Surgical treatment of Stanford type A aortic dissection after coronary artery stenting / 中国胸心血管外科临床杂志

@#Objective    To retrospectively analyze the surgical treatment of Stanford type A aortic dissection after coronary artery stenting, and to explore the surgical techniques and surgical indications. Methods    Clinical data of 1 246 consecutive patients who underwent operations on Stanford type A aortic dissection from April 2016 to July 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Patients with Stanford type A aortic dissection after coronary artery stenting were enrolled. Results    Finally 19 patients were collected, including 16 males and 3 females with an average age of 54±7 years ranging from 35 to 66 years. There were 11 patients in acute phase, 15 patients with AC (DeBakey Ⅰ) type and 4 patients with AS (DeBakey Ⅱ) type. In AC type, there were 10 patients receiving Sun's surgery and 5 patients partial arch replacement. Meanwhile, coronary artery bypass grafting was performed in 7 patients and mitral valve replacement in 1 patient. Stents were removed from the right coronary artery in 4 patients. In this group, 1 patient died of multiple organ failure in hospital after operation combined with malperfusion of viscera. Eighteen patients recovered after treatment and were discharged from hospital. The patients were followed up for 30 (18-56) months. One patient underwent aortic pseudoaneurysm resection, one thoracic endovascular aortic repair, one emergency percutaneous coronary intervention due to left main artery stent occlusion, and one underwent femoral artery bypass due to iliac artery occlusion. Conclusion    Iatrogenic aortic dissection has a high probability of coronary artery bypass grafting at the same time in patients with Stanford type A aortic dissection after coronary artery stenting. Complicated type A aortic dissection after percutaneous coronary intervention should be treated with surgery aggressively.

A CASE REPORT OF RIGHT UNILATERAL PULMONARY ARTERY ATRESIA (UPAA) MISDIAGNOSED AS RIGHT CHRONIC PULMONARY THROMBO-EMBOLISM

Unilateral pulmonary artery atresia is a rare condition with clinical presentation as exercise intolerance, recurrent infections, hemoptysis to asymptomatic state with incidental diagnosis. Common modalities of management include medical management for pulmonary hypertension , angioembolisation of collaterals followed by pneumonectomy. However surgical reconstruction of atretic pulmonary artery segment is an uncommon surgical management strategy employed in our case with satisfactory outcome

Application of a sleep electroencephalogram in the diagnosis of epilepsy in children / 中国基层医药

Objective:To investigate the significance of sleep electroencephalogram (EEG) monitoring in the diagnosis and differential diagnosis of childhood epilepsy.Methods:The clinical data of 56 children with epilepsy diagnosed in The Maternal and Child Health Hospital of Huainan from February 2020 to February 2022 were retrospectively analyzed. The relationship between the positive rate of epileptiform discharge under sleep EEG monitoring and its location and sleep phase was analyzed.Results:Of the 56 children, 36 (64%) children had normal results of routine awake EEG monitoring, and 20 (36%) children had abnormal results. Among the 56 children, 9 (16%) children had normal sleep and 47 (84%) had abnormal sleep. The difference in EEG monitoring results between the awake and asleep states was statistically significant ( χ2 = 27.08, P < 0.001). Among abnormal EEG in 47 patients, paroxysmal abnormality (epileptiform discharge) was found in 44 patients and non-specific abnormality was found in 3 patients. Among the 44 children with epileptic discharges, 5 (11%) had epileptic discharges during wakefulness, 11 (25%) children had epileptic discharges during a sleepless period, and 28 (64%) had epileptic discharges during a slight sleep period. EEG epileptiform discharges occurred in the central temporal region in 9 (21%) patients, temporal region in 8 (18%) patients, parieto-occipital region in 1 (2%) patient, frontal region in 5 (11%) patients, and the frontotemporal region in 6 (14%) patients. Generalized discharges were found in 14 (32%) patients, and generalized hypsarrhythmia was found in 1 (2%) patient. Conclusion:Children with clinically highly suspected epilepsy should be reexamined by sleep EEG if the routine awake EEG, monitoring results are normal, to reduce the rates of misdiagnosis and missed diagnosis in children with epilepsy.

Cystic echinococcosis misdiagnosed as hepatic cyst: a case report / 中国血吸虫病防治杂志

This case report presents the diagnosis and treatment of a case of cystic echinococcosis misdiagnosed as hepatic cyst. The case had anaphylactic shock caused by extravasation of cyst fluid during extraction of hepatic cyst and suffered from postoperative recurrence of echinococcosis. This case report may provide insights into diagnosis and treatment of cystic echinococcosis among healthcare workers in non-endemic areas.

Missed diagnosis or misdiagnosis: Common pitfalls in genetic testing

Genetic testing has the power to identify individuals with increased predisposition to disease, allowing individuals the opportunity to make informed management, treatment and reproductive decisions. As genomic medicine continues to be integrated into aspects of everyday patient care and the indications for genetic testing continue to expand, genetic services are increasingly being offered by non-genetic clinicians. The current complexities of genetic testing highlight the need to support and ensure non-genetic professionals are adequately equipped with the knowledge and skills to provide services. We describe a series of misdiagnosed/mismanaged cases, highlighting the common pitfalls in genetic testing to identify the knowledge gaps and where education and support is needed. We highlight that education focusing on differential diagnoses, test selection and result interpretation is needed. Collaboration and communication between genetic and non-genetic clinicians and integration of genetic counsellors into different medical settings are important. This will minimise the risks and maximise the benefits of genetic testing, ensuring adverse outcomes are mitigated.

Clinical characteristics in the misdiagnosis of cytomegalovirus retinitis: A retrospective analysis of eight patients

Purpose: To highlight characteristics in the misdiagnosis of cytomegalovirus retinitis (CMVR). Methods: Misdiagnosed cases related to CMVR were analyzed retrospectively at the Department of Ophthalmology, Beijing Youan Hospital, from July 2017 to October 2019. The medical records were reviewed by two independent senior ophthalmologists and the patients’ clinical characteristics were analyzed. Results: Eight patients (16 eyes) were identified with misdiagnoses related to CMVR. Six of the patients with CMVR were previously unaware of their human immunodeficiency virus (HIV) infection; one patient with CMVR concealed their history of HIV infection. The cases were initially misdiagnosed as diabetic retinopathy (1/7, 14.3%), branch retinal vein occlusion (1/7, 14.3%), ischemic optic neuropathy (1/7, 14.3%), Behçet’s disease (1/7, 14.3%), iridocyclitis (2/7, 28.6%), and progressive outer retinal necrosis (1/7, 14.3%). One patient with binocular renal retinopathy and chronic renal insufficiency was misdiagnosed with CMVR. Four eyes (4/16, 25%) presented with pan?retinal involvement. Fourteen eyes (14/16, 87.5%) had optic disc or macular area involvement. At the final diagnosis, one patient was blind, and two patients had low vision. Seven AIDS patients showed an extremely low level of CD4+ T lymphocytes (median of 5 cells/?l; range 1–9 cells/?l). Conclusion: CMVR may be misdiagnosed in the absence of known immune suppression. CMVR and HIV screening cannot be overlooked if a young male patient presents with yellowish?white retinal lesions. These misdiagnosed patients had severe retinitis associated with poor vision

Osteomielite crônica como uma armadilha ao diagnóstico na prática do dermatologista / Chronic osteomyelitis as a diagnostic pitfall in the practice of the dermatologist: a case report

Na prática clínica da dermatologia não é incomum nos depararmos com situações desafiadoras, de difícil caracterização e que podem nos induzir ao erro diagnóstico. Quadros cutâneos com apresentações semelhantes entre si estão aqui inclusas e, neste caso, é de suma importância a atuação do médico dermatologista de forma a unir as informações da anamnese, exame físico e exames complementares, a fim de excluir condições de pior prognóstico e que requerem atuação mais agressiva de outras condições benignas e/ou com menor impacto negativo. Apresentamos abaixo uma dessas situações de desafio diagnóstico em que uma lesão cutânea secundária à osteomielite crônica foi inicialmente atribuída à causa inflamatória ou neoplásica (AU)

In the clinical practice of Dermatology, it is not uncommon to encounter challenging situations that are difficult to characterize and may lead to misdiagnosis. Skin conditions with similar presentations are included here and, in this case, it is of utmost importance that the dermatologist combines information from the medical history, physical examination and complementary tests in order to exclude conditions with worse prognosis and that require more aggressive action than other benign conditions and/or with less negative impac (AU)

Misdiagnosis of Acute Renal Artery Thrombosis as Acute Abdominal Disease:Report of One Case / 中国医学科学院学报

Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.

Analysis of diagnosis and treatment of 18 cases with patellar sleeve fracture in children / 中华实用儿科临床杂志

Objective:To analyze the clinical characteristic of patellar sleeve fracture in children, so as to improve the understanding of pediatric patellar sleeve fracture and reduce the misdiagnosis rate.Methods:Clinical data of 18 children with patellar sleeve fractures admitted and followed up in Department of Pediatric Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University from January 2013 to December 2019 were retrospectively analyzed, including 10 males and 8 females with the mean age of 11.4 years (8.0-14.0 years). There were 10 right patellar sleeve fracture cases, 7 left cases, and 1 case on both sides.Classified by the fracture cause, 10 cases were caused by falls, 3 cases of high jump, 2 cases of falling from height, 2 cases of car accidents, and 1 case of rope skipping, and all of cases were closed injuries.The mean post-injury visit to Affiliated Hospital of Zunyi Medical University was 3.5 days (4 hours -7 days). Twelve out of cases were transferred from other hospitals.All patients were treated with the open reduction and tension band wiring or patella tendon suturing through bone tunnel + patella circumferential wire banding and fixation.The curative effect of patella fracture was evaluated by the Bostman score.Results:Eighteen children with patellar sleeve fracture were diagnosed and treated promptly after admission, and regularly followed up after the operation for an average of 14 months (9-28 months). All cases achieved stage Ⅰ wound healing, and Kirschner wires and steel wires were removed according to the condition of fracture healing at 6 to 10 months postoperatively.According to the Bostman score for evaluating the patella fracture, 15 cases were excellent, 3 cases were good, and there were no missed or misdiagnosed cases.Conclusions:Patella sleeve avulsion fracture is a unique type of fracture in children.As cartilage is the main distal avulsion fracture lesion, it is difficult to be detected on X-ray scans, thus easily leading to missed diagnosis and misdiagnosis.Improving the understanding of this fracture type is the key to the early diagnosis and treatment.

Main causes of aplastic anemia misdiagnosed as immune thrombocytopenia in children / 中华实用儿科临床杂志

Objective:To explore the main causes of 50 children with aplastic anemia misdiagnosed as immune thrombocytopenia(ITP), summarize differential diagnosis experience, and provide clinical reference.Methods:According to the diagnostic criteria of aplastic anemia and ITP in children, the initial data of misdiagnosed cases in other hospital admitted to the Department of Pediatrics, Shanghai Tongji Hospital from January 2007 to December 2020, and the results of their re-examination tests in this hospital were analyzed.The causes of misdiagnosis and the main points of differential diagnosis were summarized.Results:Of the 165 children with aplastic anemia treated in the same period, 50 cases (30.3%) had been misdiagnosed as ITP.The main causes of misdiagnosis were summarized as follows.(1) The clinical manifestations in 22 cases disagreed with " typical symptoms of ITP" , and necessary bone marrow examinations were not performed in accordance with the international guidelines to confirm the diagnosis.(2) The bone marrow test results were interpreted falsely.Among 28 patients who underwent the bone marrow smear examination, 6 cases (21%) showed typical aplastic bone marrow, but they were still misdiagnosed with ITP.(3) Patients (15/28 cases, 54%) with atypical bone marrow smears did not receive further bone marrow biopsy to facilitate the diagnosis.(4) In 7 cases (7/28 cases, 25%), their bone marrow examination results met the diagnostic criteria of ITP at initial diagnosis, but no necessary review was performed to verify and correct the diagnosis after glucocorticoid trea-tment failed.Conclusions:Clinical diagnosis should be made in restrict accordance with related disease diagnostic criteria to avoid empirical errors.Diagnosis of ITP requires caution.Especially for those with atypical clinical manifestations or irresponsive to first-line drugs, bone marrow examinations (bone marrow biopsy if necessary) must be performed, and the test results should be correctly interpreted according to the diagnostic criteria to prevent clinical misdiagnosis or missed diagnosis.

Hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis: one case report / 中国血吸虫病防治杂志

Hepatic cystic echinococcosis is a chronic parasitic disease caused by the infection with the larvae of Echinococcus granulosus in human or animal liver tissues. As a chronic active infectious disease, tuberculous empyema mainly invades the pleural space and then causes visceral and parietal pleura thickening. It is rare to present comorbidity for hepatic cystic echinococcosis and tuberculous empyema. This case report presents a case of hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis, aiming to improve clinicians’ ability to distinguish this disorder.

The current situation of the diagnosis of fibromyalgia syndrome / 中华风湿病学杂志

Objective:To investigate the currentstatus of the diagnosis of fibromyalgia syndrome (FMS), and analyze the related factors in order to improve the diagnostic level of the disease.Methods:A survey was carried out, A "FMS diagnosis table" was developed. The demographic data and past medical experience of patients were recorded. The rates of misdiagnosis and missed diagnosis were calculated. The specific misdiagnosed cases were recorded and analyzed. According to the previous diagnosis history, patients were divided into misdiagnosed group, missed diagnosis group and correct diagnosis group. The demographic characteristics, medical history and disease severity in the misdiagnosis group and missed diagnosis group were statistically analyzed, and compared with the correct diagnosis group. The reasons for missed diagnosis or misdiagnosis were explored.Results:A total of 277 patients were included in the survey. Only 19.1%(53 cases) of patients were correctly diagnosed, 22.7%(63 cases) of patients were misdiagnosed, 58.1% of patients were missed. The mean time from first symptom to disease diagnosis was (51.0±81.2) months. They were often misdiagnosed as osteoarthritis ( n=21, 33.3%), rheumatoid arthritis ( n=13, 20.6%), lumbar disease ( n=12, 19.0%), and anxiety and depression ( n=11, 17.4%). Patients' social and economic status such as age, income, educational level and the diagnosis level of pain related clinicians in medical institutions at all levels were factors that might influence misdiagnosis and missed diagnosis rate. In terms of demographic characteristics, the correctly diagnosed group had a lower average age of (44±13) years ( t=8.64/9.20, P<0.05), a higher proportion of employees, a higher monthly income ( χ2=7.10/6.87, P<0.05), and a higher education level ( χ2=7.12, P<0.05). In terms of visits, the rate of visits to other medical institutions (private hospitals) in the missed diagnosis group was higher, and the number of doctors visited was also lower. In terms of illness, the diffuse pain index (WPI) score and FMS symptom severity (SSS) score were lower in the missed diagnosis group. Conclusion:The current situation of the diagnosis of FMS in China is not optimistic, and the diagnosis should be differentiated from osteoarthritis, rheumatoid arthritis, cervical and lumbar diseases, and cardiac diseases. In order to reduce the misdiagnosis and missed diagnosis of this disease, it is necessary to strengthen the public education, improve the understanding of this disease in primary care doctors, and physicians in orthopedics, acupuncture and pain departments.

Patrones morfológicos erróneamente diagnosticados como huellas de mordedura en contextos forenses: una revisión con búsqueda sistemática / Morphological patterns misdiagnosed as bite marks in forensic contexts: a scoping review

RESUMEN: El análisis de huellas de mordedura para identificación forense puede ser clave para establecer la inocencia o culpabilidad del acusado. Sin embargo, esta evidencia ha sido cuestionada por su falta de consenso y objetividad, y por sus reportadas identificaciones erróneas. Se presenta una revisión con búsqueda sistemática de casos indicando errores diagnósticos y sus caracterizaciones, y se discuten las recomendaciones realizadas para evitarlos. Se utilizó la estrategia ("bite mark" OR "bitemark") AND ("artefactual" OR "misidentification" OR "misdiagnosis" OR "mistake"), incluyendo casos de huellas de mordedura humana en piel con reportes de errores diagnósticos, excluyendo diseños experimentales, huellas en alimentos u objetos. Fueron seleccionados un total de 13 documentos reportando 21 casos, abarcando los años 1989 a 2014. Los patrones morfológicos con mayor reporte de error diagnóstico fueron los producidos por trauma cortante o contuso por otras causas (10 casos), seguidos de los producidos por condiciones médicas y tratamientos de emergencia (6 casos). Al menos tres de los casos tomaron estado público, dos de ellos con sentencia de muerte y uno con condena de 25 años a prisión perpetua. Se ha enfatizado el dar minuciosidad y estandarización a la evaluación morfológica de este tipo de evidencias por la importante cantidad de condenas erróneas. Esta revisión pone en evidencia la escasa exposición y análisis de estos errores, con la insuficiente información para un aprendizaje significativo crítico y diseño de herramientas para evitarlos. Se coincide en la necesidad de estandarizar y optimizar protocolos para estas evidencias y adoptar una conducta reflexiva para sus análisis con fines de identificación forense.

SUMMARY: Bite mark analysis for forensic identification can be key to establishing the innocence or guilt of the defendant. However, this evidence has been challenged for its lack of consensus and objectivity, and its reported misidentifications. We present a scoping review of cases indicating misidentifications and their characterizations, and recommendations for avoid them are discussed. The strategy ("bite mark" OR "bitemark") AND ("artifactual" OR "misidentification" OR "misdiagnosis" OR "mistake") was used, including cases of human bite marks on skin with reported misdiagnosis, excluding experimental designs, bite marks on food or objects. A total of 13 documents were selected reporting 21 cases, covering the years 1989 to 2014. The morphological patterns with the highest report of misdiagnosis were those produced by cutting or blunt trauma due to other causes (10 cases), followed by those produced by medical conditions and emergency treatments (6 cases). At least three of the cases became public, two of them with a death sentence, and one with a 25-year sentence to life in prison. The thoroughness and standardization of the morphological evaluation of this type of evidence has been emphasized due to the significant number of erroneous convictions. This review highlights the scarce exposure and analysis of these errors, with insufficient information for critical meaningful learning and the design of tools to avoid them. There is agreement on the need to standardize and optimize protocols for these evidences and adopt a reflective behavior for their analysis for forensic identification purposes.

Cystic echinococcosis of the waist and hip: a case report / 中国血吸虫病防治杂志

A patient with cystic echinococcosis was presented with primary lesions in the waist and hip. The case was misdiagnosed as subcutaneous abscess at initial diagnosis, and then definitively diagnosed as echinococcosis by means of imaging examinations and anti-Echinococcus antibody test. This case was reported with aims to improve the awareness of cystic echinococcosis among clinical physicians to avoid and reduce the misdiagnosis and missing diagnosis.

Analysis of 118 cases of clinically misdiagnosed cutaneous melanoma / 中华皮肤科杂志

Objective:To investigate clinical features and preventive measures of misdiagnosed cutaneous melanoma, as well as causes of its misdiagnosis.Methods:Clinical data were collected from patients with pathologically confirmed cutaneous melanoma which was initially clinically misdiagnosed as other diseases in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2005 to December 2019, and clinical manifestations and causes of its misdiagnosis were analyzed.Results:A total of 118 patients with clinically misdiagnosed cutaneous melanoma were collected, including 38 males and 80 females. The median age at misdiagnosis was 48 years, the median age at onset was 40.5 years, and the median disease duration was 54 months. The main skin lesions were black maculae and papules. The initial clinical diagnoses were pigmented nevi (53 cases, 44.92%) , nail matrix nevi (12 cases, 10.17%) , seborrheic keratosis (14 cases, 11.86%) , vascular tumors (10 cases, 8.47%) , squamous cell carcinoma (5 cases, 4.24%) , basal cell carcinoma (4 cases, 3.39%) and other diseases (20 cases, 16.95%) . As far as the ABCDE (asymmetry, border irregularity, color variegation, diameter > 6 mm, evolving) rule for melanoma was concerned, 78 (66.10%) , 64 (54.24%) , 57 (48.31%) , 66 (55.93%) and 39 (33.05%) cases conformed to hte A, B, C, D and E rules respectively, 14 conformed to the ABCDE rule, 13 conformed to the ABCD rule, and 13 did not conform to any of them. Among the 53 cases of melanoma in situ, 28 (52.83%) were misdiagnosed as pigmented nevi, 11 (20.75%) as nail matrix nevi; among the 66 cases of invasive melanoma, 25 (37.88%) were misdiagnosed as pigmented nevi, 9 (13.64%) as vascular tumors, and 5 (7.58%) as squamous cell carcinoma. The information of physicians of 67 misdiagnosed patients was available, and those of 42 out of the 67 patients had clincial experience of ≤ 5 years; among 27 misdiagnosed patients conforming to the ABCD or ABCDE rule, the information of physicians of 9 patients was available, and those of 7 out of the 9 patients had clinical experience of ≤ 5 years. Conclusion:Cutaneous melanoma has a variety of lesion patterns and is easily misdiagnosed, and physicians′ clinical experience and the ABCDE rule-based evaluation are important for diagnosis.

The misdiagnosis reported about a case of adrenal alveolar echinococcosis / 中华泌尿外科杂志

The clinical data of a case of adrenal alveolar echinococcosis treated and misdiagnosed in our hospital were reported retrospectively. The pre-operative CT examination of this patient showed that the liver S7 segment-the right adrenal gland area showed irregular masses of mixed density lesions, the boundary was unclear, consider the possibility of liver hydatid. During the operation, hydatid was found to only invade the liver capsule, and the primary lesion was the adrenal gland. The right adrenal gland and lesion were resected by urological surgeons. The pathological diagnosis was adrenal alveolar echinococcosis. When the imaging examination considers hepatic alveolar echinococcosis, and the lesion is mainly in the right adrenal gland area, it should be considered that the primary lesion could be in the adrenal gland.

Misdiagnosis analysis of 5 cases of pneumonia type lung cancer / 中国综合临床

The clinical data of 5 patients with pneumonia type lung cancer from January 2017 to January 2020 were retrospectively analyzed.The results showed that the clinical symptoms of the 5 patients were cough and expectoration.The infection index was mildly abnormal, and the tumor marker index was increased.After anti infection treatment, the effect was not good.The diagnosis of pneumonia type lung cancer was confirmed by improving the fiberoptic bronchoscopy biopsy.Due to the lack of specificity of clinical manifestations, if the early diagnosis of pneumonia type lung cancer can not be confirmed, the chest imaging can be reviewed after anti infection treatment, and the pathological basis can be obtained by timely improvement of fiberoptic bronchoscopy, bronchoalveolar lavage and lung biopsy.

Effectiveness of an educational program on improving healthcare providers’ knowledge of acute stroke: A randomized block design study / 世界急诊医学杂志（英文）

@#BACKGROUND: Stroke is a time-sensitive neurological disease and a life-threatening medical condition. Providing timely management for stroke patients is a crucial issue in healthcare settings. The primary objective of this study is to evaluate the effectiveness of an evidence-based educational program on healthcare providers’ (HCPs) overall knowledge of stroke. METHODS: A randomized block design with post-test only was used. A total of 189 HCPs (physicians, registered nurses, and paramedics) involved with treating stroke patients in the emergency were recruited. Participants were randomly assigned to either the intervention or waiting list control group. A one-session, stroke educational program was offered to the HCPs followed by a post-test designed to assess knowledge about stroke. RESULTS: A significant main effect on the profession type was found, with physicians having higher mean scores of stroke knowledge compared with nurses and paramedics (F [2, 183]=48.55, P<0.001). The implemented educational program had a positive effect on increasing the level of stroke knowledge among HCPs (F [1, 183]=43.31, P<0.001). The utilization of any evidence-based assessment tools for patients with suspected stroke was denied by 36% of the total sample. CONCLUSIONS: The implemented intervention can increase HCP’s knowledge regarding stroke. Stroke education should be considered as one of the essential requirements for professional development for all HCPs in the emergency.

The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre / 中国医学科学杂志(英文版)

Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.

Pneumonia, Multiple Pulmonary Infarction and Abscess Caused by a Bamboo Stick Accidentally Piercing into Chest: a Case Misdiagnosed as Pulmonary Tuberculosis / 中国医学科学杂志(英文版)

Computed tomography (CT) examination is the major measure for detecting and diagnosis of foreign bodies in human body. Although CT has high sensitivity in diagnosis of foreign body, some interference factors may still lead to missed diagnosis or misdiagnosis. Here we report a rare case that a bamboo stick accidentally pierced into the left chest of a young man who was drunk and unware of this hurt. The patient experienced cough, chest pain, fever, hemoptysis, and was misdiagnosed as primary and secondary tuberculosis based on chest CT examinations at a local hospital, although no tubercular bacillus detected by sputum smear. He subsequently received anti-tuberculous treatments in the following three years, but no improvement of his symptoms was observed. Until one month before his death, the bamboo stick was detected by spiral CT examination as well as three-dimensional image reconstruction at another hospital. Postmortem examination revealed pneumonia, pulmonary infarction, and abscess as the causes of his death. We analyze the potential reasons of misdiagnosis in this case, aiming to provide reference for the diagnosis and treatment of pulmonary inflammation associated with foreign body in the future.