Iku Abe

Factors that make it difficult to diagnose cervical tuberculous lymphadenitis

Cervical tuberculous lymphadenitis is mainly diagnosed by analyzing tissue samples obtained by fine-needle aspiration (FNA). However, some cases remain diagnostic challenges even after polymerase chain reaction analysis of FNA specimens. To delineate differences between cases that are relatively easy to diagnose and those for which diagnosis is difficult, 22 patients with cervical tuberculous lymphadenitis were studied retrospectively. FNA tissues were used to diagnose 14 cases (group A), whereas excisional biopsy was required for accurate diagnosis of 8 cases (group B). These two groups were compared with regard to results of blood examinations, ultrasound appearance, and various other procedures required to reach the final diagnosis. The results indicated that diagnosis of cervical tuberculous lymphadenitis was more difficult for patients with lower white blood cell counts, lower serum C-reactive protein levels, and absence of lymph node fusion or abscess formation on ultrasonography. The possibility of tuberculosis as a cause of cervical lymphadenopathy should always be considered, even when the presenting symptoms are not typical of this disease.

Time-lag between symptom onset and laboratory findings in patients with subacute thyroiditis

OBJECTIVE The objective of this study was to delineate the frequency of delayed diagnosis in cases of subacute thyroiditis (SAT) and intervals between onset of clinical symptoms and appearance of abnormal laboratory findings. METHODS We reviewed the medical records of 27 patients (7 men and 20 women) with SAT who visited our hospital between 2007 and 2013. RESULTS On presentation to the hospital, 5 of 27 SAT cases (18.5%) showed normal laboratory findings. Among these 5 cases, the mean interval between symptom onset and thyrotropin (TSH) suppression was 6.3 weeks, and the mean interval to elevation of fT4 was 6.7 weeks. The longest interval from symptom onset to appearance of an abnormal laboratory finding was 11 weeks. CONCLUSION Sometimes time-lag exists between onset of clinical symptoms and the appearance of abnormal laboratory findings in patients with SAT. The possibility of this disease should not be excluded from the differential diagnoses for patients with clinical symptoms consistent with SAT but showing normal laboratory findings.

A Case of a Foreign Body in the Maxillary Sinus That Was Discharged into the Nasal Cavity

上顎洞異物は原因により医原性と外傷性に大別されるが,近年医原性,特に歯科治療に関連するものが多い。 今回我々は,歯科治療後の上顎洞異物が鼻腔内に自然排出された症例を経験したので,若干の文献的考察を加 えて報告する。 症例は52歳,男性。近医歯科にて歯の処置後より左頬部痛及び左上歯肉より悪臭を伴う排膿を認めた。パノ ラマX線写真にて根管充填剤の迷入による上顎洞異物が疑われた。副鼻腔単純CTにて左上顎洞内に均一な高 吸収の線状陰影,及びその周囲の粘膜肥厚像を認めた。1年4カ月経過後に手術を希望され,術前にCTを施 行したところ上顎洞内に存在した線状陰影が中鼻道に移動していた。左中鼻道に存在した異物は周囲に癒着や 肉芽形成は認めず鉗子にて容易に摘出できた。その後症状の再燃はなく現在外来にて経過観察中である。 本症例においては幸い異物が中鼻道まで自然排出されたため,より低侵襲な方法で異物の摘出を行うことが できたが,画像検査にて経時的にみて異物の位置に変化がみられない場合には適切な方法を用いて摘出術を行 うことも必要と考えた。

Three Cases of Nasal and Paranasal Hematocele

Hematoceles are benign hemorrhagic masses. We report three cases of nasal and paranasal sinus hematocele involving prolonged nasal bleeding. Computed tomography (CT) showed an expanding enhanced lesion with a bone defect at the maxillary sinus and magnetic resonance imaging (MRI) varied lesion intensities. We conducted preoperative angiography and selective embolization to be controlled very effectively enabling surgical bleedings. We conducted endoscopic sinus surgery in 1 case and Caldwell-Luc or Denker procedure in 2 cases. We found preoperative imaging to be vital in determining surgical procedures, with preoperative embolization providing an adjunct in estimating vascular proliferation.