卵巢畸胎瘤CT误诊55例分析

目的 分析卵巢畸胎瘤的CT误诊原因.方法 对术前CT误诊经病理证实为卵巢畸胎瘤55例进行分析.结果 良性45例,恶性或合并恶性肿瘤者10例.CT表现无脂肪密度者43例,极少量脂肪者7例,含脂肪密度者5饲;无钙化38例,有钙化者17例;小肿瘤潜伏于卵巢内和全脂肪密度与盆腔脂肪混淆者占6例.结论 缺乏特征性CT表现是误诊的主要原因,良恶性难鉴别、肿瘤特殊性、潜伏性和隐蔽性也是易误诊因素.     

26例卵巢恶性肿瘤误诊分析

1961～1979年我院收治的卵巢恶性肿瘤中,经病理诊断证实,诊为其它疾患者26例。26例中来源于体腔上皮肿瘤16例,性索间质肿瘤4例,生殖细胞肿瘤4例,非特异性间质肿瘤2例。本组误诊为子宫肌瘤13例中45～60岁者10例,45岁以下者3例;误诊为盆腔炎性肿块10例中45~60岁者6例,25~45岁者3例,25岁以下者1例;误诊为其它3例     

脑星形细胞肿瘤不典型CT征象及误诊分析

目的:对术前误诊或诊断不确切并经病理证实的23例脑星形细胞肿瘤的不典型CT征象作一分析并探讨其误诊的原因。材料和方法:收集术前误诊或诊断不确切并经病理证实的23例脑星形细胞肿瘤作回顾性分析。男性16例,女性7例。年龄6—61岁(平均32岁)。全部病例作CT平扫加增强。结果:误诊病种:误诊为脑梗塞6例、脑出血4例、拟诊为脑炎3例;误诊为脑膜瘤4例;误诊为转移瘤6例。结论:误诊除因征象不典型且资料不全(无增强扫描)或经验不足外,分析时应注意年龄,病程;肿瘤形态、增强形式、环壁厚薄、水肿范围等,还应结合临床作综合性诊断。     

30例肾柱肥大误诊分析

资料与方法 本组30例病例,均为误诊病例而来我院复查的患者。男20例,女10例,年龄28—60岁。无泌尿系统任何症状者18例,双侧或一侧腰部疼痛者4例,颜面部浮肿者2例,双下肢浮肿者2例,肉眼血尿2例,镜下血尿2例。外院误诊为肾盂肿瘤10例,肾实质内小肿瘤14例,肾囊肿6例（其中肾实质囊肿4例,肾盂旁囊肿2例）。     

回盲部肿瘤误诊为阑尾炎11例分析

目的：探讨回盲部肿瘤误诊为阑尾炎的原因,寻找减少误诊的方法。方法：对近7 a我院收治误诊为阑尾炎的回盲部肿瘤患者进行回顾性分析。结果：11例回盲部肿瘤患者误诊为阑尾炎而行手术。结论：对中老年患者表现为右下腹持续性疼痛,有慢性消化道症状或伴有贫血、消瘦者,临床医生应警惕有回盲部肿瘤的可能。     

高位颈段脊髓肿瘤误诊原因分析

我院自1976年8月至1991年6月共收治高位颈段脊髓肿瘤70例,其中有33例分别被误诊为颈椎病、肩周炎、枕大神经痛、蛛网膜炎或蛛网膜粘连等,现就误诊原因分析如下。临床资料一、一般资料:男19例,女,14例,年龄最大61岁,最小19岁。手术前病程不足1年的2例,1～4年21例,5～7年10例,平均病程为3年零1个月。二、症状与体征:首发症状表现为颈项部疼痛者21例,头昏、颈疼伴有背部或上肢酸痛者9例,单纯上肢疼痛或麻木者3例。入院时已有     

16例胃结核误诊分析

我院自1985年2月～1988年12月,胃镜检查发现16例胃结核误诊为胃溃疡或胃癌,其中12例系外院转来复查者;4例为本院首次胃镜检查误诊。16例均经胃镜复查和病理或部分手术证实为胃结核。现将本组病例误诊分析报告如下。临床资料本组男12例,女4例,年龄29～70岁,平均55.4岁;>55岁12例(75％)。12例经上消化道,钡餐诊断:胃溃疡7例,胃癌5例;4例经B超诊断:胃溃疡2例,胃肿瘤2例。     

无症状性胃癌卵巢转移误诊11例分析

女性胃癌易发生卵巢转移,但大多发生在原发性胃癌治疗后,诊断不很困难。而对原发胃癌症状出现之前发生卵巢转移的病人,则易发生误诊,本院自1972—1988年共误诊11例,现将误诊病例进行分析、讨论。一、误诊病例的临床特点本组年龄30—52岁,平均39岁,40岁以下占7例。就诊时主诉:下腹部肿块7例,腹胀3例,腹痛1例。有胃病史2例。卵巢病变为双侧者7例,单侧4例;肿瘤最大直径30×25×25厘米,最小6×6×4厘米,以10厘米左右最多见。肿瘤以不规则形、分叶结节状或似肾形多见,占8例。实体瘤9例,囊实相间、囊性各1例。4例伴有腹水。术中见肿瘤大多呈灰白或黄白色,较少与周围脏器发生粘连。但常伴有其它部位或脏器的转移灶。本组病例术前均误诊为原发性卵巢癌,经术中探查发现为胃癌较移者7例,术后病理诊断卵巢转     

恶性滋养细胞肿瘤14例误诊分析

目的:探讨恶性滋养细胞肿瘤的误诊原因及误诊防范.方法:回顾分析中山大学附属第一医院2001年10月至2009年12月收治恶性滋养细胞肿瘤中误诊病例14例的临床资料.结果:误诊为异位妊娠6例,卵巢肿瘤3例,胎盘残留3例,不全流产2例.最终确诊为绒癌8例.侵蚀性葡萄胎3例,异位绒癌2例,异住侵蚀性葡萄胎1例.结论:恶性滋养细胞肿瘤的正确诊断及鉴别诊断很重要.对于难以诊断的患者可以通过腹腔镜或开腹手术以明确诊断.     

枕骨大孔区肿瘤14例报告

枕骨大孔区肿瘤多为良性,如能早期明确诊断并及时手术切除肿瘤预后良好。现将我院1983年10月～1998年10月收治的14例报告如下。 1 临床资料及结果 1.1 一般资料:本组男8例,女6例,年龄22～63岁,平均42.4岁,病程1～4年,平均2.3年。 1.2 临床症状及体征:首发症状为枕颈部疼者8例,其中伴有单侧肢体无力、麻木,手肌萎缩者6例;颈肩部和上肢灼痛者4例,伴有颈部活动受限者3例。胸闷、呼吸困难者1例,排尿障碍者2例。早期误诊为其它疾病者6例,误诊为颈椎病3例,颈椎间盘突出1例,脊髓炎1例,心脑血管病1例。入院     

The psychiatrist's management of patients with undiagnosed brain neoplasm.

Of 679 patients with brain neoplasms admitted to either a medical school center or a community hospital during a nine-year period, 24 had been examined by a psychiatrist before definitive diagnosis of brain neoplasm. These 24 cases were studied to evaluate the role of the psychiatrist in the management of the patients before the neoplasm was diagnosed. Such cases pose many subtle problems for psychiatrists. However, ten of the 24 patients either were sent for definitive tests by the psychiatrist with the tentative diagnosis of brain neoplasm or were triaged to other consultants to pursue that diagnosis.     

Uveitis and neurologic diseases: an often overlooked relationship

AIM: Eye and brain are linked by development, and immune privileges preserve the integrity of these delicate organs thereby preventing irreversible defects in function. Manifestation of inflammatory or immune-mediated diseases in both systems seems perspicuous, yet during check-up of patients with uveitis they are rarely considered. In this study we aimed to determine the frequency of neurologic diseases in our uveitis patients and to describe the characteristics of ophthalmologic findings. METHODS: We analyzed the database of 1973 consecutive patients seen between 2000 and 2004 at the uveitis clinic at the hospital of the Medical University of Vienna. All cases of uveitis associated with neurologic co-manifestations of immune-mediated diseases were selected. RESULTS: Of 1973 patients with uveitis, 52 (2.6%) had neurologic diseases that were considered to be related to the eye inflammation. The most frequent entities were multiple sclerosis, Vogt-Koyanagi-Harada's disease, neurobehcet, central nervous system lymphoma, neurosyphilis and neurosarcoidosis. Uveitis was only rarely seen with infectious meningoencephalitis (neuroborreliosis, mumps, measles), Takayasu arteritis, Guillain-Barre syndrome or orbital pseudotumor. CONCLUSIONS: Several diseases can cause both ocular and/or central nervous system inflammation. This should prompt ophthalmologists and neurologists in the presence of one to rule out the other. In uveitis patients without evident neurological symptoms, specific ocular pathologies can help the treating ophthalmologist to tailor the work-up, whereas neurologists should always screen their patients, even when they are asymptomatic for ocular disease. Early diagnosis in both cases can help to initiate adequate treatment, thereby modulating the course of the disease and preventing complications.     

Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures

BACKGROUND: Which diagnostic procedures should be used to differentiate between idiopathic and malignant pleural effusions, is not well established. AIM: To identify which parameters allow differentiation between idiopathic and malignant pleural effusions. DESIGN: Case-note review. METHODS: Over a 12-year period, we treated 1014 consecutive pleural effusion patients, of whom 346 were diagnosed as having an idiopathic or malignant aetiology. We analysed medical history, chest X-ray, pleural fluid analysis (biochemical, microbiological and cytological), chest CT scan and additional examinations that were used according to clinical findings, and compared them with the eventual diagnosis and outcome. RESULTS: Eighty-three patients with idiopathic effusions and 263 with malignant effusions were included. Idiopathic pleural effusion resolved in 47 patients, improved in 20 and persisted in 16. Biochemical pleural fluid analysis did not predict these outcomes. A history of neoplasm, chest X-ray and CT features, as well as additional examinations according to clinical findings, established a diagnosis or suspicion of malignancy in 256 (97.7%) of the 263 patients who received a diagnosis of malignant effusion. Diagnostic thoracoscopy was helpful in seven patients in whom malignant disease was strongly suspected, despite the absence of other pathological findings. DISCUSSION: Non-invasive complementary examinations generally allowed accurate differentiation between malignant and idiopathic effusions. Patients with idiopathic pleural effusions generally had favourable outcomes.     

干燥综合征合并中枢神经系统脱髓鞘疾病的临床特点分析

目的:探讨干燥综合征合并中枢神经系统脱髓鞘疾病的临床特点。方法:回顾分析2007年至2011年收治的原发性干燥综合征(primary Sj觟gren′s syndrome,pSS)合并中枢神经系统脱髓鞘疾病患者的相关资料。结果:297例pSS患者中,有4例(1.35%)合并中枢神经系统脱髓鞘疾病。4例患者中,脱髓鞘病变在脑部者2例,在脊髓者2例。脱髓鞘病变位于脑部的患者主要表现为头晕、肢体乏力,而病变位于脊髓的主要表现为肢体乏力、损伤平面以下感觉减退、括约肌功能障碍。病变发生在脊髓的2例患者全部累及颈胸髓,1例患者纵向脊髓节段累及超过4个,为国内外较罕见。经激素及环磷酰胺治疗后,4例患者均好转出院。结论:pSS合并脱髓鞘疾病具有异质性特点,应结合临床特点及体液神经免疫学指标、神经影像具体分析诊断。     

Herpes simplex encephalitis: an audit of the use of laboratory diagnostic tests

BACKGROUND: The combination of both PCR and intrathecal antibody studies is recommended to confirm or refute the diagnosis of herpes simplex encephalitis (HSE). AIM: To investigate the pattern of use of laboratory tests in the diagnosis of suspected cases of HSE, and to determine the final diagnosis in cases proven not to be HSE. DESIGN: Structured audit. METHODS: We reviewed the case-notes of all patients who, over a five-year time period, presented with suspected encephalitis; and/or were prescribed aciclovir. Clinical and laboratory criteria were used to categorize the likelihood of HSE. RESULTS: We identified 222 patients: 10 (5%) had definite HSE, 24 (10%) possible HSE, and 144 (65%) a definite alternative diagnosis. In 44 (20%), no final diagnosis was made, but the diagnosis of HSE was excluded. PCR was performed in 68 (31%), intrathecal antibody studies in 24 (11%), and brain biopsy in 17 (8%). A wide range of diseases mimicked HSE, but most common were inflammatory diseases and other infections of the central nervous system. DISCUSSION: Laboratory tests, particularly intrathecal antibody assays, are under-used in the diagnosis of HSE. Although early empirical treatment of suspected HSE is essential, confirmation or exclusion of the diagnosis is equally important to avoid overlooking alternative diagnoses. Identification of the aetiology of encephalitis is of particular importance, given the current concerns of emerging infections and bioterrorism.     

MRI研究慢性疲劳综合征脑结构及功能进展

2016年WHO国际疾病分类将慢性疲劳综合征(CFS)归为神经系统其他疾病,脑结构及功能异常在CFS发病过程中具有关键作用。MRI有助于观察脑结构及功能变化,为诊断CFS及解析其发病机制提供影像学依据。本文就MRI研究CFS脑结构及功能进展进行综述。     

A normal second-trimester ultrasound does not exclude intracranial structural pathology.

OBJECTIVE: To report the prenatal diagnosis and management of 34 fetuses with various intracranial structural pathologies diagnosed following a normal second-trimester ultrasound examination. METHODS: We retrospectively reviewed the images of 203 abnormal central nervous system ultrasound examinations performed between 13 and 37 weeks of gestation at our prenatal diagnosis unit. In 34 (16.7%) of them at least one previous second-trimester ultrasound examination had been performed and considered normal. These 34 fetuses represent the study group. RESULTS: The following intracranial pathologies were diagnosed: dysgenesis of the corpus callosum, ventriculomegaly, cerebral cysts or hemorrhage, migrational disorders, vermian dysgenesis, arachnoid cysts, macrocephaly, enlarged subarachnoid space, brain calcifications and microcephaly. CONCLUSION: A normal second-trimester ultrasound scan does not rule out significant intracranial anomalies. Parents and physicians should be informed about the limitations of second-trimester sonography as far as brain diagnosis is concerned. A repeat third-trimester scan may enable more accurate diagnosis and counseling.     

Stroke versus primary CNS lymphoma in the immunocompromised patient.

Primary central nervous system (CNS) lymphomas are an uncommon form of brain neoplasm that should be considered in the immunocompromised patient with neurological changes. It can be difficult to distinguish primary CNS lymphoma from stroke on initial radiographic images. Neuroscience nurses who are involved in the care of these patients should be prepared to assist the patient and family in coping with an evolving diagnosis and in explaining the related diagnostic procedures, treatment options, and eventual discharge plan.     

Noninvasive tools based on immune biomarkers for the diagnosis of central nervous system graft-vs-host disease: Two case reports and a review of the literature

BACKGROUNDCentral nervous system graft-vs-host disease (CNS-GVHD) is a rare cause of CNS disorders after allogeneic hematopoietic stem cell transplantation. Currently, establishing a diagnosis of CNS-GVHD is challenging because the diagnostic criteria and diagnostic methods are not well defined and many confounding factors need to be ruled out.CASE SUMMARYHere, we present two patients with CNS-GVHD. Both patients with a history of acute GVHD or chronic GVHD developed neurological symptoms that could not be explained by other causes, and had abnormal cerebrospinal fluid (CSF) studies as determined by CSF and blood immune biomarker examinations, suggestive of suspected CNS-GVHD. Due to the lack of specific magnetic resonance imaging abnormalities and the rapid clinical deterioration of the patients, we did not attempt to perform a brain biopsy, but prompted the initiation of empirical immunosuppressive therapy. In view of the rapid and favorable response to local and systematic immunosuppressive treatment and the aforementioned neurologic manifestations together with CSF abnormalities and other negative findings, a final diagnosis of CNS-GVHD was made. CONCLUSIONCSF and blood immune biomarker examinations facilitated the diagnosis of CNS-GVHD, which are particularly suitable for patients who are critically ill and require urgent treatment and for those who are unsuitable for invasive diagnostic procedures.     

Three-dimensional sonographic evaluations of embryonic brain development.

OBJECTIVE: The purpose of this presentation is to show 3-dimensional development of the ventricles of the brain in early pregnancy, from 6 to 13 weeks, and to provide a reference for early diagnosis of central nervous system anomalies such as hydrocephalus and holoprosencephaly. METHODS: From March 2007 to August 2007, 46 patients were included. All patients had routine first-trimester 2- and 3-dimensional sonographic examinations at the same time. All cases were examined with a Voluson 730 Expert or Voluson E8 ultrasound scanner (GE Healthcare, Milwaukee, WI) using a 4- to 8- or 6- to 12-MHz transvaginal probe. Volumes were reviewed and analyzed with GE 4DView release 6 software. After the inversion-rendering mode was selected, volumes were dissected by the MagicCut function to show the ventricles. RESULTS: A total of 34 volumes from 7 to 12 complete gestational weeks were successfully dissected. Those before 7 and after 12 weeks could not be dissected properly. The crown-rump length ranged from 12.7 to 68 mm. Twelve representative images of the rendered volumes in chronologic order are shown. The brain volume dissections of 2 fetuses with ventriculomegaly and alobar holoprosencephaly are shown for comparison. CONCLUSIONS: Early human brain ventricular structures could be evaluated in vivo with 3-dimensional sonography. This presentation shows the timeline of brain development and provides reference images to compare possible anomalies of development.