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PubMedDate not supplied

Diagnostic pitfalls in transesophageal echocardiography.

The technology of transesophageal echocardiography is now widely available and has proved extremely useful in evaluating cardiovascular anatomy and pathology. Unfortunately, the enhanced echocardiographic detail and multiple transesophageal imaging planes may sometimes be confusing and cause misinterpretations. The majority of these problems are simply the result of operator inexperience. To help prevent misdiagnoses, we have collected a series of the more common diagnostic and technical "pitfalls" of transesophageal echocardiography.

Aorta↗
PubMed1996

Cytologic findings in a case of T-cell rich B-cell lymphoma: potential diagnostic pitfall in FNA of lymph nodes.

Fine-needle aspiration biopsy (FNAB) is a reliable diagnostic technique for most palpable masses. This technique is utilized routinely to diagnose metastatic carcinoma and melanomas in lymph nodes. However, the role of FNAB in the investigation of lymphoproliferative lesions is still controversial. Recent publications have supported the use of FNAB cytology, in conjunction with immunophenotyping, as an accurate, reliable diagnostic modality for the classification of most lymphomas (Sneige et al., Acta Cytol 1990; 34:311-322; Skoog and Tani, Diagn Oncol 1991; 1:12-18; Robins et al., Am J Clin Pathol 1994; 101:569-576; Katz, Clin Lab Med 1991; 11:469-499). We present a case of a T-cell rich, large B-cell lymphoma. Material obtained by FNAB mimicked a reactive process by both cytomorphological and immunophenotypical analysis. This case demonstrates a potential pitfall in the use of FNAB to evaluate lymphoproliferative disorders even when used in conjunction with immunophenotypic studies. The case also emphasizes the need for detailed clinical and prior pathologic information when a cytologic sample is being evaluated for a lymphoproliferative disorder. To our knowledge, the cytomorphologic findings of this particular type of lymphoma have not been previously described as seen on an FNAB.

Aged↗
PubMed2006

Fine-needle aspiration cytology of salivary glands: diagnostic pitfalls--revisited.

Fine needle aspiration cytology (FNAC) of salivary gland lesions is a safe, effective diagnostic technique. Several amply illustrated reviews are available in the English literature. The reported diagnostic accuracy varies between 86% to 98%. The sensitivity ranges from 62% to 97.6% and specificity is higher from 94.3% to 100%. In this present study, we have analyzed 172 cases of salivary gland aspirates and the histopathological diagnosis was available in 45 cases. There was discordance in cytological and histopathological diagnosis in nine cases. Five cases had discrepancies in benign versus malignant diagnosis with four cases being false negative. The errors in these FNA diagnoses were due to sampling error, observational error and interpretational error. Therefore, this study illustrates high diagnostic accuracy of FNAC in salivary gland lesions and shows that FNAC offers valuable information that allows the planning of subsequent patient management.

Adolescent↗
PubMed1994

Needle aspiration cytology of acinar-cell carcinoma of the pancreas: report of a case with diagnostic pitfalls and unusual ultrastructural findings.

A case of histologically and ultrastructurally confirmed acinar-cell carcinoma of the pancreas examined by needle aspiration cytology is reported. The aspirate showed isolated and loosely clustered cells with variable granular cytoplasm, and central or eccentrically located oval hyperchromatic nuclei displaying prominent nucleoli, suggesting a pancreatic neuroendocrine tumor. Numerous intracytoplasmic zymogen granules and several microtubules within cisternae of rough endoplasmic reticulum (MCRER) were found by electron microscopic study of metastatic tumor tissue. Cytodiagnostic pitfalls of this rare pancreatic cancer are discussed as well as the diagnostic value of MCRERs.

Aged↗
PubMed2005

Adjustment disorder: a review of diagnostic pitfalls.

Adjustment disorder is a common diagnosis in psychiatric settings and carries a significant rate of morbidity and mortality. However, both current and previous diagnostic criteria are vague and lead to many difficulties in terms of validity and reliability. This review is based on a thorough literature search and a systematic evaluation of the empiric and theoretic data. The various pitfalls inherent in the process of diagnosing this disorder are discussed in light of the diagnostic criteria for the disorder.

Adjustment Disorders↗
PubMed1985

Fetal uropathies: diagnostic pitfalls and management.

Based on the experience of 63 antenatal diagnoses of fetal uropathic conditions we discuss the diagnostic problems, practical implications of antenatal diagnosis and potential indications of in utero intervention. A correct diagnosis was established in 43 of the 63 cases (70 per cent). Diagnostic problems were encountered in differentiating among multicystic dysplastic kidneys and ureteropelvic junction obstruction, dilatation owing to reflux or obstruction and lack of visualization of small hypoplastic kidneys. Transitory urinary tract dilatation was found in 14 cases (22 per cent) and can be responsible for additional false positive findings. Evaluation of the thoracic development and amniotic fluid must be part of the examination, since they are related to severe obstructive uropathy. Repeat examinations are necessary in these cases. During evaluation of the eventual benefit of an in utero decompression one should consider the diagnostic difficulties, mainly the time of onset of fetal uropathic conditions during morphogenesis and the absence of a clinically reliable method to evaluate fetal renal function. To date there are no real indications for in utero intervention in most detectable cases. The major benefit of prenatal echography is to allow early recognition of major uropathic conditions before postnatal infection worsens the prognosis.

Female↗
PubMedDate not supplied

Diagnostic pitfalls in the fine needle aspiration of thyroid nodules. A study of 555 cases in Chinese patients.

The diagnostic value and limitations of fine needle aspiration (FNA) were determined by examining 555 palpable thyroid nodules in Chinese patients who had a definitive diagnosis established by thyroidectomy (529 cases) or large-needle biopsy (26 cases). Of the aspirates, 97.8% were satisfactory for cytologic examination. The overall malignancy rate was 20%. FNA detected 73 (74.5%) of 98 primary malignant tumors and 9 (90%) of 10 metastatic tumors. Diagnostic errors were most commonly due to inadequate specimens and cystic lesions. Cystic fluid, present in one-third of all lesions, was associated with a malignant nodule in 13% of the cases. FNA was most valuable for detecting papillary carcinomas; it may at times suggest the likelihood of a follicular carcinoma.

Adenoma↗
PubMed2002

Cystic change in metastatic lymph nodes: a common diagnostic pitfall in fine-needle aspiration cytology.

Fine-needle aspiration cytology (FNAC) of cystic metastases is a challenging diagnostic category and has been investigated in a limited number of malignancies and sites. The present study retrospectively reviewed 1,211 FNAC of superficial masses, including lymph nodes (1,102 aspirates), benign cystic lesions (64 aspirates), and lymphocysts (45 aspirates) with the aim of determining the tumors that cause cystic change in metastases. Cytology results from 1,102 lymph node aspirations were suspicious or positive for malignancy in 541 specimens (49.1%), benign in 230 (20.9%), and unsatisfactory in 331 (30%). There were 28 malignant aspirates demonstrating cystic change (5.2%). The tumor type that most frequently caused cystic change was thyroid papillary carcinoma (42.8% of cases), followed by squamous cell carcinoma (primary in the head and neck region 30.8% and in the skin 24%), tumors of unknown origin (6.3%), serous papillary carcinoma of the ovary or endometrium (4.8%), and malignant melanoma (2.1%). Cystic change was observed most commonly in the head and neck region lymph nodes (60%). The most challenging lesions to assess using FNAC were metastatic lymph nodes showing cystic change, accounting for six of the 16 false-negative diagnoses and one false-positive diagnosis. The results of this study suggest that cystic change in metastatic lymph nodes occurs in certain types of tumors and is an important cause of diagnostic error. FNAC should be repeated in case of suspicious hypocellular cystic aspirations, especially in patients with known malignancy.

Adult↗
PubMedDate not supplied

Diverticulitis of the caecum and ascending colon: an unavoidable diagnostic pitfall?

PURPOSE: The infrequency of right-sided colonic diverticulitis prompted this presentation of our experiences, with emphasis on the diagnostic aspects. PATIENTS AND METHODS: Charts and documentation regarding 20 patients who underwent surgery for diverticulitis of the caecum and/or ascending colon over 22 years were reviewed. RESULTS: Eleven patients underwent pre-operative instrumental examinations: right-sided diverticulitis was recognized in five patients (two by barium enema, two by both ultrasonography and computerized tomography, one by all three examinations) and was suspected in another four. All diagnoses on merely clinical grounds--acute appendicitis in 10 patients and perforated peptic ulcer in one--were erroneous. Surgery consisted of 13 right standard or limited hemicolectomies, six conservative procedures and one Mickulicz' operation and subsequent right hemicolectomy. No operative deaths or long-term failures were reported. CONCLUSIONS: In the presence of clinical features atypical of acute appendicitis, right-sided colonic diverticulitis should be taken into account; pre-operative instrumental examinations might increase diagnostic accuracy, thereby leading to a more correct therapeutic approach.

Adult↗
PubMedDate not supplied

Diagnostic pitfalls in the cholangiographic diagnosis of choledochoceles: cholangiographic quality and its effect on visualization.

BACKGROUND: We wanted to establish reasonable cholangiographic diagnostic criteria by determining the sensitivity of cholangiography in detecting choledochoceles and those factors that could compromise visualization of choledochoceles. METHODS: Over 4 years, 21 patients (seven male, 14 female; mean age = 67 years) were confirmed as having choledochoceles on endoscopic retrograde cholangiopancreatography (ERCP). Cholangiographic diagnosis was made by following three criteria: a radiolucent halo around the distal common bile duct (CBD), bulbous dilatation of the distal CBD, and the presence of sequential morphologic changes on serial cholangiography. Any two or more combinations of these three criteria were considered enough to diagnose a choledochocele on cholangiography. We compared cholangiographic imaging findings with the ERCP results. RESULTS: Of 21 patients with choledochoceles, nine (43%) were correctly diagnosed on cholangiography. A radiolucent halo was present in six (28%) patients; four of these cases showed optimal duodenal filling, one showed faint duodenal filling, and one showed poor duodenal filling. The shapes of the distal CBD were bulbous, conelike, and blunt. Morphologic changes such as collapsing and bulging of the choledochocele could be seen in 12 (57%) patients on serial cholangiography. Waists were seen in 11 (52%), pseudowebs in four (19%), and wrinkling of the distal CBD in seven (33%). CONCLUSION: Cholangiography should be obtained with optimal timing and adequate conditions to diagnose choledochocele correctly.

Aged↗
PubMed2002

Duodenal perforation: a diagnostic pitfall in non-accidental injury.

Duodenal perforation is a rare, life threatening injury associated with non-accidental blunt abdominal trauma. Diagnostic delay is common, as the true history is concealed and signs may be minimal. Double contrast computed tomography is the most sensitive investigation to confirm clinical suspicion. We report three cases, all with other features typical of non-accidental injury.

Child, Preschool↗