1/4. lung cancer associated with sarcoidosis.sarcoidosis is often identified as swollen hilar lymph nodes found in chest radiography during routine physical checkups. We report a patient with concomitant sarcoidosis and lung cancer necessitating thoracoscopic lymph node biopsy to differentiate between sarcoidosis and lung cancer as the cause of mediastinal/hilar lymph node swelling prior to conducting pulmonary lobectomy. Thoracoscopic biopsy of left mediastinal lymph nodes and sampling of frozen sections of right lymph nodes during intraoperative diagnosis did not detect metastasis. A permanent pathological slide, however, indicated that right interlobar (#11s) lymph nodes involved both sarcoidosis and lung cancer metastasis. Despite careful preparation, it thus remains difficult to distinguish between these conditions even when lymph nodes are strictly evaluated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Bilateral facial paralysis: case presentation and discussion of differential diagnosis.Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. We report the case of a 34-year-old healthy woman with sequential bilateral facial paralysis as a sole manifestation of sarcoidosis. She initially presented with an isolated left sided Bell's palsy without any symptoms to suggest alternative diagnoses. Within a month there was progression to peripheral facial paresis on the contra lateral side, prompting a diagnosis of lyme disease. Her physical examination and chest x-ray did not reveal any clinical evidence of sarcoidosis. After failing to respond to an empiric trial of intravenous ceftriaxone for a presumptive diagnosis of lyme disease, computed tomography scan of the chest was ordered which demonstrated bilateral hilar lymphadenopathy. Bronchoscopic biopsy confirmed a diagnosis of sarcoidosis. The patient then made a complete recovery on steroid therapy. We discuss the differential diagnosis of facial diplegia and focus on the clinical presentation, diagnosis and treatment of neurosarcoidosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Diagnostic pitfalls in asthma.asthma is a common disease, diagnosed and treated routinely, that still lacks a clear, universally accepted definition. The diagnosis, made mostly by history and physical diagnosis, is often supported by peak flow rate or spirometric measurements. This time-honored approach may prove to be unreliable, resulting in overdiagnosis of the disease. The literature is replete with reports about patients treated as if they had asthma in whom other pulmonary diseases were eventually diagnosed. The incidence of asthma is increasing; there seems to be a lower threshold now for making this diagnosis. Overdiagnosis can be avoided, however, by systematic evaluation and complete pulmonary function testing. This paper presents two examples of clinical carelessness resulting in diagnostic delay of underlying disorders mimicking bronchial asthma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. Intense muscle uptake of gallium-67 in a patient with sarcoidosis.sarcoidosis has been associated with muscle involvement. In general, this involvement remains asymptomatic. The following case report demonstrates a patient with a 4-mo history of sarcoidosis who reported severe fatigue and slight muscular complaints at a regular checkup. gallium scintigraphy indicated unexpected and unusually extensive muscular localizations of the disease. The latter findings were confirmed by examination of biopsy specimens. The importance of gallium scintigraphy lies in the possibility of wholebody screening for inflammation localizations, particularly when physical, laboratory, lung function and radiographic examinations fail to provide convincing evidence of active sarcoidosis. Furthermore, it can be helpful in the follow-up of the effect of supportive treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |