A Case of Pulmonary Hydatid Cyst Misdiagnosed as Encysted Effusion

Echinococcosis or hydatid disease is caused by larvae of the tapeworm Echinococcus. In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cystor develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material andsecondary immunological reactions that develop from cyst rupture.

Clinical retrospective analysis of 138 cases of multiple myeloma / 中华急诊医学杂志

Objective To analysis of multiple myeloma (MM) and non-MM patients with the same clinical manifestations but significant differences in laboratory findings at the first visit to the Emergency Medicine Department suggesting that patient should be rule out the possibilities of suffering from MM by the attending physicians engaging in a specialty other than hematology as soon as possible to avoid misdiagnosis of MM.Methods Retrospective analysis of clinical features of MM cases from February 2013 to December 2016.Patients with renal dysfunction (serum creatinine ≥ 177 mmol/L),infection,bone pain and anemia were divided into four groups.The non-MM patients with the same clinical symptoms were enrolled as control group.SPSS22.0 and Medcalce 15.10 software were used for analyzing the distinct difference and diagnostic validity of routine laboratory tests in patients with MM and non-MM.Results ①The patients with serum creatinine≥ 177 mmol/L,and unexplained renal insufficiency with blood Ca2+ ＞ 2.39mmol/L,ALB ≤ 30.31 g/L and Hb≤84 g/L should be investigated the possibility of MM.②The patient with poor response to the conventional treatment and unexplained infection with IgM ＜0.42 g/L and ALB≤32.7 g/L or ESR ＞ 82 mm/h and Hb ＜ 100 g/L should be investigated the possibility of MM.③The male patients with the first symptom in bone and joint pain associated with bone damage with urinary protein and blood,and the emergence of Ca2+ ＞ 2.39 mmol/L,ALB ＜ 37.5 g/L,Hb ＜ 104 g/L and TT ＞ 19.8 s were suggested to detect MM.④The poor respose to conventional treatment,unexplained anemia (Hb≤90 g/L),IgM ＜ 0.51 g/L,ALB ＜ 34.1 g/L and GLB ＞ 46.4 g/L suggested to detect MM.Conclusions On the basis of symptoms such as renal insufficiency,infection,bone pain,anemia,routine blood laboratory findings of high calcium,low IgM,low albumin,and high globulin,it was recommended that bone marrow biopsy be made to detect MM.

Risk factors to suicide risk in misdiagnosed bipolar disorder II treated for major depressive disorder / 中国神经精神疾病杂志

Objective To analyze the risk factors of socio-demographic and clinical characteristics related to sui?cide risk in misdiagnosed bipolar disorderⅡ(BPⅡ) treated for major depressive disorder. Methods A total of l478 con?secutive major depressive disorder patients were interviewed with the Mini International Neuropsychiatric Interview (MINI) in 13 major mental health centers in China. Of the 1478 patients, 190 patients were diagnosed BPⅡ, who were divided into two groups (nonsuicidal risk and suicidal risk) with the suicidality module of MINI. Logistic regression was performed to evaluate significant risk factors associated with suicide risk in misdiagnosed BPⅡtreated for major depres?sive disorder. Results Of the 190 patients, 116 were in the nonsuicidal risk group and 74 were in the suicidal risk group. In comparison to the nonsuicidal risk group, the suicidal risk group had younger age [(34.45 ± 11.18) vs.(37.23 ± 13.22), P=0.008], earlier age at onset [(26.20 ± 9.16) vs. (30.37 ± 11.59), P=0.007], and more suicidal ideation (82.4%vs. 53.4%, P=0.001). Logistic regression analysis showed that age (OR=0.969,95% CI:0.945~0.993) and depressive epi?sodes with suicidal ideation (OR=4.129,95%CI:2.030~8.397) were significantly associated with suicide risk in patients of misdiagnosed BPⅡtreated for major depressive disorder (P<0.05). Conclusions Younger age, severer suicidal ide?ation may be potential independent risk factors to suicide risk in BPⅡwith misdiagnosed with major depressive disor?der.

Complex Regional Pain Syndrome (CRPS type-1) in an Adolescent Following Extravasation of Dextrose Containing Fluid-an Underdiagnosed Case

Due to its complex pathophysiology and wide spectrum of clinical manifestations, the diagnosis of CRPS is often missed in the early stage by primary care physicians. After being treated by a primary care physician for 5 months for chronic cellulitis, a 16-year-old girl was referred to our hospital with features of type-1 CRPS of the right upper extremity. Inability to diagnose early caused prolonged suffering to the girl with all the consequence of CRPS. The patient responded well with marked functional recovery from multimodal therapy. Ability to distinguish CRPS from other pain conditions, referral for specialty care at the appropriate time and full awareness of this condition and its clinical features among various healthcare professionals are essential in reducing patient suffering and stopping its progression towards difficult-to-treat situations.

Misdiagnosis of Ectopic Pregnancy:A Clinical Analysis of 48 Cases / 中国基层医药

Objective To investigate the causes of ectopic pregnancy misdiagnosis.Thus we can increase the rate of early diagnosis and avoid complications that could threaten life.Methods 48 cases which were misdiagnesed were retrospectively analyzed.Results Of the 48 cases,28 cases were misdiagnosed as intrauterine pregnancy,accounting for 58.3%,of which 16 cases were early pregnancy;12 cases were threatened abortion;7 cases were acute inflammation annex;6 cases were acute appendicitis;2 cases were acute gastroenteritis;3 cases were corpus luteum rupture;and 2 cases were dysfunctional uterine bleeding.Conclusion The complicated clinical manifestation of ectopic pregnancy makes misdiagnosis easy to happen.In order to reduce the rate of misdiagnosis,clinical practitioners should strengthen the professional quality,make a detailed inquiry on the history of illness and inspect carefully.

Differential Diagnosis of Optic Neuropathy

PURPOSE: In order to prospectively investigate the causative mechanisms of visual loss in 42 patients referred to rule out optic neuropathy or diagnosed with optic neuropathy in other hospitals. METHODS: Thorough history taking and ophthalmologic examinations were performed. In some patients, evaluation of extraocular movement, nerve fiber layer photography, contrast sensitivity, visual evoked potential, electroretinogram and visual field were tested. RESULTS: Functional visual loss was most common(18 patients), followed by retinopathy(nine patients). Three patients suffered from amblyopia and glaucoma, respectively, two from keratoconus, pseudopapilledema, miscorrected refractive error, and Leber's congenital amaurosis, respectively, and one from cortical visual impairment. In the differential diagnosis of optic neuropathy, history taking and ophthalmologic examinations including pupillary light reflex, color vision test, nerve fiber layer photography, funduscopy and visual field test were useful. Especially the color vision test was very simple, but useful. CONCLUSION: Clinical entities including functional visual loss and retinopathy should be considered when diagnosing visual loss of unknown etiology.

Two Cases of Angiosarcoma, Misdiagnosed as Infectious Disease / 대한피부과학회지

Angiosarcoma are highly aggressive neoplasm with poor prognosis and most patients die within a short period after presentation. We, herein, report two cases of cutaneous angiosarcomas in a 73-year-old man and a 79-year-old man. A 73-year-old man had an 8X8 cm sized red purple colored nodule with brownish crust and bean sized satellite lesions on the vertex. A 79-year-old man had a well demarcated 8X12 cm sized, and 6X5 cm sized purpuric plaques on both cheeks and a 2X2 cm sized nodule on the temporal area. Both cases had been misdiagnosed as infectious disease. They were confirmed with histologic findings.