The three-step test.
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Diagnostic Errors↗
Biomedical subjects
D B Wyatt
Publications and source records attributed to D B Wyatt.
Actinic granuloma of the conjunctiva.
The key histologic feature of pingueculas is the presence of actinic elastosis of the conjunctival connective-tissue fibers. We describe a patient who had a pinguecula that, on pathologic examination, exhibited a prominent foreign-body giant-cell reaction in association with the elastotic fibers. The term actinic granuloma has been coined recently to designate a similar reaction in sun-damaged skin. Because the nature of the inflammatory reaction may be misinterpreted on pathologic examination as indicating the presence of microorganisms or a foreign body, both the clinician and the pathologist should be aware of this peculiar inflammatory response, which has been described on two previous occasions in patients with pingueculas.
Adult↗
Splenic rupture and infectious mononucleosis.
Infectious mononucleosis is an acute viral illness associated with a high incidence of splenomegaly, although the incidence of splenic rupture is low. When rupture occurs, the mortality has been significant, presumably, because a history of trauma is not present. The spleen may be vulnerable to injury due to the histopathologic changes that occur as a result of this illness. Essentially all patients with spontaneous rupture related to infectious mononucleosis have epigastric or upper abdominal pain. The diagnosis of splenic rupture may be confirmed in a variety of ways. In those patients who are hemodynamically stable, CT scan, ultrasound, or radionuclide scan may aid in establishing the diagnosis. Selective splenic angiography is very accurate but has been largely abandoned because of the invasive nature of the study. Peritoneal lavage is efficacious in establishing the diagnosis in hemodynamically unstable patients. The treatment of choice, at this time, is splenectomy. Current interest in splenic salvage has resulted in reports of nonoperative therapy in stable patients and splenorrhaphy in one instance. Due to the extent of the histologic changes in the spleen, caution is urged in electing the conservative approach to this clinical situation.
Adult↗