Aortoesophageal fistula： A case misdiagnosed as esophageal polyp

Aortoesophageal fistula (AEF) is a rare and fatal disorder.It is also a life-threatening cause of massive upper gastrointestinal hemorrhage. Thoracic aortic aneurysm is the most common cause of AEF. Management of a patient with this disorder requires rapid diagnosis and immediate intervention, which is considered the best way to save the patient's life. We report a case of AEF misdiagnosed as esophageal polyp.     

A huge pancreatic cystic adenoma misdiagnosed as an ovarian cyst

Pancreatic cyst mimicking an ovarian cyst ultrasonographically has not yet been reported. We report an elderly woman with such a huge pancreatic cyst whose initial presentation was low abdominal pain. Ultrasound showed a hypoechoic cyst measuring 13.6 x 13.2 x 11.8 cm occupying pelvic cavity. She received laparotomy under the impression of ovarian cyst. Interestingly, the cyst was found to have originated from the pancreas. Total cyst excision was performed and pathologic report was pancreatic microadenoma. The patient's postoperative course was unremarkable.     

后腹膜囊肿误诊为肝占位性病变1例报告

患者,女性,53岁,于2004年5月健康体检作B超检查时发现肝脏占位性病变,为排除包虫病到我院就诊。查包虫皮试阳性,血包虫酶标阳性,以肝脏占位性病变性质待查、肝包虫病待排收住院。入院后查体:一般状况好,皮肤、巩膜未见黄染,浅表淋巴结无肿大;心肺未闻异常;全腹软,无压痛,腹壁可见静脉曲张;肝肋下6cm,剑下9cm,边缘钝,质中,无触痛。常规化验检查及胸片、心电图检查未见异常。患者1999年因子宫肌瘤行子宫切除术,有轻度外伤史。腹部MIR;右肝可见一17cm×18cm×22cm大小长T1长T2信号影,边界清晰,其内可见放射状T1W2更低信号;右肾受压移位,肿…     

Hepatic cyst misdiagnosed as a gastric submucosal tumor： A case report

We describe here a case of 51-year-old woman with a symptomatic hepatic cyst that was misdiagnosed as a gastric submucosal tumor （SMT） with endoscopic ultrasound （EUS） and CT scan. The patient presented with an epigastric pain for two months. On endoscopy, a submucosal tumor was found on the cardia of the stomach. Based on EUS and abdominal CT scan, the lesion was diagnosed as a gastric duplication cyst or a gastrointestinal stromal tumor （GIST）. The operative plan was laparoscopic wedge resection for the GIST of the gastric cardia. A cystic mass arising from the left lateral segment of the liver was found at the laparoscopic examination. There was no abnormal finding at the gastric cardia. She was treated by laparoscopic hepatic wedge resection including the hepatic cyst using an endoscopic linear stapler.     

梨状窝瘘致颈部脓肿误诊为甲状腺炎一例

梨状窝瘘是一种罕见的鳃源性畸形,合并感染时才出现症状,多见于儿童,临床上极易误诊.同济大学附属第十人民医院内分泌科近期收治一例成人梨状窝瘘致颈部脓肿,现报告如下. 1病例介绍     

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.     

Ectopic bronchogenic cyst of liver misdiagnosed as gallbladder diverticulum: A case report

BACKGROUNDEctopic bronchogenic cysts are a type of congenital cystic tumor that are extremely difficult to diagnose and can be ectopically located in various organs, with the possibility of malignant transformation. Here we report a case of an ectopic bronchogenic cyst in the liver initially misdiagnosed as a gallbladder diverticulum.CASE SUMMARYThe patient was a middle-aged woman whose chief complaint was intermittent pain in the upper abdomen. Imaging examination revealed a cystic space in the left inner lobe of the liver. She was admitted to our hospital for treatment. Based on abdominal examination and imaging findings, the initial diagnosis was gallbladder diverticulum with cholestasis combined with chronic cholecystitis. However, following intraoperative observations and postoperative pathologic assessment, the diagnosis was revised to ectopic bronchogenic cyst of the liver.CONCLUSIONRadiologists, hepatobiliary and pancreatic surgeons, gastrointestinal surgeons, urologists, and even neurosurgeons should be aware and consider a possible diagnosis of ectopic bronchogenic cysts, especially when other types of cyst, cystadenoma, and other diseases are excluded. The disease and its complications should be detected and correctly diagnosed and treated as early as possible in order to avoid adverse outcomes.     

胃窦异位胰腺误诊为肝囊肿1例报告

正1病例资料患者男性,57岁,以发现肝脏囊性占位4年为主诉于2014年5月4日收入本院。患者4年前至当地医院体检腹部彩超示肝左叶囊性回声,大小约10 mm×20 mm,未予处理,2个月前复查腹部彩超提示肝左叶囊性回声(50 mm×60 mm),内透声欠佳,无腹痛、腹胀,无反酸、嗳气,无呕血、黑便,无腹泻、便秘及里急后重,无食欲减退等,为求进一步诊治至本院。     

肺动静脉瘘长期误诊为肺结核12例分析

目的提高对肺动静脉瘘与肺结核病的诊断水平。方法1990年1月至2005年10月确诊为肺动静脉瘘而在外院长期误诊为肺结核的12例进行回顾分析。结果12例病人均曾被外院长期误诊为肺结核,抗结核治疗时间长短不等,最后确诊。结论结核发病率升高,使临床医生对结核的警惕性普遍增强;肺动静脉瘘和肺结核的临床表现不典型及X线胸片的多样性导致了误诊率的增加。结核病专科医师应打破结核的思维定势,包括综合性医院的医师均应熟悉包括肺动静脉瘘在内的多种肺部疾病,提高肺动静脉瘘和肺结核的诊断与鉴别水平。对痰检阴性肺结核的诊断应慎重,积极通过其他途径确诊,经验性抗结核治疗后应及时复查X线胸片,以确定诊断。胸部CT(增强)或肺动脉造影检查对肺动静脉瘘的诊断、鉴别诊断有重要作用。     

肺动静脉瘘长期误诊为肺结核12例分析

目的提高对肺动静脉瘘与肺结核病的诊断水平。方法1990年1月至2005年10月确诊为肺动静脉瘘而在外院长期误诊为肺结核的12例进行回顾分析。结果12例病人均曾被外院长期误诊为肺结核，抗结核治疗时间长短不等，最后确诊。结论结核发病率升高，使临床医生对结核的警惕性普遍增强；肺动静脉瘘和肺结核的临床表现不典型及X线胸片的多样性导致了误诊率的增加。结核病专科医师应打破结核的思维定势，包括综合性医院的医师均应熟悉包括肺动静脉瘘在内的多种肺部疾病，提高肺动静脉瘘和肺结核的诊断与鉴别水平。对痰检阴性肺结核的诊断应慎重，积极通过其他途径确诊，经验性抗结核治疗后应及时复查X线胸片，以确定诊断。胸部CT（增强）或肺动脉造影检查对肺动静脉瘘的诊断、鉴别诊断有重要作用。     

Comparative study on low back pain misdiagnosed as spondyloarthropathy

This study aims to investigate features of different diseases with low back pain misdiagnosed as spondyloarthropathy so as to improve the accuracy of diagnosis for spondyloarthropathy. The clinical and laboratory data of 24 cases misdiagnosed as spondyloarthropathy in recent 3 years were comparatively and retrospectively analyzed. The diagnostic accuracy of the European Spondyloarthropathy Study Group (ESSG) criteria, Amor criteria, and the combination of them in these misdiagnosed cases was also analyzed. The final diagnoses of these 24 cases were listed below: four malignant tumors (retroperitoneal adipose sarcoma, advanced gastric carcinoma, ovarian papillary epithelioma, acute lymphocytic leukemia), six benign tumors (two parathyroid adenoma with hyperparathyroidism, one intraspinal lipoma, intraspinal ependymomas, sacral tubulocyst, and intraspinal schwannoglioma, respectively). The other 14 cases included fibromyalgia syndrome (3), osteitis condensans (3), diffuse idiopathic skeletal hyperostosis (2), lumbar intervertebral disk protrusion (1), congenital scoliosis (1), Wilson’s disease (1), ochronosis (1), Fanconi syndrome (1) and hypophosphatemic rachiopathy (1). Among patients with tumor, all except three patients had persistent low back pain without morning stiffness, which aggravated at night and could not be relieved by rest or exercise. The symptoms could not be relieved by administration of multiple nonsteroidal anti-inflammatory drugs. Eleven patients had inflammatory low back pain defined by Calin. Of the total misdiagnosed cases, 54.17–83.33% could be prevented by application of ESSG criteria or Amor criteria, or a combination of them. From the data, we could see that the clinical features of different diseases with low back pain were different from each other and from those of spondyloarthropathy. The various criteria for spondyloarthropathy may be more effective in combination, along with other clinical information like these clinical features.     

长期误诊为腰椎间盘突出症的硬脊膜动静脉瘘:1例报道并文献复习

硬脊膜动静脉瘘(spinal dural arteriovenous ftstulas,SDAVF)是指硬膜供血动脉与硬膜下和脊髓表面静脉形成直接交通的血管瘘,临床上多表现为进展性充血性脊髓病[1].SDAVF是最常见的脊髓动静脉畸形类型,约占70％[2],但总体发病率低,为(5～10)/100万,其病因多数为后天获得性,可能与外伤、感染等因素相关[3].该病多见于40岁以上人群,男女比例约为5:1[4],大多数瘘口为单发,多位于胸腰段,80％以上患者病变位于T6～L2水平[5-6].     

17例肺支气管囊肿长期误诊肺结核原因分析

目的　通过对肺支气管囊肿(pulmonary bronchogenic cyst,PBC)长期误诊为肺结核的原因分析,提高对二种疾病的鉴别诊断能力。方法 对17例经手术病理证实的PBC长期误诊肺结核原因进行回顾性分析。结果 长期误诊肺结核的PBC患者占同期手术治疗的PBC的43.6%(17/39)。主要症状:咳嗽、咳痰、咯血、胸痛、低热和乏力。X线表现形态多样,球形病变10例,部分有卫星灶及钙化灶、空洞或溶解等,大片密度不均匀阴影5例,一侧毁损肺1例,叶间裂积液1例。所有病人均查痰结核菌阴性。正规抗结核治疗后反复咳痰、咯血、发热11例(64.7%),无效6例(35.3%)。结论 误诊原因是对不典型的PBC缺乏认识。痰结核菌阴性而临床症状和X线表现与肺结核相似、经正规抗结核治疗后仍反复发作或无效的病人,应考虑到PBC。     

误诊为肝炎的进行性肌营养不良25例原因分析

目的分析进行性肌营养不良的临床特点,探讨血清肌酸激酶、肌电图、肌肉病理及免疫组织化学检查对其诊断价值,以提高诊断水平。方法回顾性分析2006年01月至2011年12月误诊为肝炎的进行性肌营养不良的25例患儿的临床特征及肌酸激酶、肌电图、基因分析及病理等资料,探讨误诊原因。结果本组25例患儿因起病隐匿,多为幼年起病,早期常无典型肌病表现,由于各种原因偶然发现ALT异常,均误诊为"病毒性肝炎"而就诊于肝病科,发病至确诊时间为1个月～3年。结论遇到无明显诱因的持续肝功能异常且护肝疗效不佳的患儿,应考虑进行性肌营养不良症(PMD),及时进行肌酶、基因检测,必要时行肌电图辅助检查,以利于及早诊断,避免误诊。     

吸收延迟肺炎误诊肺结核16例分析及误诊原因探讨

目的 探讨吸收延迟肺炎误诊肺结核的原因,提高对两种疾病的鉴别诊断能力。方法 对16例吸收延迟肺炎误诊肺结核病例进行回顾性分析。结果误诊患者临床表现发热10例,其中高热3例,中度发热4例,低热3例;盗汗2例;查痰结核菌均阴性;血常规检查白细胞总数在4.0~10.0×10⁹／L之间12例;结核菌素纯蛋白衍生物（PPD）皮试阳性7例;X线胸片病变位于上叶尖后段、下叶背段16例;有肺结核病史2例。结论 误诊的主要原因：吸收延迟的肺炎临床症状不典型,X线胸片、血常规检查与肺结核相似,对PPD的诊断价值估计过高。 对临床资料综合分析,抗炎治疗动态观察,是防止吸收延迟的肺炎误诊肺结核的重要措施。     

支气管结核误诊为哮喘的原因分析和诊断方法探讨

目的探讨支气管结核误诊为哮喘的原因及其正确诊断的方法。方法对误诊为哮喘的24例支气管结核患者的临床资料进行分析。结果临床特征以刺激性咳嗽为主（91．7％）,其次是活动后胸闷气促、肺部哮鸣音,胸部影像学无特征性。10例（41．7％）患者轻至中度的阻塞性或混合性通气功能障碍,其中4例支气管舒张试验阳性（16．7％）;支气管镜下表现为炎性浸润型58．3％,溃疡及干酪坏死型8．3％,肉芽增殖型12．5％,瘢痕狭窄型20．9％;病变部位最常见左主支气管和左上叶支气管,多部位受累占87．5％;支气管镜活检诊断11例（45．8％）,刷检抗酸杆菌阳性13例（54．2％）,支气管镜检后痰抗酸杆菌阳性14例（58．3％）。结论结核中毒症状不明显,而主要表现为喘鸣、咳嗽及胸闷的支气管结核患者,易于被误诊为哮喘,支气管镜检查是鉴别诊断的重要方法。     

31例肺曲霉菌病误诊为肺结核原因分析

目的　分析肺曲菌病患者的临床特征及误诊原因。方法 对误诊为肺结核并经手术病理证实为肺曲菌病的31例病例进行回顾性分析。结果 男性20例,女性11例,年龄17～55岁,平均35.8岁,病程6月～20年,平均36.8月。主要症状为咳嗽、咯痰28例次,占90.3%,咯血29例次,占93.5%,发热9例次,占29%。胸部X线表现为团块或结节影12例,占38.7%,均为单发;形态各异的片状、条索状阴影17例,占54.8%;一侧肺损毁2例,占6.45%;有典型“新月征”表现18例,占58%。病变位于上叶尖后段、下叶背段及一侧肺24例,占77%。所有病例痰结核菌检查均阴性,经正规抗结核及抗炎治疗,其中6例术前曾抗真菌治疗,病情变化不明显。结论 误诊原因主要是肺曲霉菌病与肺结核病的临床表现及X线表现相似,痰曲霉菌检查阳性率低。部分病例既往有肺结核病史,如病情有变化,易认为是结核复发。因此对反复咯血、抗结核治疗效果不佳或X线胸片有“新月征”表现者应想到肺曲霉菌病,如果有条件者及时手术治疗。