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.
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 discuss the CT characteristics of combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC), and analyze the reasons for its misdiagnosis. MethodWe retrospectively analyzed the CT data of 7 patients diagnosed to have combined hepatocellular carcinoma and cholangiocarcinoma by postoperative pathological analysis between January 2009 and February 2015. We analyzed such characteristics as location, shape, density, enhanced features, surrounding invasion, mediastinal lymph node metastasis, cirrhosis and pyoperitoneum of the disease. ResultsThere were 7 tumors among the 7 patients. Plain scan showed slightly lower density nodules or masses. After the enhancement of arterial phase, 5 tumors showed obvious inhomogeneous enhancement but 2 mild marginal enhancement. During the portal venous phase and the delay stage, the regional degree of tumor foci was significantly decreased, but some regions sustained annular or nodular and patchy enhancement. Among the 7 cases, the portal vein was invaded in 2, bile duct in 1, lymph node metastasis in 2, cirrhosis in 1, and peritoneal effusion in 1. Preoperative diagnosis was correct in only 2 cases and the other 5 cases were misdiagnosed by CT. ConclusionsThe cHCC-CC possesses some characteristic appearances on CT. Analyzing the characteristics carefully combining with symptom and cytological examination of hydrothorax can reduce the incidence of misdiagnosis.
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.
Objective To retrospectively analyze the clinical information of a series of patients with cryptococcal neoformans meningitis in order to improve the diagnosis and treatment level. Methods Fifteen patients with etiological diagnosis as cryptococcal neoformans meningitis from January 2004 to December 2009 in the Affiliated Shengjing Hospital of China Medical University were included in the study. The clinical manifestations, treatment and prognosis of those patients were retrospectively analyzed. Results Seven of the total 15 patients were misdiagnosed with misdiagnosis rate of 46.7%. Twelve patients were treated by combination of amphotericin B/Lipo-AMB and fluconazole intravenously infusion, and then followed by the maintenance therapy of fluconazole orally administration, of which 7 were cured, 3 were improved, and 2 died. Five patients undergoing lumbar cisterna drainage were all cured. The follow-up study showed that 4 cases were accompanied by auditory or/and visual dysfunction within 1 to 5 years after hospital discharge. Three cases died that were not treated with anti-fungal drugs. Conclusion The misdiagnosis rate of cryptococcal neoformans meningitis is high. The keys to reduce mortality are raising vigilance, early diagnosis, rational use of antifungal drugs, and effectively lowering the intracranial pressure. The integrated therapy of amphotericin B/Lipo-AMB and fluconazole is effective and safe. Lumbar cisterna drainage can effectively lower the intracranial hypertension, quickly relieve symptoms and improve prognosis.
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.
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 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.
Objective To investigate the reasons of misdiagnosis and missing diagnosis in blunt abdominal trauma (BAT), and to put forward effective preventive measures. Methods Literature on BAT diagnosis in recent years was reviewed. Results Misdiagnosis and missing diagnosis, which can take place in every segment of BAT patients, were still quite common nowadays. Conclusion Detailed case history collecting, faithful medical examination and making good use of assistant examinations can efficiently decrease the misdiagnosis and missing diagnosis rates of BAT patients.