List Of Differential Diagnoses Research Articles

Congenital vascular rings as a cause of respiratory and esophageal problems in children

Congenital anomalies of the aortic arch include a wide range of anatomic pathologies, which may be completely asymptomatic or accompanied by severe respiratory and/or esophageal symptoms, especially in the case of complete vascular rings (VR). Purpose - to draw the attention of pediatricians and family phisicians to possible clinical presentations of aortic arch anomalies, namely VR, to increase their awareness of this pathology, that will contribute to differential diagnosis. VR, are anomalies of the aortic arch that result from abnormal development of the embryonic aortic arches. The prevalence of VR is approximately 1%, of which 55% are double aortic arch. This congenital heart defect can be either isolated or combined with other congenital heart defects. Associated cardiac pathology occurs in 12.6%, and includes ventricular septal defect and Tetralogy of Fallot. Sometimes this defect is associated with DiGeorge’s and Turner’s syndrome. The timing of appearance of clinical symptoms varies from the early neonatal period to adulthood. However, most patients develop clinical symptoms in the first months after birth, and they indicate the need of cardiac surgery during the first year of life. Given the serious consequences of this anomaly, VR should be included in the list of differential diagnoses of wheezing, stridor, difficulty swallowing and bronchial obstruction syndrome in children, especially when these symptoms appear since birth, are persistent and respond poorly to standard therapeutical approaches. Therefore, it is important for pediatricians to be alert for a congenital heart defect such as VR as one of the possible causes of congenital stridor, wheezing, and swallowing disorders in infants. Contrast-enhanced computed tomography and magnetic resonance imaging of the heart are the diagnostic modalities of choice for VR diagnosis. These diagnostic methods provide accurate location, nature of branching and dominance of the aortic arch as well as the degree of compression of the airway and esophagus. Three-dimensional reconstruction helps to plan future surgical intervention. No conflict of interests was declared by the authors.

Macroprolactinoma with secondary resistance to dopamine agonists: a case report and review of the literature

BackgroundResistance to dopamine agonists is not uncommonly seen in prolactinomas. However, development of resistance to dopamine agonists after an initial period of robust treatment response is rare, and only 39 cases have been reported in the past four decades. We describe a Chinese man with this rare condition and explored the postulated mechanisms that may explain this phenomenon. We compiled similar cases that were previously reported and compared their etiology, progress, and response to treatment. On the basis of these cases, we derived a list of differential diagnoses to consider in patients with secondary resistance to dopamine agonists.Case presentationA 63-year-old Chinese man presented with blurred vision and was subsequently diagnosed with a macroprolactinoma. He had initial response to cabergoline but developed secondary resistance to it after 5 years. The prolactinoma continued to grow, and his serum prolactin remained markedly elevated despite adherence to escalating dosages of cabergoline up to 6 mg/week. The patient finally underwent transsphenoidal surgery and was found to have a sparsely granulated lactotroph tumor with Ki-67 index of 5%. Postoperatively, there was improvement in his serum prolactin level, although he still required treatment with cabergoline at 6 mg/week.ConclusionsSurgery can facilitate disease control in patients with prolactinomas that develop secondary resistance to dopamine agonists. Malignant prolactinoma is an important differential diagnosis in this group of patients, especially when serum prolactin remains markedly elevated despite resolution or stability of the primary pituitary lesion, suggesting a metastatic source of prolactin secretion.

Adult-Onset Genetic Leukoencephalopathies With Movement Disorders

Genetic leukoencephalopathies (GLEs) are a group of white matter abnormalities with heterogeneous radiological and phenotypic features. Although these conditions have mostly been described in children, adult-onset cases are increasingly recognized owing to the widespread use of neuroimaging and advances in molecular genetic testing. The disease course is often progressive with a varied spectrum of presentations, trapping neurologists in the dilemma of differential diagnosis. Movement disorders are among the most common symptoms, and their diversity makes diagnosis challenging. In this review, we focus on adult-onset GLEs with movement disorders and offer a step-by-step diagnostic approach by clarifying the phenomenology of movement, advising investigations for acquired causes, describing the clinical and radiological clues to each disease, emphasizing the limitations of advanced molecular testing, and discussing the future application of artificial intelligence. We provide a list summarizing the leukoencephalopathies associated with different categories of movement disorders. In addition to guiding clinicians on how to narrow the list of differential diagnoses with the tools currently available, another aim of this review is to emphasize the inevitable trend toward applying advanced technology in diagnosing these difficult diseases.

Approach to the orthopaedic patient

Approaching orthopaedic patients represents a common challenge for first opinion practitioners. Knowledge and understanding of the correct steps necessary to narrow down the list of differential diagnoses, and selection of appropriate diagnostic modalities, is crucial to success. The approach to orthopaedic patients should comprise obtaining a history, observing the standing patient, gait analysis, orthopaedic examination and a brief neurological examination. Orthopaedic examination can be separated into palpation and manipulation. This methodical approach allows the clinician to avoid the common mistakes of delayed diagnosis and subsequent owner dissatisfaction. This article will focus on a methodical approach to orthopaedic patients, with particular attention on the common challenges encountered by first opinion practitioners.

Clinical and biochemical footprints of inherited metabolic disorders. XI. Gastrointestinal symptoms.

Inherited metabolic disorders presenting with gastrointestinal (GI) symptoms are characterized by the dysfunction of the esophagus, stomach, small and large intestines, and pancreas. We have summarized associations of signs and symptoms in 339 inherited metabolic diseases presenting with GI symptoms. Feeding difficulties represent the most common abnormality reported for IMDs with GI involvement (37%) followed by intestinal problems (30%), vomiting (22%), stomach and pancreas involvement (8% each), and esophagus involvement (4%). This represents the eleventh of a series of articles attempting to create and maintain a comprehensive list of clinical and metabolic differential diagnoses according to system involvement.

Pleural effusion in critically ill patients and intensive care setting.

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses. Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients, with a wide range of variable prevalence rates of up to 50%-60% in some studies. This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit (ICU). The original disease that caused pleural effusion can be the exact cause of ICU admission. There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients. There are also many difficulties in diagnosing pleural effusion in the ICU, including clinical, radiological, and even laboratory difficulties. These difficulties are due to unusual presentation, inability to undergo some diagnostic procedures, and heterogenous results of some of the performed tests. Pleural effusion can affect the patient's outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients, who usually have frequent comorbidities. Similarly, pleural effusion drainage can modify the ICU-admitted patient's outcome. Finally, pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

Physical Therapists Use of Diagnostic Ultrasound Imaging in Clinical Practice: A Review of Case Reports.

Ultrasound diagnostic imaging (USI) is widely utilized in sports medicine, orthopaedics, and rehabilitation. Its use in physical therapy clinical practice is increasing. This review summarizes published patient case reports describing USI in physical therapist practice. Comprehensive literature review. PubMed was searched using the keywords "physical therapy" AND "ultrasound" AND "case report" AND "imaging". In addition, citation indexes and specific journals were searched. Papers were included if the patient was attending physical therapy, USI was necessary for patient management, the full text was retrievable, and the paper was written in English. Papers were excluded if USI was only used for interventions, such as biofeedback, or if the USI was incidental to physical therapy patient/client management. Categories of data extracted included: 1) Patient presentation; 2) Setting; 3) Clinical indications; 4) Who performed USI; 5) Anatomical region; 6) Methods of USI; 7) Additional imaging; 8) Final diagnosis; and 9) Case outcome. Of the 172 papers reviewed for inclusion, 42 were evaluated. Most common anatomical regions scanned were the foot and lower leg (23%), thigh and knee (19%), shoulder and shoulder girdle (16%), lumbopelvic region (14%), and elbow/wrist and hand (12%). Fifty-eight percent of the cases were deemed static, while 14% reported using dynamic imaging. The most common indication for USI was a differential diagnosis list that included serious pathologies. Case studies often had more than one indication. Thirty-three cases (77%) resulted in confirmation of a diagnosis, while 29 case reports (67%) documented significant changes in physical therapy intervention strategies due to the USI, and 25 case reports (63%) resulted in referral. This review of cases provides details on unique ways USI can be used during physical therapy patient care, including aspects that reflect the unique professional framework.

Interstitial Lung Disease in Primary Biliary Cholangitis: A Cohort Prospective Study.

Interstitial lung disease (ILD) has been recognized as an extrahepatic manifestation ofprimary biliary cholangitis (PBC), althoughlimited data are available on its prevalence and clinical significance. Therefore, we evaluated the occurrence and clinical features of ILD in a cohort of PBC patients. Ninety-three individuals without concomitant rheumatic diseases were enrolled in our prospective cohort study. All patients underwent chest high-resolution computed tomography (HRCT). Liver-related and lung-related survival wereassessed. A lung-related outcome was defined as death from ILD complications; a liver-related outcome was defined as liver transplantation or death from liver cirrhosis complications. HRCT findings suggestive ofILD were detected in 38 patients (40.9%). A sarcoid-like pattern of PBC-associated ILD was the most frequent, followed by subclinical ILD and organizing pneumonia. Patients with ILD were less likely to have liver cirrhosis and liver-related symptoms and presented with higher serum immunoglobulin M(IgM) and M2 subtype antimitochondrial antibodies (AMA-M2) positivity rates. In a multivariate analysis, the absence of liver disease symptoms at the disease presentation (OR 11.509; 95% CI 1.210-109.421; p = 0.033), the presence of hepatic non-necrotizing epithelioid cell granulomas (OR 17.754; 95% CI 1.805-174.631; p = 0.014), higher serum IgM (OR 1.535; 95% CI 1.067-2.208; p = 0.020) and higher blood leukocyte count (OR 2.356; 95% CI 1.170-4.747; p = 0.016) were independent risk factors associated with ILD in PBC. More than a third of patients with ILD showed no respiratory symptoms, and only one ILD-related death occurred during a follow-up of 29.0 months (IQR 11.5; 38.0). Patients with ILD had better liver transplant-free survival.ILD in PBC had a benign course and was associated with a lower liver disease severity. PBC-associated ILD should be included in a list of differential diagnoses of ILD.

Acute Tonsillitis Due To Monkeypox

BackgroundThe emerging 2022 human mpox virus outbreak has presented with unique disease manifestations challenging prior case definitions. Case ReportWe present a case of a 42-year-old transgender woman with human immunodeficiency virus controlled on antiretroviral therapy, presenting with sore throat, who, after three emergency department visits, was found to have acute tonsillitis complicated by airway obstruction secondary to mpox. Why Should an Emergency Physician Be Aware of This?Sore throat is a common presentation to the emergency department. mpox should be placed on the list of differential diagnoses when evaluating patients who present with pharyngitis to avoid complications or a missed diagnosis.

Adrenal incidentaloma: A case report of Pheochromocytoma (PCC) with atypical radiological features

Abstract Introduction Adrenal incidentaloma (AI) is an adrenal lesion ≥ 1 cm discovered accidentally during an imaging technique not aimed to assess the adrenal gland (1). Most AIs are benign and nonfunctioning, about 20% are functioning in form of hypercortisolism, hyperaldosteronism, pheochromocytoma (PCC) or sex steroid overproduction (2). Computed Tomography (CT) scan is vital in differentiating adenoma from non-adenoma. Triphasic CT adrenal protocol (TCTAP) with absolute percentage washout (APW) has good sensitivity and specificity in diagnosis of AI. Here we present a case of PCC with atypical CT features. Clinical Case A 45 years old male patient presented with abdominal pain, abdominal US revealed a right suprarenal mass of 55 mm and referred to endocrinologist for further management. During assessment, the patient had attacks of hypertension, no cushingoid features, BMI was 35 kg/m2 and his blood pressure 180/120 mmHg. Normetanephrine was very high (1016.9 pg/mL), cortisol (10.1 μg/dL), suppressible serum cortisol (1.7 μg/dL), normal DHEA-S (110 μg/dL) and ACTH was 13 pg/mL. Aldosterone, renin, aldosterone/renin ratio (ARR), Metanephrine, K+ are normal. TCTAP showed a homogenous 51×46 mm right adrenal mass of a native Hounsfield units (HU) of 25, portal phase HU of 86, delayed phase (at 15 minute) HU of 36 and APW was 81%, which are features consistent with lipid poor adenoma (LPA) rather than PCC or carcinoma. The patient referred to surgery, right adrenalectomy had been done after good preparation and the diagnosis of PCC had been confirmed by histopathological (HP) and immunohistochemical (IHC) staining. TCTAP used to differentiate adenomatous from non-adenomatous AI with good sensitivity and specificity (3). PCC is an uncommon with variable clinical presentation ranging from severe symptoms to very mild and even sometimes discovered incidentally as AI with about 1.5–14% of all cases of AIs (1). PCC has heterogeneous texture, variable sizes, native HU > 10, avid enhancement and slow washout (4). The present AI was homogenous, has a native HU of 25 and has avid enhancement at portal phase reaching to 86 HU, but the APW was 81% which is atypical for PCC, making lipid poor adenoma at the top list of differential diagnoses. Hormonal assessment revealed the diagnosis of PCC which was confirmed by histopathological (HP) and immunohistochemical (IHC) staining. An American study showed that two of eight PCCs have an APW > 60%, but both of these cases have native HU< 10 and the APW had been calculated at 10 minutes (5). Coincided with our patient and our protocol of 15-minute APW calculation, Yoon et al presented a case of PCC with native HU of 37, portal phase HU of 127 and delayed phase HU of 62 HU with APW of 72% (6). Conclusion PCC is serious condition, could be asymptomatic and may be presented with a typical radiological feature, so biochemical and hormonal assessment is a cornerstone in management of AI.

Wandering, twisted spleen in a deerhound

AbstractA 14‐month‐old, entire, deerhound bitch experienced episodes of abdominal discomfort. During some episodes, the abnormally shaped spleen could be palpated in the dorsocaudal abdomen, rather than in its normal cranioventral location. Exploratory laparotomy revealed an enlarged spleen that was twisted on its long axis but not on its suspensory ligaments. The spleen was excised, and the dog made an uneventful recovery. To the best of our knowledge, this is the first report of a so‐called wandering spleen in a dog, a condition that has been described in humans, albeit rarely. This also is the first report of a twisted spleen in a dog. Veterinary practitioners should include these two possibilities (wandering spleen and twisted spleen) in their list of differential diagnoses when presented with a dog experiencing abdominal discomfort or with an abdominal mass.

Investigating hypercalcaemia in cats and dogs

Background: Hypercalcaemia is an important biochemical abnormality in dogs and cats and can lead to a wide variety of clinical signs, including polyuria, polydipsia and vomiting. It can be caused by several diseases of which the prognoses are variable. Both dogs and cats should undergo appropriate investigations, and cat owners in particular must be prepared for likely extensive investigation, excluding all known aetiologies, before a potential diagnosis of idiopathic hypercalcaemia. Understanding calcium physiology and pathophysiology can help both the general practitioner and referral practitioner streamline their investigation and achieve a rapid diagnosis. Hypercalcaemia has a well‐defined list of differential diagnoses and methodical investigation will allow the clinician to optimise patient outcome.Aim of the article: This article describes a stepwise approach to the investigation of patients with ionised hypercalcaemia, and highlights some of the key differences between dogs and cats.

Infarto cerebral e meningoencefalite trombótica em um bezerro devido a candidíase

ABSTRACT: We described a case of cerebral infarction and thrombotic meningoencephalitis due to candidiasis in a seven-month-old calf. The death occurred three days after the onset of apathy, fever, and the head’s lateral deviation to the left. Macroscopic changes in the brain consisted of asymmetry of telencephalic hemispheres; the right hemisphere was enlarged, causing cerebellar herniation. A focally extensive red area was observed on the surface of the right occipital lobe. At cross-sections of the fixed brain, the lesions revealed to be extensive, red-brown, soft or cavitated areas affecting the white and grey matter from the level of the thalamus to the cerebellum and compressing subjacent structures. Histologically, there was acute, coalescent, multifocal necrosupurative meningoencephalitis, associated with vasculitis, congestion, thrombosis, edema, infarction, and intralesional fungal hyphae. The diagnosis of cerebral infarction and thrombotic meningoencephalitis due to candidiasis was made by the pathological changes, the staining and morphological characteristics of the agent, and immunohistochemistry. The cerebral infarction and thrombotic meningoencephalitis in cattle can result from vascular lesions due to infection by Candida sp.; although uncommon, this case demonstrated that candidiasis should be part of a list of differential diagnoses of severe brain injuries in cattle.

Eyes Cannot See what the Mind Does not Know!

We present a previously healthy female who presented with life-threatening bilateral pneumonia causing respiratory failure associated with severe hemolysis. Because of their endemicity in India, malaria, dengue, and leptospirosis top the list of differential diagnosis in such cases. However, we found an alternate cause.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging.

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

Acute Chest Syndrome.

Acute Chest Syndrome.

Mimics of cancer in pregnancy.

Pregnancy is a remarkable time of pronounced growth and development of the fetus. Benign pathologies outside of the uterus, including those containing hormonally responsive tissue which undergo physiologic changes and other incidentally identified lesions, may mimic malignancy on clinical evaluation and imaging. A detailed history and physical exam, ultrasound and non-contrast magnetic resonance imaging features and comparison with prior imaging if available may help to narrow the list of potential differential diagnoses. Follow-up imaging in the postpartum period is often vital to confirm benignity and, in some cases, sampling to confirm the diagnosis is necessary. This review will cover the clinical, pathological and multimodality imaging features of numerous potential mimickers of cancer in the setting of pregnancy organized by organ systems. The goal is to better equip abdominal radiologists to accurately identify benign disease and help guide further imaging or follow-up recommendations to avoid unnecessarily aggressive intervention and improve patient care.

Role of C - reactive protein for Assessment for Exploration of Acute Scrotum in Children: A Study was done in a Tertiary Care Hospital

Background: Acute scrotum comprises a long list of differential diagnosis. The patient suffering from an acute scrotal condition requires urgent medical care. It must be evaluated promptly and accurately to make a management plan especially to save the testis from necrosis in torsion. Decision making regarding the plan for exploration is more important than reaching an exact diagnosis. Objectives: To differentiate emergency surgical acute scrotal conditions from non-surgical cases. To establish an early diagnosis of acute scrotum in children. To avoid negative exploration of acute scrotum in many cases. Methods: Sixty four patients of different age groups ranging from neonate to 12 years were underwent surgical exploration under general anesthesia (GA) between January 2016 to December 2019. The study was conducted in the Faculty of Paediatric Surgery in Bangladesh Shishu Hospital & Institute (BSH&I). A total of 72 patients were admitted with acute scrotal pain and/or swelling and evaluated by taking detailed history of presenting complaints, careful physical examinations, different laboratory investigations including serum c-reactive protein (CRP) level and radiology & imaging studies whenever appropriate and available. Results: Out of 72 cases admitted for acute scrotum, serum C - reactive protein (CRP) level estimation was done in all cases and surgical exploration was done in 64 cases. Total sample size was 64. In age incidence majority of patients were >1 year-6 years (37.5%) and >6 years-12 years (34.37%). Majority of patients came with scrotal swelling (100%), pain (93.77%) and fever (65.62%). Majority of patients came after 48 hours of onset of symptoms and exploration was performed within 6 hours to 12 hours. Blood collection was done >48 hours since complaints in majority cases (59.38%). Serum CRP level was negative in majority cases of Torsion testis (TT) and Torsion appendix testis (TAT). Total count of WBC was raised in majority of inflammatory cases ...

Diagnostic Testing Procedures and Challenges for Primary Immunodeficiencies

Primary immunodeficiencies are rare but are often on the differential diagnosis list when patients present with recurrent or atypical infections. Patients with primary immunodeficiencies can present with a variety of symptoms and can present providers with diagnostic challenges given this variability, and the severe implications of immunodeficiencies can sometimes lead providers to pursue broad workups that may not be necessary. However, there are certain symptom patterns providers can look out for and diagnostic steps that can be taken to triage these presentations. We have used the practice modeled in the "Five Fingers of the Immune Workup" to outline common laboratory tests for clinicians to order when they are concerned for immunodeficiencies while remembering that these diagnoses are often rare, and true concern for this pathology would warrant referral to a specialist. [Pediatr Ann. 2022;51(12):e480-e484.].

Diabetic Myonecrosis: A Vascular Complication.

Diabetic myonecrosis is an unpublicised problem that can occur in patients having either type 1 or type 2 diabetes mellitus. It usually affects patients who have long-standing, uncontrolled diabetes with associated microvascular complications. We report a case of a 78-year female with diabetic myonecroses admitted to a tertiary care hospital. Although it is a self-limiting disease, we lay down the management approach of how to exclude the extensive list of differential diagnoses and limit the life-threatening complications as urgent evaluation is critical. Clinicians taking care of patients with uncontrolled diabetes should be mindful and aware of the complication of diabetic myonecrosis in a patient presenting with pain in any limb and having negative venous doppler ultrasound for deep vein thrombosis. Magnetic resonance imaging (MRI) is the most specific and sensitive modality for diagnosis. Muscle biopsy can be used for anomalous cases. Although diabetic muscle infarction is a rare pathology, it presents a high risk for diabetes-related morbidity and mortality. Key Words: Myonecrosis, Diabetes mellitus, Doppler ultrasound, Magnetic resonance imaging.