ObjectiveTo explore the status,reasons and precautions of misdiagnosis of pulmonary sequestration. MethodsSeventy-seven articles about pulmonary sequestration published in Wanfang and CNKI databases between January 2005 and December 2013 were retrospectively analyzed,of which 41 articles referring to misdiagnosis rate.The misdiagnosis rate,time,status,consequence,reason and main means of definite diagnosis were analyzed. ResultsThe total number of cases of pulmonary sequestration in the 41 articles was 689,in whom 399 cases were misdiagnosed.Misdiagnosis rate was 57.91%.The minimum misdiagnosis time was 14 days and the maximum was 40 years.Pulmonary sequestration was most often misdiagnosed as pulmonary cyst(23.16%),bronchiectasis(22.73%),lung cancer(20.08%),lung abscess(6.93%)and pneumonia(6.28%).Most misdiagnosed patients did not suffer adverse consequences,except 4 patients were dead and 1 patient undertook unnecessary extended operation.Lack of specificity in clinical manifestations,lack of awareness of the disease,diversity of imaging performance and complications covering the original disease were the most common reasons of misdiagnosis.Postoperative pathological examination(83.77%),intraoperative findings(13.42%)and computed tomography angiography(2.16%)were the main means of definite diagnosis in misdiagnosed cases. ConclusionPulmonary sequestration is lack of specificity in clinical manifestations and easy to be misdiagnosed.Imaging showing the abnormal blood supply vessels is the key to the diagnosis.Improving the awareness of it can reduce misdiagnosis and incorrect treatment.
ObjectiveTo analyze the reasons for misdiagnosis of gastrointestinal metastatic ovarian cancer, in order to increase the rate of correct diagnosis and treatment, and to investigate the prognostic factors. MethodsWe retrospectively analyzed the clinical features, pathological features and prognostic factors of 43 cases of metastatic ovarian carcinoma from gastrointestinal tract treated between 2004 and 2014. ResultsGastrointestinal metastatic ovarian cancer was characterized by the diversity of clinical manifestations and lack of specific symptoms. The common initial symptom was pelvic mass, frequently accompanied with gastrointestinal symptoms of ascites, anemia or weight loss, abdominal pain, bloating, gastrointestinal obstruction and bleeding. Signs and symptoms of primary and secondary tumor sites often coexisted with each other, leading to misdiagnosis. Univariate analysis showed that primary site, histological type, surgical treatment, the residual tumor debulking size, lymph node metastasis, tumor invasion and standard chemotherapy had significant impacts on the prognosis (P < 0.05). ConclusionsGastrointestinal metastatic ovarian cancer occurs in premenopausal women, often with ascites, abdominal pelvic masses as the first symptom. Primary tumor site is often ignored, and the initial correct diagnosis rate is low. Metastasis from stomach cancer is the most common, followed by colorectal cancer and esophageal cancer. Prognosis is correlated with the primary site, histological type, degree of differentiation, depth of invasion, lymph node metastasis and other factors. Radical surgery and chemotherapy can improve survival.
ObjectiveTo investigate the clinical, radiographic characteristics and differential diagnosis of pulmonary Langerhans cell histiocytosis (PLCH) mimicking metastasis of cancer in radiography. MethodsClinical data of 2 patients with PLCH manifesting as metastatic cancer on HRCT and PET/CT were retrospectively analyzed. Patients reported as PLCH on WanFang Database, China Knowledge Resource Integrated Database and Pubmed were reviewed to screen misdiagnosis literature and further analyzed the clinical and radiographic characteristics. ResultsTwo cases both presented with cough and sputum. 18F-FDG PET/CT showed increased 18F-FDG up-take in both nodules in the lungs. One patient presented with multiple nodules, diffuse multiple cystic changes in lungs and osteoclasia in the right 4th rib on HRCT who was diagnosed by a video-assisted thoracoscopic biopsy of rib biopsy. The other patient presented with diffuse multiple nodules on HRCT who was diagnosed by a video-assisted thoracoscopic biopsy of lung biopsy. The pathological characteristics of both biopsy specimen demonstrated infiltration by Langerhans cells (LC) and eosinophils. The LC were positive for CD1a. Literature review found seven PLCH cases who were misdignosed as depression, eosinophilic pneumonia, interstitial lung disease involvement of autoimmune disorders and malignant tumor. ConclusionWhen clinician faced with a patient suspected as metastatic cancer by HRCT and PET/CT, it is reasonable to consider PLCH as a differential diagnosis and obtain the pathological information as soon as possible so that better prognosis can be achieved through early intervention.
Objective To summarize the clinical features of motor neuron disease ( MND) with main presentation of pulmonary hypertension, so as to improve the diagnosis.Methods A patientwithMND whose main presentation was pulmonary hypertension was analyzed retrospectively. Meanwhile related literatures were reviewed. Clinical data including symptoms, early signs, misdiagnosis causes, and necessary functional examination of respiratory muscle were collected. Results The symptoms of MND was slow-onset and insidious with gradual progression over time. History inquiring found that the symptoms of muscle wasting and physical debilitation emerged long time before the respiratory symptoms. Physical examination also revealed obvious sign of muscle atrophy. Conclusions MND with main presentation of pulmonary hypertension has been recognized insufficiently and often misdiagnosed as other pulmonary diseases. Detailed history taking, systematic physical examination, and convenient functional examination of respiratory muscle,can not only reduce misdiagnosis, but also avoid some expensive and traumatic process.
ObjectiveTo analyze the MR findings of primary gallbladder carcinoma so as to improve the diagnostic accuracy. MethodsA retrospective study was developed involving 15 primary gallbladder carcinoma patients identified by postoperative pathology between January 2010 and March 2013. Imaging findings were analyzed including lesions location, enhancement characteristics, the dilatation of bile ducts and gallstones. ResultsAmong the 15 gallbladder carcinoma patients, 5 were misdiagnosed as neoplasms in the porta hepatis combined with dilation of intrahepatic bile ducts. Intra- and extrahepatic bile ducts dilated in 7 patients, which were misdiagnosed as tumors or inflammation. Two cases of gallbladder carcinoma with right lobe mass were misdiagnosed as gallbladder polyps. One patient was misdiagnosed as cholecystitis. The retrospective analysis revealed that the gallbladder wall thickened in 12 cases, with focal thickening in 9 and diffuse thickening in 3 cases. Enhanced scanning demonstrated that gallbladder wall enhanced in varying degrees, and 11 cases had delayed enhancement features. There were 8 patients with gallstones and 2 with gallbladder wall nodules. ConclusionPrimary gallbladder carcinoma can easily cause bile duct dilatation, and manifests as focal or diffuse mural thickening, often accompanied by gallstones.
Objective To investigate the clinical features of hypersensitivity pneumonitis and misdiagnosis causes. Methods The morbidity, misdiagnosis, progression, treatment, recovery, relapse and experience of treatment of a case with hypersensitivity pneumonitis was retrospectively analyzed. Results Patients with hypersensitivity pneumonitis usually have a contact history of organic dust, and clinical manifestations are nonspecific. Chest radiography shows wandering pattern of multiple reticular or patchy infiltration shadows. Lung function tests showrestricted ventilation and impaired diffusion. Blood eosinophil is usually normal. Lymphocyte and sedimentation antibody in serum and bronchoalveolar lavage fluid may still be normal. Pathohistology is complicated, with a progression from acute inflammation to chronic fibrosis. Systemic steroid should be prescribed as soon as possible. Antigen avoidance should be emphasized. Conclusions Clinical symptoms of hypersensitivity pneumonitis is atypical, which may be easily misdiagnosed. The contact history, clinical features, chest radiography, laboratory examination and pathological changes should all be considered in such cases.
Objective To investigate the imaging characteristics of endometrial polyps by using transvaginal ultrasound and analyze the causes of misdiagnosis. Methods Fifty-seven patients pathologically diagnosed of endometrial polyps were retrospectively analyzed. Results The endometrial polyps had its own characteristics of ultrasound images, especially the lesion, size, shape, echo, border, color Doppler flow imaging (CDFI) and so on. Conclusion Endometrial polyps has some special features on ultrasound image. Inspection in the secretary period, along with endometrial hyperplasia of the merger as well as multiple myoma the merger may result in misdiagnosis.
ObjectiveTo discuss the CT characteristics of pleural lung cancer, and analyze the reason for misdiagnosis. MethodsThe CT data of 8 patients with pleural lung cancer confirmed by postoperative pathology and treated in Renshou People's Hospital and Fist Affiliated Hospital of Chongqing Medical University between January 2010 and December 2013 were retrospectively analyzed. ResultsAmong the 8 cases of pleural lung cancer, 6 occurred on the left and 2 on the right; there were 3 nodular and 5 irregular masses; 6 had uniform density and 2 had irregular focus and relatively lower density; 4 had osteolytic destruction of adjacent ribs; 6 had pleural effusion; and 5 had mediastinal lymph nodes enlargement, in which 1 had multiple lymph node metastasis of left lung hilum, left supraclavicular region and left axillary. All the 8 cases were enhanced moderately. ConclusionPleural lung cancer has certain featured manifestations on CT. Analyzing the features carefully, considering clinical symptoms, and cytological examination of hydrothorax can reduce the incidence of misdiagnosis.
Objective To investigate the reasons, status, treatment and precautions of misdiagnosis of pulmonary inflammatory pseudotumor. Methods Between January 2005 and December 2015, one hundred eighteen articles about pulmonary inflammatory pseudotumor published in Wanfang and CNKI databases were retrospectively analyzed, among them forty-four articles referring to misdiagnosis rate. The misdiagnosis rate, distribute of misdiagnosed diseases, reasons and main means of definite diagnosis were analyzed. Results There were 1 286 cases of pulmonary inflammatory pseudotumor in the 44 articles, of them 1 012 cases were misdiagnosed. The misdiagnosis rate was 78.84%. Pulmonary inflammatory pseudotumor was often misdiagnosed as lung cancer (65.81%), tuberculosis (15.42%, which included 72 cases of tuberculoma and accounted for 7.11%) and benign pulmonary neoplasms (9.59%). Most misdiagnosed patients did not suffer from adverse consequences, except a few patients undergo unnecessary extended operations. Lack of specificity in clinical manifestations, lack of awareness about the disease, dependent on auxiliary examination and lack of awareness about the fine feature of the disease were the main reasons of misdiagnosis. The majority of misdiagnosed cases were terminal pathological diagnosed through the operation or after percutaneous biopsy. Conclusions Pulmonary inflammatory pseudotumor is lack of specificity in clinical manifestations and easy to be misdiagnosed. It is very important to analyze and identify the fine feature of imaging changes. To reduce and avoid misdiagnosis, clinicians should improve the awareness of this disease.
ObjectiveTo analyze misdiagnosis of other lung diseases as asthma to avoid medical error. MethodsSixty-nine cases who were misdiagnosed as asthma between February 2012 and February 2014 were recruited. Clinical data was collected and analyzed including characteristics of symptoms, induced sputum, pulmonary function and blood tests. ResultsThere were 13 diseases misdiagnosed as asthma, and eosinophilic bronchitis(21.74%), upper airway cough syndrome(20.29%), chronic obstructive pulmonary disease(13.04%), allergic bronchopulmonary aspergillosis(7.25%) and hyperventilation syndrome (7.25%) were the top five diseases in these cases. Some rare diseases were also found such as idiopathic hypereosinophilic syndrome and vocal cord dysfunction. ConclusionsA variety of diseases have the similar clinical symptoms with asthma. The key to avoid and reduce misdiagnosis is to strengthen the understanding of asthma and similar diseases.