Unilateral Edema Research Articles

Pronounced unilateral eyelid edema secondary to hypoalbuminaemia

Pronounced unilateral eyelid edema secondary to hypoalbuminaemia

Unilateral Leg Edema as the First Manifestation of Testicular Seminoma in a Kidney Transplant Patient

Unilateral Leg Edema as the First Manifestation of Testicular Seminoma in a Kidney Transplant Patient

Time to fellow eye involvement in patients with unilateral diabetic macular oedema.

To examine the time to onset of disease in the fellow eye of patients with unilateral DMO in routine clinical practice and to identify risk factors for development of bilateral DMO. Retrospective cohort study. One hundred forty treatment-naive patients 18 years or older with unilateral DMO presenting to Cole Eye Institute between January 2012 and July 2021. Records of patients with unilateral DMO were reviewed for development of DMO in the fellow eye. Demographic, diabetic, ocular, and systemic characteristics were collected at initial DMO diagnosis date. Bivariate and multivariate analyses were performed and significant factors were modelled using Kaplan-Meier curves. Fifty patients with conversion to bilateral DMO and 90 patients without conversion were identified. Average time to bilateral DMO was 15.0 ± 15.7 months. 64% of patients converted within 1 year and 90% converted within 3 years. HbA1c (p = 0.003), diabetic retinopathy duration (p = 0.029), and diabetic foot disease (DFD) (p = 0.002) were identified as significant risk factors for conversion. Patients with better visual acuity at time of initial diagnosis and history of panretinal photocoagulation (PRP) (p = 0.044) or focal laser (p = 0.035) in the primary eye were also more likely to convert. Participants were most likely to develop fellow eye DMO within the first year after initial DMO diagnosis. In routine clinical practice, poor glycaemic control and DFD were risk factors associated with bilateral eye involvement. Clinicians may consider screening the fellow eye of high-risk individuals at each appointment within the first year of diagnosis.

Diagnostic Challenge of d-dimer Negative Upper Extremity DVT

Studies suggest D-Dimer has a high sensitivity with negative predictive value for upper extremity DVT (UEDVT). Sensitivity is around 92% with a negative predictive value of 98%. UEDVT is an uncommon presentation with an incidence rate of 4-10%. Risk factors for UEDVT include thrombophilia, central venous catheters, malignancy, pacemakers and upper limb surgery and/or immobilisation. The use of scoring systems for assessing UEDVT risk is less well known and therefore poorly utilised. A scoring system similar to a Wells' score, known as Constans criteria, is a 2 level scoring system developed and first published in 2008. The Criteria considers, venous material in-situ, localised pain, unilateral oedema and plausibility of alternative cause. Score interpretation; -1 to 0 points (low probability of UEDVT 12%), 1 point (intermediate probability 20%), 2 to 3 points (high probability 70%). Kleinjan, et al., sought further improved upon this scoring tool by incorporating D-dimer results in the stratification of intermediate risk patients, asserting that its use can safely and effectively exclude venous thrombosis of the upper extremity. This case series shows 2 patients diagnosed with UEDVT. both patients had a Constans score of 1 therefore prompting use of D-Dimer results to stratify risk. Irrespective of negative D-dimer results, ultrasound doppler scans where performed and appropriate treatment given. The authors of this case series reviewed the limitations/interference factors of HemosIL HS D-Dimer reagent, along with 2 other D-Dimer reagents and subsequently developed recommendations which may be useful in interpretation of D-Dimers in clinical practice. Additionally, recommendation for cautious intrepretation of D-Dimer results in conjunction the Constans scoring tool with scores of 1 or less

Isolated Tonsillar Sarcoidosis Presenting with Dysphonia, Dysphagia, Unilateral Edema and Swelling of Oropharynx and Hypopharynx

Sarcoidosisis a chronic granulomatous condition that primarily affects the respiratory system. Its aetiology remains poorly understood. Isolated sarcoidosis of the palatine tonsils, when there is no evidence of disease elsewhere, is very rare occurrence, with only a few reported cases in the literature.

Lower Extremity Edema and Lesions Not Responsive to Conservative Therapy

A 66-year-old man with at least 2 years of progressively worsening unilateral left lower extremity edema and recurrent episodes of cellulitis of the anterior left lower leg, treated repeatedly with diuresis and antibiotic therapy, was referred by his rural family physician to the community paramedic (CP) service for diuresis, compression wrapping, wound care, and self-management education. His medical history included prior stroke with residual left-sided hemiplegia; insulin-treated type 2 diabetes complicated by peripheral neuropathy, retinopathy, and stage 3b chronic kidney disease; and obesity with body mass index 39 kg/m.

Prolonged neurologic deficits with brain MRI changes following ECT in an adolescent with a CACNA1a-related disorder; a case report

Electroconvulsive therapy is used to treat depression and schizophrenia with infrequent use in pediatric patients. We report a case of an adolescent with autism spectrum disorder and acute catatonia that presented with status epilepticus (SE) and prolonged neurologic deficits with unilateral left cerebral edema on imaging following unilateral electroconvulsive therapy (ECT) on the right side, subsequently found to have a CACNA1a pathogenic variant. This case highlights a potential adverse effect of ECT in patients with CACNA1a related disorders. The patient received unilateral ECT to the right side and subsequently had an episode of SE with right-sided hemiplegia for 72h prior to regaining some function with persistent mild right-hand weakness that persisted for at least 1-2weeks. A brain MRI 2days after ECT was unremarkable, but a repeat MRI on day four of admission showed left hemisphere cortical diffusion restriction, increased perfusion and T2 prolongation suggestive of cortical edema. They had whole exome genetic testing sent after discharge that showed a known pathogenic CACNA1a variant (p.I1709T). CACNA1a encodes the P/Q type calcium channels and deleterious variants in this gene result in a channelopathy associated with a spectrum of neurodevelopmental disorders that include autism spectrum disorder, hemiplegic migraine with unilateral cerebral edema, epileptic encephalopathies, or episodic ataxia syndromes. A literature review of ECT and neurologic deficits showed that most neurologic deficits resolve within 30min of ECT. Case reports of prolonged deficits are rare and there are no prior reports of acute MRI changes related to ECT. Thus, the acute deterioration and MRI findings in this patient are likely related to the underlying CACNA1a channelopathy disorder with ECT as a precipitating event. This case report suggests care should be taken when using ECT in patients with pathogenic variants in CACNA1a. Furthermore, it reinforces the utility and importance of expanded genetic testing in patients with neurodevelopmental disorders as findings can provide valuable information that can guide treatment decisions.

Unilateral asymptomatic optic disc edema: do not forget sinusitis

Background: Optic disc edema is a pathological condition with various causes. Cases of optic disc swelling should be dealt with a multidisciplinary approach to rule out those causes. Unilateral optic disc edema is seen in papillitis, non-arteritic anterior ischemic optic neuropathy, retinal vein occlusion, and infection or inflammation of the contiguous sinus or orbit. Here, we report a rare case of unilateral asymptomatic optic disc edema due to posterior ethmoid sinusitis. 
 Case Presentation: A 53-year-old man presented for a routine 3-monthly follow-up after an uneventful cataract surgery of the right eye. All examinations were unremarkable, except for the right eye optic disc edema on fundus examination, consistent with an enlarged blind spot in the visual field test. Contrast-enhanced magnetic resonance imaging revealed mucosal thickening with muco-inflammatory exudates of the posterior ethmoidal sinus overriding the optic disc on the right side, leading to optic disc edema of the right eye. The patient was diagnosed with unilateral asymptomatic optic disc edema in the right eye due to posterior ethmoid sinusitis and referred to an otorhinolaryngologist for the management. The otorhinolaryngologist performed functional endoscopic sinus surgery and prescribed antibiotics and anti-histamines for 6 weeks. At the final examination, his visual acuity was 6/6, and the fundus examination revealed no optic disc edema.
 Conclusions: We reported a rare case of unilateral optic nerve edema and visual field loss with a treatable cause. Contemporary imaging provided the accurate diagnosis. Therefore, in cases of disc edema, sinusitis of the adjacent paranasal sinuses should be ruled out as a possible cause of compressive optic neuropathy or inflammation overriding the optic nerve.

Painful unilateral facial swelling due to superficial temporal artery thrombosis: a rare presentation of Antiphospholipid Syndrome

Introduction Persistent painful unilateral temporal swelling is rarely seen in clinical practice. Antiphospholipid syndrome (APS) is an autoimmune and systemic disorder that causes changes in blood clotting homeostasis, marked by arterial or venous thrombosis, gestational morbidity, and high and persistently positive serum levels of antiphospholipid antibodies (aPL). APS is more common in young women and middle-aged adults, with no preference for race. Among its clinical features, temporal artery thrombosis, associated with headache and temporal and hemifacial edema is extremely rare, with few publications worldwide on this topic. Objective This report aims to present the case of a unilateral painful facial edema due to thrombosis of the superficial temporal artery as an unprecedented manifestation of Antiphospholipid Syndrome. Thus, the only record in the English-language literature surveyed in the Pubmed database in July 2022 highlights the rarity of this APS presentation and the consequent challenge in suspecting the correct diagnosis for adequate treatment. Methods Case report. Data disclosure was authorized by the patient through an informed consent form. Results A 32-year-old woman was presented with pain in the right temporal region of her face. The pain was intense, daily and continuous, pulsating, without irradiation, which worsened with physical activity and presented partial relief with common analgesics. After 20 days, she developed a right pale temporal edema (Figure 1) associated with a significant worsening of pain and intense right unilateral headache attacks triggered by chewing and speaking. She has a history of deep vein thrombosis in the left lower limb. Physical examination and imaging tests showed significant cold edema of the right temporal region with asymmetry of the temporal muscles, which was extremely painful on palpation and made it difficult to open the mouth. There were no other changes in the general physical... (Too see the complete abstract, please, check out the PDF.)

A RARE CASE OF PRIMARY CUTANEOUS DIFFUSE LARGE B-CELL LYMPHOMA, LEG TYPE: A CASE REPORT

Edema with ulceration is one of the common presentation encountered in the clinical setting. The main aim is to identify the cause of edema with ulceration and treat the underlying cause. The edema and ulceration can be unilateral or bilateral. The main cause of unilateral leg edema with ulceration is mainly due to venous insufficiency (deep vein thrombosis) and rarely because of tumor. Presence of unilateral limb edema with ulceration but without inguinal lymphadenopathy is extremely rare. In this paper, we are reporting a very rare case of Non Hodgkin Lymphoma (NHL) of lower limb with ulceration but no lymphadenopathy1, 2

A Patient With Recurrent Immune Stromal Keratitis and Adherence Challenges.

Herpes simplex keratitis (HSK) is a common yet potentially blinding condition caused by a primary or reactivated herpetic infection of the cornea. Immune stromal keratitis (ISK), a type of HSK, is classified by a cellular and neovascularization infiltration of the cornea, and patients with ISK may experience low-grade chronic keratitis for years. A 52-year-old man presented to the eye clinic complaining of a watery and itchy right eye with mildly blurred vision. With consultation from a corneal specialist, the patient was given the presumptive diagnosis of ISK in the right eye based on the unilateral corneal presentation and lack of corneal sensitivity. ISK presents unilaterally with decreased or absent corneal sensitivity and nonspecific symptoms. It should be at the top of the list in the differential diagnosis in any patient with unilateral corneal edema, opacification, or neovascularization, and the patient should be started on oral antiviral therapy.

Approach to: Venous Thromboembolism

Venous thromboembolisms can manifest as a spectrum of diseases and complications, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), as a consequence of hypercoagulability, endothelial damage and/or venous stasis. DVT can present as localized pain or heaviness, unilateral edema, dilatation of superficial nonvaricose veins, a palpable cord or Homans’s sign. Symptoms of PE include acute or worsening shortness of breath and pleuritic chest pain while physical examination may be remarkable for tachycardia and tachypnea. However, given their non-specificity, using these signs and symptoms alone allows for poor differentiation between VTE and other entities. This review will focus on a multi-step diagnostic tree allowing for evidence-based interpretation of tests following a determined pre-test probability (PTP), as per Thrombosis Canada recommendations and ASH clinical guidelines. An introduction to VTE in Pediatrics and pregnancy will also be discussed.

Morphologic and Functional Changes of Macula and Optic Nerve Head in Adult Kidney Transplant Recipient

To assess macular and optic nerve head characteristics in patients after kidney transplantation using noninvasive optical coherence tomography (OCT) imaging. The study had a prospective character and was performed during period from November 2019 to November 2020 at the University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina, and included 59 patients with renal graft who underwent OCT. The obtained OCT images, pathologic changes on the fundus, including macula and optic nerve, were analyzed by reviewing nonparametric measures such as scanning laser ophthalmoscope, B-scan, 3D display, as well as parametric measurements such as central macular thickness, optic nerve head excavation, and retinal nerve thickness fiber (RNFL). There is a statistically significant difference in RNFL values (P=0.031) and cup to disc (P=0.002) ratio in relation to duration of graft. The highest average values of RNFL was in patients with creatinine clearance <30 mL/min, while average cup to disc ratio was lowest in patients with creatinine clearance >60 mL/min. Optic nerve head edema was bilateral in 9 and unilateral in 5 patients. Fundus examination also revealed changes on posterior segment, including retinal detachment (1 patient), bilateral macular edema (9 patients), unilateral macular edema (3 patients), central serous chorioretinopathy (2 patients), and macular pseudo hole (3 patients). Different retinal pathology is present in high incidence in patients secondary to renal transplant. Immunosuppressive therapy, older age, and comorbidities are the usual causes of these changes.

A Case of Unilateral Corneal Edema after Exposure to 0.12% Cholorohexidine

Purpose: We report a case of permanent corneal opacity caused by unilateral chemical burns after exposure to a low-dose (0.12%) chlorhexidine antiseptic solution during a dental procedure.Case summary: A 33-year-old woman presented to our clinic with conjunctival injection, ocular irritation, and blurred vision in her right eye; all symptoms had been present for 2 weeks. These symptoms began several hours after a dental procedure, in which 0.12% chlorhexidine antiseptic solution had been splashed into the right eye. Initial examination revealed that the patient’s best-corrected visual acuity (BCVA) was 20/200 in the right eye. Slit lamp examination and anterior segment optical coherence tomography revealed substantial corneal edema and stromal infiltration on the nasal side. The patient’s BCVA improved to 20/20 in the right eye after 3 months of treatment with topical corticosteroid. However, the stromal opacity was permanent and the corneal endothelial cell count was substantially reduced to approximately 550 cells/mm2.Conclusions: Low-dose (0.12%) chlorhexidine on the ocular surface may cause irreversible corneal opacity and chemical burn-induced endothelial cell damage.

Severe Macular Edema after Traumatic Head Injury: A Case of Whiplash Maculopathy.

Whiplash or "traumatic" maculopathy is associated with retinal concussion, typically following the rapid acceleration/deceleration experienced in motor vehicle collisions. It has rarely been discussed in the literature, likely given the spontaneous and relatively rapid nature with which the acute macular edema resolves. A focused clinical history around the trauma, as well as characteristics signs and structural features on retinal imaging, help to distinguish this condition from other sequelae of concussive retinal injury. We report a case of whiplash maculopathy following a blunt injury to the head, which presented with unilateral and substantial macular edema in the left eye. Case report. A 38 year old male presented with complaint of a central scotoma in his left eye following a blunt trauma to his head. Comprehensive ophthalmological evaluation and retinal imaging with optical coherence tomography (OCT) confirmed whiplash maculopathy, with acute macular edema in his left eye. Management with observation and close follow-up showed rapid improvement in his visual symptoms over the course of days, and improvements in the severity of macular edema. One month following his injury, macular edema had resolved with only mild irregularities, the patient's vision had improved and he was asymptomatic. When observing patients with significant macular edema following concussive head injury, whiplash maculopathy should be considered, regardless of the history of motor vehicle collision. The condition can present with significant asymmetry of disease. The diagnosis generally carries a good prognosis for vision; however, there are cases of persistent central visual disturbances.

Unilateral vulval edema as the presenting cutaneous manifestation of Crohn's disease.

SynopsisVulval edema is an archetypal manifestation of metastatic Crohn's disease, which may predate clinical presentation of gastrointestinal Crohn's disease.

Unilateral primary breast edema: Can T2-weighted images meet the diagnostic challenge?

BackgroundUnilateral primary breast edema may pose a diagnostic challenge. Excluding malignant etiologies is of utmost importance and may require the use of dynamic MRI examination as a problem solver. Yet, the enhancement pattern of benign and malignant disorders associated with edematous breasts may overlap, and this may add to the dilemma. So, our aim in the current study was to assess the role of T2-weighted MR imaging as a problem-solving sequence in differentiating benign from malignant causes of the edematous breast.ResultsIn the current prospective study, 65/96 cases were benign and 31/96 cases were malignant. By the individual analysis of the signal intensity in T2-weighted imaging of MRI examination, there was a significant correlation between low T2 signal intensity lesion and malignant etiology of breast edema with a resultant higher sensitivity of 83.87% and a higher specificity of 98.46% as compared to the contrast-enhanced series, which achieved a sensitivity of 80.65% and a specificity of 20.00%. The combined assessment of T2 WI and the contrast-enhanced series yielded a higher sensitivity of 100% and a specificity of 98.46%.ConclusionsT2WI is a problem-solving sequence in the evaluation of the primary edematous breast, yielding a significant added value in the diagnostic approach and improving the overall diagnostic performance of dynamic contrast-enhanced MRI.

Oral Calcinosis Circumscripta Associated with Wasp (Hymenoptera vespidae) Sting in a Cat

In veterinary medicine, calcinosis circumscripta is a morphological diagnosis for which the cause may be known or idiopathic. The aetiology of the lesion must be investigated because the nature of the underlying disease process will dictate appropriate treatment. We present a case of oral calcinosis circumscripta in a cat caused by a wasp sting and associated with moderate unilateral facial oedema. Following corticosteroid therapy and oedema resolution, hyperaemic, circular, firm, elevated lesions were observed on the buccal mucosa and evolved into whitish, slightly elevated multifocal plaques with an irregular surface. As antibiotic and corticosteroid therapy was ineffective, an excisional biopsy was performed after 6 months of lesion development and a diagnosis of calcinosis circumscripta of dystrophic aetiology was made. To our knowledge, this is the first report of calcinosis circumscripta in association with an insect sting in an animal. Insect stings should be included in the differential diagnosis of calcinosis circumscripta in cats.

Tissue Dielectric Constant of the Lower Leg as an Index of Skin Water: Temporal Variations.

Tissue dielectric constant (TDC) measurements are a convenient, reliable, and accurate way to noninvasively access local tissue water content and its change with time or treatment. The method has been widely used for upper extremity lymphedema assessments but less so for lower extremities. For lower extremity assessments, it would be useful to have an estimate of the expected inter-leg TDC differentials of normal non-affected legs to help interpret measured inter-leg differentials when such measurements are done in patients with lower extremity edema or lymphedema. The goals of this study were to determine normal inter-leg TDC differences, quantify TDC temporal changes during 60 minutes of supine lying in a group of 10 middle-aged women (42-57 years), and evaluate the change in TDC values as measured throughout the day from 0800 to 2000 hours in a group of 10 younger women (23-28 years). The overall findings indicate that TDC measurements, as an assessment parameter of lower extremity localized skin-to-fat tissue water, are only minimally dependent on potential confounding factors such as 60-minute supine lying or the time of day at which the measurements are made. If the small sample size of the present study is reflective of the larger population, an inter-leg TDC ratio exceeding a value of 1.2 is suggested as a threshold for judging unilateral lower extremity edema or lymphedema. This possibility needs assessment in women with these conditions.

Bilateral swollen optic nerve head etiology and management: A cross-sectional study

BackgroundThe differential diagnosis of optic disc edema varies according to the presence of unilateral or bilateral edema. Papilledema may occur due to benign and life-threatening causes, but even benign causes may leave serious consequences for vision if not treated emergently. This study aimed to find out the prevalence of these causes in two major hospitals in Syria and observing the response of edema to treatment within a month and how visual acuity can be saved if edema is treated urgently. MethodsThis cross-sectional study was conducted in Al-Assad and Al-Mowasat Hospitals in Syria from October 2020 to the beginning of February 2022. It included 50 patients who had bilateral optic disc edema. Then a full study was carried out to reach the diagnosis and management appropriately and to monitor the extent of the efficacy of conservative measure in reducing edema, and how many of them needed surgical intervention. Resultsthe study included 50 patients, 13 males and 37 females, the most common diagnosis was venous sinus thrombosis (12 cases with 24%), followed by idiopathic intracranial hypertension and tumors (10 cases each by 20%), infectious meningitis (8 cases by 16%), leptomeningeal metastasis (5 cases by 10%), arterial hypertension (3 cases by 6%) and autoimmune meningitis (2 by 4%). Edema improved after management within a month in most patients (37 patients by 74%) and edema was accompanied by low visual acuity in 21 patients (42%). 20 patients (40%) needed surgical intervention. Visual acuity reduced in 10 patients (20%) despite all treatments. Conclusionvenous sinus thrombosis is the most common cause of bilateral optic disc edema then idiopathic intracranial hypertension and tumors, and despite the provision of all treatments, the visual acuity of 20% of patients has decreased.