1/11. dyspnea lusoria: compression of the pulmonary artery by a Kommerell's diverticulum.We report a rare case of Kommerell's diverticulum presenting as dyspnea on exertion. After careful physical examination, selective imaging tests demonstrated a significant flow abnormality in the left pulmonary artery caused by an aneurysm of the descending aorta in the area of the ligamentum arteriosum.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/11. Contemporary evaluation and management of the female urethral diverticulum.We are in agreement with Davis and Telinde, who state, "The most important single diagnostic instrument for the discovery of suburethral diverticula is the high index of suspicion" [25]. The key to successful treatment of a female diverticulum is not only in the surgical management but also in the identification and evaluation of patients who present with a myriad of symptoms. It is our responsibility to include urethral diverticula in the differential diagnoses before the labels of interstitial cystitis, urethral syndrome, or urgency frequency syndrome are misplaced. The diagnosis may be elusive and the pathology difficult to identify on physical examination. However, if the index of suspicion is high and the proper radiologic imaging studies are gathered, then the correct diagnosis will often be made. The evaluation of the female urethral diverticulum has evolved greatly over the past several years. However, once appropriate diagnosis is made, the management scheme is fairly straightforward. Strict adherence to principles of surgical reconstruction allows one to eradicate the diverticulum while simultaneously preventing complications and recurrences.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/11. endometriosis presenting as a urethral diverticulum: a case report.BACKGROUND: pelvic pain is a common complaint among women of childbearing age. It has an extensive differential diagnosis that at times can make it difficult to determine its etiology. One must therefore rely on the characteristics of the physical examination, symptoms and imaging studies. However, in doing so, one should keep in mind that many diseases mimic one another. physicians must be careful not to fall into the trap of simply assigning a specific disease to a given group of symptoms. CASE: A 35-year-old woman, gravida 2, para 0020, presented to a clinic complaining of left lower abdominal pain. She had a history of dyspareunia, dysmenorrhea, urinary frequency and numerous urinary tract infections. Previous laparoscopies had been negative for endometriosis. Physical examination demonstrated a 1.5-cm mass left of the midurethra. No pus was expressed through the urethra with cyst massage. Imaging showed a 1.1 x 1.1-cm lesion in the left posterolateral aspect of the urethra consistent with a urethral diverticulum. Uterine adenomyosis was also noted. Although clinical symptoms, physical examination and imaging suggested a urethral diverticulum, a vaginal endometriotic cyst was encountered at surgery. Pathologic evaluation of the surgically excised lesion revealed endometriosis, revealed endometriosis. CONCLUSION: In this case, clinical findings, location and imaging characteristics of a periurethral endometriotic lesion suggested a urethral diverticulum. endometriosis should be considered in patients with a history of pelvic pain who present with urinary frequency and a periurethral lesion.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
4/11. Enterolithiasis in jejunal diverticulosis, a rare cause of obstruction of the small intestine: a case report.Jejunal diverticula are rare and usually asymptomatic; they occur twice as frequently in men. They are discovered incidentally during small-bowel enteroclysis, CT scan or laparotomy. Complications include diverticulitis, perforation, hemorrhage and enterolith formation. intestinal obstruction due to enterolithiasis is uncommon. We present the association of enterolithiasis and jejunal diverticulosis causing obstruction of the small intestine in a 74-year-old female who was admitted for abdominal cramps, nausea and vomiting. On physical examination, there was discomfort on palpation of the upper abdomen. Laboratory tests revealed mild elevation of leucocytes and c-reactive protein. CT scan demonstrated dilatated loops of proximal jejunum with thickening of the wall, suggesting ingestion of a foreign body. Clinical and radiological findings did not indicate conservative therapy; our patient underwent minilaparotomy, and pronounced jejunal diverticulosis was identified. An enterotomy was performed and a cylindrical enterolith, 10cm long and 3cm in diameter, was removed. The operative and postoperative course was uneventful. Enterolithiasis must be considered as a potential source of intestinal obstruction. The differential diagnosis should take gallstone ileus and ingestion of a foreign body into consideration. Initial therapy is nonoperative; if this management fails, surgery is indicated.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/11. Multiple gastrointestinal stromal tumors and synchronous ileal carcinoids.BACKGROUND: A 74-year-old African-American male presented with a 3-day history of hematemesis and melena. The patient reported no abdominal pain, constitutional symptoms, bright red blood per rectum, constipation, or diarrhea. His physical examination and medical history were unremarkable except for benign prostatic hypertrophy. An esophagogastroduodenoscopy showed a 3 x 2 x 2 cm smooth round mass in the cardia, 2 cm distal to the gastroesophageal junction. biopsy of the mass revealed an ulcerated tumor composed of spindle cells. immunohistochemistry showed positive staining for a number of biochemical markers, including KIT, Ki-67 and smooth muscle actin, but was negative for the markers S100 and desmin. A gastric-wedge resection revealed an ulcerated 4.5 cm mass in the stomach, and exploration of the abdomen revealed two ileal carcinoid tumors, jejunal diverticula and reactive mesenteric lymphadenopathy. INVESTIGATIONS: Esophagogastroduodenoscopy, biopsy, CT scan, immunohistochemistry, dna microarray analysis and quantitative reverse transcriptase-PCR. diagnosis: Multiple gastrointestinal stromal tumors occurring concomitantly with ileal carcinoids. MANAGEMENT: Gastric-wedge resection and segmental resection.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/11. Giant diverticulum of the bladder simulating ovarian cyst.A patient was admitted for investigation of a giant ovarian cyst, confirmed by physical examination. At laparotomy the genital organs appeared normal. Ultrasonic reexamination affirmed the preliminary findings of a pelvic cystic mass. A urinary bladder diverticulum was suspected and confirmed by cystography and found to be nonobstructive in nature. Although extremely rare, bladder diverticulum should be considered in the differential diagnosis of a cystic pelvic mass.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/11. Complications of acquired diverticula of the ileum.Acquired diverticula of the small bowel are extremely rare. These diverticula occur in less than one per cent of the population. Acquired diverticula of the ileum make up approximately ten per cent to 20 per cent of this number. Associated complications are noted in less than ten per cent of patients, but mortality rates related to these complications have been reported to range from 25 per cent to 50 per cent. Major reported complications include perforation, hemorrhage, and obstruction secondary to inflammation. Our experience with three cases of complicated ileal diverticula is presented. All patients presented with physical findings consistent with an acute abdomen, but the correct diagnosis was not made in any of these patients preoperatively. Two patients were found to have perforation of an ileal diverticulum: one with localized abscess formation and the other with diffuse peritonitis. The third patient had ileal diverticulitis without perforation. Two of the patients had resection and primary anastomosis. The third patient had resection and an ileostomy and mucous fistula created. Postoperatively, one patient died of a massive cerebrovascular accident. A thorough discussion of the literature concerning these rare acquired ileal diverticula is presented. Clinical manifestations, complications, and associated surgical therapy are discussed. Usually, resection of the involved segment with primary anastomosis can be performed.- - - - - - - - - - ranking = 0.045868337927393keywords = physical (Clic here for more details about this article) |
8/11. female urethral diverticula: double-balloon catheter study.A double-balloon catheter was used to evaluate the female urethra in 51 patients. Six different radiographic appearances were identified. Three of the categories are considered variants of normal. One of the categories consisted of eight patients with urethral diverticula. All showed large rounded or lobulated collections of contrast material which were adjacent to the urethra and which persisted on postvoid films. Other abnormalities should be closely correlated with the clinical findings to determine their significance. The diagnosis of urethral diverticulum may be missed, as physical examination and endoscopy can be negative. Therefore, the optimal method for identifying its presence and extent includes both a double-balloon catheter study and a voiding cystourethrogram.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/11. Perforated jejunal diverticula: an analysis of reported cases.We recently encountered two cases of perforated jejunal diverticula. We analyzed the data from all available cases of perforated jejunal diverticula, including our two cases. Our purpose was to increase awareness of this rare clinical entity as a cause of abdominal pain. An extensive literature review using medline from its inception in 1972, and a manual review of all previously published reports was performed. Data collected included age, gender, length of symptoms from history and physical exam, operative findings, type of operation, and outcome (survival). Data analysis was performed using student's t test and multivariate analysis. survival was not influenced by gender or type of operation. When the reports documented the number of diverticula present in the area of perforation (22 cases) a majority (19/22) had multiple diverticula. Perforated jejunal diverticula are a rare clinical entity in which age, type of operation, and gender does not influence outcome, but a longer duration of symptoms before operation trended towards a worse outcome. This clinical diagnosis should be entertained as part of any evaluation of abdominal pain.- - - - - - - - - - ranking = 0.045868337927393keywords = physical (Clic here for more details about this article) |
10/11. Symptomatic lacrimal duct diverticulum associated with closed nasal fracture.Diverticula of the nasolacrimal collecting system are rare. Their cause may be congenital, inflammatory, or traumatic. A diverticulum of the nasolacrimal duct that presented 26 years after nasal trauma is described. The location of this diverticulum is extremely uncommon, and a case occurring after closed nasal trauma has not yet been presented. Evaluative studies and pertinent anatomy are reviewed. In any patient with recurrent dacryocystitis after nasal fracture, the diagnosis of a lacrimal system diverticulum should be considered. A detailed history and physical examination combined with dacryocystography can be confirmatory. Treatment should consist of surgical exploration with a nasolacrimal system bypass procedure.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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