Sandbox: Gertrude

Revision as of 15:39, 7 February 2019 by Gertrude Djouka (talk | contribs)
Jump to navigation Jump to search

Xyz Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Xyz from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sandbox: Gertrude On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sandbox: Gertrude

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sandbox: Gertrude

CDC on Sandbox: Gertrude

Sandbox: Gertrude in the news

Blogs on Sandbox: Gertrude

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Sandbox: Gertrude

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Gertrude Djouka, M.D.[2]

Differential diagnosis of neck masses==

Differential diagnosis of neck masses include:

Category Diseases Benign or Malignant Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Skin changes LAP Others
Congenital Branchial cleft cyst Benign
Thyroglossal duct cyst
Hemangioma
Vascular malformations
Lymphatic malformations
Laryngocele
Ranula
Teratoma
Dermoid cyst
Thymic cyst
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Acute sialadenitis
Chronic sialadenitis
Reactive viral lymphadenopathy CMV
EBV
HIV
Viral URI
Bacterial lymphadenopathy Tularemia
Brucellosis
Cat-scratch disease[1][2] Benign More common in the Southern of U.S among children and young adults. Cat exposure

Fever

Fatigue

headache

+ - Tender cervical nodes Vesicular, Erythema, Papule at site of inoculation + ESR

Serology: + antibody to Bartonella Henselae

Satellite micro-abscess with granuloma - - Bacillary Angiomatosis

Bacillary Peliosis

Actinomycosis[3][4] Benign No predilection in race, age

Male to female ratio : 1.5 to 3:1

History of dental procedure or trauma

Poor oral hygiene

Swelling mandible

- - Tender at the beginning , Painless

Fluctuant

Non-tender at late stage

Reddish

Bluish

- ESR

CRP

Gram stains: Gram + filamentous rods

Sulfur granules

Filamentous organism

- Histological examination

Bacterial culture of the abcess

mandible osteomyelitis
Mycobacterial infections[5][6][7] Benign More common in adults and children in endemic continent such as African Recent travel to endemic regions

Exposure to TB patients

- - Matted cervical nodes

Firm

Non-tender

Indurated + PPD: +

Sputum smear: presence of acid fast bacilli

Chronic necrotizing caseating calcified granuloma Neck Ultrasound: Multiple lymph nodes

Fusion tendency

Internal echoes

Culture for mycobacteria -
Staphylococcal or streptococcal infection Benign More common in children + + + + Gram stain: gram (+) cocci in clusters for Staph

Gram (+) cocci in chains for strep

Blood Culture: +

Follicular hyperplasia

Infiltration of polymorphonuclear cells

Acute rheumatic fever

Post-streptoccocal glomerulonephritis

Parasitic lymphadenopathy Toxoplasma gondii[8][9] Benign 6 years and older adults are more affected in U.S.

Seen in Hot climates

Cats or birds feces exposure

Drinking unpasteurized milk

Undercooked food

Organ transplant recipients

+ - Bilateral

Non-tender

Symmetrical

Non-fluctuant

- + Serology : + IgG and IgM

antibodies

Follicular hyperplasia MRI:

Multiple rings enhanced lesions

Serology

Immunofluorescence

MRI

CT scan

Sarcoidosis[10][11] Benign More common in African American women aged 20 - 40 years. Family history of sarcodosis,

Fatigue, swelling and pain in the joints,

- - Bilateral

tender LAD

Swollen, non-tender parotid glands

Erythema nodosum,

Lupus pernios

+ ESR

ACE

Non-necrotizing epithelioid granuloma CXR: B/L hilar adenopathy

MRI: B/L multiples enlarged cervical lymph nodes

Biopsy Heerfordt's syndrome: uveitis, facial nerve paralysis, parotitis
Amyloidosis Benign Men are affected women.

Mean age: 55-60 years old

+ Biopsy
Sjögren syndrome[12] Benign Female to male ratio: 9 to 1

May happen at any age

Mean age: 40-50

History of RA, SLE, and non-hodgkin B-cell lymphoma.

Dry mouth, dry eyes.

- + Firm,

B/L enlarged parotid glands

Itchy

Rashes

Dry

+ ESR

Anti-SSA/Ro

Anti-SSB/La

Cytopenia

Hyperactivity of B cells and lymphocytes which lead to infiltration of the exocrine glands. Biopsy
Castleman disease (angiofollicular lymphoproliferative disease)[13] Benign Mean age: 30-40 years Biopsy
Kikuchi disease (histiocytic necrotizing lymphadenitis)[14] Benign High prevalence in Japan

More common in young adults <30 years old

Fever

Flu-like prodrome

+ - Tender cervical node rashes + ESR

Abnormal liver enzymes

leucopenia

Irregular paracortical areas of coagulative necrosis with abundant karyorrhectic debris - Biopsy Hashimoto thyroiditis
Kimura disease[15] Benign More common in Asian males. History of painless cervical lump - - Large

Non-tender cervical node

Ictching + Increase eosinophils Conserved lymph node structure

Eosinophilic infiltration

High postcapillary venules

- Biospsy Nephrotic syndrom

Hypercoaguble state

Rosai-Dorfman disease[16][17] Benign More common in children Fever - - Non-tender enlarged cervical lymph nodes Erythema + ESR

Polyclonal hypergammaglobulinemia

- - - -
Kawasaki disease[18][19] Benign More common in children younger than 5 years old.

Highest incidence in Japan.

Most leading cause of acquired heart disease in U.S.

High fever

B/L conjunctivitis

Rash

Swelling of hands and feet

Inflammation of lips

Strawberry tongue

- - Large, single palpable cervical node Rashes

Desquamation of skin

+ ESR

CRP

Inflammation of medium sized arteries and organs. Echocardiography:

Coronary artery

dilation

Coronary artery aneurysm

Clinical findings
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Primary thyroid tumor
Salivary gland neoplasm Pleomorphic adenoma[20] Benign More common in Females

Incidence increase with age.

Incidence : 2-3.5 cases per 100,000 population

History of swelling,

Dysphagia

Horseness

- + Palpable mass of deep lobe of parotid gland

Firm

Mobile

- - - Proliferation of epithelial cells and stromal matrix in the ducts. MRI:[21] Homogenous on T1

Abundant myxochondroid stroma on T2

Biopsy
Warthin's tumour[22][23] Benign Male to Female ratio : 4:1

More common in people aged 60 to 70 years old.

History of swollen salivary gland

Jaw pain

Tinnitus

- + Non tender

Mobile

Firm

Solitary

- - - Papillae

Fibrous capsule

Cystic spaces

Neck CT: Cystic lesion posteriorly within the parotid gland.

MRI: B/L lesions

Heterogeneous

Biopsy
Lymphoepithelioma +
Oncocytoma
Monomorphic adenoma
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Adenocarcinoma
Salivary duct carcinoma
Squamous cell carcinoma
Parathyroid tumors
Carotid body tumors
Paraganglioma
Schwannoma
Lymphoma
Liposarcoma
Lipoma
Glomus vagale, glomus jugulare tumors
Metastatic head and neck carcinoma
Other Hematoma
Arteriovenous fistula
Goiter
Category Diseases Benign Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings

References

  1. "Cat-Scratch Disease in the United States, 2005–2013 - Volume 22, Number 10—October 2016 - Emerging Infectious Diseases journal - CDC".
  2. Hansmann, Y.; DeMartino, S.; Piemont, Y.; Meyer, N.; Mariet, P.; Heller, R.; Christmann, D.; Jaulhac, B. (2005). "Diagnosis of Cat Scratch Disease with Detection of Bartonella henselae by PCR: a Study of Patients with Lymph Node Enlargement". Journal of Clinical Microbiology. 43 (8): 3800–3806. doi:10.1128/JCM.43.8.3800-3806.2005. ISSN 0095-1137.
  3. Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, Gleizal A, Boussel L, Laurent F, Braun E, Chidiac C, Ader F, Ferry T (2014). "Actinomycosis: etiology, clinical features, diagnosis, treatment, and management". Infect Drug Resist. 7: 183–97. doi:10.2147/IDR.S39601. PMC 4094581. PMID 25045274.
  4. Bonnefond S, Catroux M, Melenotte C, Karkowski L, Rolland L, Trouillier S, Raffray L (June 2016). "Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations". Medicine (Baltimore). 95 (24): e3923. doi:10.1097/MD.0000000000003923. PMC 4998488. PMID 27311002.
  5. Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (March 2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
  6. Suskind DL, Handler SD, Tom LW, Potsic WP, Wetmore RF (July 1997). "Nontuberculous mycobacterial cervical adenitis". Clin Pediatr (Phila). 36 (7): 403–9. doi:10.1177/000992289703600705. PMID 9241478.
  7. Drobniewski FA, Caws M, Gibson A, Young D (March 2003). "Modern laboratory diagnosis of tuberculosis". Lancet Infect Dis. 3 (3): 141–7. PMID 12614730.
  8. Kumar GG, Mahadevan A, Guruprasad AS, Kovoor JM, Satishchandra P, Nath A, Ranga U, Shankar SK (June 2010). "Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature". J Magn Reson Imaging. 31 (6): 1469–72. doi:10.1002/jmri.22192. PMC 2908244. PMID 20512900.
  9. [+https://www.cdc.gov/parasites/toxoplasmosis/diagnosis.html "CDC - Toxoplasmosis - Diagnosis"] Check |url= value (help).
  10. "Sarcoidosis | National Heart, Lung, and Blood Institute (NHLBI)".
  11. Abdel Razek A, Mukherji S (June 2017). "Imaging of sialadenitis". Neuroradiol J. 30 (3): 205–215. doi:10.1177/1971400916682752. PMC 5480791. PMID 28059621. Vancouver style error: initials (help)
  12. Mavragani CP, Moutsopoulos HM (October 2014). "Sjögren syndrome". CMAJ. 186 (15): E579–86. doi:10.1503/cmaj.122037. PMC 4203623. PMID 24566651.
  13. Dispenzieri A, Armitage JO, Loe MJ, Geyer SM, Allred J, Camoriano JK, Menke DM, Weisenburger DD, Ristow K, Dogan A, Habermann TM (November 2012). "The clinical spectrum of Castleman's disease". Am. J. Hematol. 87 (11): 997–1002. doi:10.1002/ajh.23291. PMC 3900496. PMID 22791417.
  14. Bosch X, Guilabert A (May 2006). "Kikuchi-Fujimoto disease". Orphanet J Rare Dis. 1: 18. doi:10.1186/1750-1172-1-18. PMC 1481509. PMID 16722618.
  15. AlGhamdi FE, Al-Khatib TA, Marzouki HZ, AlGarni MA (March 2016). "Kimura disease: No age or ethnicity limit". Saudi Med J. 37 (3): 315–9. doi:10.15537/smj.2016.3.14448. PMC 4800898. PMID 26905356.
  16. "Rosai-Dorfman disease | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".
  17. Foucar E, Rosai J, Dorfman R (February 1990). "Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): review of the entity". Semin Diagn Pathol. 7 (1): 19–73. PMID 2180012.
  18. "About Kawasaki Disease | Kawasaki Disease | CDC".
  19. "Kawasaki Disease | National Heart, Lung, and Blood Institute (NHLBI)".
  20. Debnath SC, Adhyapok AK (June 2010). "Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip". J Maxillofac Oral Surg. 9 (2): 205–8. doi:10.1007/s12663-010-0052-5. PMC 3244097. PMID 22190789.
  21. Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M (August 2018). "Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features". Jpn J Radiol. 36 (8): 463–471. doi:10.1007/s11604-018-0747-y. PMID 29845358.
  22. Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP (December 2013). "Warthin's tumour of the parotid gland: our experience". Acta Otorhinolaryngol Ital. 33 (6): 393–7. PMID 24376295.
  23. "Warthin tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".