scholarly journals Sarcoidosis presenting with splenomegaly and abdominal pain: a case report

2012 ◽  
Vol 6 (3) ◽  
pp. 91-96
Author(s):  
Clara Faini ◽  
Natalia Manetti ◽  
Francesca Bucciero ◽  
Giulia Razzolini ◽  
Maria Marsico ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lymph Nodes ◽  
Granulomatous Inflammation ◽  
Abdominal Ultrasound ◽  
Lung Parenchyma ◽  
Final Diagnosis ◽  
Skin Lesions ◽  
Mild Renal Impairment ◽  
Bilateral Hilar Lymphadenopathy ◽  
Noncaseating Granulomas

Sarcoidosis is a multisystemic disease of unknown aetiology characterized by proliferation of noncaseating granulomas at disease sites. It commonly affects young and middle-age adults and frequently presents with pulmonary infiltration, bilateral hilar lymphadenopathy, ocular and skin lesions. The liver, spleen, lymph nodes, salivary glands, heart, nervous system, muscles, bones, and other organs may also be involved. A diagnosis of the disorder usually requires the demonstration of typical lesions in more than one organ system and exclusion of other disorder known to cause granulomatous inflammation. We present the case of a young woman with abdominal pain and weight loss. The finding of splenomegaly by abdominal ultrasound and the presence of hypercalciuria, hypercalcemia and mild renal impairment led us to include sarcoidosis in the differential diagnosis. The final diagnosis was established by demonstration of involvement of lymph nodes and lung parenchyma on CT scan, and typical histology in bioptic specimens collected from bronchial mucosa.

scholarly journals Generalized Lymphadenapathy - An Unusual Presentation of Sarcoidosis

2014 ◽  
Vol 15 (1) ◽  
pp. 58-60
Author(s):  
Aparna Das ◽  
Maruf H Chowdhury ◽  
A B M G Mostafa ◽  
M Hasan ◽  
M A Kahhar
Keyword(s):  
Nervous System ◽  
Lymph Nodes ◽  
Unknown Origin ◽  
Giant Cells ◽  
Unusual Presentation ◽  
Granulomatous Disease ◽  
Multinucleated Giant Cells ◽  
Bilateral Hilar Lymphadenopathy ◽  
Granulomatous Diseases ◽  
Noncaseating Granulomas

Sarcoidosis is a systemic granulomatous disease of unknown origin. It is manifested pathologically by the presence of noncaseating granulomas containing multinucleated giant cells,although other granulomatous diseases may produce identical findings. The vast majority of patients have thoracic sarcoidosis with bilateral hilar lymphadenopathy and/or bronchonodular pulmonary infiltrates on chest radiographs. About 40% of patients have extrathoracic disease involving the eye, skin, lymph nodes, liver, spleen, heart, and musculoskeletal or nervous system. Here we report a case of sarcoidosis who presented only with generalized lymphadenopathy.DOI: http://dx.doi.org/10.3329/jom.v15i1.19874 J Medicine 2014; 15: 58-60

Laryngeal sarcoidoisis – a case report

2019 ◽  
Vol 8 (2) ◽  
pp. 38-42
Author(s):  
Magdalena Michałkowska-Pędzisz ◽  
Karolina Raczkowska-Łabuda ◽  
Paweł Dobrzyński
Keyword(s):  
Lymph Nodes ◽  
Clinical Course ◽  
Skin Lesions ◽  
Chest Ct ◽  
Bronchial Biopsy ◽  
Upper Respiratory Tract ◽  
Short Term ◽  
Diagnosis By Exclusion ◽  
Upper Respiratory ◽  
Noncaseating Granulomas

Introduction. Sarcoidosis is a multi-organ disease characterized by noncaseating granulomas. The lesions are usually localized within the lungs and hilar lymph nodes. The sarcoidosis of the upper respiratory tract (SURT) rate is estimated at 0.5-6%. The involvement of the larynx is extremely rare - it occurs in 1.2% of cases of SURT. Materials and methods. We present a case of a patient with laryngeal sarcoidosis. Results. A 48-year-old man had had a diagnosed of dysphonia for 5 years. A diagnosis of chronic hypertrophic laryngitis was made. Empirical course of methylprednisolone was attempted with a short-term improvement. Due to coexisting skin lesions, he was diagnosed with allergy. Chest CT showed moderately enlarged mediastinal and hilar lymph nodes as well as bilateral nodules around the hila. The bronchial biopsy showed no granulomas. Samples taken during microlaryngoscopy revealed sarcoid infiltrates. Conclusions and discussion. There is no unambiguous test confirming the diagnosis of sarcoidosis. It is a typical example of a diagnosis by exclusion. Laryngeal involvement is extremely rare and occurs in 1.2% of cases of SURT. The clinical course of the disease is often difficult to predict. In many patients, the lesion may undergo spontaneous regression. In patients poorly responding to steroid therapy or developing side effects, cytotoxic drugs may be considered.

Intermittent hydronephrosis in childhood

2013 ◽  
Vol 154 (24) ◽  
pp. 940-946 ◽  
Author(s):  
Miklós Merksz ◽  
Bálint Sulya ◽  
Mária Polovitzer ◽  
Ildikó Héjj ◽  
Diana Molnár ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Medical Records ◽  
Abdominal Ultrasound ◽  
Recurrent Abdominal Pain ◽  
Final Diagnosis ◽  
Occurrence Rate ◽  
Unknown Etiology ◽  
Delay In Diagnosis ◽  
Pelviureteric Junction Obstruction ◽  
Difficult Condition

Introduction: Intermittent pelviureteric junction obstruction, and its consequence,intermittent hydronephrosis is a difficult condition to identify. The renal collecting system is not dilated between the episodes of abdominal pain attacks and a prompt investigation is hard to carry out during the time of painful crisis. Therefore, most of the patients are initially misdiagnosed. Aim: The aim of the study was to assess the occurrence and the clinical characteristics of this phenomenon in children operated in the Department of Urological Surgery, Heim Pál Children Hospital, Budapest, Hungary. Patients and methods: Medical records of children operated for hydronephrosis between 2008 and 2012 were reviewed. The occurrence rate and clinical features of intermittent hydronephrosis were analyzed. Results: 76 children were operated for pelviureteric junction obstruction, of which 10 met the criteria of intermittent hydronephrosis. The average interval between the onset of symptoms and the final diagnosis was 2 years and 4 months. In 7 patients pyeloplasty, and in 3 patients nephrectomy were performed. Conclusions: Intermittent hydronephrosis represents a well-defined proportion among cases operated for hydronephrosis. The delay in diagnosis led to the loss of the kidney in one third of the patients, and this finding urges for the awareness of health professionals for this phenomenon. In case of recurrent abdominal pain of unknown etiology one must suspect a urological origin, even if a previous abdominal ultrasound showed normal kidneys. Orv. Hetil., 2013, 154, 940–946.

Bayesian Diagnostic Probabilities without Assuming Independence of Symptoms

1991 ◽  
Vol 30 (01) ◽  
pp. 15-22 ◽  
Author(s):  
A. Gammerman ◽  
A. R. Thatcher
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Bayes Theorem ◽  
Bayes Method ◽  
Hospital Records ◽  
Computer Diagnosis ◽  
Bayes Model ◽  
Chi Squared ◽  
Past Data

The paper describes an application of Bayes’ Theorem to the problem of estimating from past data the probabilities that patients have certain diseases, given their symptoms. The data consist of hospital records of patients who suffered acute abdominal pain. For each patient the records showed a large number of symptoms and the final diagnosis, to one of nine diseases or diagnostic groups. Most current methods of computer diagnosis use the “Simple Bayes” model in which the symptoms are assumed to be independent, but the present paper does not make this assumption. Those symptoms (or lack of symptoms) which are most relevant to the diagnosis of each disease are identified by a sequence of chi-squared tests. The computer diagnoses obtained as a result of the implementation of this approach are compared with those given by the “Simple Bayes” method, by the method of classification trees (CART), and also with the preliminary and final diagnoses made by physicians.

scholarly journals Intrabiliary and abdominal rupture of hepatic hydatid cyst leading to biliary obstruction, cholangitis, pancreatitis, peritonitis and septicemia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Manouchehr Aghajanzadeh ◽  
Mohammad Taghi Ashoobi ◽  
Hossein Hemmati ◽  
Pirooz Samidoust ◽  
Mohammad Sadegh Esmaeili Delshad ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Hydatid Cyst ◽  
Hydatid Disease ◽  
Biliary Obstruction ◽  
Abdominal Ultrasound ◽  
Sporadic Case ◽  
Gallbladder Wall ◽  
Liver Cyst ◽  
Biliary Duct ◽  
Wall Thickening

Abstract Background Hydatid cysts are fluid-filled sacs containing immature forms of parastic tapeworms of the genus Echinococcus. The most prevalent and serious complication of hydatid disease is intrabiliary rupture, also known as cystobiliary fistulae. In this study, a sporadic case of biliary obstruction, cholangitis, and septicemia is described secondary to hydatid cyst rupture into the common bile duct and intraperitoneal cavity. Case presentation A 21-year-old Iranian man was admitted to the emergency ward with 5 days of serious sickness and a history of right upper quadrant abdominal pain, fatigue, fever, icterus, vomiting, and no appetite. In the physical examination, abdominal tenderness was detected in all four quadrants and in the scleral icterus. Abdominal ultrasound revealed intrahepatic and extrahepatic biliary duct dilation. Gallbladder wall thickening was normal but was very dilated, and large unilocular intact hepatic cysts were detected in segment IV and another one segment II which had detached laminated membranes and was a ruptured or complicated liver cyst. Conclusion Intrabiliary perforation of the liver hydatid cyst is an infrequent event but has severe consequences. Therefore, when patients complain of abdominal pain, fever, peritonitis, decreased appetite, and jaundice, a differential diagnosis of hydatid disease needs to be taken into consideration. Early diagnosis of complications and aggressive treatments, such as endoscopic retrograde cholangiopancreatography and surgery, are vital.

scholarly journals Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tomoko Mizota ◽  
Masato Suzuoki ◽  
Saya Kaku ◽  
Kenichi Mizunuma ◽  
Kazuto Ohtaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Epithelioid Cell ◽  
Imaging Modalities ◽  
Hepatoduodenal Ligament ◽  
Regional Lymph Nodes ◽  
Multiple Imaging

Abstract Background Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. Case presentation A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. Conclusions SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis.

scholarly journals Identifying threshold sizes for enlarged abdominal lymph nodes in different age ranges from about 200,000 individual’s data

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lili He ◽  
Yinghua Sun ◽  
Guoying Huang
Keyword(s):  
Abdominal Pain ◽  
Lymph Nodes ◽  
Short Axis ◽  
Threshold Size ◽  
Different Ages ◽  
Using Data ◽  
Asymptomatic Individuals

AbstractThe threshold size for enlarged abdominal lymph nodes (E-ALNs), a common pediatric disorder, has yet to be standardized. According to the maximum short-axis diameter, this study divided ALNs into Grade A (≥ 10 mm), Grade B (8–10 mm), Grade C (5–8 mm), and Grade D (< 5 mm, normal). To identify the threshold size for E-ALNs, the prevalence of each grade was compared between asymptomatic individuals and symptomatic (e.g., abdominal pain) individuals without other diseases (e.g., appendicitis) that could explain the symptoms for different ages using data from > 200,000 individuals. The results showed the following: (1) For ages 1–3 years, the recommended threshold size is 8 mm, as the differences in the prevalence between the two groups were nonsignificant for Grade C but significant (p < 0.05) for both Grades A and B. (2) For ages 3–14 years, the recommended threshold size is 5 mm, as the differences between the two groups were significant (p < 0.05) for Grades A, B, and C. (3) The prevalence of Grades A, B, and C was very low for ages 0–1 years and high for ages 1–6 years. (4) The prevalence for males was generally higher than that for females for Grades A and B.

Sarcoidosis and Sarcoid Reactions in Endometrial Cancer Cases Masquerading Advanced Stage Malignancy

2021 ◽  
Vol 17 ◽  
Author(s):  
Serkan Akis ◽  
Canan Kabaca ◽  
Esra Keles ◽  
Handan Cetiner ◽  
Hatice Akay
Keyword(s):  
Endometrial Cancer ◽  
Lymph Nodes ◽  
Inflammatory Diseases ◽  
Uterine Cavity ◽  
Standardized Uptake Value ◽  
Granulomatous Inflammation ◽  
Pathological Examination ◽  
Pet Ct ◽  
Granulomatous Lesions ◽  
Granulomatous Lymphadenitis

Background: Sarcoidosis is usually diagnosed by ruling out other granulomatous inflammatory diseases. Rarely, it may be suspected with a pathological examination after surgical intervention for another disease. The sarcoid reaction is noninfectious granulomatous lymphadenitis which can occur at nodes draining a neoplasm. We demonstrated granulomatous lesions masquerading metastasis by Positron Emission Tomography/Computed Tomography (PET/CT) in endometrial cancer. We presented two cases of endometrial cancer with sarcoidosis and sarcoid-like reactions because of their challenging clinical and radiological findings. Cases: In case 1, there was diffuse granulomatous inflammation (no metastasis) in lymph nodes (n=92) and giant cells containing calcifications (Schaumann bodies). In case 2, PET/CT revealed hypermetabolism with malignancy suspicion in the pelvic lymph nodes (maximum standardized uptake value= 13) and pathological evaluation reported a 4.5 cm tumor within the uterine cavity without any nodal metastasis. Results: PET/CT has no role in the evaluation of differential diagnosis between granulomatous lymphadenitis and metastatic disease. Conclusions: Granulomatous lesions might mimic the metastasis of coexisting malignant diseases.

scholarly journals Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

2018 ◽  
Vol 27 (2) ◽  
pp. 79-86
Author(s):  
Nalan Kozaci ◽  
Mustafa Avci ◽  
Gul Tulubas ◽  
Ertan Ararat ◽  
Omer Faruk Karakoyun ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Physician ◽  
Gold Standard ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Free Fluid ◽  
Emergency Physicians ◽  
Abdominal Ultrasonography

Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

scholarly journals Sphincter of Oddi Dysfunction: A Perplexing Presentation

2016 ◽  
Vol 10 (3) ◽  
pp. 714-719 ◽  
Author(s):  
Sana Ahmad Din ◽  
Iman Naimi ◽  
Mirza Beg
Keyword(s):  
Abdominal Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Sphincter Of Oddi ◽  
Abdominal Ultrasound ◽  
Sphincter Of Oddi Dysfunction ◽  
Sphincter Pressure ◽  
Abdominal Symptoms ◽  
Biliary Sphincterotomy ◽  
Bile Drainage ◽  
Oddi Dysfunction

Sphincter of Oddi dysfunction is caused by stenosis or dyskinesia of the sphincter of Oddi, leading to blockage of bile drainage from the common bile duct. We present the case of a 16-year-old female with chronic abdominal pain who underwent laparoscopic cholecystectomy for cholelithiasis but continued to experience abdominal pain, nausea, and vomiting along with persistently elevated ALT and AST levels. Postoperative abdominal ultrasound was nondiagnostic. Esophagogastroduodenoscopy showed mild reflux esophagitis and mild chronic Helicobacter pylori-negative gastritis. Omeprazole was started, but it did not decrease the frequency and severity of the abdominal symptoms. Magnetic resonance cholangiopancreatography did not reveal any pathology. Endoscopic retrograde cholangiopancreatography with manometry confirmed an elevated biliary sphincter pressure. Biliary sphincterotomy was performed, and the symptoms improved.

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