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Search Patient Charts: Recurrent

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Search Results for => Recurrent <= Result Items 1 - 20

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Case ID: 12511 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent Shoulder Dislocation/Instability
	History	22 year-old man presenting to acute care with pain in left shoulder after reaching out to catch a football. He reports a history of 6 prior 'shoulder separations.'
	Findings	1. Anterior and lateral dislocation of the left humeral head without evident fracture. 2. Prior glenoid labrum repair with 3 osseus anchors
	Differential Dx	Shoulder Dislocation Shoulder Fracture/Dislocation Recurrent Shoulder Dislocation/Instability
	Discussion	... (continues ...)
	User Group
	Contributor	Hugh M Dainer :: National Capital Consortium -
	Reviewer	Albert V Porambo :: Civilian Medical Center - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 12481 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Stent Placement for Recurrent Central Venous Occlusion
	History	73 year old man with ESRD presents with severe left arm swelling following regular dialysis. When questioned he reports that the size of his arm has increased significantly over the preceding 2 weeks.
	Findings	Chronic left brachiocephalic vein stenosis Sub-acute complete occlusion Angioplasty and stenting of the occlusion
	Differential Dx	Central venous stenosis or central venous occlusion can be due to a number of disparate primary pathologies: Chronic local venous hypertension in the arm of a dialysis patient, Paget Schroder syndrome in an athlete using anabolic steroids, fibrosis due to indwelling pacemaker leads, and superior vena cava syndrome due to cancer are some of the more common of these processes. Lymphedema (subsequent to axiallary node dissection or other etiology)
	Discussion	... (continues ...)
	User Group
	Contributor	Hugh M Dainer :: National Capital Consortium -
	Reviewer	Michael A Winkler :: University of Kentucky - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 10445 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Multiple pulmonary metastases from Recurrent melanoma
	History	SOB, rule out pneumothorax.
	Findings	Scattered, diffuse rounded and somewhat hazy opacities of both lungs.
	Differential Dx	Fungal pulmonary infection/septic emboli Bacterial septic emboli
	Discussion	... (continues ...)
	User Group
	Contributor	Dana G. Borgeson :: Naval Medical Center Portsmouth -
	Reviewer	Stephanie A Bernard :: Penn State University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 9848 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent VARICOCELE TREATED WITH GONADAL VEIN/VARICOCELE EMBOLIZATION.
	History	27 Y.O. MALE WITH TWO PRIOR VARICOCELE SURGICAL LIGATIONS (ONE VIA SCROTAL INCISION AND ONE VIA INGUINAL INCISION) PRESENTS WITH CONTINUING LEFT SCROTAL DISCOMFORT.
	Findings	SELECTED VENOGRAPHY OF THE LEFT GONADAL VEIN DEMONSTRATED SIGNIFICANT VENOUS DILITATION FROM THE LEVEL OF THE LEFT RENAL VEIN TO THE SCROTUM.
	Differential Dx	Recurrent LEFT-SIDED VARICOCELE
	Discussion	... (continues ...)
	User Group
	Contributor	william T lewis :: Madigan Army Medical Center -
	Reviewer	John D Statler :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 9713 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent pyogenic (Oriental) cholangiohepatitis with intrahepatic biliary stricture and stone formation.
	History	46 year-old female with history of Oriental cholangiohepatitis who undergoes routine cholangiogram and biliary stone removal.
	Findings	After accessing the Hutson-Russell cutaneous choledochojejunostomy loop, a glidewire and vascular sheath were passed into the biliary system allowing a cholangiogram to be performed which demonstrated numerous small filling defects consistent with stones within the left dorsal and ventral hepatic biliary system. The right biliary system was clear of stones. The entire biliary tract was diffusely mildly dilated. A short segment stenosis was noted within the left hepatic duct near the confluence of the right and left ducts. This was dilated with a 10 mm angioplasty balloon. A Fogarty balloon was advanced into the left biliary systems, inflated, and retracted pulling the stones into the common bile duct. Post procedure cholangiogram reveled significant improvement in the left-sided stone burden and reduction of the stricture of the left hepatic duct.
	Differential Dx	Recurrent pyogenic (Oriental) cholangiohepatitis Hemobilia Caroli's Disease with stone formation hemolytic anemia with intrahepatic stone formation
	Discussion	... (continues ...)
	User Group
	Contributor	Jason T Scism :: Madigan Army Medical Center -
	Reviewer	John D Statler :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 9704 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	(Recurrent) Inflammatory Myxohyaline Tumor of Distal Extremities (Acral Myxoinflammatory Fibroblastic Sarcoma)
	History	A 56 year-old healthy female presented with a one-month history of an enlarging, fluctuant left lateral ankle mass. An MRI showed a 4 cm irregular mass in the left lateral supramalleolar area, intimately associated with the left peroneal tendon. The mass was resected in a piecemeal fashion. Grossly, the specimen consisted of multiple yellow-tan fragments of tissue, measuring 3.3 x 2.5 x 1.2 cm in aggregate. The cut surfaces were yellow-white with focal gelatinous areas. A 56 year-old healthy female presented with a one-month history of an enlarging, fluctuant left lateral ankle mass. An MRI showed a 4 cm irregular mass in the left lateral supramalleolar area, intimately associated with the left peroneal tendon. The mass was resected in a piecemeal fashion. Grossly, the specimen consisted of multiple yellow-tan fragments of tissue, measuring 3.3 x 2.5 x 1.2 cm in aggregate. The cut surfaces were yellow-white with focal gelatinous areas. Microscopically, the tumor was multinodular with cellular areas composed of spindle to epithelioid cells with abundant eosinophilic cytoplasm and ovoid nuclei. Also present, were myxoid areas characterized by abundant myxoid stroma, stellate cells and numerous pseudolipoblasts. Sparse enlarged cells with mild nuclear atypia and conspicuous single eosinophilic nucleoli were seen. Rare mitoses and chronic inflammation were identified. No additional treatment was given. Four months later the patient presented with a Recurrent mass in the same area. The mass was again excised revealing a lesion with similar morphologic features. This was felt to be a recurrence of the previous lesion, with slightly increased cellularity and atypia compared to the previous lesion.
	Findings	MRI showed a 4 cm irregular mass in the left lateral supramalleolar area, intimately associated with the left peroneal tendon.
	Differential Dx	Benign differential diagnoses include nodular fasciitis, tenosynovial giant cell tumor, inflammatory myofibroblastic tumor and infectious lesions. Malignant tumors that show some resemblance with this lesion are myxoid liposarcoma and myxofibrosarcoma. A liposarcoma is usually localized in a deeper anatomical level and lacks the inflammatory component. Although there could be some resemblance, myxofibrosarcoma has a propensity to occur in the proximal extremities, has a prominent curvilinear vascular pattern, and is, in its classic presentation, not an inflammatory lesion.
	Discussion	... (continues ...)
	User Group
	Contributor	Keith J Kaplan :: Mayo Clinic -
	Reviewer	Lorraine G. Shapeero, M.D. :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 9540 Sample Image Click to View	:: - TF Case :: - Thumbnails :: No Topic ::


	Diagnosis	Recurrent epithelioid sarcoma
	History	82 year old female with history of "sarcoma" right knee s/p resection with positive margin in 2004. Patient did not receive radiation therapy following surgery. Presents with increasing right knee/leg pain. MRI performed.
	Findings	1. 3.5 x 2.2 x 1.7 cm enhancing soft tissue lesion located predominantly within the distal vastus lateralis muscle at the level of the distal femoral diaphysis. This is most suggestive of tumor recurrence. 2. 1.3 x 0.8 x 0.9 cm enhancing lesion within the deep subcutaneous soft tissues of the anterior proximal thigh, suspicious for soft tissue sarcoma. 3. Postoperative changes about the knee from prior resection. A crescentic shaped fluid collection anterior to the proximal tibia has decreased in size. 4. Small joint effusion.
	Differential Dx	• Recurrent sarcoma
	Discussion	... (continues ...)
	User Group
	Contributor	Keith J Kaplan :: Mayo Clinic -
	Reviewer	Keith J Kaplan :: Mayo Clinic - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 9044 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Chronic Recurrent DVT
	History	32 y/o WF with a 4-day history of left leg pain beginning at mid-thigh level and edema below the level of the knee over the previous 24-hour period. She was feeling well prior to the onset of these symptoms. About 18 months earlier, the patient had been involved in a MVA, during which she sustained soft tissue trauma to the right lower leg, and multiple metatarsal fractures. A short cast was applied, and the patient was discharged from the hospital on crutches without RLE weight bearing. The patient returned one week later complaining about pain in the right calf and that the “cast was too tight”. The cast was removed and compression ultrasound confirmed DVT. The patient was started on Lovenox 1mg/kg SC q12h until PO anticoagulation with Coumadin was established. The patient remained on Coumadin for 4 months without any complications or recurrence. Prior to this current problem, the patient was fully ambulatory, there was no recent history of trauma to the left leg, and no other risk factors for DVT could be identified.
	Findings	CXR – unremarkable, NAPD. Compression U/S – RLE: Normal, easily compressible hypoechoic veins with some posterior wall enhancement in proximal RLE. No evidence of venous distention. Compression U/S - LLE: Noncompressibility of common femoral vein with echogenic thrombus within the vein lumen consistent with chronic DVT.
	Differential Dx	Chronic DVT, Acute DVT, Baker’s cyst, cellulitis, lymphedema, chronic venous insufficiency, superficial thrombophlebitis, popliteal venous or arterial aneurysm, enlarged lymph nodes compressing the veins, heterotopic ossification, hematoma, and muscle tears.
	Discussion	... (continues ...)
	User Group
	Contributor	Shawn D Redding :: Uniformed Services University -
	Reviewer	Aimee Hawley :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 8898 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent DCIS LEFT BREAST
	History	55 year old postmenopausal woman G2P0 with menarche at age 11. History of left breast DCIS 1996, Stage 0 (Tis, N0, M0). Had lumpectomy and radiation. Declined Tamoxifen.
	Findings	1, 2) CC, MLO views left breast - upper outer left breast middle one/third demonstrates architectural distortion and pleomorphic segmental calcifications posterior to a stereotactic biopsy clip/marker. 3,4) MAGNIFIED CC, MLO spots better demonstrate the abnormal microcalcifications.
	Differential Dx	Indeterminate cluster of calcifications: 1. DCIS 2. Atypical ductal hyperplasia 3. Degenerating fibroadenoma 4. Infarcted papilloma 5. Fat necrosis 6. Benign cluster of calcification
	Discussion	... (continues ...)
	User Group
	Contributor	Laura N Modzelewski :: National Naval Medical Center Bethesda -
	Reviewer	Claudia E Galbo :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 8258 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Diagnosis: 64 y.o. female with Recurrent breast cancer with metastasis to lymph nodes and lungs. Liver mass biopsy reveals adenocarcinoma, with histology consistent with breast tissue.
	History	History (can include gestational age, or age in days, weeks, months): 64 y.o. WF with hx of Breast CA (1996), s/p lumpectomy and XRT, admitted for workup of fatigue, 15-20 lb weight loss in 8 months, and increased abdominal girth in the setting of imaging studies, which show ascites (with peritoneal fluid negative for malignant cells), liver lesions, and multiple lung masses. Prior workup demonstrated elevated LFTs, Elevated CEA, CA 19-9, CA 125, and negative viral hepatitis panels.
	Findings	Image Findings: 1. PET scan—2 hypermetabolic foci in Left breast; Focal hypermetabolic uptake in inferior Right liver lobe and Left liver lobe with diffuse/heterogeneous uptake in Right lobe; diffuse bone uptake in axial/appendicular skeleton that is nonspecific: malignant vs liver failure. 2. MRCP/MRI abdomen—liver cirrhosis and portal HTN leading to splenomegaly and ascites; no pancreatic ductal dilatation; liver lesions are peripheral with capsular retraction 3. CT chest—too numerous to count non-calcified nodules in lungs; Left breast lesion and axillary lymph node 4. Breast U/S (image not available for MedPix) used for core Bx—1.2cm lesion in Left upper outer breast; BIRADS category 5
	Differential Dx	Differential Diagnosis for these findings in this case: 1. Liver lesions and ascites: Periportal fibrosis, cirrhosis leading to HCC, regenerating nodules, inflammation, neoplastic infiltration in interstitium 2. Lung nodules: metastasis, infectious, granulomatous, TB, mycobacterial 3. Breast lesions: primary lesion, metastasis
	Discussion	... (continues ...)
	User Group
	Contributor	Russell A. Patterson :: Uniformed Services University -
	Reviewer	Claudia E Galbo :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 8216 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent pyogenic cholangitis (a.k.a. oriental cholangitis or oriental cholangiohepatitis)
	History	41 year old samoan woman presented with Recurrent bouts of pancreatitis.
	Findings	Both CT and MRI demonstrate dilated intrahepatic biliary ducts in the posterior right lobe of the liver. Within the dilated system are several calculi that were formed secondary to chronic infection.
	Differential Dx	Biliary Cystadenoma or Cystadenocarcinoma Caroli Disease Cholangiocarcinoma Primary Sclerosing Cholangitis AIDS Cholangitis Choledochal Cyst Cholelithiasis Metastases
	Discussion	... (continues ...)
	User Group
	Contributor	Michael Krasnokutsky :: Uniformed Services University -
	Reviewer	Michael A Winkler :: University of Kentucky - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 7336 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent uveitis with hyphema
	History	History of uveitis 25 years ago. Red eye, photophobia, irritation onset 2 weeks ago.
	Findings	The anterior segment images show pigment on the anterior surface of the lens and the resultant hyphema after the posterior synechiae were broken.
	Differential Dx
	Discussion	... (continues ...)
	User Group
	Contributor	Aaron M Betts :: Uniformed Services University -
	Reviewer	Thomas P Ward :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 6964 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent breast carcinoma
	History	Remote history of invasive ductal cancer in the right breast, treated with lumpectomy and radiation therapy. Presents for annual screening mammogram.
	Findings	pleomorphic calcifications upper outer quadrant right breast
	Differential Dx	breast carcinoma sclerosing adenosis dystrophic change
	Discussion	... (continues ...)
	User Group
	Contributor	Aimee Hawley :: Uniformed Services University -
	Reviewer	Aimee Hawley :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 6668 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent high-grade astrocytoma
	History	38 y.o. white male with previously diagnosed high-grade glioma in the left parietal lobe, s/p radiation treatment.
	Findings	Initial multiple MR images demonstrate a ring-enhancing lesion in the site of glioma, previously treated with radiation therapy, with some areas of nodular changes. MR spectroscopy of normal site, TE = 144 msec, which demonstrates prominent N-acetylaspartate (NAA) peak at the 2.0 ppm, which is the normal neuronal marker. Creatine peak at 3.0 ppm and choline peak at 3.2 ppm are also demonstrated, showing normal relationships. MR spectroscopy of the abnormal site, TE = 144 msec, which demonstrates elevation of the choline peak, and the suppression of the NAA peak, along with an inverted peak at the 1.0-1.2 ppm, which is the lactate peak (which characteristically inverts at TE = 144 msec). These findings suggest tumor recurrence with some areas of necrosis, rather than radiation-induced changes.
	Differential Dx	• Residual tumor • Recurrent tumor • Radiation effect • Normal brain • Post-operative changes
	Discussion	... (continues ...)
	User Group
	Contributor	Pil Kang :: Uniformed Services University -
	Reviewer	James G. Smirniotopoulos, M.D. :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 6314 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent Bochdalek Hernia
	History	Six month old G-tube fed infant with history of right congenital diaphragmatic hernia repaired at birth. He now presents with episodic abdominal pain.
	Findings	Scout: - abnormal density in the lower right hemithorax with areas of lucency (bowel gas) - There is rightward cardiomediastinal shift due to right pulmonary hypoplasia. Frontal and lateral delayed images of SBFT with contrast administered through a gastric tube. -small bowel is seen in the right posterior/lateral hemithorax above the diaphragm.
	Differential Dx	-Morgagni hernia (anteromedial herniation) -Diaphragmatic eventration
	Discussion	... (continues ...)
	User Group
	Contributor	Clinton Nelson Wells :: Tripler Army Medical Center -
	Reviewer	Lynne Ruess :: Tripler Army Medical Center - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 6162 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent Metastatic Melanoma to Lung
	History	67 y/o WF with h/o of prior partial wedge resection of LLL for metastatic melanoma two years ago.
	Findings	PA and lateral chest radiographs demonstrate a large spherical opacity 5 cm in diameter. It is retrocardiac as it does not obscure the the left heart border on frontal view. On lateral view, the opacity is seen to lie posteriorly in the left lower lobe
	Differential Dx	Recurrent melanoma vs new primary hamartoma, adenoma tuberculoma lung abcess, round pneumonia echinococcus granulosus histoplasmosis, coccidiodomycosis
	Discussion	... (continues ...)
	User Group
	Contributor	Brendan T Doherty :: National Capital Consortium -
	Reviewer	David S. Feigin, M.D. :: Johns Hopkins Hospitals - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 5924 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Meningioma (surgical path proven, Recurrent)
	History	S/P resection of meningioma approx. 2-3 yrs. ago; h/o metastic meningioma met. to lung; h/o r. sided stageIIIa breast adeno ca. Patient with slowly enlarging left neck mass.
	Findings	Enhancing bulky soft tissue mass involving the left neck. Angiography demonstrated a very large, moderately hypervascular left neck mass supplied primarily by multiple left vertebral artery segmental branches from C2-C5.
	Differential Dx	Menginoma Schwannoma
	Discussion	... (continues ...)
	User Group
	Contributor	Thomas C Alewine :: National Capital Consortium -
	Reviewer	James G. Smirniotopoulos, M.D. :: Uniformed Services University - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 5610 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent Malignant Fibrous Histiocytoma - pathology proven.
	History	27 year old female with known previous malignant fibrous histiocytoma of the left chest wall, status post previous left chest wall excision. Now with new right chest wall mass.
	Findings	Smoothly marginated mass projecting from the right chest wall. Obtuse angles as the mass appears to project from the chest wall.
	Differential Dx	1. Recurrent malignant fibrous histiocytoma. 2. Lipoma 3. Sarcoma
	Discussion	... (continues ...)
	User Group
	Contributor	Carl R Cowen :: National Naval Medical Center Bethesda -
	Reviewer	David S. Feigin, M.D. :: Johns Hopkins Hospitals - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 5006 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent Metastatic Papillary Thyroid Carcinoma
	History	Pt is a 26 y/o WF with hx of Papillary thyroid cancer, s/p total thyroidectomy in 1999 with 1.4 cm primary tumor and with numerous positive cervical lymph nodes at that time. Due to residual disease in neck/chest, including multiple small pulmonary metastases, she has received total of approx 700 mCi of I131 therapy to date, with last Tx dose in 8/01.
	Findings	I-131 Head/Neck Scan: No focal accumulations of radiotracer. Chest/Neck MRI: There is no visible thyroid tissue within the thyroid bed. Shotty bilateral anterior cervical chain lymph nodes. No masses or enhancing lesions within the neck. Normal appearance to the parotid and submandibular glands. On coronal images #13 and axial images #23, there is a long axis, 1.5 cm oval soft tissue nodule in the right supraclavicular region that correlates with a lesion exhibiting abnormal radiopharmaceutical uptake on the PET scan. This implies pathologic involvement. Ultrasound: Sonographic evaluation of the right and left thyroid beds demonstrate no definite residual thyroid tissue. No discrete masses are noted to correlate with the patient’s palpable findings. No abnormally enlarged lymph nodes can be delineated. 18-FDG PET: There is a focus of moderately intense radiotracer accumulation in the right supraclavicular region approximately 2 cm superolateral to the right clavicular head and determined to be at a depth of less than 1 cm from the skin surface. (This focus was not palpable.) Also of note is increased uptake in the patient’s thymus (which appears normal on both CT and MRI).
	Differential Dx	Recurrent Metastatic Thyroid Cancer Inflammatory Node
	Discussion	... (continues ...)
	User Group
	Contributor	Erik S Storm :: Uniformed Services University -
	Reviewer	:: - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

Case ID: 4053 Sample Image Click to View	:: - TF Case :: - Thumbnails :: - Topic ::


	Diagnosis	Recurrent metastatic pancreatic cancer
	History	85 year old male with a history of metastatic pancreatic cancer. He is several months status post stenting of the common hepatic duct and has Recurrent elevated bilirubin.
	Findings	Previously positioned biliary stent. The intrahepatic bile ducts are dilated.
	Differential Dx	Post-procedure stricture Cholangiocarcinoma Recurrent metastatic pancreatic cancer Hepatocellular carcinoma Primary bile duct stones
	Discussion	... (continues ...)
	User Group
	Contributor	Aaron M Taylor :: National Capital Consortium -
	Reviewer	:: - Case Accepted: 2008-10-26 14:42:09-04 :: Revised: :: Submitted:

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