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Zhong P, Wei S, Xiao H, Zeng Y. Rhabdomyosarcoma With FUS::TFCP2 Fusion in the Mandible: A Rare Aggressive Subtype, but Can Be Misdiagnosed as Ossifying Fibroma. Int J Surg Pathol 2024; 32:758-766. [PMID: 37545350 DOI: 10.1177/10668969231189172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Rhabdomyosarcoma (RMS) with TFCP2 rearrangement has been identified recently. This entity has a distinctive clinicopathologic features: a rapidly aggressive clinical course, a preference for the craniofacial bones, a spindle and epithelioid histomorphology, and positive immunohistochemistry for epithelial markers, ALK, and myogenic markers. RMS with TFCP2 rearrangement is rare and may be misdiagnosed as other spindle cell tumors. Here, we report a case of this entity arising in the mandible, which was initially diagnosed as ossifying fibroma in primary tumor in another hospital. A 26-year-old man presented with a recurred mass in the mandible for 1 month after the operation of mandibular tumor. The first excisional specimen was initially diagnosed as ossifying fibroma in another hospital. Histopathologic examination revealed the tumor with a hybrid spindle cell and epithelioid cytomorphology, spindle cells and spindle-to-epithelioid cells with eosinophilic and rich cytoplasm, with high-grade features, prominent nucleoli and some atypical mitosis. Immunohistochemical analysis revealed positivity for desmin, MYOD1, pan-keratin, ALK (5A4), ALK (D5F3). Based on the morphology and immunophenotype, molecular studies were performed, which revealed a FUS::TFCP2 fusion transcript, confirming the diagnosis of Rhabdomyosarcoma with FUS::TFCP2 fusion. Making a correct diagnosis is primarily dependent on awareness by the pathologist of this rare subtype of RMS and careful histopathological evaluation, supported by immunohistochemical and molecular analysis, to avoid potential diagnostic pitfalls.
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Affiliation(s)
- Peng Zhong
- Department of Pathology, Daping Hospital, Amy Medical University (Third Military Medical University), Chongqing, China
| | - Shirong Wei
- Department of Pathology, Daping Hospital, Amy Medical University (Third Military Medical University), Chongqing, China
| | - Hualiang Xiao
- Department of Pathology, Daping Hospital, Amy Medical University (Third Military Medical University), Chongqing, China
| | - Ying Zeng
- Department of Pathology, Chongqing General Hospital, Chongqing, China
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2
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Pasquinucci M, Tardini G, Cortella MF, Pirlo D, Moscatelli A. Considering Hirschsprung-associated enterocolitis in infants dehydration: Misdiagnosis risk and management of an underestimated lethal disease. Acta Paediatr 2024; 113:1444-1445. [PMID: 38624026 DOI: 10.1111/apa.17246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/08/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Affiliation(s)
- M Pasquinucci
- DINOGMI, IRCCS G. Gaslini - Children's Hospital, Genoa, Italy
| | - G Tardini
- Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M F Cortella
- DINOGMI, IRCCS G. Gaslini - Children's Hospital, Genoa, Italy
| | - D Pirlo
- Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Yun J, Gidumal S, Saturno MP, Wein LE, Fan J, Khorsandi AS, Chung D, Chen H, Chai RL. Diagnostic Difficulties of Plunging Ranula: A Review of 18 Cases. Laryngoscope 2024; 134:2689-2696. [PMID: 38217447 DOI: 10.1002/lary.31288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE(S) Despite advancements in imaging techniques and cytological analysis, plunging ranula remains a challenging surgical, radiologic, and pathologic phenomenon. Of the 18 patients we evaluated at our institution, we highlight three cases that illustrate the high rate of misleading imaging and cytological results when assessing plunging ranula. METHODS Imaging results, biopsy findings, operative techniques, and pathological reports were reviewed from patients who had either a preoperative or postoperative diagnosis of ranula and underwent surgery by a single head and neck surgeon at a tertiary care center. RESULTS Of the 18 identified patients, computed tomography was correct on preoperative imaging 73% of the time and magnetic resonance imaging was correct on preoperative imaging 71% of the time. Two patients underwent preoperative ultrasound and their ultrasound reports did not accurately diagnose the presence of a ranula. Two patients underwent preoperative fine needle aspiration biopsy due to inconclusive preoperative imaging, in which results suggested either a ranula or epidermal cyst. Both ultimately did not match the final pathology. Three of eighteen patients (17%) underwent an inappropriate initial surgery due to incorrect imaging diagnoses and/or biopsy findings. CONCLUSION Despite use of preoperative modalities to distinguish plunging ranula from other cystic floor of mouth lesions, surgeons must be aware that no workup modality is fully precise. The potential for revision surgery must be included in all preoperative discussions for presumed plunging ranula. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2689-2696, 2024.
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Affiliation(s)
- Jun Yun
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sunder Gidumal
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael P Saturno
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren E Wein
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jun Fan
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Daniel Chung
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hua Chen
- FNA Medical Diagnostics, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Smith HJ, Al-Zubaidi F, Sitaranjan D, Chiu S, Jenkins D. Pulmonary artery sarcoma affecting the pulmonary valve mistaken as pulmonary vasculitis: a case report and comparative literature review. J Cardiothorac Surg 2024; 19:288. [PMID: 38745263 DOI: 10.1186/s13019-024-02700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
Pulmonary arterial sarcomas (PAS) are rare aggressive tumours occurring mainly in the pulmonary trunk. We report a case of PAS involving the pulmonary trunk wall and valve, with uniform wall thickening which represents an atypical imaging manifestation of this tumour. A 63-year-old male presented with vague respiratory symptoms with rapid progression. CTPA showed low density filling defects in both pulmonary arteries and PET scan showed increased uptake in the pulmonary trunk, which along with raised ESR suggested Pulmonary Vasculitis. Echo imaging showed Right ventricular hypertrophy and pulmonary stenosis. Response to steroid therapy was minimal and his symptoms worsened. A referral for second opinion was made and he was diagnosed with PAS. He underwent Pulmonary thromboendarterectomy with Pulmonary valve replacement. Post-operative histopathology confirmed the diagnosis. PAS is rare and frequently misdiagnosed. Surgical resection is not curative, but together with chemotherapy can prolong survival.
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Affiliation(s)
- Harry James Smith
- Royal Papworth Hospital, Papworth Road, Trumpington, Cambridge, CB2 0AY, UK.
| | - Fadi Al-Zubaidi
- Royal Papworth Hospital, Papworth Road, Trumpington, Cambridge, CB2 0AY, UK
| | - Daniel Sitaranjan
- Royal Papworth Hospital, Papworth Road, Trumpington, Cambridge, CB2 0AY, UK
| | - Steven Chiu
- Royal Papworth Hospital, Papworth Road, Trumpington, Cambridge, CB2 0AY, UK
| | - David Jenkins
- Royal Papworth Hospital, Papworth Road, Trumpington, Cambridge, CB2 0AY, UK
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5
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Harris E. Study: Roughly 1 in 8 Patients Wrongly Diagnosed With Pneumonia. JAMA 2024; 331:1525. [PMID: 38639961 DOI: 10.1001/jama.2024.5920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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Çubukçu HC. The trade-off between bias and imprecision: Debunking the myth of bias as the primary culprit in patient result misclassification. Am J Clin Pathol 2024; 161:513-516. [PMID: 38113369 DOI: 10.1093/ajcp/aqad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Hikmet Can Çubukçu
- Turkish Ministry of Health, Ankara, Turkey, and Hacettepe University Institute of Informatics, Ankara, Turkey
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Loh TP, Lim CY, Markus C. Reply to "The trade-off between bias and imprecision: debunking the myth of bias as the primary culprit in patient result misclassification". Am J Clin Pathol 2024; 161:517-518. [PMID: 38113374 DOI: 10.1093/ajcp/aqad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023] Open
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Waldron JL, Glennon CM, Kroshinsky DA, Khan DA, Wolfson AR. Drug Allergy Mimics. J Allergy Clin Immunol Pract 2024; 12:1122-1129.e1. [PMID: 38325764 DOI: 10.1016/j.jaip.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that could be commonly referred to an allergist for assessment as "drug allergy," however, a real diagnosis exists that mandates a different diagnostic and treatment strategy, including a case of inducible laryngeal obstruction, multiple drug intolerance syndrome, viral rash, seizure due to metastatic malignancy, and hemophagocytic lymphohistiocytosis initially diagnosed as drug reaction and eosinophilia with systemic symptoms. The initial misdiagnoses of these patients delayed or interfered with their medical care, emphasizing the importance of accurate diagnoses for the benefit of our patients.
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Affiliation(s)
- Jamie L Waldron
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Mass
| | - Colleen M Glennon
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anna R Wolfson
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Mass.
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Chou ML, Chen HC, Tai SH, Huang CW. Seronegative Immunoglobulin G4-related hypertrophic pachymeningitis misdiagnosed as meningitis and meningioma. Kaohsiung J Med Sci 2024; 40:506-508. [PMID: 38362805 DOI: 10.1002/kjm2.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Affiliation(s)
- Meng-Leo Chou
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Chun Chen
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Huang Tai
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Lorenset LC, Percicote AP, Munhos SHDO, Zanine RM. Reevaluation of negative cervical conizations: Frequency, diagnostic errors, risk factors and management. Pathol Res Pract 2024; 257:155283. [PMID: 38614053 DOI: 10.1016/j.prp.2024.155283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/10/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Cervical conization is an effective treatment for precancerous lesions. However, in cases where no high-grade lesion is identified in the surgical specimen, managing these patients may be challenging due to the absence of established follow-up protocols for negative conizations. This study aimed to assess the negative conization rates at our institution by histopathological review, identify diagnostic errors, possible risk and recurrence factors and propose follow-up strategies for this group of patients. METHODS A retrospective study from January-2010 to December-2020 analyzed patients with negative conization including all surgical techniques and procedure indications. Biopsy and cervical conizations slides were reviewed and patients who kept a negative result underwent deeper levels sectioning of the paraffin blocks with immunohistochemical stains application: p16, Ki-67 and geminin. Data were compared with a control group composed by 29 women with CIN3. RESULTS Out of 1022 conizations, 186 were negative (18.1%), with 151 cases selected for the study after excluding 35 patients. Following pathology review, 4 patients were excluded due to false-positive cervical biopsy results, 16 for false-negative conization results and 9 for hidden dysplasia identified after deeper sectioning. The remaining 122 patients were considered truly negative cones (11.9%) and exhibited IHC staining with p16 positive in 20.4% of cases, low Ki-67 expression, and low geminin score in most cases. Specimens with CIN 1 had higher prevalence of p16 staining, Ki-67 expression and geminin score when compared to absence of neoplasia, nevertheless geminin had no statistical difference. Older age, higher parity and IHC pattern with negative p16, low Ki-67 and geminin expressions were identified as risk factors for negative cones (p<0.05). Only 10 patients recurred for high-grade lesions, with no statistically significant risk factors identified. CONCLUSIONS The negative conization rate was 11.9%, with diagnostic errors identified across pre-surgical biopsy, cone specimen, and deeper levels. Risk factors included older age, higher parity, low expression of p16, Ki-67 and geminin (p<0.05). Recurrence represented 8.1% of the negative cones, without identification of statistically significant risk factors. Pathological review with deeper level sections and 2-year follow-up are recommended for patients with negative conizations.
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Affiliation(s)
- Larissa Chioquetta Lorenset
- Department of Obstetrics and Gynecology, Clinical Hospital Complex of the Federal University of Paraná, Curitiba, Paraná, Brazil.
| | - Ana Paula Percicote
- Department of Medical Pathology, Clinical Hospital Complex of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Sue Hellen de Oliveira Munhos
- Department of Medical Pathology, Clinical Hospital Complex of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Rita Maira Zanine
- Department of Obstetrics and Gynecology, Clinical Hospital Complex of the Federal University of Paraná, Curitiba, Paraná, Brazil
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Han JW, Son J, Oh C. Features of colonic diverticulitis in children and adolescents: A multicenter study. Asian J Surg 2024; 47:2195-2199. [PMID: 38388263 DOI: 10.1016/j.asjsur.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/21/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Colonic diverticulitis (CD), typically seen in the elderly of Western countries, is increasingly prevalent worldwide, yet data on CD in children and adolescents are scarce. This study explores the characteristics of CD in this younger demographic. METHODS In a multicenter, retrospective review, 104 patients under 20 years diagnosed with CD at four Korean tertiary hospitals from June 2003 to December 2020 were analyzed. Abdominal CT scans were used for diagnosis, with the modified Hinchey classification assessing the severity of CD. RESULTS CD was found in the cecum or ascending colon in 103 (99%) of cases. The mean patient age was 17.24 ± 2.4 years, with males constituting 59.6% of cases. Solitary lesions were noted in 93 (89.4%) of patients. Severity was classified as modified Hinchey stage 0 in 58.7%, stage Ia in 29.8%, and stage Ib in 11.5%, with no cases of stage II or higher. Misdiagnosis as acute appendicitis occurred in six instances. IV antibiotics were administered to 68.3%, and oral antibiotics were sufficient for 24%. Surgical treatment was necessary for two patients. A 7.8% recurrence rate was noted among first-time CD patients, yet all cases were amenable to conservative management. CONCLUSION While uncommon, CD in children and adolescents is a growing concern, with most cases presenting as solitary lesions in the cecum or ascending colon. The severity is typically less than that in adults, and conservative treatment is generally effective. These findings underscore the need for specific management guidelines for pediatric CD, advocating for non-surgical initial approaches.
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Affiliation(s)
- Ji-Won Han
- Department of Surgery, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Joonhyuk Son
- Department of Pediatric Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Chaeyoun Oh
- Department of Surgery, Korea University College of Medicine, Ansan, South Korea.
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Pierce TT, Prabhu V, Baliyan V, Hedgire S. Imaging of Visceral Vessels. Radiol Clin North Am 2024; 62:543-557. [PMID: 38553185 DOI: 10.1016/j.rcl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The visceral vasculature is inextricably intertwined with abdominopelvic disease staging, spread, and management in routine and emergent cases. Comprehensive evaluation requires specialized imaging techniques for abnormality detection and characterization. Vascular pathology is often encountered on nondedicated routine imaging examinations, which may obscure, mimic, or confound many vascular diagnoses. This review highlights normal arterial, portal venous, and systemic venous anatomy and clinically relevant variants; diagnostic pitfalls related to image-acquisition technique and disease mimics; and characteristics of common and rare vascular diseases to empower radiologists to confidently interpret the vascular findings and avoid misdiagnosis.
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Affiliation(s)
- Theodore T Pierce
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, White Building, Room 270, 55 Fruit Street, Boston, MA 02114, USA.
| | - Vinay Prabhu
- Department of Radiology, NYU Langone Health, 660 First Avenue, Third Floor, New York, NY 10016, USA
| | - Vinit Baliyan
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital-Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital-Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA
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Li Y, Li P, Tao FK, Li JM. Adrenocortical oncocytic carcinoma misdiagnosed as adrenal cortical adenoma. Asian J Surg 2024; 47:2475-2476. [PMID: 38302362 DOI: 10.1016/j.asjsur.2024.01.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Yang Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No.374 Dian-Mian Avenue, Kunming, 650101, China.
| | - Pei Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No.374 Dian-Mian Avenue, Kunming, 650101, China.
| | | | - Jiong-Ming Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No.374 Dian-Mian Avenue, Kunming, 650101, China.
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Dallinga MG, Bolhuis K, Bins A, de Hoog J. BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION MISTAKEN FOR NIVOLUMAB-INDUCED VOGT-KOYANAGI-HARADA DISEASE-LIKE SYNDROME. Retin Cases Brief Rep 2024; 18:332-336. [PMID: 36728009 PMCID: PMC11027975 DOI: 10.1097/icb.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/PURPOSE To describe a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that was mistaken for nivolumab-induced Vogt-Koyanagi-Harada disease-like syndrome. METHODS We present the case of a 58-year-old white man with metastatic renal clear cell carcinoma for which he was palliatively treated with IV nivolumab immunotherapy. The patient developed subacute onset of blurry vision and gray spots in the visual fields of both eyes, macular subretinal fluid, thickening of the retinal pigment epithelium, and swollen optic nerve heads. Differential diagnosis included nivolumab-induced Vogt-Koyanagi-Harada disease-like syndrome, and the patient was initially treated with steroids, which gave no improvement. Investigation showed the development of dark-gray patches in the peripheral retina of both eyes and cataract, which prompted reevaluation of the diagnosis, deeming BDUMP most likely. The patient was successfully treated with plasmapheresis. RESULTS The initial presentation of the case was incorrectly diagnosed as nivolumab-induced Vogt-Koyanagi-Harada disease-like syndrome. On repeat studies of the patients' symptoms and imaging, we concluded we had missed signs of BDUMP. CONCLUSION The diagnosis BDUMP was missed in the first evaluation. We present this case to discuss the similarities and differences between this disease and nivolumab-induced Vogt-Koyanagi-Harada disease-like syndrome. More importantly, we want to highlight that reevaluation of the diagnosis on worsening of a disease was key in this unusual case.
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Affiliation(s)
- Marchien Geesje Dallinga
- Department of Ophthalmology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; and
| | - Karen Bolhuis
- Department of Internal Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Adriaan Bins
- Department of Internal Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Joeri de Hoog
- Department of Ophthalmology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; and
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Mahmood R, Gehi AK. Inappropriate ICD classification of ventricular fibrillation as sinus tachycardia. What is the etiology? J Cardiovasc Electrophysiol 2024; 35:1026-1032. [PMID: 38439167 DOI: 10.1111/jce.16236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Rafat Mahmood
- Department of Medicine, Division of Cardiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anil K Gehi
- Department of Medicine, Division of Cardiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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Ma Y, Hu W. Ornithonyssus bacoti Dermatitis Incorrectly Diagnosed as Delusional Parasitosis. Am J Trop Med Hyg 2024; 110:847. [PMID: 38507801 PMCID: PMC11066341 DOI: 10.4269/ajtmh.23-0747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/22/2023] [Indexed: 03/22/2024] Open
Affiliation(s)
- Yangyang Ma
- Department of Dermatology, Hangzhou Third People’s Hospital, Hangzhou, China
| | - Wenting Hu
- Department of Dermatology, Hangzhou Third People’s Hospital, Hangzhou, China
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Yang Y, Zhang W. Asymmetric familial exudative vitreoretinopathy in a premature infant misdiagnosed as retinopathy of prematurity. Clin Exp Optom 2024; 107:469-472. [PMID: 36948182 DOI: 10.1080/08164622.2023.2191783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023] Open
Affiliation(s)
- Yi Yang
- Department of Ophthalmology, Lanzhou university second hospital, Lanzhou, Gansu, PR China
| | - Wenfang Zhang
- Department of Ophthalmology, Lanzhou university second hospital, Lanzhou, Gansu, PR China
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Song X, Niu H, Yang M, Wang X. Granulomatous orchitis: A case report of misdiagnosis and review of the literature. J Clin Ultrasound 2024; 52:470-472. [PMID: 38288520 DOI: 10.1002/jcu.23640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 05/08/2024]
Abstract
Granulomatous orchitis is a relatively rare clinical testicular lesion. The imaging manifestations and clinical symptoms are similar to those of testicular tumors. In order to improve the understanding of this disease, this article reports the ultrasonographic manifestations of a case of granulomatous orchitis and reviews the relevant literature with.
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Affiliation(s)
- Xinrong Song
- Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huimin Niu
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Ming Yang
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiaona Wang
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, Hebei, China
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19
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Tosur M, Huang X, Inglis AS, Aguirre RS, Redondo MJ. Inaccurate diagnosis of diabetes type in youth: prevalence, characteristics, and implications. Sci Rep 2024; 14:8876. [PMID: 38632329 PMCID: PMC11024140 DOI: 10.1038/s41598-024-58927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Classifying diabetes at diagnosis is crucial for disease management but increasingly difficult due to overlaps in characteristics between the commonly encountered diabetes types. We evaluated the prevalence and characteristics of youth with diabetes type that was unknown at diagnosis or was revised over time. We studied 2073 youth with new-onset diabetes (median age [IQR] = 11.4 [6.2] years; 50% male; 75% White, 21% Black, 4% other race; overall, 37% Hispanic) and compared youth with unknown versus known diabetes type, per pediatric endocrinologist diagnosis. In a longitudinal subcohort of patients with data for ≥ 3 years post-diabetes diagnosis (n = 1019), we compared youth with steady versus reclassified diabetes type. In the entire cohort, after adjustment for confounders, diabetes type was unknown in 62 youth (3%), associated with older age, negative IA-2 autoantibody, lower C-peptide, and no diabetic ketoacidosis (all, p < 0.05). In the longitudinal subcohort, diabetes type was reclassified in 35 youth (3.4%); this was not statistically associated with any single characteristic. In sum, among racially/ethnically diverse youth with diabetes, 6.4% had inaccurate diabetes classification at diagnosis. Further research is warranted to improve accurate diagnosis of pediatric diabetes type.
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Affiliation(s)
- Mustafa Tosur
- The Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 77030, USA.
- Children's Nutrition Research Center, Baylor College of Medicine, USDA/ARS, Houston, TX, 77030, USA.
| | - Xiaofan Huang
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Audrey S Inglis
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
| | - Rebecca Schneider Aguirre
- The Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 77030, USA
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Maria J Redondo
- The Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 77030, USA
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20
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Yu WQ, Gao HJ, Zhai LX, Wei YC. Abnormal performance of peroral endoscopic myotomy (POEM): a case misdiagnosed as achalasia of cardia. J Cardiothorac Surg 2024; 19:214. [PMID: 38616255 PMCID: PMC11017660 DOI: 10.1186/s13019-024-02688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/24/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Pseudoachalasia is a rare disease that behaves similarly to achalasia (AC), making it sometimes difficult to differentiate. CASE PRESENTATION We report a case of 49-year-old male with adenocarcinoma of the gastroesophageal junction misdiagnosed as achalasia. No obvious abnormalities were found in his initial examinations including upper digestive endoscopy, upper gastrointestinal imaging and chest computed tomography (CT). During the subsequent introduced-peroral endoscopic myotomy (POEM), it was found that the mucosal layer and the muscular layer had severe adhesion, which did not receive much attention, delayed the clear diagnosis and effect treatment, and ultimately led to a poor prognosis for the patient. CONCLUSIONS This case suggests that when patients with AC found mucosal and muscular adhesions during POEM surgery, the possibility should be considered that the lesion may be caused by a malignant lesion.
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Affiliation(s)
- Wen-Quan Yu
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Hui-Jiang Gao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Li-Xue Zhai
- Department of Ultrasonography, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yu-Cheng Wei
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China.
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21
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Eikenboom AM, Lambregts MMC, de Boer MGJ, le Cessie S. Influence of initial misdiagnosis on mortality in patients with bacteraemia: propensity score matching and propensity score weighting analyses. BMC Infect Dis 2024; 24:389. [PMID: 38605292 PMCID: PMC11007998 DOI: 10.1186/s12879-024-09299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The diagnostic process is a key element of medicine but it is complex and prone to errors. Infectious diseases are one of the three categories of diseases in which diagnostic errors can be most harmful to patients. In this study we aimed to estimate the effect of initial misdiagnosis of the source of infection in patients with bacteraemia on 14 day mortality using propensity score methods to adjust for confounding. METHODS Data from a previously described longitudinal cohort of patients diagnosed with monobacterial bloodstream infection (BSI) at the Leiden University Medical Centre (LUMC) between 2013 and 2015 were used. Propensity score matching and inversed probability of treatment weighting (IPTW) were applied to correct for confounding. The average treatment effect on the treated (ATT), which in this study was the average effect of initial misdiagnosis on the misdiagnosed (AEMM), was estimated. Methodological issues that were encountered when applying propensity score methods were addressed by performing additional sensitivity analyses. Sensitivity analyses consisted of varying caliper in propensity score matching and using different truncated weights in inversed probability of treatment weighting. RESULTS Data of 887 patients were included in the study. Propensity scores ranged between 0.015 and 0.999 and 80 patients (9.9%) had a propensity score > 0.95. In the matched analyses, 35 of the 171 misdiagnosed patients died within 14 days (20.5%), versus 10 of the 171 correctly diagnosed patients (5.8%), yielding a difference of 14.6% (7.6%; 21.6%). In the total group of patients, the observed percentage of patients with an incorrect initial diagnosis that died within 14 days was 19.8% while propensity score reweighting estimated that their probability of dying would have been 6.5%, if they had been correctly diagnosed (difference 13.3% (95% CI 6.9%;19.6%)). After adjustment for all variables that showed disbalance in the propensity score a difference of 13.7% (7.4%; 19.9%) was estimated. Sensitivity analyses yielded similar results. However, performing weighted analyses without truncation yielded unstable results. CONCLUSION Thus, we observed a substantial increase of 14 day mortality in initially misdiagnosed patients. Furthermore, several patients received propensity scores extremely close to one and were almost sure to be initially misdiagnosed.
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Affiliation(s)
- Anna M Eikenboom
- Department of Infectious Diseases, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Merel M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
- Department of Clinical Epidemiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
- Department of Biomedical Data Sciences, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
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22
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Owiwi M, Argo D. Kleine-Levin Syndrome in a Closed Psychiatric Ward: A Case of Misdiagnosis. Prim Care Companion CNS Disord 2024; 26:23cr03633. [PMID: 38621225 DOI: 10.4088/pcc.23cr03633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Affiliation(s)
- Mohannad Owiwi
- Jerusalem Mental Health Center, Jerusalem, Israel
- Corresponding Author: Mohannad Owiwi, MD, Jerusalem Mental Health Center, 1 Mete Yehuda, Jerusalem, Israel
| | - Daniel Argo
- Jerusalem Mental Health Center, Jerusalem, Israel
- Hebrew University, Jerusalem, Israel
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23
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Venkatakrishna SSB, Ghosh A, Sharma P, Miranda-Schaeubinger M, Prakash AV, Addisu L, Sze RW, Andronikou S. Frequency and classification of addenda in paediatric neuroradiological reports as part of quality assurance. Clin Radiol 2024; 79:303-311. [PMID: 38310059 DOI: 10.1016/j.crad.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 02/05/2024]
Abstract
AIM To determine the frequency and classification of addenda seen in paediatric brain magnetic resonance imaging (MRI) reports. MATERIALS AND METHODS A retrospective review of the addenda of brain MRI reports from a large tertiary children's hospital was undertaken between January 2013 to December 2021 and a subset of above radiology reports was used to classify addenda over 6-month periods, October to March, spanning 2018 to 2021. A radiology fellow and a medical doctor classified the addenda into previously published categories using their best judgement. RESULTS Out of 73,643 brain MRI reports over 9 years (108 months) included in the study, only 923 reports (1.25%) had addenda. There was a total of 13,615 brain MRI reports from 6-month periods, of which only 179 reports (1.31%) had an addendum. The number of errors according to categories were: observational 88/13,615 (0.65%); interpretational 16/13,615 (0.12%); non-observational and non-interpretative 82/13,615 (0.6%). Notifications to referring physician made in 29/13,615 (0.21%). CONCLUSIONS The overall proportion of addenda to the brain MRI reports of children in the present study was low, at 1.25%. Categorisation of different addenda revealed the most common errors to be observational in 0.65%, including under-reading in the region of interest in 0.25%. Appropriate measures can now be introduced to minimise the error-based addenda further and improve MRI diagnosis in children. Other paediatric practices may choose to follow suit in evaluating their addenda and errors to improve practice.
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Affiliation(s)
- S S B Venkatakrishna
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - A Ghosh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - P Sharma
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - M Miranda-Schaeubinger
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - A V Prakash
- Department of Internal Medicine, St Vincent Hospital, Worcester, MA, USA
| | - L Addisu
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - R W Sze
- Department of Radiology, University of California San Francisco, Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - S Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
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24
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Vaidya A, Chen RJ, Williamson DFK, Song AH, Jaume G, Yang Y, Hartvigsen T, Dyer EC, Lu MY, Lipkova J, Shaban M, Chen TY, Mahmood F. Demographic bias in misdiagnosis by computational pathology models. Nat Med 2024; 30:1174-1190. [PMID: 38641744 DOI: 10.1038/s41591-024-02885-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/23/2024] [Indexed: 04/21/2024]
Abstract
Despite increasing numbers of regulatory approvals, deep learning-based computational pathology systems often overlook the impact of demographic factors on performance, potentially leading to biases. This concern is all the more important as computational pathology has leveraged large public datasets that underrepresent certain demographic groups. Using publicly available data from The Cancer Genome Atlas and the EBRAINS brain tumor atlas, as well as internal patient data, we show that whole-slide image classification models display marked performance disparities across different demographic groups when used to subtype breast and lung carcinomas and to predict IDH1 mutations in gliomas. For example, when using common modeling approaches, we observed performance gaps (in area under the receiver operating characteristic curve) between white and Black patients of 3.0% for breast cancer subtyping, 10.9% for lung cancer subtyping and 16.0% for IDH1 mutation prediction in gliomas. We found that richer feature representations obtained from self-supervised vision foundation models reduce performance variations between groups. These representations provide improvements upon weaker models even when those weaker models are combined with state-of-the-art bias mitigation strategies and modeling choices. Nevertheless, self-supervised vision foundation models do not fully eliminate these discrepancies, highlighting the continuing need for bias mitigation efforts in computational pathology. Finally, we demonstrate that our results extend to other demographic factors beyond patient race. Given these findings, we encourage regulatory and policy agencies to integrate demographic-stratified evaluation into their assessment guidelines.
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Affiliation(s)
- Anurag Vaidya
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
- Health Sciences and Technology, Harvard-MIT, Cambridge, MA, USA
| | - Richard J Chen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Drew F K Williamson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew H Song
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Guillaume Jaume
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yuzhe Yang
- Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
| | - Thomas Hartvigsen
- School of Data Science, University of Virginia, Charlottesville, VA, USA
| | - Emma C Dyer
- T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ming Y Lu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
- Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
| | - Jana Lipkova
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Muhammad Shaban
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tiffany Y Chen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Faisal Mahmood
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Data Science Initiative, Harvard University, Cambridge, MA, USA.
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Logan NZ, Kilmarx PH, Rolle I, Patel HK, Duong YT, Lee K, Shang JD, Bodika S, Koui IT, Balachandra S, Li M, Brown K, Nuwagaba-Biribonwoha H, Getaneh Y, Lulseged S, Haile A, West CA, Mengistu Y, McCracken SD, Kalua T, Jahn A, Kim E, Wadonda-Kabondo N, Jonnalagadda S, Hamunime N, Williams DB, McOllogi Juma J, Mgomella GS, Mdodo R, Kirungi WL, Mugisha V, Ndongmo CB, Nkwemu KC, Mugurungi O, Rogers JH, Saito S, Stupp P, Justman JE, Voetsch AC, Parekh BS. Brief Report: Self-Reported HIV-Positive Status but Subsequent HIV-Negative Test Results in Population-Based HIV Impact Assessment Survey Participants-11 Sub-Saharan African Countries, 2015-2018. J Acquir Immune Defic Syndr 2024; 95:313-317. [PMID: 38412045 DOI: 10.1097/qai.0000000000003363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/05/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND HIV testing is a critical step to accessing antiretroviral therapy (ART) because early diagnosis can facilitate earlier initiation of ART. This study presents aggregated data of individuals who self-reported being HIV-positive but subsequently tested HIV-negative during nationally representative Population-Based HIV Impact Assessment surveys conducted in 11 countries from 2015 to 2018. METHOD Survey participants aged 15 years or older were interviewed by trained personnel using a standard questionnaire to determine HIV testing history and self-reported HIV status. Home-based HIV testing and counseling using rapid diagnostic tests with return of results were performed by survey staff according to the respective national HIV testing services algorithms on venous blood samples. Laboratory-based confirmatory HIV testing for all participants identified as HIV-positives and self-reported positives, irrespective of HIV testing results, was conducted and included Geenius HIV-1/2 and DNA polymerase chain reaction if Geenius was negative or indeterminate. RESULTS Of the 16,630 participants who self-reported as HIV-positive, 16,432 (98.6%) were confirmed as HIV-positive and 198 (1.4%) were HIV-negative by subsequent laboratory-based testing. Participants who self-reported as HIV-positive but tested HIV-negative were significantly younger than 30 years, less likely to have received ART, and less likely to have received a CD4 test compared with participants who self-reported as HIV-positive with laboratory-confirmed infection. CONCLUSIONS A small proportion of self-reported HIV-positive individuals could not be confirmed as positive, which could be due to initial misdiagnosis, deliberate wrong self-report, or misunderstanding of the questionnaire. As universal ART access is expanding, it is increasingly important to ensure quality of HIV testing and confirmation of HIV diagnosis before ART initiation.
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Affiliation(s)
- Naeemah Z Logan
- Epidemic Intelligence Service, CDC, Atlanta, GA
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Peter H Kilmarx
- Fogarty International Center, National Institutes of Health, Bethesda, MD
| | - Italia Rolle
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Hetal K Patel
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Kiwon Lee
- ICAP-Columbia University, New York, NY
| | - Judith D Shang
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Stephane Bodika
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Shirish Balachandra
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Michelle Li
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Kristin Brown
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Yimam Getaneh
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Ashenafi Haile
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Christine A West
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Yohannes Mengistu
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | | | - Andreas Jahn
- Department for HIV and AIDS, Ministry of Health and Population, Lilongwe, Malawi
- I-TECH, Department of Global Health, University of Washington, Seattle, WA
| | - Evelyn Kim
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Sasi Jonnalagadda
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Ndapewa Hamunime
- Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Daniel B Williams
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - James McOllogi Juma
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
- Tanzania National AIDS Control Program, Dodoma, Tanzania
| | - George S Mgomella
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Rennatus Mdodo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | | | - Clement B Ndongmo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Paul Stupp
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | | | - Andrew C Voetsch
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
| | - Bharat S Parekh
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA
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26
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Cho Y, Kim AY, Song JJ, Chae SW. Mucosa-associated Lymphoid Tissue Misdiagnosis as Glomus Tympanicum. Laryngoscope 2024; 134:1894-1896. [PMID: 37602748 DOI: 10.1002/lary.30998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
Middle ear tumors are diverse, but relatively uncommon. The most frequent tumor in the middle ear is glomus tumor, followed by others such as schwannoma and cholesteatoma. We experienced a case of Mucosa-associated lymphoid tissue hyperplasia as a middle ear tumor. The mass behind tympanic membrane appeared a hypervascular tumor, mimicking a glomus tumor, but the form of multiple separate masses in middle ear and mastoid cavity was the distinguishing feature that set it apart from a glomus tumor. Additionally, another characteristic was its tendency to easily shrink under pressure. This characteristic should be considered when encounter a hypervascular looking middle ear mass. Laryngoscope, 134:1894-1896, 2024.
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Affiliation(s)
- Yongmin Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Angela Y Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Sung-Won Chae
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Seoul, South Korea
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27
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Campo I, Granata A, Derchi LE, Piccoli G, Cassetti P, Cova MA, Bertolotto M. Tips and tricks for a correct interpretation of contrast-enhanced ultrasound. Radiol Med 2024; 129:536-548. [PMID: 38512611 DOI: 10.1007/s11547-024-01784-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Abstract
Although contrast-enhanced ultrasound (CEUS) is a widespread and easily manageable technique, image interpretation errors can occur due to the operator's inexperience and/or lack of knowledge of the frequent pitfalls, which may cause uncertain diagnosis and misdiagnosis. Indeed, knowledge of the basic physical and technical principles of ultrasound is needed both to understand sonographic image findings and to evaluate the potential and limits of the method. Like the B-mode ultrasound, the quality of the CEUS examination is also subject not only to the adequate manual skill of the operator but also to his/her deep knowledge of the technique which improves the quality of the image helping avoid misleading artifacts. In this review, the main parameters influencing a CEUS examination will be described by taking into account the most common errors and pitfalls and their possible solutions.
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Affiliation(s)
- Irene Campo
- Department of Radiology, University of Trieste, Ospedale San Giovanni di Dio, Via Fatebenefratelli, 34, 34170, Gorizia, Italy.
| | - Antonio Granata
- Nephrology and Dialysis Unit, Ospedale Cannizzaro in via Messina, 829, 95126, Catania, CT, Italy
| | - Lorenzo E Derchi
- Radiology Section, Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | | | - Paolo Cassetti
- Department of Radiology, University of Trieste, Ospedale San Giovanni di Dio, Via Fatebenefratelli, 34, 34170, Gorizia, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale San Giovanni di Dio, Via Fatebenefratelli, 34, 34170, Gorizia, Italy
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale San Giovanni di Dio, Via Fatebenefratelli, 34, 34170, Gorizia, Italy
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
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Zhang Y, Zhang S, Xu Y, Zhang D. Humeral cephalic coronal shear fracture initially misdiagnosed but fixed successfully after 5 months: A case report. Asian J Surg 2024; 47:1823-1824. [PMID: 38160161 DOI: 10.1016/j.asjsur.2023.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Yao Zhang
- Department of Orthopaedics, The First People's Hospital of Ziyang, Ziyang, 641300, PR China
| | - Shaobing Zhang
- Department of Orthopaedics, The First People's Hospital of Ziyang, Ziyang, 641300, PR China
| | - Ying Xu
- Department of Dermatology, The First People's Hospital of Ziyang, Ziyang, 641300, PR China
| | - Dexiang Zhang
- Department of Orthopaedics, The First People's Hospital of Ziyang, Ziyang, 641300, PR China.
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Spierer R, Herskovitz M. Which psychogenic nonepileptic seizure (PNES) patients are more likely to be treated with anti-seizure medications? Seizure 2024; 117:111-114. [PMID: 38368830 DOI: 10.1016/j.seizure.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The average time for psychogenic nonepileptic seizures (PNES) diagnosis is about 7.5 years. Many patients receive inadequate treatment and sometimes even life-threatening treatments such as tracheal intubation during this time. PURPOSE To determine the risk factors for misdiagnosis of PNES as Epilepsy. METHODS The medical records of patients who underwent video-electroencephalogram (EEG) monitoring were reviewed retrospectively. Patients who had PNES without epileptic seizures (ES) were included in this study. Baseline personal and monitoring characteristics were collected. The patients were then divided into two groups based on their therapeutic status. Patients in the treatment group were again divided into two groups based on the number of anti-seizure medications (ASM) they were treated with. RESULTS Fifty-seven patients diagnosed with PNES were included in this study. Thirty-seven patients were under treatment, and 20 patients were not under treatment at the time of monitoring. Motor seizures, abnormal interictal EEG patterns, and pathological brain imaging findings were more frequent among patients in the treatment group (p<0.05). Patients with motor seizures were more likely to be treated with multiple ASM than patients with only dialeptic nonmotor seizures (p<0.05). Lastly, patients in the treatment group were monitored longer and had fewer seizures during monitoring (p<0.05). CONCLUSION PNES patients with abnormal EEG patterns and pathological brain imaging findings are more likely to be treated with ASM. The pure dialeptic nature of seizures is less likely to be misdiagnosed as ES. In addition, patients with such seizures are less likely to be treated with multiple treatment lines.
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Affiliation(s)
- Ronen Spierer
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Moshe Herskovitz
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel; Department of Neurology, Rambam Health Care Campus, Haifa, Israel.
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30
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Wang YW, Mo SY, Li YZ. [A case of hepatocellular carcinoma of fibrolamellar type misdiagnosed as a liver abscess]. Zhonghua Gan Zang Bing Za Zhi 2024; 32:242-244. [PMID: 38584106 DOI: 10.3760/cma.j.cn501113-20230815-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Y W Wang
- Department of Gastroenterology, Liuzhou People's Hospital, Liuzhou 545000, China
| | - S Y Mo
- Department of Gastroenterology, Liuzhou People's Hospital, Liuzhou 545000, China
| | - Y Z Li
- Department of Gastroenterology, Liuzhou People's Hospital, Liuzhou 545000, China
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31
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Yang J, Imlay-Gillespie L, Dierkes JG, Khoo TK. Erdheim-Chester disease: misdiagnosed as multiple sclerosis. Pract Neurol 2024; 24:144-147. [PMID: 37932040 DOI: 10.1136/pn-2023-003865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
Erdheim-Chester disease is a rare histiocytic neoplasm with a wide range of clinical manifestations. Due to its rarity and protean characteristics, this condition often presents a diagnostic challenge. A Caucasian woman in her late 60s presented with unsteadiness, dysphagia and dysarthria. She was initially diagnosed with secondary progressive multiple sclerosis but deteriorated over 2 years with a potential lack of therapeutic response. Subsequent investigations resulted in the diagnosis of Erdheim-Chester disease. She received targeted therapy with BRAF and MAPK-pathway inhibitors. Her initial response to treatment has been positive with functional gains and reduced disease burden on MR brain imaging, and with no significant adverse effects.
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Affiliation(s)
- Jason Yang
- Medicine, The University of Queensland - Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | | | | | - Tien Kheng Khoo
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Patel K, Smith DJ, Huntley CC, Channa SD, Pye A, Dickens AP, Gale N, Turner AM. Exploring the causes of COPD misdiagnosis in primary care: A mixed methods study. PLoS One 2024; 19:e0298432. [PMID: 38446828 PMCID: PMC10917297 DOI: 10.1371/journal.pone.0298432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Within primary care there exists a cohort of patients misdiagnosed with Chronic Obstructive Pulmonary Disease (COPD). Misdiagnosis can have a detrimental impact on healthcare finances and patient health and so understanding the factors leading to misdiagnosis is crucial in order to reduce misdiagnosis in the future. The objective of this study is to understand and explore the perceived causes of COPD misdiagnosis in primary care. METHODS A sequential mixed methods study, quantifying prevalence and features of patients misdiagnosed with COPD in primary care followed by a qualitative analysis to explore perceived causes of misdiagnosis. Quantitative data was collected for 206 patients identified as misdiagnosed with COPD within the INTEGR COPD study (NCT03482700). Qualitative data collected from 21 healthcare professionals involved in providing COPD care and 8 misdiagnosed patients who were recruited using a maximum variation purposive sampling. RESULTS Misinterpretation of spirometry results was the prevailing factor leading to patients initially being misdiagnosed with COPD, affecting 59% of misdiagnosed patients in this cohort. Of the 99 patients who were investigated for their underlying diagnosis; 41% had normal spirometry and 40% had asthma. Further investigation through qualitative methodology uncovered reluctance to challenge historical misdiagnoses and challenges in differential diagnosis as the underlying explanations for COPD misdiagnosis in this cohort. CONCLUSIONS Patients historically diagnosed with COPD without spirometric evidence are at risk of remaining labelled and treated for COPD despite non-obstructive respiratory physiology, leading to a persistent cohort of patients misdiagnosed with COPD in primary care. The lack of spirometry services during and after the COVID19 pandemic in primary care risks adding to the cohort of misdiagnosed patients. Support from respiratory specialists can potentially help to reduce the prevalence of COPD misdiagnosis in primary care. TRIAL REGISTRATION NCT03482700.
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Affiliation(s)
- Ketan Patel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Sunita D. Channa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anita Pye
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Andrew P. Dickens
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - Nicola Gale
- School of Social Policy, University of Birmingham, Birmingham, United Kingdom
| | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Balasubramanian S, Yu S, Behera SK, Bhat AH, Camarda JA, Choueiter NF, Jone P, Lopez L, Natarajan SS, Parra DA, Parthiban A, Sachdeva R, Srivastava S, Tierney ESS. Consensus-Based Development of a Pediatric Echocardiography Complexity Score: Design, Rationale, and Results of a Quality Improvement Collaborative. J Am Heart Assoc 2024; 13:e029798. [PMID: 38390878 PMCID: PMC10944062 DOI: 10.1161/jaha.123.029798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/07/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND The complexity of congenital heart disease has been primarily stratified on the basis of surgical technical difficulty, specific diagnoses, and associated outcomes. We report on the refinement and validation of a pediatric echocardiography complexity (PEC) score. METHODS AND RESULTS The American College of Cardiology Quality Network assembled a panel from 12 centers to refine a previously published PEC score developed in a single institution. The panel refined complexity categories and included study modifiers to account for complexity related to performance of the echocardiogram. Each center submitted data using the PEC scoring tool on 15 consecutive inpatient and outpatient echocardiograms. Univariate and multivariate analyses were performed to assess for independent predictors of longer study duration. Among the 174 echocardiograms analyzed, 68.9% had underlying congenital heart disease; 44.8% were outpatient; 34.5% were performed in an intensive care setting; 61.5% were follow-up; 46.6% were initial or preoperative; and 9.8% were sedated. All studies had an assigned PEC score. In univariate analysis, longer study duration was associated with several patient and study variables (age <2 years, PEC 4 or 5, initial study, preoperative study, junior or trainee scanner, and need for additional imaging). In multivariable analysis, a higher PEC score of 4 or 5 was independently associated with longer study duration after controlling for study variables and center variation. CONCLUSIONS The PEC scoring tool is feasible and applicable in a variety of clinical settings and can be used for correlation with diagnostic errors, allocation of resources, and assessment of physician and sonographer effort in performing, interpreting, and training in pediatric echocardiography.
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Affiliation(s)
| | - Sunkyung Yu
- Department of PediatricsUniversity of MichiganAnn ArborMIUSA
| | | | - Aarti H. Bhat
- Department of PediatricsUniversity of Washington and Seattle Children’s HospitalSeattleWAUSA
| | - Joseph A. Camarda
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoILUSA
| | | | - Pei‐Ni Jone
- Department of PediatricsLurie Children’s HospitalChicagoILUSA
| | - Leo Lopez
- Department of PediatricsStanford School of MedicinePalo AltoCAUSA
| | - Shobha S. Natarajan
- Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - David A. Parra
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - Anitha Parthiban
- Texas Children’s Hospital, Baylor College of MedicineHoustonTXUSA
| | - Ritu Sachdeva
- Emory University and Children’s Healthcare of AtlantaAtlantaGAUSA
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Yu Z, Zhang H, Wang Y. In Reply to the Letter to the Editor Regarding "Cervical Spondylotic Amyotrophy Initially Misdiagnosed as Amyotrophic Lateral Sclerosis". World Neurosurg 2024; 183:270. [PMID: 38468173 DOI: 10.1016/j.wneu.2023.12.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 03/13/2024]
Affiliation(s)
- Zhong Yu
- Department of Emergency, Honghui Hospital, Xi'an Jiaotong Uinversity, Xi'an, China
| | - Haofuzi Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yanjun Wang
- Department of Emergency, Honghui Hospital, Xi'an Jiaotong Uinversity, Xi'an, China.
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Toxopeus R, Kasalak Ö, Yakar D, Noordzij W, Dierckx RAJO, Kwee TC. Is work overload associated with diagnostic errors on 18F-FDG-PET/CT? Eur J Nucl Med Mol Imaging 2024; 51:1079-1084. [PMID: 38030745 DOI: 10.1007/s00259-023-06543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE To determine the association between workload and diagnostic errors on 18F-FDG-PET/CT. MATERIALS AND METHODS This study included 103 18F-FDG-PET/CT scans with a diagnostic error that was corrected with an addendum between March 2018 and July 2023. All scans were performed at a tertiary care center. The workload of each nuclear medicine physician or radiologist who authorized the 18F-FDG-PET/CT report was determined on the day the diagnostic error was made and normalized for his or her own average daily production (workloadnormalized). A workloadnormalized of more than 100% indicates that the nuclear medicine physician or radiologist had a relative work overload, while a value of less than 100% indicates a relative work underload on the day the diagnostic error was made. The time of the day the diagnostic error was made was also recorded. Workloadnormalized was compared to 100% using a signed rank sum test, with the hypothesis that it would significantly exceed 100%. A Mann-Kendall test was performed to test the hypothesis that diagnostic errors would increase over the course of the day. RESULTS Workloadnormalized (median of 121%, interquartile range: 71 to 146%) on the days the diagnostic errors were made was significantly higher than 100% (P = 0.014). There was no significant upward trend in the frequency of diagnostic errors over the course of the day (Mann-Kendall tau = 0.05, P = 0.7294). CONCLUSION Work overload seems to be associated with diagnostic errors on 18F-FDG-PET/CT. Diagnostic errors were encountered throughout the entire working day, without any upward trend towards the end of the day.
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Affiliation(s)
- Romy Toxopeus
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ömer Kasalak
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Derya Yakar
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Walter Noordzij
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Huang HP, Ran HM, Li ZS, Xie J. A case of POEMS syndrome comprising of a complicated diagnostic procedure: Case report. Medicine (Baltimore) 2024; 103:e37200. [PMID: 38428848 PMCID: PMC10906610 DOI: 10.1097/md.0000000000037200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024] Open
Abstract
RATIONALE This article presents the case of a patient with recurrent chronic diarrhea and cachexia who was misdiagnosed, followed by a literature review to summarize the reasons for misdiagnosis of POEMS syndrome and the treatment strategies. PATIENT CONCERNS The diagnosis and treatment of this patient suggest that with the improvement of M-protein detection levels, the diagnosis of patients with low M-protein levels, such as those with POEMS syndrome, has been greatly aided. DIAGNOSES POEMS syndrome requires polyneuropathy and monoclonal plasma cell proliferation as mandatory diagnostic criteria. Therefore, patients presenting with polyneuropathy should routinely undergo M-protein testing and consider the possibility of POEMS syndrome. INTERVENTIONS The patient, in this case, was treated primarily with relatively conservative immunomodulatory agents. OUTCOMES During follow-up after treatment, the patient's diarrhea and malnutrition showed significant improvement. LESSONS SUBSECTIONS POEMS syndrome has low clinical specificity and a high rate of misdiagnosis. However, once a definitive diagnosis is made, the treatment outcome is favorable.
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Affiliation(s)
- Hai-Ping Huang
- Department of Nephrology, The Second Affiliated Hospital of Guizhou University of TCM, Guiyang, China
| | - Hong-Mei Ran
- Department of Nephrology, Chongqing Hechuan District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Zheng-Sheng Li
- Department of Nephrology, The Second Affiliated Hospital of Guizhou University of TCM, Guiyang, China
| | - Juan Xie
- Department of Nephrology, The Second Affiliated Hospital of Guizhou University of TCM, Guiyang, China
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Betancourt A, Benrashid E, Gupta PC, McGinigle KL. Current concepts in clinical features and diagnosis of thoracic outlet syndrome. Semin Vasc Surg 2024; 37:3-11. [PMID: 38704181 DOI: 10.1053/j.semvascsurg.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/14/2023] [Accepted: 01/19/2024] [Indexed: 05/06/2024]
Abstract
The diagnosis and clinical features of thoracic outlet syndrome have long confounded clinicians, owing to heterogeneity in symptom presentation and many overlapping competing diagnoses that are "more common." Despite the advent and prevalence of high-resolution imaging, along with the increasing awareness of the syndrome itself, misdiagnoses and untimely diagnoses can result in significant patient morbidity. The authors aimed to summarize the current concepts in the clinical features and diagnosis of thoracic outlet syndrome.
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Affiliation(s)
- Alexis Betancourt
- Division of Vascular Surgery, University of North Carolina at Chapel Hill, Burnett Womack Building, 3(rd) Floor, Campus Box 7212, Chapel Hill, NC, 27599
| | - Ehsan Benrashid
- University Surgical Associates, University of Tennessee at Chattanooga, Chattanooga, TN
| | - Prem Chand Gupta
- Department of Vascular and Endovascular Surgery, Care Hospital, Banjara Hills, Hyderabad, India
| | - Katharine L McGinigle
- Division of Vascular Surgery, University of North Carolina at Chapel Hill, Burnett Womack Building, 3(rd) Floor, Campus Box 7212, Chapel Hill, NC, 27599.
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King A, Pope E. Dermatitis versus nonaccidental trauma: A systematic review of initial pediatric misdiagnoses. Pediatr Dermatol 2024; 41:215-220. [PMID: 38400817 DOI: 10.1111/pde.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/27/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND/OBJECTIVES Pediatric dermatitis and nonaccidental trauma (NAT) may have overlapping cutaneous presentations, posing a risk of misdiagnosis and subsequent emotional distress and further harm. Through a systematic literature review, we reviewed pediatric (<18 years old) patients investigated for both dermatitis and NAT. METHODS EMBASE and MEDLINE databases were searched. English publications with original data involving pediatric patients investigated for both dermatitis and NAT were included. Nonhuman studies and incomplete articles/conference abstracts were excluded. Data extracted included the first author, year of publication, study design, participant count, sex of the population, age of the population, cutaneous presentation, timing of presentation, Child Protective Services involvement, and case relation to dermatitis and NAT. RESULTS This review included 21 case reports or series encompassing 29 patients. Among 26 patients initially investigated as NAT (26.9% involving Child Protective Services), final diagnoses included irritant contact dermatitis (53.8%), phytophotodermatitis (30.8%), allergic contact dermatitis (7.7%), perianal infectious dermatitis (3.8%), and atopic dermatitis (3.8%). Three patients initially diagnosed with nontraumatic dermatitis were later found to be victims of physical (2/3; 66.7%) or sexual abuse (1/3; 33.3%). CONCLUSIONS Effective history-taking and physical examinations should encompass a history of laxative use, contact with furocoumarin-containing plants/fruit, parallel family/peer cutaneous presentations, caregiver involvement, financial burden, patient discomfort, birthmark assessment, and lesions aligning with diaper borders or toilet seats. Limitations of this review include potential underreporting and the inclusion of low-quality study designs and evidence.
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Affiliation(s)
- Aliyah King
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Elena Pope
- Section of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Xu T, Zhang X, Zhu J, Huang C, Zhou M, Hu L, Guo L, Lin S, Lin X, Zang S. Angioimmunoblastic T-cell lymphoma involving the nasopharynx: An easily misdiagnosed disease with atypical histopathological features. Hum Pathol 2024; 145:86-94. [PMID: 38431056 DOI: 10.1016/j.humpath.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To explore the clinicopathologic features, treatment, and survival outcomes of angioimmunoblastic T-cell lymphoma (AITL) involving the nasopharynx. METHODS We retrospectively analyzed 73 cases of AITL. Among them, 64 cases with complete pre-treatment 18F-FDG positron emission tomography/computed tomography (PET/CT) images were integrated into the analysis of clinical characteristics and PET/CT findings of AITL involving the nasopharynx; 14 cases with both biopsies from lymph node and nasopharynx were included in the comparison of pathological characteristics of AITL in the two areas. Forty-six of the 73 patients who received first-line systemic treatment at our institute were included in the treatment efficacy and survival analyses. RESULTS Nasopharyngeal involvement was seen in 44/64 (68.8%) patients. Histologically, lymph node and nasopharyngeal biopsies in 14 patients both showed small to medium-sized tumor cells, complex inflammatory infiltration, and Reed-Sternberg-like cells or B immunoblasts. However, tumor cells with clear cytoplasm, significant high endothelial venule (HEV) hyperplasia, and perivascular infiltration were observed in 5/14, 3/14, and 2/14 nasopharyngeal biopsies, respectively, but in all fourteen lymph node biopsies (P < 0.05). Immunophenotypic profiles and gene rearrangements were highly concordant. Treatment efficacy and survival were similar between patients with nasopharyngeal involvement and those without (P > 0.05), indicating nasopharyngeal involvement is not a prognostic factor for AITL patients. CONCLUSIONS Nasopharyngeal involvement is common in AITL but can be easily misdiagnosed because of its atypical pathologic pattern, especially when a lymph node biopsy is unavailable. However, the patient's clinical presentation, PET/CT manifestations, the typical immunophenotype, and gene rearrangements help the diagnosis.
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Affiliation(s)
- Ting Xu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Xuanye Zhang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Junhui Zhu
- Department of Pathology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong, China.
| | - Chaoyun Huang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Mengyao Zhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Lina Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Lin Guo
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Suxia Lin
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Xiaoping Lin
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Shengbing Zang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
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Yang W, Jiang J, Zhao Q, Ren HQ, Yao XX, Sun SY, Zhang L, Fu AS, Ge YL. A Case of Tuberculosis Misdiagnosed as Sarcoidosis and then Confirmed by NGS Testing. Clin Lab 2024; 70. [PMID: 38469771 DOI: 10.7754/clin.lab.2023.230823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Pulmonary tuberculosis (PTB) is an important infectious disease that threatens the health and life of human beings. In the diagnosis of PTB, imaging plays a dominant role, but due to the increasing drug resistance of Mycobacterium tuberculosis, atypical clinical manifestations, "different images with the same disease" or "different diseases with the same image" in chest imaging, and the low positivity rate of routine sputum bacteriology, which leads to a high rate of misdiagnosis of PTB. We report a case of pulmonary tuberculosis that was misdiagnosed on imaging. We report a case of pulmonary tuberculosis that resembled sarcoidosis on imaging and was negative for antacid staining on sputum smear and alveolar lavage fluid, and was later diagnosed by microbial next-generation sequencing (NGS). The case was initially misdiagnosed as sarcoidosis. METHODS Alveolar lavage fluid NGS, chest CT, bronchoscopy. RESULTS Chest CT showed multiple inflammatory lesions in both lungs, multiple nodular foci in both lungs, and multiple enlarged lymph nodes in the mediastinum and hilar region on both sides. Fiberoptic bronchoscopy was performed in the basal segment of the left lower lobe of the lungs to carry out bronchoalveolar lavage, and the lavage fluid was sent to the NGS test and returned the following results: Mycobacterium tuberculosis complex group detected in the number of sequences of 293. Based on the results of the NGS test, the diagnosis of pulmonary tuberculosis could be confirmed. CONCLUSIONS The diagnosis of pulmonary tuberculosis cannot be easily excluded in patients with "different images with the same disease" or "different diseases with the same image" on chest imaging without the support of sputum positivity. The goal was to improve the alertness of medical personnel to the misdiagnosis of tuberculosis and the application of NGS technology.
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41
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Chang MC. Letter to the Editor Regarding "Cervical Spondylotic Amyotrophy Initially Misdiagnosed as Amyotrophic Lateral Sclerosis". World Neurosurg 2024; 183:269. [PMID: 38468172 DOI: 10.1016/j.wneu.2023.10.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 03/13/2024]
Affiliation(s)
- Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
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42
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Dhanrajani P. Metastatic tumour misdiagnosed as abscess. Br Dent J 2024; 236:389. [PMID: 38459310 DOI: 10.1038/s41415-024-7207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/10/2024]
Affiliation(s)
- P Dhanrajani
- Oral Surgeon, HCF Dental Centre, 403 George Street, Sydney, NSW 2000, Australia.
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43
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Khan RN, Ahmad M, Neill BC, Tolkachjov SN. Unusual case of isolated palmar basal cell carcinoma and misdiagnosis. Int J Dermatol 2024; 63:385-386. [PMID: 38124371 DOI: 10.1111/ijd.16995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | | | | | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, TX, USA
- Department of Dermatology, University of Texas at Southwestern, Dallas, TX, USA
- Texas A&M School of Medicine, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
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44
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Yang X, Yu X, Zhang S, Zhang Z. Angiomyolipoma with epithelial cysts misdiagnosed as cystic renal carcinoma: A case report. Asian J Surg 2024; 47:1571-1573. [PMID: 38087691 DOI: 10.1016/j.asjsur.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/01/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Xi Yang
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China.
| | - Xinrui Yu
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China.
| | - Siran Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China.
| | - Zhuo Zhang
- Department of Radiation Oncology, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China.
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45
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Barile J, Margolis A, Cason G, Kim R, Kalash S, Tchaconas A, Milanaik R. Diagnostic Accuracy of a Large Language Model in Pediatric Case Studies. JAMA Pediatr 2024; 178:313-315. [PMID: 38165685 PMCID: PMC10762631 DOI: 10.1001/jamapediatrics.2023.5750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/24/2023] [Indexed: 01/04/2024]
Abstract
This diagnostic study evaluates the accuracy of a large language model against physician diagnoses in pediatric cases.
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Affiliation(s)
- Joseph Barile
- Cohen Children’s Medical Center, New Hyde Park, New York
| | - Alex Margolis
- Cohen Children’s Medical Center, New Hyde Park, New York
| | - Grace Cason
- Cohen Children’s Medical Center, New Hyde Park, New York
| | - Rachel Kim
- Cohen Children’s Medical Center, New Hyde Park, New York
| | - Saia Kalash
- Cohen Children’s Medical Center, New Hyde Park, New York
| | | | - Ruth Milanaik
- Cohen Children’s Medical Center, New Hyde Park, New York
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46
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Yu D, Li J, Tai H, Ma J, Zhang Z, Tang W. Neuronal intranuclear inclusion disease misdiagnosed as Parkinson's disease: a case report. J Int Med Res 2024; 52:3000605241233159. [PMID: 38436278 PMCID: PMC10913512 DOI: 10.1177/03000605241233159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare progressive neurodegenerative disease that mainly manifests as dementia, muscle weakness, sensory disturbances, and autonomic nervous dysfunction. Herein, we report a 68-year-old Chinese woman who was hospitalized because of resting tremor and bradykinesia that had been present for 7 years. Five years prior, bradykinesia and hypermyotonia had become apparent. She had urinary incontinence and rapid eye movement sleep behavior disorder. She was diagnosed with Parkinson's disease (PD) and received levodopa and pramipexole, which relieved her motor symptoms. During hospitalization, diffusion-weighted imaging revealed a high-intensity signal along the cortical medullary junction. Moreover, a skin biopsy revealed the presence of intranuclear inclusions in adipocytes, fibroblasts, and sweat gland cells. NIID was diagnosed by testing the Notch 2 N-terminal-like C (NOTCH2NLC) gene. We report this case to remind doctors to consider NIID when diagnosing patients with symptoms indicative of Parkinson's disease. Moreover, we note that further research is needed on the mechanism by which levodopa is effective for NIID.
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Affiliation(s)
- Dandan Yu
- Dalian University Affiliated Xinhua Hospital, Dalian, China
| | - Jing Li
- Donggang Center Hospital, Donggang, China
| | - Hongfei Tai
- Beijing Tiantan Hospital Capital Medical University, Beijing, China
| | - Jing Ma
- Donggang Center Hospital, Donggang, China
| | - Zaiqiang Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wei Tang
- Dalian University Affiliated Xinhua Hospital, Dalian, China
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47
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Washington L, O'Sullivan-Murphy B, Christensen JD, McAdams HP. Radiographic Imaging of Community-Acquired Pneumonia: A Case-Based Review. Infect Dis Clin North Am 2024; 38:19-33. [PMID: 38280764 DOI: 10.1016/j.idc.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The chest radiograph is the most common imaging examination performed in most radiology departments, and one of the more common indications for these studies is suspected infection. Radiologists must therefore be aware of less common radiographic patterns of pulmonary infection if they are to add value in the interpretation of chest radiographs for this indication. This review uses a case-based format to illustrate a range of imaging findings that can be associated with acute pulmonary infection and highlight findings that should prompt investigation for diseases other than community-acquired pneumonia to prevent misdiagnosis and delays in appropriate management.
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Affiliation(s)
- Lacey Washington
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA.
| | - Bryan O'Sullivan-Murphy
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
| | - Jared D Christensen
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
| | - H Page McAdams
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
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48
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Chen L, Xu YY, Lin JY, Ji ZP, Yang F, Tan S, Wang G, Fang Y, Lu Z, Yang H, Hu J, Chen Z, Huang Y, Sun J, Wang X, Li H, Zhang J, Wang Y, Su Y, Zhao Y, Si T. The prevalence and clinical correlates of suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: Results from a national survey in China. Asian J Psychiatr 2024; 93:103958. [PMID: 38364597 DOI: 10.1016/j.ajp.2024.103958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 02/02/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND AND AIM Suicide is nearly always associated with underlying mental disorders. Risk factors for suicide attempts (SAs) in patients with bipolar disorder (BD) misdiagnosed with major depressive disorder (MDD) remain unelucidated. This study was to evaluate the prevalence and clinical risk factors of SAs in Chinese patients with BD misdiagnosed with MDD. METHODS A total of 1487 patients with MDD from 13 mental health institutions in China were enrolled. Mini International Neuropsychiatric Interview (MINI) was used to identify patients with BD who are misdiagnosed as MDD. The general sociodemographic and clinical data of the patients were collected and MINI suicide module was used to identify patients with SAs in these misdiagnosed patients. RESULTS In China, 20.6% of patients with BD were incorrectly diagnosed as having MDD. Among these misdiagnosed patients, 26.5% had attempted suicide. These patients tended to be older, had a higher number of hospitalizations, and were more likely to experience frequent and seasonal depressive episodes with atypical features, psychotic symptoms, and suicidal thoughts. Frequent depressive episodes and suicidal thoughts during depression were identified as independent risk factors for SAs. Additionally, significant sociodemographic and clinical differences were found between individuals misdiagnosed with MDD in BD and patients with MDD who have attempted suicide. CONCLUSIONS This study highlights the importance of accurate diagnosis in individuals with BD and provide valuable insights for the targeted identification and intervention of individuals with BD misdiagnosed as having MDD and those with genuine MDD, particularly in relation to suicidal behavior.
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Affiliation(s)
- Lin Chen
- Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Yu-Yu Xu
- Universiti Tunku Abdul Rahman (UTAR), Kampar, Malaysia
| | - Jing-Yu Lin
- Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Zhen Peng Ji
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Fude Yang
- Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Shuping Tan
- Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Gang Wang
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, China
| | - YiRu Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Lu
- Shanghai Tongji Hospital, Tongji University Medical School, Shanghai, China
| | - HaiChen Yang
- Division of Mood Disorders, Shenzhen Mental Health Center, Guangdong province, China
| | - Jian Hu
- The First Hospital of Harbin Medical University, Heilongjiang province, China
| | - ZhiYu Chen
- Hangzhou Seventh People's Hospital, Zhejiang province, China
| | - Yi Huang
- West China Hospital, Sichuan University, Sichuan province, China
| | - Jing Sun
- The Affiliated Brain Hospital, Nanjing Medical University, Jiangsu province, China
| | - Xiaoping Wang
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Hunan province, China
| | - Huichun Li
- The Second Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang province, China
| | - Jinbei Zhang
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong province, China
| | - Ying Wang
- The 261st hospital of PLA, Beijing, China
| | - Yunai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), China
| | - Yanli Zhao
- Beijing Huilongguan Hospital, Peking University, Beijing, China.
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), China.
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49
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Halle-Smith JM, Bartlett D, Chatzizacharias N, Dasari BV, Marudanayagam R, Sutcliffe RP, Brown RM, Roberts KJ. Investigating misdiagnosis of suspected cancer among patients undergoing pancreatoduodenectomy: three decades of experience. HPB (Oxford) 2024; 26:344-351. [PMID: 38071186 DOI: 10.1016/j.hpb.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/29/2023] [Accepted: 11/17/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Diagnostic error can result in pancreatoduodenectomy (PD) being mistakenly performed for benign disease. The aims of this study were to observe the error rate in PD over three decades and identify characteristics of benign disease that can mimic malignancy. METHODS Patients with a benign histological diagnosis after having PD performed for suspected malignancy between 1988 and 2019 were selected for review. Preoperative clinical features, imaging and pathological samples were reviewed alongside resection specimens to identify features that may have led to misdiagnosis. RESULTS Over the study period, 1812 patients underwent PD for suspected malignancy and 97 (5.2 %) of these had a final benign diagnosis. The rate of benign cases reduced across the study period. Some 62 patients proceeded to surgery without a preoperative tissue diagnosis; the decision to operate was made upon clinical and radiologic features alone. There were six patients who had a preoperative pathological sample suspicious for malignancy, of which two had autoimmune pancreatitis in the postoperative histology specimen. DISCUSSION Benign conditions, notably autoimmune and chronic pancreatitis, can mimic malignancy even with the use of EUS-FNA. The results of all available diagnostic modalities should be interpreted by a multidisciplinary team and honest discussions with the patient should follow.
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Affiliation(s)
- James M Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - David Bartlett
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nikolaos Chatzizacharias
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Bobby Vm Dasari
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ravi Marudanayagam
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Robert P Sutcliffe
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rachel M Brown
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Keith J Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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50
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Zhu HY, Cheng Y, Wang SY, Shao D. Urinary Endometriosis Misdiagnosed as Ureteral Malignant Tumor by PET/CT: A Case Study. Clin Nucl Med 2024; 49:e129-e130. [PMID: 38271236 DOI: 10.1097/rlu.0000000000005045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT Endometriosis is a chronic inflammatory estrogen-dependent benign disease. It is defined as the endometrium growing outside the uterine cavity and the myometrium. It usually has low FDG uptake but rarely occurs in the ureters. We reported a case of a 47-year-old woman's left ureteral nodule originally misdiagnosed as a ureteral malignant tumor by PET/CT and finally pathologically confirmed as endometriosis.
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Affiliation(s)
| | - You Cheng
- Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Si-Yun Wang
- Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Dan Shao
- Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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