Similar Radiological Findings Research Articles

Proportion of Patients Pulmonary Cancer With History of Slow Diagnosis Due to Diagnosis as Lung Tuberculosis

Background: In tuberculosis (TB) endemic countries, the diagnosis delay in lung cancer is due to initially misdiagnosed as pulmonary tuberculosis. The major concern that rose since early diagnosis of lung cancer could improve survival by tumor resectability chance and chemo-radiotherapy modality options. This study objective was to find out the proportion of lung cancer diagnosis delay due initially to misdiagnosed as pulmonary TB.
 Method: The cross-sectional study was held in Persahabatan Hospital and the subjects were histopatologically proven lung cancer patients between September 2012 to February 2013 involving totally 100 patients. The diagnosis delay were determined as whether the patients had been diagnosed as pulmonary tuberculosis and received anti-tuberculosis treatment (ATT) more than one month since current symptoms onset. All patients were interviewed and all chest X-rays were documented.
 Results: Fourty one of 100 patients were diagnosed as pulmonary TB and 29 of 41 patients received ATT more than one month. It consisted of 21 men and 8 women with the mean age of 51.5 years old. The cytology and histopatological biopsy revealed 28 Non Small Cell Lung Cancer (NSCLC) cases, and One Small Cell Lung Cancer (SCLC) case with all case were in end stage condition (6 cases in stage III and 22 cases in stage IV). Pre-referral sputum Acid Fast Bacilli (AFB) was conducted in only 9 cases with all negative results. Mean duration of ATT taken was 4.5±0.4 months. The ATT were given by 13 general practitioners, 12 pulmonologists and 4 internists.
 Discussion: Similar radiological findings in highly incidence of pulmonary TB could cause a large number of diagnosis delay in lung cancer due to initially diagnosed as pulmonary tuberculosis. Without proper investigation based on International Standard of TB Care, starting ATT with inadequate evaluation leads to diagnosis delay and lung cancer progression. (J Respir Indo 2019; 39(2))

Machine learning applications for the differentiation of primary central nervous system lymphoma from glioblastoma on imaging: a systematic review and meta-analysis.

OBJECTIVEGlioblastoma (GBM) and primary central nervous system lymphoma (PCNSL) are common intracranial pathologies encountered by neurosurgeons. They often may have similar radiological findings, making diagnosis difficult without surgical biopsy; however, management is quite different between these two entities. Recently, predictive analytics, including machine learning (ML), have garnered attention for their potential to aid in the diagnostic assessment of a variety of pathologies. Several ML algorithms have recently been designed to differentiate GBM from PCNSL radiologically with a high sensitivity and specificity. The objective of this systematic review and meta-analysis was to evaluate the implementation of ML algorithms in differentiating GBM and PCNSL.METHODSThe authors performed a systematic review of the literature using PubMed in accordance with PRISMA guidelines to select and evaluate studies that included themes of ML and brain tumors. These studies were further narrowed down to focus on works published between January 2008 and May 2018 addressing the use of ML in training models to distinguish between GBM and PCNSL on radiological imaging. Outcomes assessed were test characteristics such as accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).RESULTSEight studies were identified addressing use of ML in training classifiers to distinguish between GBM and PCNSL on radiological imaging. ML performed well with the lowest reported AUC being 0.878. In studies in which ML was directly compared with radiologists, ML performed better than or as well as the radiologists. However, when ML was applied to an external data set, it performed more poorly.CONCLUSIONSFew studies have applied ML to solve the problem of differentiating GBM from PCNSL using imaging alone. Of the currently published studies, ML algorithms have demonstrated promising results and certainly have the potential to aid radiologists with difficult cases, which could expedite the neurosurgical decision-making process. It is likely that ML algorithms will help to optimize neurosurgical patient outcomes as well as the cost-effectiveness of neurosurgical care if the problem of overfitting can be overcome.

Myositis Ossificans in Elbow Mimicking Soft Tissue Sarcoma: Similar Clinical and Radiological Findings

Myositis Ossificans in Elbow Mimicking Soft Tissue Sarcoma: Similar Clinical and Radiological Findings

A 2-Week Steroid Trial for Differentiating Isolated IgG4-Related Sclerosing Cholangitis from Cholangiocarcinoma

Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is rare disease which is steroid-responsive and often associated with IgG4 related systemic disease such as autoimmune pancreatitis. It is characterized by increased serum IgG4 and IgG4- positive lymphoplasmacytic infiltration in bile ducts. It is often difficult to distinguish IgG4-SC to hilar cholangiocarcinoma if it manifests as an isolated bile duct. We report a case of 79-year-old woman with IgG4-SC which was difficult to distinguish hilar cholangiocarcinoma due to similar clinical and radiologic findings, showing good therapeutic effect after a 2-week steroid trial.

Is the pathology related to the amount of pleural thickening measured by thorax CT?

Background: Pathologies associated with pleural thickening are presented along with similar clinical and radiological findings. The present study highlights the importance of the differential diagnosis verification of patients with pleural thickening. Video-assisted thoracoscopic surgery (VATS) is one of the most common diagnostic and therapeutic method used for this purpose. In this study, we aim to deliver our clinical investigation results on patients diagnosed with pleural pathology in the light of recent literature. Methods: During the period of May 2012-June 2014, single port VATS pleural biopsy were successfully performed on 40 patients (25 male and 15 female) in our hospital. Thoracic CT and pathology results were compared. Clinical diagnosis, radiologic findings, and biopsy results were evaluated retrospectively. Results: The average age of the patients is 59.15 ±12.13 (age range 23, 82). There was an environmental exposure to asbestos in 14 patients (35%). 25 patients (62.5 %) was followed with clinical pre-diagnosis of mesothelioma, 8 patients (20%) of tuberculosis, 4 patients (10%) of pleural metastasis and 3 patients (7.5 %) of pleuritis. Histopathologically 8 patients (20%) were diagnosed with malignant mesothelioma, 1 patient (2.5 %) was localized fibrous tumor, 2 patients were (5%) diagnosed with reactive mesothelial hyperplasia, 6 patients (15%) were malignant epithelial tumor metastasis, 16 patients (40%) were fibrinous pleuritis, 6 patients (15%) were chronic granulomatous inflammation, and 1 patient (2.5%) was chronic lymphocytic inflammation. Conclusions: The present study demonstrates insufficency of thoracic CT for diagnosis and differential diagnosis due to similar clinical and radiological findings associated with pathological pleural thickening. Histopathologic examination is required for diagnosis. However, thoracic CT is still a method of radiographic imaging that is actively used in determination of pleural biopsy position, evaluation, and clinical monitoring of response to treatment.

Intestinal tuberculosis and Crohn's disease: the importance and difficulty of a differential diagnosis.

Tuberculosis (TB) is the most prevalent infection worldwide and affects one third of the population, predominantly in developing countries. Intestinal TB (ITB) is the sixth most frequent extra-pulmonary TB infection. Crohn's disease (CD) is a chronic inflammatory bowel disease that arises from the interaction of immunological, environmental and genetic factors. Due to changes in the epidemiology of both diseases, distinguishing CD from ITB is a challenge, particularly in immunocompromised patients and those from areas where TB is endemic. Furthermore, both TB and CD have a predilection for the ileocecal area. In addition, they share very similar clinical, radiological and endoscopic findings. An incorrect diagnosis and treatment may increase morbidity and mortality. Thus, a great degree of caution is required as well as a familiarity with certain characteristics of the diseases, which will aid the differentiation between the two diseases.

Advances in the Pathology and Molecular Biology of Sarcomas and the Impact on Treatment

Sarcomas are a complex group of childhood and adult neoplasms with differentiation towards mesenchymal tissues that can occur at almost every anatomic site. Although pathologically diverse, they frequently show similar clinical presentations and radiological findings, such that correct histopathologic diagnosis, utilising the appropriate ancillary immunohistochemical and molecular techniques, underpins their management. This article gives an overview of the pathology, coupled with recent advances in molecular biology, of a selection of soft tissue sarcomas from a clinicopathological perspective, discussing histopathological diagnosis with developments in molecular diagnosis and the incorporation of these findings into diagnostic practice and current and potential targeted treatments.

The Common Accomplice of Pains, Moans, Groans: Imaging of Brown Tumors Debusted

Brown tumors are focal bone lesions, caused by increased osteoclastic activity and fibroblastic proliferation, encountered in patients with uncontrolled hyperparathyroidism (HPT). They can be located in any part of the skeleton, but are most frequently encountered in the ribs, clavicles, extremities, and pelvic girdle. Clinically significant lesions in the craniofacial bones are rare Brown tumors are focal reactive osteolytic lesions caused by hyperparathyroidism (HPT) and represent the terminal stage of the hyperparathyroidism-dependent bone pathology. Nowadays, the manifestation of hyperparathyroidism with these lesions is extremely rare in developed countries, because of the early detection of the disease, using routine laboratory examination and early treatment of that. These benign lesions present similar radiologic findings as bone metastasis, which makes the diagnosis difficult Brown tumors are focal bone lesions, caused by increased osteoclastic activity and fibroblastic proliferation, encountered in patients with uncontrolled hyperparathyroidism (HPT). They can be located in any part of the skeleton, but are most frequently encountered in the ribs, clavicles, extremities, and pelvic girdle. Clinically significant lesions in the craniofacial bones are rare Brown tumors are focal reactive osteolytic lesions caused by hyperparathyroidism (HTP) and represent the terminal stage of the hyperparathyroidism-dependent bone pathology. Nowadays, the manifestation of hyperparathyroidism with these lesions is extremely rare in developed countries, because of the early detection of the disease, using routine laboratory examination and early treatment of that. These benign lesions present similar radiologic findings as bone metastasis, which makes the diagnosis difficult.

Cerebral Venous Thrombosis in Behçet's Disease Patients Compared to Other Causes of Cerebral Venous Thrombosis: a Retrospective Study.

This study aims to report the outcomes of patients with Behçet's disease (BD) with cerebral venous thrombosis (CVT) due to BD compared to patients with CVT due to other causes and to discuss the treatment options. Files of 47 patients admitted to our outpatient clinic for CVT between January 2007 and November 2014 were retrospectively reviewed. Patients were divided into two groups; group 1 included 21 CVT patients with BD (9 males, 12 females; mean age 47±12 years; range 27 to 69 years) and group 2 included 26 CVT patients without BD (11 males, 15 females; mean age 45±16 years; range 25 to 79 years). We collected data for diagnosis for BD and CVT, duration of all medications, functional system involvement, baseline Expanded Disability Status Scale scores, modified Rankin Scale scores at follow-up, and localizations of lesions in brain magnetic resonance imaging and magnetic resonance venography. Mean follow-up duration was four years in group 1 and two years in group 2. There was no significant difference between the groups regarding age, sex, neurological symptoms/findings and baseline Expanded Disability Status Scale scores. Localizations of occluded sinus in group 1 and group 2 were similar. For acute CVT, patients were treated with intravenous high dose prednisolone in group 1 and with anticoagulant in group 2. Follow-up modified Rankin Scale score was 0 in both groups. Our study revealed similar clinical and radiological findings in CVT patients with or without BD. Although medications used for treatment were different between the groups, treatment responses were good in both groups. Treatment with prednisolone may be sufficient and anticoagulation therapy may not be necessary for acute CVT attacks in BD.

Gender and hormonal influences in reversible cerebral vasoconstriction syndrome

The reversible cerebral vasoconstriction syndromes, including postpartum angiopathy, have been characterized over the last decade. Women are predominantly affected. Some studies suggest that postpartum angiopathy carries a worse prognosis. We compared the clinical, neuroimaging, and angiographic features of 36 men, 110 non-pregnant women and 16 postpartum women included in our single-center cohort of patients with reversible cerebral vasoconstriction syndromes encountered from 1998 to 2016. As compared to men, non-pregnant women were older (48 ± 11 vs. 34 ± 13 years, p < 0.001), had more underlying migraine (49% vs. 19%, p = 0.002), depression (53% vs. 14%, p < 0.001) and serotonergic antidepressant use (45% vs. 11%, p < 0.001), developed more clinical worsening (18% vs. 3%, p = 0.022), more infarcts (39% vs. 20%, p = 0.031) and worse angiographic severity scores (23 ± 14 vs. 10.9 ± 10.3, p < 0.001), but had similar discharge outcomes (modified Rankin scale scores 0-3, 90% vs. 91%, p = 0.768). Sexual activity was an important trigger in men (22% vs. 4%, p = 0.002). As compared to non-pregnant women, postpartum angiopathy patients were younger (33 ± 6 years, p < 0.001) and had less vasoconstrictive drug exposure (25% vs. 67%, p = 0.002) but showed similar clinical, radiological and angiographic findings and similar discharge outcomes (modified Rankin scale scores 0-3 in 94%, p = 0.633). There were no significant differences between pre- and post-menopausal women, or those with and without hysterectomy. The observed gender differences in reversible cerebral vasoconstriction syndromes may result from hormonal or non-hormonal factors. Hormonal imbalances may trigger reversible cerebral vasoconstriction syndromes. Given the absence of significant differences in the female subgroups, hormonal factors do not appear to significantly affect the course or outcome of reversible cerebral vasoconstriction syndromes.

Florid Diffuse Peritoneal Deciduosis Mimicking Peritoneal Carcinomatosis: A Case Report

Deciduosis is defined as the presence of decidual tissue in an ectopic site and must be distinguished from the more alarming conditions that it can simulate. Ectopic decidua is observed usually in the uterus, cervix, fallopian tube, and the ovaries. Peritoneal location is rare. It usually involutes within four to six weeks postpartum. We present this case because of its similar clinical and radiological findings with malignancy.

Gross examination and reporting of soft tissue tumours: evaluation of compliance with the UK Royal College of Pathologists soft tissue sarcoma dataset

AimsSoft tissue tumours are a heterogeneous group of neoplasms that can arise at almost every anatomical site. As they often show similar clinical and radiological findings, histology is the definitive...

Ulnar Abutment Syndrome

With regard to the published article “arthroscopic curettage of intraosseous ganglions of lunate bone” in the last journal edition, it is time to review ulnar abutment syndrome with similar clinical and radiologic findings (1). The main cause of this syndrome is the overload of carpal bones, especially lunate bone related to positive ulnar variance. In normal wrist, 20% of the load is transmitted to ulna whereas 2 mm positive ulnar variance increases this load up to 40%. This problem may even happen in normal wrists because of ulnar variance changes during forearm rotation (2). Other predisposing factors are radial shortening after healed distal radius fractures, scapholunate dissociation, lunatotriquetral dissociation and triangular fibrocartilage complex (TFCC) tears. Most of these patients have pain in ulnar side of wrist associated with dorsoulnar wrist tenderness and positive Nakamura's ulnar stress test (ulnar side wrist pain during flexion and extension of ulnar deviated and pronated and axially loaded wrist). Differential diagnoses are lunate ganglion cysts, vascular grooves and Kienbock’s disease. Routine X-ray and MRI are useful for diagnosis. Radiologic findings are positive ulnar variance associated with lunate sclerosis and sometimes lunate cysts. Pronated grip view may better define ulnar impactions. Diagnostic MRI findings are TFCC degenerative tears and lunate chondromalacia. First line of treatment is nonoperative, including decreasing wrist load and using pain killers. In the absence of good response, operative treatment may be indicated. The most prevalent surgical treatment is ulnar shortening osteotomy to unload lunate bone (3). Alternative option is wafer distal ulna resection (removal of 2 4 mm of distal ulna below TFCC). In Palmers types 2a through 2D, (4) salvage procedures are distal ulna resection in low demand patients (Darrach procedure), Sauve-Kapandji procedure in manual laborers, distal ulnar hemi-resection arthroplasty, and finally ulnar head replacement.

Intracranial meningeal hemangiopericytoma: Recurrences at the initial and distant intracranial sites and extraneural metastases to multiple organs.

Regardless of the controversial pathogenesis, intracranial meningeal hemangiopericytoma (M-HPC) is a rare, highly cellular and vascularized mesenchymal tumor that is characterized by a high tendency for recurrence and extraneural metastasis, despite radical excision and postoperative radiotherapy. M-HPC shares similar clinical manifestations and radiological findings with meningioma, which causes difficulty in differentiation of this entity from those prognostically favorable mimics prior to surgery. Treatment of M-HPC, particularly in metastatic settings, remains a challenge. A case is described of primary M-HPC with recurrence at the initial and distant intracranial sites and extraneural multiple-organ metastases in a 36-year-old female. The metastasis of M-HPC was extremely extensive, and to the best of our knowledge this is the first case of M-HPC with delayed metastasis to the bilateral kidneys. The data suggests that preoperative computed tomography and magnetic resonance imaging could provide certain diagnostic clues and useful information for more optimal treatment planning. The results may imply that novel drugs, such as temozolomide and bevacizumab, as a component of multimodality therapy of M-HPC may deserve further investigation.

The clinical experience of recurrent central nervous system hemangioblastomas

ObjectiveHemangioblastomas (HBLs) of the central nervous system are benign vascular tumors that may occur sporadically or in von Hippel–Lindau disease (VHLD). We analyzed the clinical and radiological findings of HBLs focusing on recurrence. Material and MethodsFrom 1998 to 2012, 36 patients with HBLs were treated. Twenty nine patients (80.6%, mean age 46.7 years) had sporadic HBLs and seven (19.4%, mean age 39 years) had HBLs associated with VHLD. Initially, the mass was totally removed in 32 patients, subtotally in one and partially in one, and gamma knife radiosurgery was done in two patients. The mean duration of follow-up was 48.4 months. We retrospectively analyzed the clinical and radiologic findings. ResultsThe location of cerebellum and brainstem was common. The HBLs of spinal cord and cerebral hemisphere were related with VHLD. The common radiologic findings of sporadic HBLs showed a cyst with a mural nodule in 15 patients (51.7%) and pure solid lesion in eight (27.6%). In HBLs related with VHLD, five of seven patients had multiple lesions and pure solid mass was common. Three (10.3%) and two (28.6%) patients showed recurrence in sporadic and VHLD-related HBLs, respectively. Two totally resected mural nodules on the cyst showed recurrence with similar radiologic findings 3 years later in sporadic HBLs. In recurred HBLs related with VHLD, one pure solid mass and one mural nodule on cyst showed the local recurrences after the total resection 8 years later and associated with distant recurrence. ConclusionsAll patients should be more specifically followed to detect local and distant recurrence, even if the clinical course was benign and mass was totally removed.

Unusual presentation of retroperitoneal leiomyosarcoma mimicking an adnexal tumor with highly elevated serum CA-19-9

When retroperitoneal leiomyosarcoma develops in pelvic cavity, it often presents similar symptoms and radiological findings to adnexal tumor, therefore obscures diagnostic approaches until an exploratory laparotomy is performed. We report an unusual presentation of retroperitoneal leiomyosarcoma mimicking an adnexal tumor with extremely elevated serum CA-19-9. Though the most of the prominent mass was removed during surgery, there was massive bleeding due to tearing of internal iliac vein while dissecting the ureter close to vessels. This case focuses on the significance of considering retroperitoneal tumor even if the mass is located in ovarian fossa and has highly elevated serum level of CA-19-9. And in attempt of tumor removal, the excision needs to be clean-cut without damaging nerves or vessels around the mass and avoid causing any prospective complications.

Carotidynia: Similar Clinical Picture, Different Radiological Findings

Carotidynia is an unusual condition that is characterized by pain at the carotid artery bifurcation without any abnormality except for tenderness on palpation. The independent existence of this entity is generally doubted. Recently, some radiological and histological clues to this disease have been reported. Although the exact cause of carotidynia is unknown it is thought that this entity is a self-limiting inflammatory process and may be a subset of vasculitis. Treatment is conservative and anti-inflammatory drugs are effective. In this paper, we report three carotidynia patients with similar clinical features but different radiological findings.

Successful treatment of pulmonary angiosarcoma along with pulmonary endarterectomy and pulmonary valve replacement

Pulmonary endarterectomy (PEA) is an effective treatment of choise for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Symptoms of pulmonary angiosarcoma (PS) can mimic CTEPH, showing similar radiological findings. In this article, we report on a 69-year-old male case with progressive dyspnea and angina. Clinical and radiographic examination revealed pulmonary hypertension with a mass extending to the pulmonary valve, indicating potential PS in the differential diagnosis. A pulmonary valve replacement was performed concurrently with PEA surgery. Histological examination confirmed the diagnosis of PS. The patient was referred into a local oncology service for adjuvant chemotherapy.

GM1 Gangliosidosis, Late Infantile Onset Dystonia, and T2 Hypointensity in the Globus Pallidus and Substantia Nigra

GM1 gangliosidosis is a rare disease due to mutations in the GLB1 gene and autosomal recessive deficiency of β-galactosidase. There is considerable overlap between classical phenotypes and clinical and imaging findings, which are often difficult to interpret. The patient in this study had dysmorphism, dysostosis, progressive dystonia, and T2 hypointensity in the basal ganglia. Partially similar clinical and radiologic findings were described previously in two reports. T2 hypointensity in the globus pallidus should, in the appropriate clinical setting, lead to consideration of the diagnosis of GM1 gangliosidosis.

Primary Intraosseous Hemangioma in the Frontal Bone

Primary Intraosseous Hemangioma in the Frontal Bone