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SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is a rare chronic autoinflammatory disorder of unknown etiology. Radiological investigation, including the use of magnetic resonance imaging and nuclear medicine is pivotal to the diagnosis of SAPHO syndrome. We present a case of a 15-year-old male diagnosed with SAPHO syndrome displaying the classic diagnostic findings of this condition on bone scan and magnetic resonance imaging.
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We report a case of a 53-year-old man who presented with a diagnostic dilemma mimicking septic arthritis. It is important to consider the diagnosis of calcific peri-arthritis clinically and recognize the hallmarks on radiograph and magnetic resonance imaging as this disease process resolves completely with conservative management like in our patient, and does not require operative intervention.
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Artritis Infecciosa/diagnóstico por imagen , Artrografía , Calcinosis/diagnóstico por imagen , Fosfatos de Calcio/metabolismo , Articulación de la Cadera/diagnóstico por imagen , Imagen por Resonancia Magnética , Periartritis/diagnóstico por imagen , Antiinflamatorios no Esteroideos/uso terapéutico , Calcinosis/tratamiento farmacológico , Calcinosis/metabolismo , Cristalización , Diagnóstico Diferencial , Articulación de la Cadera/efectos de los fármacos , Articulación de la Cadera/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Periartritis/tratamiento farmacológico , Periartritis/metabolismo , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
Background: Carpal tunnel syndrome (CTS) is a sporadic event with compression of the median nerve (MN). Persistent median artery (PMA) thrombosis is an exceptionally rare cause of CTS. Case report: 38-year-old male presented with acute on subacute right wrist pain with positive Tinel's sign. An ultrasound and computed angiography study confirmed a PMA with thrombosis. The patient was treated with intravenous heparin then discharged home on enoxaparin and warfarin crossover. Discussion: PMA can lead to CTS by compression from the adjacent median nerve. Thrombosis of the PMA can also lead to CTS. Surgical intervention is needed in cases of severe CTS. Carpal tunnel release is usually successful. Excision of the PMA can risk vascular compromise of the digits. Ultrasound is excellent for detecting rare causes of CTS. Conclusion: Ultrasound examination for CTS should include search for PMA and associated anatomical variations.
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Arteritis de Células Gigantes/diagnóstico por imagen , Claudicación Intermitente/diagnóstico por imagen , Alendronato/uso terapéutico , Antiinflamatorios/uso terapéutico , Aspirina/uso terapéutico , Quimioterapia Combinada , Femenino , Arteritis de Células Gigantes/complicaciones , Arteritis de Células Gigantes/tratamiento farmacológico , Humanos , Claudicación Intermitente/tratamiento farmacológico , Claudicación Intermitente/etiología , Persona de Mediana Edad , Prednisona/uso terapéutico , Cintigrafía , Resultado del TratamientoRESUMEN
OBJECTIVE: Patients presenting to the ED with obstructive nephropathies benefit from early detection of hydronephrosis. Out of hours radiological imaging is expensive and disruptive to arrange. Emergency physician ultrasound (EPU) could allow rapid diagnosis and disposition. If accurate it might avert the need for formal radiological imaging, exclude an obstruction and improve patient flow through the ED. METHODS: This was a prospective study of a convenience sample of all adult non-pregnant patients with presumed ureteric colic attending the ED with prior ethics committee approval. An emergency physician or registrar performed a focused ultrasound scan and were blinded to the patient's other management. A computerized tomography scan was also performed for all patients while in the ED or within 24 h of the EPU. The accuracy of EPU detection of hydronephrosis was determined; using computerized tomography scans reported by a senior radiologist as the 'gold-standard'. RESULTS: Sixty-three patients with suspected ureteric colic were enrolled of whom 57 completed both EPU and computerized tomography imaging. Forty-nine had confirmed nephrolithiasis by computerized tomography with 39 having evidence of hydronephrosis. Overall prevalence of hydronephrosis was 68% (95% confidence interval [CI] 56-79%); compared with computerized tomography, EPU had a sensitivity of 80% (95% CI 65-89%); specificity of 83% (95% CI 61-94%); positive predictive value of 91% (95% CI 75-98%) and negative predictive value of 65% (95% CI 43-83%). The overall accuracy was 81% (95% CI 69-89%). CONCLUSION: Although the accuracy of detection of hydronephrosis after focused training in EPU is encouraging, further experience and training might improve the accuracy of EPU and allow its use as a screening tool.