1/16. A bleeding disorder caused by a cardiac tumor: case report.A 22-year-old female developed symptomatic thrombocytopenia. On physical examination, apart from ecchymoses, a loud holosystolic murmur was heard. echocardiography revealed a cardiac tumor. The thrombocytopenia did not respond to corticosteroids, but after surgical removal of the intracardiac tumor, a papillary fibroelastoma, the platelet count normalised. There are no similar case reports in the literature. Our case report illustrates that thrombocytopenia may be associated with a cardiac tumor and that complete physical examination is essential in every patient presenting with easy bruising.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/16. A case of head and neck kaposiform hemangioendothelioma simulating a malignancy on imaging.Kaposiform hemangioendothelioma (KH) is an endothelial-derived spindle cell neoplasm often associated with kasabach-merritt syndrome. Most cases arise in infancy and childhood and are soft-tissue tumors. The tumor displays an appearance between capillary hemangioma and Kaposi's sarcoma. We report a case of KH in a 1-year-old girl involving a mass that showed abnormal enhancement of soft tissue superficial to the right temporal bone with partial destruction of the temporal bone, the temporomandibular joint, mandibular condyle, and occipital bone. The physical finding of a discolored mass led clinicians to consider a hemangiomatous lesion, whereas the radiological picture suggested a more aggressive diagnosis of rhabdomyosarcoma and aggressive fibromatosis.- - - - - - - - - - ranking = 0.062625888680343keywords = physical (Clic here for more details about this article) |
3/16. Bilateral elastofibroma dorsi: proper positioning for an accurate diagnosis.Elastofibroma dorsi is a rare, slow-growing, ill-defined soft tissue tumor of the chest wall, most commonly located beneath the rhomboid major and latissimus dorsi muscles. It is usually unilateral, and bilateral involvement occurs in only 10% of patients. We report herein a case of a 56-year-old woman with bilateral elastofibroma dorsi. The patient was found to have bilateral involvement of the tumor following a physical examination with proper positioning. An elastofibroma should be considered in the differential diagnosis of tumors deeply located at the periscapular area. Meticulous physical examination may reveal a nonpalpable coexisting tumor with deep subscapular location and help the accurate diagnosis of bilateral elastofibroma dorsi, hence preventing a secondary operation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/16. July 2002: 66-year-old female with a one-year history of progressive left proptosis.The July 2002 Case of the Month (COM). This 66-year-old Caucasian female presented with gradually increasing protrusion of her left eye over a one-year period. She complained of increased tearing and foreign body sensation. The physical examination revealed a visual acuity of 20/20, normal color testing, full vision field with motility of her left eye limited in lateral gaze. Pupils were round, symmetric, with no afferent pupillary defect noted. On external examination, her left eye was grossly proptotic with resistance to retropulsion. She had 4 mm proptosis of the left eye. Computed tomography and MR imaging demonstrated a left retro-orbital mass with gadolinium enhancement and focal remodeling of orbital bones. She underwent surgical resection of tumor with a diagnosis of solitary fibrous tumor, and postoperatively she was symptom free. The histopathological differential diagnoses of spindle cell neoplasms of the orbit are discussed. Five months after surgery, no evidence of tumor recurrence was seen on neuroimaging and her vision was 20/20.- - - - - - - - - - ranking = 0.5keywords = physical examination, physical (Clic here for more details about this article) |
5/16. Pelviscopic treatment of ovarian cysts in premenopausal women.Between 1984 and 1989, 773 patients less than or equal to 45 years of age, presenting with a total of 809 ovarian cysts, underwent pelviscopy at the Department of obstetrics and gynecology of Kiel University. In 36 cases, cysts were bilateral. 678 cysts (84%) were treated by pelviscopy alone. Organ-preserving treatment was performed in 83%, oophorectomy or adnexectomy in only 17% of cases. Two stage Ia ovarian carcinomas (0.26% of all cysts) were operated on by pelviscopy before laparotomy. Sonography is particularly important in determining whether a pelviscopic approach is appropriate. Pelviscopic procedures are unacceptable in multilocular cysts measuring greater than or equal to 7 cm in diameter with echo-dense components. Special caution is required for any cyst measuring greater than 9 cm in diameter. The risk of opening a malignant cyst must be weighed against the advantages of pelviscopic surgery: minimal physical strain, better postoperative quality of life, and organ conservation. In doubtful cases, laparotomy is recommended.- - - - - - - - - - ranking = 0.062625888680343keywords = physical (Clic here for more details about this article) |
6/16. Endoscopic sinus surgery treatment for a huge sinonasal fibroma.Fibromas are rare tumors of the nasal cavity, which may result from progressive inflammation or fibroblastic proliferation of the nasal mucosa. The tumors are usually too small to cause symptoms. We present a 47-year-old woman suffering through right nasal obstruction, purulent rhinorrhea and severe headaches for 6 months. A gray-white, smooth-surfaced, gigantic firm mass occupying the right nostril was found in physical examination. Sinus computed tomography revealed 4 x 3 x 3 cm soft-tissue-density mass in the right nasal cavity and right maxillary sinusitis. The huge sinonasal fibroma measuring 4.5 x 3 x 3-cm in the right posterior ethmoid sinus, which was successfully endoscopically resected. The final diagnosis of fibroma was made histologically, according to light microscopy and immunohistochemical stain examinations, which were important for determining the patient's treatment. After endoscopic resection, her initial signs and symptoms were relieved and no recurrence was noted after 2 years of follow up.- - - - - - - - - - ranking = 0.5keywords = physical examination, physical (Clic here for more details about this article) |
7/16. Fibromatosis: the breast cancer imitator.Fibromatosis of the breast is a rare benign tumor that should be included in the differential diagnosis for breast cancer. It is usually indistinguishable from malignancy on ultrasound, mammography, physical examination, and on gross evaluation. Distinction is easily made by histologic findings. This benign tumor does not metastasize, but is locally aggressive and tends to recur postoperatively, which accounts for considerable morbidity. We present two cases and a discussion from the perspective of the radiologist, the surgeon, and the pathologist.- - - - - - - - - - ranking = 0.5keywords = physical examination, physical (Clic here for more details about this article) |
8/16. Clinical aspects of cardiac tumors.Due to surgical advances, cardiac tumors now represent a potentially curable form of heart disease. Primary cardiac tumors are very rare; secondary, metastatic tumors are 10-40 times more frequent. The majority (75%) of primary tumors is benign. Cardiac tumors may produce hemodynamic disturbances, mechanical hemolysis, biochemical effects and constitutional symptoms. According to the anatomic location of the tumor, some special symptoms and physical findings can be grouped with regard to pericardial, myocardial, and endocardial involvement. Several laboratory data (elevated sedimentation rate, anemia, thrombocytopenia etc.) may give additional hints to suggest cardiac involvement in neoplastic disease. Among the diagnostic procedures, two-dimensional echocardiography has become the most important method for non-invasive detection of cardiac tumors. The importance of invasive procedures has declined by the improvement of non-invasive imaging techniques, but pressure measurements within the cardiopulmonary system, left-sided, pulmonary angiography as well as coronary angiography give additional useful and necessary information prior to surgery. Within the spectrum of differential diagnosis, particularly mitral, aortic, or tricupid valve disease, bacterial endocarditis, or autoimmune diseases have to be ruled out. Thus, in the vast majority of cases the correct diagnosis can be made. This is crucial for further management of the patient since the majority of primary cardiac tumors can be successfully treated by surgery.- - - - - - - - - - ranking = 0.062625888680343keywords = physical (Clic here for more details about this article) |
9/16. Intracardiac fibroma in an asymptomatic infant.Primary tumors of the heart are rare in infancy and childhood. A one-year-old, asymptomatic, male infant with unimpressive physical findings in whom an echocardiogram demonstrated a large, encapsulated, solid fibroma filling the right ventricle without obstruction of either the inflow or outflow tract is presented. Successful complete surgical excision of the tumor was accomplished. The histological examination was compatible with a benign fibroma. The infant has remained asymptomatic postoperatively with subsidence of the heart murmur. He has not shown any evidence of recurrence of the tumor during a follow-up period of 29 months. This represents an unusual case of a huge right ventricular fibroma and only the fifth youngest patient, to our knowledge, to undergo successful surgical removal.- - - - - - - - - - ranking = 0.062625888680343keywords = physical (Clic here for more details about this article) |
10/16. The clinical spectrum of cardiac fibroma with diagnostic and surgical considerations: noninvasive imaging enhances management.A cardiac fibroma was successfully resected from the interventricular septum of a 25-year-old woman. The clinical data were correlated with a review of the data on 144 other patients, thereby providing a clinical profile and management strategy for this type of tumor. Initial manifestations of a fibroma were determined to be congestive heart failure (21%), tachyarrhythmias (13%), and chest pain (3.5%). A majority of patients were asymptomatic (36%) with abnormal physical findings or an abnormal chest roentgenogram. Finding the tumor at autopsy incidentally or on sudden death (23%) indicated the lethal potential. A few (3.5%) of the reports on patients with cardiac fibroma were without clinical data. Noninvasive imaging by echocardiography, computed tomography, and nuclear magnetic resonance improved the diagnosis. Surgical treatment was successful in 53 of the 84 patients for whom it was attempted.- - - - - - - - - - ranking = 0.062625888680343keywords = physical (Clic here for more details about this article) |
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