Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery

The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which often make early diagnosis difficult,thus losing the best treatment opportunity.Once cerebral infarction occurs,the consequences are difficult to recover.This is also an important reason for the high misdiagnosis rate and mortality of this disease.In this paper,the characteristics of the disease were analyzed to provide clinical reference.

Clinical review and literature analysis of hepatic epithelioid angiomyolipoma in alcoholic cirrhosis: A case report

BACKGROUND Hepatic epithelioid angiomyolipoma(HEA)has a low incidence and both clinical manifestations and imaging lack specificity.Thus,it is easy to misdiagnose HEA as other tumors of the liver,especially in the presence of liver diseases such as hepatitis cirrhosis.This article reviewed the diagnosis and treatment of a patient with HEA and alcoholic cirrhosis,and analyzed the literature,in order to improve the understanding of this disease.CASE SUMMARY A 67-year-old male patient with a history of alcoholic cirrhosis was admitted due to the discovery of a space-occupying lesion in the liver.Based on the patient’s history,laboratory examinations,and imaging examinations,a malignant liver tumor was considered and laparoscopic partial hepatectomy was performed.Postoperative pathology showed HEA.During outpatient follow-up,the patient showed no sign of recurrence.CONCLUSION HEA is difficult to make a definite diagnosis before surgery.HEA has the poten-tial for malignant degeneration.If conditions permit,surgical treatment is recom-mended.

The Downsides of Evidence-Based Medicine

There exist problems in the actual evidence-based in the practice of medicine relating to the time available and the stringent algorithms employed by the attending physicians. The mistakes are often serious. Illustrating clinical examples are given as to how things can go wrong under the pressure baring on clinicians by the factors given.

Cholecystocolic fistula caused by gallbladder carcinoma:Preoperatively misdiagnosed as hepatic colon carcinoma

Cholecystocolic fistula secondary to gallbladder carcinoma is extremely rare and has been reported in very few studies. Most cholecystocolic fistulae are late complications of gallstone disease, but can also develop following carcinoma of the gallbladder when the necrotic tumor penetrates into the adjacent colon. Although no currently available imaging technique has shown great accuracy in recognizing cholecystocolic fistula, abdominopelvic computed tomography may show fistulous communication and anatomical details.Herein we report an unusual case of cholecystocolic fistula caused by gallbladder carcinoma, which was preoperatively misdiagnosed as hepatic flexure colon carcinoma.

Bladder perforation caused by long-term catheterization misdiagnosed as digestive tract perforation:A case report

BACKGROUND Spontaneous bladder rupture is relatively rare,and common causes of spontaneous bladder rupture include bladder diverticulum,neurogenic bladder dysfunction,gonorrhea infection,pelvic radiotherapy,etc.Urinary bladder perforation caused by urinary catheterization mostly occurs during the intubation process.CASE SUMMARY Here,we describe an 83-year-old male who was admitted with 26 h of middle and upper abdominal pain and a history of long-term catheterization.Physical examination and computed tomography of the abdomen supported the diagnosis of diffuse peritonitis,most likely from a perforated digestive tract organ.Laparoscopic exploration revealed a possible digestive tract perforation.Finally,a perforation of approximately 5 mm in diameter was found in the bladder wall during laparotomy.After reviewing the patient's previous medical records,we found that 1 year prior the patient underwent an ultrasound examination showing that the end of the catheter was embedded into the mucosal layer of the bladder.Therefore,the bladder perforation in this patient may have been caused by the chronic compression of the urinary catheter against the bladder wall.CONCLUSION For patients with long-term indwelling catheters,there is a possibility of bladder perforation,which needs to be dealt with quickly.

Ocular leech infestation initially misdiagnosed as conjunctival pigmented nevus

Dear sir,Iam Dr.Wen-Wei Li,from the Department of Ophthalmology,Zhejiang Provincial People’s Hospital,Hangzhou,China.I write to present a case of ocular leech infestation initially misdiagnosed as conjunctival pigmented nevus.Although human interaction with leeches is not uncommon

Large and unusual presentation of gallbladder adenoma: A case report

BACKGROUND Gallbladder adenoma is a relatively rare benign tumor with a potential for malignant transformation if found to be greater than 1 cm in size.CASE SUMMARY Herein,we report a case of a 51-year-old female with large 3 cm×3 cm mass of gallbladder adenoma that was misdiagnosed as adenocarcinoma due to its clinical presentation.Computed tomography and magnetic resonance imaging scans showed an irregularly shaped cauliflower-like lump in the gallbladder measuring 38 mm×32 mm corresponding to a malignant tumor and several gallbladder stones with low diffusion-weighted imaging and equisignal of T1-weighted imaging and T2-weighted imaging;moreover,the CA 19-9 levels were very high(184.1 U/mL).Pathology reports after tumor resection showed adenoma with moderate epithelial atypia and moderate atypia in the focal area with fine pedicle and no clear infiltration.CONCLUSION Computed tomography and magnetic resonance imaging scans need to be carefully scrutinized in certain rare cases of adenomas with abnormal imaging features.

Esophageal tuberculosis misdiagnosed as esophageal carcinoma

Esophageal tuberculosis （ET） is a rare clinical entity; the clinical features of this infection may be similar to the esophageal carcinoma. The differential diagnosis is very difficult and some cases may result in an unnecessary esophagectomy. We reported herein a 48-year-old man with symptoms of dysphagia and pectoralgia for one month. Our primary diagnosis was established as esophageal carcinoma and the patient underwent surgical therapy. Histopathological examination of the excised tumor lesion and lymph nodes showed epithelioid granulomas, Langhans＇ giant cells, caseous necrosis. No evidence of malignancy has been found. The Mantoux test revealed a positive reaction with 20 mm in diameter. Antituberculous treatment was given alter operation. Clinicians should aware the features of ET and this rare disease should be considered in the differential diagnosis of esophageal lesions.

A Case Report of Fever of Unknown Origin (FUO)

A 10-year-old boy had a long time of fever, and was diagnosed as JRA at first, but the patient’s condition got worse and worse after the treatment, then we did the cervical lymph node biopsy, which showed ALCL (Anaplastic Large Cell Lymphoma). After receiving the correct treatment, the patient’s condition got better.

Commonly Misdiagnosed Rare Condition – Toe Tourniquet Syndrome – Literature Review

Toe Tourniquet Syndrome (TTS) is a rare yet potentially devastating, acquired defect, which is repeatedly misdiagnosed in the United Kingdom and abroad. Due to the relatively infrequent presentation, it can be easily missed. Toe tourniquet syndrome is strangulation of the toes by what is usually hair, although synthetic fibres have also been described. It is considered a surgical emergency as left untreated, the tissues of the toe can become necrotic and the patient would lose that appendage. In this paper, we have done a literature review and written the article with illustrations which would explain this repeatedly misdiagnosed condition very thoroughly to all the clinicians dealing with this rare problem.

Coronary Artery Fistula with a Giant Saccular Aneurysm Misdiagnosed as a Mediastinal Mass

To the Editor:An 85-year-old female with a history of chest blunt trauma three years ago was referred for the left mediastinal mass detected incidentally by chest radiography.The patient did not have any symptoms.

Determining the spatial distribution of environmental and socio-economic suitability for human leptospirosis in the face of limited epidemiological data

Background:Leptospirosis is among the leading zoonotic causes of morbidity and mortality worldwide.Knowledge about spatial patterns of diseases and their underlying processes have the potential to guide intervention efforts.However,leptospirosis is often an underreported and misdiagnosed disease and consequently,spatial patterns of the disease remain unclear.In the absence of accurate epidemiological data in the urban agglomeration of Santa Fe,we used a knowledge-based index and cluster analysis to identify spatial patterns of environmental and socioeconomic suitability for the disease and potential underlying processes that shape them.Methods:We geocoded human leptospirosis cases derived from the Argentinian surveillance system during the period 2010 to 2019.Environmental and socioeconomic databases were obtained from satelite images and publicly available platforms on the web.Two sets of human leptospirosis determinants were considered according to the level of their support by the literature and expert knowledge.We used the Zonation algorithm to build a knowledge-based index and a clustering approach to identify distinct potential sets of determinants.Spatial similarity and correlations between index,clusters,and incidence rates were evaluated.Results:We were able to geocode 56.36%of the human leptospirosis cases reported in the national epidemiological database.The knowledge-based index showed the suitability for human leptospirosis in the UA Santa Fe increased from downtown areas of the largest cities towards peri-urban and suburban areas.Cluster analysis revealed downtown areas were characterized by higher levels of socioeconomic conditions.Peri-urban and suburban areas encompassed two clusters which differed in terms of environmental determinants.The highest incidence rates overlapped areas with the highest suitability scores,the strength of association was low though(CSc r=0.21,P<0.001 and ESc r=0.19,P<0.001).Conclusions:We present a method to analyze the environmental and socioeconomic suitability for human leptospirosis based on literature and expert knowledge.The methodology can be thought as an evolutive and perfectible scheme as more studies are performed in the area and novel information regarding determinants of the disease become available.Our approach can be a valuable tool for decision-makers since it can serve as a baseline to plan interventionmeasures.

Misdiagnosed Norwegian scabies in a patient with systemic sclerosis:a case report

Introduction Norwegian scabies is a rare and severe skin disorder caused by scabies mites.Severe public health problems resulted from Norwegian scabies outbreak,had been reported due to the highly contagious characteristics[1-2].Also,severe complications such as secondary bacterial infections,severe water and electrolytic disorders,which could lead to fetal outcome,were reported recently in severe Norwegian scabies cases[3].Early diagnose may prevent scabies outbreak and longtime adverse events.However,crusted scabies may be misdiagnosed due to its various and atypical skin lesions.Here,we shared our experience on diagnosis of a patient with Norwegian scabies,who was misdiagnosed as psoriasis and eczema and treated with long term of oral prednisone and methotrexate.