Wide Range

Introduction: Viral encephalitis accounts for 40-70% of all cases worldwide, central nervous system infections pose a diagnostic challenge because clinical manifestations are not typically pathognomonic for specific pathogens, and a wide range of agents can be causative. The aim: To assess the diagnostic value of intrathecal synthesis of specific antibodies in patients with inflammatory lesions of the central nervous system. Materials and methods: Within the framework of the study, two groups of 90 people in each were formed from the patients with neuroinfections admitted to our Center. Intrathecal synthesis (ITS) of total (unspecific) IgG in members of one of group (group of compare) was determined. Brain synthesis of specific antibodies (Ab) to some neurotropic pathogens (herpes simplex virus 1/2, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, rubella virus, Borrelies) was studied in the second group of patients (group of interest). There were no statistically significant differences between groups by gender and age. Encephalitis and encephalomyelitis prevailed among patients of both groups Results: ITS of total IgG was established in 30 (33.3 ± 6.1 %) patients of the first group with IgG index more than 0.6 indicating on inflammatory process in CNS and no marked changes of CSF. ITS of specific Ab was determined in 23 of 90 (25.6 ± 4.6 %) patients included into group of interest. In more than half of cases Ab to several infectious agents were detected simultaneously. ITS of various specificity, in particular, to measles and rubella viruses, and VZV, known as MRZ-reaction, is characteristic of some autoimmune lesions of CNS, multiple sclerosis first of all. In fact, further research of 5 patients with MRZ-reaction confirmed their autoimmune failure of CNS. Detection of ITS in the CSF samples didn’t depend on concentration of specific Ab in serum and CSF and wasn’t followed by HEB dysfunctions which were observed with the same frequency in patients with or without ITS (13.0 % and 13.6 % respectively). Conclusion: Specific Ab synthesis to several neurotropic pathogens in the CSF of significant part of examined patients was established. Thus, diagnostic value of ITS of specific immunoglobulins seems to be limited to cases in which autoimmune damage of the CNS is suspected.

Clinical case of recurrent vomiting in a child: diagnostic search from functional gastrointestinal disorders to piloid astrocytoma

2021 ◽  
Vol 19 (1) ◽  
pp. 78-81
Author(s):  
E. N. Voronina ◽  
◽  
D. V. Pechkurov ◽  
A. A. Tyazheva ◽  
E. V. Kozarez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Nutritional Status ◽  
Clinical Case ◽  
Anxiety Symptom ◽  
Functional Gastrointestinal Disorders ◽  
Integrated Approach ◽  
Gastrointestinal Disorders ◽  
Wide Range ◽  
High Prevalence ◽  
Recurrent Vomiting

The urgency of the problem of recurrent vomiting in children is due not only to the high prevalence of this syndrome, but also to a wide range of reasons for its development. The article presents a clinical case of observation of a child with recurrent vomiting syndrome. It shows the dynamics of the disease, the importance of identifying such «anxiety symptom» as the nutritional status violation. In this case, the cause of vomiting of central genesis was not immediately taken into account, although differential diagnosis presupposes an integrated approach, and doctors' oncological alertness should be constantly preserved even in pediatrics.

Rectovaginal extragastrointestinal stromal tumour (EGIST): an additional entity to be considered in the differential diagnosis of tumours of the rectovaginal septum

2021 ◽  
Vol 14 (3) ◽  
pp. e237669
Author(s):  
Susan Addley ◽  
Moiad Alazzam ◽  
Catherine Johnson ◽  
Hooman Soleymani majd
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
High Risk ◽  
Kinase Inhibitor ◽  
Correct Diagnosis ◽  
Rectovaginal Septum ◽  
Gastrointestinal Stromal Tumours ◽  
Diagnostic Challenge ◽  
High Quality ◽  
Primary Surgery

Gastrointestinal stromal tumours (GISTs) are rare - and rectovaginal extragastrointestinal stromal tumours (RV-EGISTs) even rarer. We share a case of RV-EGIST, complemented by high-quality radiological and surgical images. A review of current literature pertaining to RV-EGIST is also included. Our case report highlights the diagnostic challenge presented by extragastrointestinal stromal tumours. Differentiated from overlapping pathologies only by targeted application of immunohistopathology and cytogenetics, the inclusion of RV-EGIST in the differential diagnosis of a rectovaginal tumour is essential to making this correct diagnosis. Primary surgery is the treatment of choice for RV-EGIST if complete cytoreduction can be achieved, combined with adjuvant tyrosine kinase inhibitor (TKI) therapy for those with high-risk features to further reduce rates of future recurrence.

scholarly journals Difficulties in the differential diagnosis of tumors in the female reproductive system

2020 ◽  
Vol 13 (4) ◽  
pp. 369-383
Author(s):  
Ju. V. Nosova ◽  
A. E. Solopova ◽  
G. N. Khabas ◽  
A. V. Asaturova
Keyword(s):  
Differential Diagnosis ◽  
Inflammatory Reaction ◽  
Wilms Tumor ◽  
Imaging Techniques ◽  
Uterine Cancer ◽  
Diagnostic Errors ◽  
Diagnostic Tools ◽  
Cytokeratin 20 ◽  
Pelvic Tumors ◽  
Wide Range

Introduction. Most pelvic tumors originate from reproductive organs. Even using the up-to-date imaging techniques, radiologists experience difficulties in determining the source of the lesion since a wide range of tumors look similar to each other on the distorted backdrop of pelvic anatomy, large invasive formations, and an active inflammatory reaction of the pelvic peritoneum.Aim: to evaluate “pitfalls” in the preoperative noninvasive diagnosis of female pelvic tumors by applying the clinical diagnostic tools.Materials and methods. Four rare clinical cases were analyzed; all of them posed difficulties in interpreting the diagnostic examination due to their atypical characteristics. There were 2 cases of ovarian cancer, initially identified by an experienced team of radiologists as benign pelvic pathology. Also, there were fibroids with degeneration, marked proliferative activity, and a massive inflammatory reaction of the peritoneum – that was diagnosed as a malignant ovarian tumor. Tumor biopsies were examined using morphological and immunohistochemical methods (with the р16, Ki-67, p53, CD 117, S 100, CD 34 markers). Immunohistochemical (IHC) studies were performed with formalin-fixed paraffin materials using the avidin-biotin-peroxidase method. Antibodies to estrogen receptor (ER), progesterone receptor (PR), cytokeratin 7 (CK7), cytokeratin 20 (CK20) and Wilms tumor protein 1 (WT1) were also used.Results. A thorough analysis of the clinical picture and a joint multidisciplinary discussion (gynecologist, oncologist, radiologist, etc.) made it possible to avoid diagnostic errors.Conclusion. These observations demonstrate the difficulties of differential diagnosis between ovarian metastases of uterine cancer and primary multiple ovarian and uterine cancer, as well between leiomyosarcoma and uterine myoma with high mitotic activity. Obviously, the change in diagnosis calls for a change in the treatment strategy.

scholarly journals Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Riccardo Scagliola ◽  
Gian Marco Rosa ◽  
Sara Seitun
Keyword(s):  
Differential Diagnosis ◽  
Clinical Practice ◽  
Therapeutic Approach ◽  
Tissue Characterization ◽  
Case Reports ◽  
Case Series ◽  
Diagnostic Challenge ◽  
Comprehensive Overview ◽  
Search Data ◽  
Data Location

Background and Aims. Cardiac outpouchings encounter a series of distinct congenital or acquired entities (i.e. aneurysms, pseudoaneurysms, diverticula, and herniations), whose knowledge is still poorly widespread in clinical practice. This review aims to provide a comprehensive overview focusing on definition, differential diagnosis, and prognostic outcomes of cardiac outpouchings, as well as further insights on therapeutic options, in order to assist physicians in the most appropriate decision-making. Methods. The material reviewed was obtained by the following search engines: MEDLINE (PubMed), EMBASE, Google Scholar, and Clinical Trials databases, from January 1966 until March 2021. We searched for the following keywords (in title and/or abstract): (“cardiac” OR “heart”) AND (“outpouching” OR “outpouch” OR “aneurysm” OR “pseudoaneurysm” OR “false aneurysm” OR “diverticulum” OR “herniation”). Review articles, original articles, case series, and case reports with literature review were included in our search. Data from patients with congenital or acquired cardiac outpouchings, from prenatal to geriatric age range, were investigated. Results. Out of the 378 papers initially retrieved, 165 duplicates and 84 records in languages other than English were removed. Among the 129 remaining articles, 76 were included in our research material, on the basis of the following inclusion criteria: (a) papers pertaining to the research topic; (b) peer-reviewed articles; (c) using standardized diagnostic criteria; and (d) reporting raw prevalence data. Location, morphologic features, wall motion abnormalities, and tissue characterization were found to have a significant impact in recognition and differential diagnosis of cardiac outpouchings as well as to play a significant role in defining their natural history and prognostic outcomes. Conclusions. Careful recognition of cardiac outpouchings remains a diagnostic challenge in clinical practice. Due to a broad cluster of distinctive and heterogeneous entities, their knowledge and timely recognition play a pivotal role in order to provide the most appropriate clinical management and therapeutic approach.

scholarly journals Normocytic Normochromic Anemia Revealed an Early Onset Hashimoto’s Hypothyroidism in an Infant: A Case Report

2021 ◽  
pp. 1-5
Author(s):  
Manal Mustafa Khadora ◽  
Maysa Saleh ◽  
Rawah Idres ◽  
Sura Ahmed Al-Doory ◽  
Mahmoud Ahmed Radaideh
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Autoimmune Thyroiditis ◽  
Subclinical Hypothyroidism ◽  
Early Onset ◽  
Clinical Presentation ◽  
Primary Hypothyroidism ◽  
Normocytic Normochromic Anemia ◽  
Wide Range ◽  
Normochromic Anemia

Autoimmune thyroiditis is very rare etiology of primary hypothyroidism in infancy. Hypothyroidism has a wide range of clinical presentation, from subclinical hypothyroidism to overt type. It is unclear what pathological mechanisms connect thyroid function and erythropoiesis or how thyroid disease can contribute to anemia. We report a 12-month-old infant who presented with anemia associated with early onset of overt autoimmune thyroiditis. The peculiarity of our case enables us to draw attention of physician to consider acquired hypothyroidism in the differential diagnosis of unexplained anemia even if the neonatal screening is normal and congenital hypothyroidism is a remote possibility.

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