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At least 379 records · Page 21Linked to original sources
PubMed1985

Assessment of calcium homeostasis in the critically ill surgical patient. The diagnostic pitfalls of the McLean-Hastings nomogram.

Hypocalcemia is a common problem in critically ill surgical patients. We prospectively evaluated whether measurement of the total serum calcium (Ca) concentration or calculation of the serum ionized Ca level (by the McLean-Hastings nomogram) accurately reflects the measured serum ionized Ca level. Although 71% and 58% of 156 predominantly surgical intensive care unit (ICU) patients were hypocalcemic by the total serum Ca or calculated ionized Ca level, respectively, only 12% were hypocalcemic by directly measured serum ionized Ca measurement. The total serum Ca and calculated ionized Ca concentrations were sensitive (95% and 89%, respectively) but lacked specificity (32% and 46%, respectively) in predicting ionized hypocalcemia. Analyses of Ca binding to albumin in the serum of surgical ICU patients and normal subjects suggested that there is a circulating factor in critically ill patients that increases the binding of Ca to albumin. These observations may explain why the McLean-Hastings nomogram underestimates the protein-induced changes in serum Ca in critically ill surgical subjects. We conclude that: total serum Ca and calculated ionized Ca concentrations are poor indicators of the true serum ionized Ca status in critically ill surgical patients, and we recommend direct measurement of serum ionized Ca levels in these patients; and variability in the affinity of Ca for binding proteins in critical illness may explain the poor correlation between serum total and ionized Ca measurements.

Blood Proteins↗
PubMed1996

Three-phase skeletal scintigraphy in gouty arthritis: an example of potential diagnostic pitfalls in radiopharmaceutical imaging of the extremities for infection.

The three-phase bone scan has been shown to be useful in the diagnosis of osteomyelitis, with a high sensitivity and specificity under optimal conditions. However, there are many causes of focally-increased uptake of Tc-99m diphosphonates in the extremities that may mimic infection, especially when there is increase on all three phases. Radiolabeled leukocyte scintigraphy is often performed in this clinical setting, although many pitfalls resulting in false-positive scans still remain. The authors present three cases of gouty arthritis in which skeletal scintigraphy illustrates this lack of specificity. Further causes of increased extremity uptake are reviewed, with attention to those that have been reported to show an increase on all three phases of the bone scan. Additional factors that can improve the specificity of the bone scan are discussed, as are the panoply of more recent scintigraphic approaches aimed at distinguishing infection from aseptic inflammation in the extremity. Unfortunately, no nuclear medicine procedure to date has proven itself to be reliably specific for infection.

Aged↗
PubMed1987

Endosalpingiosis in female peritoneal washings: a diagnostic pitfall.

Endosalpingiosis in female peritoneal washings can be a source of false-positive diagnoses, especially in patients with known ovarian carcinoma. In this article we report the features of endosalpingiosis in the peritoneal washings of four patients, three of whom were initially reported as "suspicious for malignancy." Two of the patients had ovarian serous tumor of borderline malignancy; however, the tumors were confined to the ovaries with no evidence of disseminated peritoneal malignancy. All four patients had histologic evidence of pelvic endosalpingiosis. It is important to recognize this entity cytologically to avoid a misdiagnosis of recurrent or disseminated malignancy.

Adult↗
PubMed1995

Surface epithelial changes in endometrial adenocarcinoma: diagnostic pitfalls in curettage specimens.

A total of 161 uteri removed for endometrial cancer were studied in order to characterize the histopathologic features of the endometrial surface epithelium. Of these, 116 had endometrioid endometrial adenocarcinoma, and 45 had other endometrial cancers. A total of 57 (49%) of the endometrioid endometrial adenocarcinomas showed the following surface epithelial changes: seven had a conspicuous microglandular pattern simulating cervical microglandular hyperplasia; 17 had syncytial aggregates of relatively bland-appearing eosinophilic cells, frequently with papillary or squamoid differentiation simulating papillary syncytial change or other endometrial epithelial metaplasias; and 33 had mixed patterns. The surface epithelial changes varied in extent from rare foci to extensive surface replacement and were largely confined to FIGO grade I and II tumors. Cytologic atypicality varied from mild to moderate and was consistently less than that of the underlying carcinoma. Similar changes were present in some of the prior curettings; in some scanty curettings an unequivocal diagnosis of carcinoma was not possible. Consequently, further clinical investigation is indicated if these changes are present in scanty curettings from postmenopausal women.

Adenocarcinoma↗
PubMed1984

Postsurgical evaluation of hydatid disease with CT: diagnostic pitfalls.

Forty-five patients having previously undergone surgical removal of hydatid cysts were examined for recurrence using CT. Recurrence of hydatid disease was demonstrated in 11 patients. At the site of surgical cyst evacuation, cyst-like structures (pseudocysts) were demonstrated in 15 patients. Although pseudocysts were smaller than the original cysts and demonstrated a flattened appearance and a thicker wall, differentiation from recurrent viable hydatid cysts was difficult. Five of the pseudocysts had attenuation values between 10 and 35 HU, and eight had attenuation values close to that of fat (- 20 to - 100 HU). The findings of this study may be important in the follow-up of patients with hydatid disease.

Adolescent↗
PubMedDate not supplied

Helical CT of the abdomen and pelvis: potential diagnostic pitfalls of arterial-phase imaging in the genitourinary tract.

Spiral computed tomography (CT) is the state of the art today in imaging many features of the genitourinary tract. The use of dual-phase CT imaging improves our ability to detect and stage a wide range of pathologies. However, imaging in the arterial phase has several potential pitfalls that can result in either overcalling or undercalling genitourinary pathology. This paper reviews some of the common pitfalls and presents strategies on how to avoid them.

Diagnosis, Differential↗
PubMed2000

Nonskeletal cervical spine injuries: epidemiology and diagnostic pitfalls.

BACKGROUND: Cervical spine injuries are the most commonly missed severe injuries with serious implications for the patient and physician. The diagnosis of subluxations or spinal cord injuries in the absence of vertebral fractures, especially in unevaluable patients, poses a major challenge. The objective of this study was to study the incidence and type of cervical spine trauma according to mechanism of injury; identify problems and pitfalls in the diagnosis of nonskeletal cervical spine injuries. METHODS: Retrospective study of all C-spine injuries caused by traffic accidents or falls admitted over a 5-year period at a large Level I trauma center. Data were obtained from the trauma registry, review of patient charts, and radiology reports. RESULTS: During the study period, there were 14,755 admissions due to traffic injuries or falls who met trauma center criteria. There were 292 patients with C-spine injuries, for an overall incidence of 2.0% (3.4% in car occupants, 2.8% for pedestrians, 1.9% for motorcycle riders, and 0.9% for falls). The incidence of C-spine injuries in patients with a Glasgow Coma Scale score of 13 to 15 was 1.4%, 9 to 12 was 6.8%, and in < or =8 was 10.2% (p < 0.05). Of C-spine injuries, 85.6% (250 patients) were a vertebral fracture, 10.6% of the injuries (31 patients) were subluxation without fractures, and 3.8% (11 patients) were an isolated spinal cord injury without fracture or subluxation. Of the 31 patients with isolated subluxations, one-third required an early endotracheal intubation before clinical evaluation of the spine, because of associated severe head injury or hypotension. Adequate lateral C-spine films diagnosed or suspected 30 of the 31 subluxations (96.8%). The combination of plain films and computed tomographic (CT) scan diagnosed or suspected all injuries. Of the 11 patients with isolated cord injury, 27.3% required early intubation before clinical evaluation of the spine. The diagnosis of cord injury was made on admission in only five patients (45.5%). In three patients, the neurologic examination on admission was normal and neurologic deficits appeared a few hours later. In the remaining three patients (two intubated, one intoxicated), the diagnosis was missed clinically and radiologically. CONCLUSIONS: Isolated nonskeletal C-spine injuries are rare but potentially catastrophic because of the high incidence of neurologic deficits and missed diagnosis. In subluxations, the combination of an adequate lateral film and CT scan was reliable in diagnosing or highly suspecting the injury. A large prospective study is needed to confirm these findings, before a recommendation is made to remove the cervical collar if the findings of these investigations are normal. However, in isolated cord injuries, the diagnosis was often missed because of associated severe head trauma and the low sensitivity of the plain films and CT scans.

Accidental Falls↗
PubMed1982

Apathetic thyrotoxicosis presenting as an abdominal emergency: a diagnostic pitfall.

Thyrotoxicosis may present with a hyperkinetic clinical picture typically associated with Graves' or Plummer's disease, or in an apathetic form characterized by lethargy, weakness, and withdrawal. Both the hyperkinetic and apathetic forms of thyrotoxicosis may be associated with or masked by predominantly extrathyroidal manifestations, occasionally referable primarily to the abdomen. We present two cases of apathetic thyrotoxicosis that suggested the need for urgent surgical intervention, and review the literature on apathetic thyrotoxicosis as an abdominal emergency, as well as laboratory studies and possible etiology.

Abdomen, Acute↗
PubMed1985

Alveolar cell carcinoma: diagnostic pitfalls in evaluating the chest roentgenogram.

We have reported two cases of biopsy-proven alveolar cell carcinoma, both initially thought to be pulmonary edema. The purpose of this report is to stress the variations of the roentgenographic pattern in alveolar cell carcinoma and to suggest that fiberoptic bronchoscopy with biopsy should be considered when a pattern thought to be that of pulmonary edema does not resolve with appropriate therapy.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2000

Immunohistochemical localization of prostate-specific antigen in ductal epithelium of male breast. Potential diagnostic pitfall in patients with gynecomastia.

Enlargement of the male breast is frequently encountered in the course of adjuvant antiandrogen therapy for advanced prostate carcinoma. The clinical differential diagnosis in this setting includes hormonal imbalance-induced gynecomastia, primary breast carcinoma, and metastasis of prostatic carcinoma. Biopsy of the lesion with the identification of prostate-specific antigen (PSA) plays an important role in establishing the correct diagnosis. Recent studies showed that female mammary epithelium may be a significant source of PSA, but its expression in male breasts has not been sufficiently studied. We found that normal and hyperplastic duct epithelium in gynecomastia exhibited focal, strong (+3) PSA immunoreactivity in 5 of 18 cases (28%). In contrast, no PSA reactivity was found in eight cases of male breast carcinoma. No reactivity was seen with antiprostatic acid phosphatase (PsAP) antibody, in either benign or malignant epithelium. Frequent expression of PSA in gynecomastia may, in an appropriate clinical setting, cause confusion with metastatic prostatic carcinoma. The lack of immunoreactivity for PsAP in male breast epithelium indicates its usefulness in the differential diagnosis.

Acid Phosphatase↗
PubMed2003

Medial synovial plica syndrome of the knee: a diagnostic pitfall in adolescent athletes.

Medial plica syndrome is usually a rare cause of anterior knee pain, but in adolescent athletes it is more common. A prospective investigation of clinical criteria for the diagnosis of medial plica syndrome was carried out. Investigating the stress test for the diagnosis of medial plica syndrome, we used active extension as a kick test and flexion to test blocking of swinging of the shank. The aim of this investigation was to examine these two new tests. The tests we used improved the accuracy of the clinical examination and allowed diagnosis of the symptomatic medial plica.

Adolescent↗
PubMed2005

Primary cutaneous myxofibrosarcoma mimicking pleomorphic hyalinizing angiectatic tumor (PHAT): a potential diagnostic pitfall.

Myxofibrosarcoma (MFS) is one of the most common sarcomas of adults, and includes lesions ranging from low to high grade based on increasing cellularity, nuclear pleomorphism, and mitotic activity. We present an unusual case of MFS, which initially showed features of a pleomorphic hyalinizing angiectatic tumor (PHAT), a rare soft-tissue tumor considered benign in the WHO classification. The initial lesion showed a subcutaneous proliferation of spindled to polygonal eosinophilic cells with striking cellular pleomorphism, set in a myxoid to sclerotic stroma with prominent hyalinized and angiectatic vasculature, classic characteristics of PHAT. Rare mitotic figures were identified. The preliminary diagnosis of PHAT was confirmed by a consultant expert soft-tissue pathologist. Four months after the initial surgery, local recurrence was noted. The recurrent tumor demonstrated findings of a high-grade MFS, with a diffuse and cellular proliferation of atypical spindle cells set in a prominent myxoid stroma. Multiple mitoses, including atypical ones, were present. In light of these findings, the original specimen was reexamined and the initial diagnosis was amended to MFS. MFS may mimic or be confused with several benign soft-tissue lesions. Cases mimicking PHAT have not been previously reported. We describe a unique case of a high-grade MFS that initially showed characteristic features of a PHAT, to illuminate the fact that MFS may rarely arise in, or have areas that masquerade as, PHAT. It is also conceivable, although speculative, that at least some cases of PHAT, currently considered a benign tumor by the WHO, may actually represent or evolve into a unique form of MFS of low malignant potential.

Aged↗
PubMed2005

Focal changes of chronic pancreatitis and duct-arteriovenous relationships: avoiding a diagnostic pitfall.

A prior study of pancreatic duct-arteriovenous relationships suggested that finding ducts near muscularized blood vessels without intervening pancreatic acini indicated adenocarcinoma was present. Because focal changes of chronic pancreatitis are often seen at autopsy, it seemed reasonable to use the autopsy to test the hypothesis that this finding might be nonspecific. An unselected, consecutive series of 81 adult decedent pancreases without known pancreas cancer was evaluated for the presence of ducts near muscularized blood vessels, for fibrosis and/or atrophy, for chronic inflammation, and for duct reduplication and/or proliferation. Autolysis precluded assessment of 26% of the cases. Of evaluable cases, 37% displayed ducts near muscularized blood vessels without intervening pancreatic acini, 23% chronic inflammation, 62% fibrosis and/or atrophy, and 55% duct reduplication and/or proliferation. The finding of ducts near muscularized blood vessels was closely associated with fibrosis and/or atrophy (odds ratio = 28.87, chi = 14.59, P = 0.0001), with duct reduplication and/or proliferation (odds ratio = 19.23, chi = 15.88, P = 0.0001), but not with chronic inflammation (odds ratio = 1.41, chi = 0.05, P > 0.30). Because changes of chronic pancreatitis are associated with ducts near muscularized blood vessels and because chronic pancreatitis can mimic pancreas cancer, care should be exercised when using the finding of ducts near muscularized blood vessels without intervening pancreatic acini as a criterion for the diagnosis of pancreas cancer.

Adult↗
PubMed2006

Extragastrointestinal stromal tumors presenting as vulvovaginal/rectovaginal septal masses: a diagnostic pitfall.

Gastrointestinal stromal tumor (GIST) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Most GISTs arise in the stomach and small bowel, whereas a small number occur elsewhere in the GI tract. Rare cases are identified outside the GI tract and are collectively known as extragastrointestinal stromal tumors (EGISTs). Because of their malignant potential and recent advances in the management of GISTs with imatinib mesylate (Gleevec, Glivec), it is imperative that these tumors are correctly diagnosed. In this study, we reviewed the clinical and pathologic characteristics of 3 cases of EGIST presenting as vulvovaginal/rectovaginal septal masses that were originally misdiagnosed, presumably due to their unusual anatomic locations. The original diagnoses were leiomyoma in one case and leiomyosarcoma in 2 cases. The lesions were localized to the rectovaginal septum () or vagina () and ranged from 4 to 8 cm in diameter. All 3 lesions had a spindle cell morphology that mimicked a smooth muscle tumor. Mitotic figures numbered from 12/50 to 16/50 high power fields (HPFs; median 15). Immunohistochemistry revealed that all 3 cases were strongly positive for KIT (CD117) and CD34 and negative for smooth muscle actin, desmin, pan-cytokeratin, and estrogen receptor. KIT sequence analysis revealed oncogenic mutations in all 3 cases. The first tumor recurred at 2 years and the second tumor recurred at 10 years; the third case is too recent for meaningful follow-up. EGISTs that present as gynecologic masses are rare but may be more common than is currently recognized. Misdiagnosis may lead to inappropriate therapy because conventional chemotherapy and radiotherapy are not effective in the treatment of GISTs, whereas imatinib mesylate (Gleevec, Glivec) has a proven role in managing these tumors. Thus, it is imperative to consider EGISTs in the differential diagnosis of mesenchymal neoplasms in the vulvovaginal/rectovaginal septum.

Adult↗