nlwxpearo
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 Posted: Thu 11:53, 10 Mar 2011 Post subject: Pregnancy with acute hematogenous disseminated tub |
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Pregnancy with acute hematogenous disseminated tuberculosis case of missed diagnosis
37 cases, 39 cases (8.92%) to the main symptoms of respiratory complaints outside the system, are misdiagnosed. Analysis of the causes of misdiagnosis is as follows. Clinical data 1 1.1 General Information 28 males and 11 females; aged 27 to 78 years. 28 cases of smokers, smoking index of more than 400 years of supporting clinical manifestations and misdiagnosis of 1.2 ① bone and joint symptoms of disease: 14 cases showed limb joint pain, low back pain, paraplegia, pathological fracture, clubbing (toe), misdiagnosed as rheumatoid arthritis, hypertrophic osteoarthropathy,[link widoczny dla zalogowanych], fracture, lumbar muscle strain in 2 cases, cervical spondylosis, lumbar disc herniation 3 cases; 1 case of limb swelling, pain, misdiagnosed as thromboembolic phlebitis. ② nervous system symptoms: 1O patients were headache, dizziness, tinnitus, diplopia, vomiting, aphasia, numbness, unconsciousness, convulsions, movement disorders, gait instability, misdiagnosed as cerebral vascular accident in 4 cases, brain glial cells tumor in 3 cases, 2 cases of Meniere's disease, meningitis in 1 case; 3 cases showed limb weakness, fatigue, distal sensory disturbance, 2 cases were misdiagnosed as myasthenia gravis, peripheral neuropathy in 1 case; 1 case insensitive , stupor,[link widoczny dla zalogowanych], extreme fatigue, misdiagnosed as intractable hyponatremia. ③ Other symptoms: 4 patients with both upper limbs and facial edema, supraclavicular enlarged lymph nodes and fever for the performance of the newly diagnosed as enlarged lymph nodes of unknown origin; 1 case of multiple subcutaneous nodules misdiagnosed as multiple lipoma; 1 case of unilateral Horner syndrome misdiagnosed as eyelid drooping; 1 male breast enlargement, pain misdiagnosed as gynecomastia; 1 patient misdiagnosed as esophageal dysphagia; 1 patient misdiagnosed as laryngitis hoarseness; 1 case of central obesity, purple skin patterns, loss of libido, hypertension, hypokalemia, Cushing's syndrome misdiagnosed. 1.3 Medical examination and diagnosis technology based on 39 cases underwent x ray and lung CT scan showed central lung cancer in 14 cases, 25 cases of peripheral lung cancer. Photo x ray bone slices in 14 cases, 10 cases showed periosteal, bone hyperplasia with narrowed joint space, disc, 4 patients with osteolytic destruction and fracture. Neurological symptoms appeared caught by head CT scan, 7 patients found to have single or multiple intracranial low-density lesion. Check blood electrolytes in patients with limb weakness normal neostigmine test was negative. . 46 * difficulty swallowing barium upper gastrointestinal tract who were normal. The group were pathologically diagnosed as lung cancer, 4 cases of cervical lymph node biopsy,[link widoczny dla zalogowanych], 22 cases bronchoscopy biopsy, sputum cytology in 9 cases, 5 cases cT-guided percutaneous lung biopsy. Pathological types: adenocarcinoma 1l cases, 8 cases of squamous cell carcinoma, small cell undifferentiated carcinoma in 15 cases, 5 cases are not stereotypes. 1.4 Results of the treatment and surgery of 9 cases, 6 cases of postoperative chemotherapy, 3 patients were preoperative and postoperative chemotherapy; 4 patients chemotherapy; 17 cases chemotherapy; 6 patients only received nutritional support; 3 cases gave up treatment . Follow-up cases: 6 patients survived six months, 13 patients survived 7 months to 1 year, 2O patients survived 2 to 4 years. 2 to discuss the incidence and symptoms 2.1 2.1.1 paraneoplastic syndrome generation mechanism: the respiratory system in non-metastatic manifestations of lung cancer, also known as the first symptom of paraneoplastic syndrome, often before diagnosis of lung cancer a few months to several years appears to be the first performance of lung cancer also may occur in lung cancer progression. The occurrence of ectopic endocrine mechanism is not due to lung cancer metastasis or direct invasion,[link widoczny dla zalogowanych], can not be inhibited by drugs, when the resection of lung cancer lesions, loss of a source of ectopic hormone, blood hormone levels drop, the regression of clinical manifestations. Paraneoplastic syndrome of lung cancer reported in the literature the incidence of 10% to 20% ..., the group accounted for 30.8% (12/39). 2.1.2 Bone Metastases: Bone metastasis of lung cancer reported 38.9% ~ 81.8%, this group accounted for 25.6% (10/39). The central axis of the main bone of bone metastasis, metastatic sites, the most common bone around the lung, such as the spine, pelvis, ribs, femur; bone metastasis as the first symptom of bone pain, joint pain, pathologic fractures. Bone metastases as osteolytic destruction, bone destruction in 1 to 2 months prior to the onset of symptoms. Cancer pain is often the first symptom, and the pathological changes in bone destruction to many diseases, it is easy to mislead doctors to diagnose ideas. 2.1.3 brain metastases: incidence of lung cancer with brain metastasis of 20.7% ~ 31.8%, ranking first in brain metastases,[link widoczny dla zalogowanych], and lung cancer with brain metastasis as the first symptoms about 10%, this group accounted for 25. 6% (10/39). Misdiagnosed as lung cancer with brain metastasis cerebral vascular accident or other tumors, is difficult to differentiate between the clinical, CT showed morphology similar to symptoms of increased intracranial pressure in elderly patients is not obvious. 2.1.4 tumor compression symptoms: this group accounted for 17.9% (7 / 39). Esophageal compression caused by local tumor extension dysphagia, compression or transfer directly to the mediastinal lymph nodes, recurrent laryngeal nerve compression caused hoarseness, superior vena cava compression produces Horner
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