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Practice paper
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Temporal arteritis often presents with headache and temporal artery tenderness. Other symptoms may include jaw claudication and visual disturbance. The main concern is irreversible blindness, which may occur in both eyes, and therefore requires a high index of suspicion. If temporal arteritis is suspected, an ESR should be requested, the patient should be started on steroids and a temporal artery biopsy should be performed within the next few days. This often confirms the diagnosis, but skip lesions may be seen and a negative biopsy does not rule it out. Most cases settle with steroids within 2 years. There is an association with polymyalgia rheumatica in 25% of cases.
Musculoskeletal tumours
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Plain radiographs are usually the most useful imaging investigations in determining the diagnosis of a primary bone tumour, but further appropriate scans are usually required for confirmation and staging. Imaging should always include the whole of the affected bone to look for satellite lesions and skip metastases. Satellite lesions occur within, whilst skip lesions occur beyond, the reactive zone of the tumour.
Multiple choice questions (MCQs)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
Which of the following imaging features are more suggestive of a diagnosis of Crohn’s colitis rather than ulcerative colitis? Multiple anal fistulae.Skip lesions.Toxic megacolon.Strictures.Sclerosing cholangitis.
Ultrasound centre frequency shifts as a novel approach for diagnosing giant cell arteritis
Published in Scandinavian Journal of Rheumatology, 2023
M Naumovska, R Sheikh, J Albinsson, B Hammar, U Dahlstrand, M Malmjsö, T Erlöv
The clinical advantage of introducing ultrasound CFS as a non-invasive tool for diagnosing GCA would be the replacement of surgical biopsy, thereby avoiding the risks associated with this invasive approach. Since GCA is a treatable, but potentially sight-threatening form of systemic vasculitis, prompt and correct diagnosis is of importance, as early intervention can prevent irreversible blindness and other complications. Ultrasound CFS has a number of advantages as a non-invasive repeatable diagnostic technique for GCA. First, it allows examination of a larger area of the temporal artery than a surgical biopsy. GCA can present with so-called skip lesions (14, 15), owing to the segmental nature of the disease, which is probably one of the reasons why biopsy findings can be negative in 15–30% of patients with GCA (11–13). It is therefore necessary for the biopsy to be sufficiently long (34). Furthermore, other vessels involved in GCA, for example, the axillary artery, can be examined with ultrasound CFS, which is not possible by surgical biopsy, thereby increasing the probability of finding inflammatory changes in the arteries. In GCA, the axillary arteries are affected in up to 50% of patients (35, 36) and TAB specimens are negative in over half of patients with extracranial GCA (35). In a previous study, DiIorio et al showed that 34.8% of subjects with ultrasound findings suggestive of GCA only had involvement of extracranial vessels (axillary and/or subclavian) (37). In these cases, there is no doubt as to the additional diagnostic benefit of imaging the extracranial arteries.
An uncommon presentation of a cutaneous angiosarcoma
Published in Acta Chirurgica Belgica, 2021
Nicholas O. Wilssens, Margot Den Hondt, Jolien Duponselle, Raf Sciot, Daphne Hompes, Thomas H. G. Nevens
Most studies report that the combination of surgery with radiotherapy is the preferred treatment method [4]. However, complete surgical resection with multi-centimeter margins can be challenging, as these tumors have a very infiltrative nature, which often leads to local recurrence and metastatic disease [8]. Deep infiltration and undetected skip lesions pose extra difficulties for the surgeon. Morgan et al. concluded that prognosis was influenced by tumor size, both in diameter and in vertical depth, as well as adequacy of resection margins [3]. In some anatomical regions, such as the head and neck, wide excisions are virtually impossible. For recurrent and metastatic disease prognosis is even worse and systemic treatment is equally challenging [8]. Cytotoxic chemotherapy, including anthracycline-based regimens and taxanes, can produce significant responses in a subset of patients, but durability is limited with most patients ultimately succumbing to metastatic disease [8]. Unfortunately, in the case presented here complete resection was no longer considered attainable, so the patient was treated with radiotherapy alone.
Bilateral Posterior Scleritis Associated with Giant Cell Arteritis: A Case Report
Published in Ocular Immunology and Inflammation, 2018
Mehmet Erdogan, Nihat Sayin, Dilbade Yıldız Ekinci, Sadik Bayramoglu
Upon reviewing the literature, we found one case report showing posterior scleritis accompanied by GCA. In this case reported by Cavallini et al., the patient was diagnosed with GCA based on clinical findings and the normal results of other tests performed to exclude other autoimmune diseases associated with posterior scleritis.3 Temporal artery biopsy, the golden standard for diagnosing GCA5, was not not done in this case. Biopsy positive GCA is characterisized with granulomatous inflamation of the intima, media, and adventicia of the affected arteries. Inflamatory infiltration of multinucleated giant cells, epithelioid cells, and lymphocytes causes intimal hyperplasy and arterial lumen narrowing.9,10 Temporal artery biopsy in our case showed granulomatous inflammation consisting of lymphocytes, macrophages, and giant cells. Negative biopsy results may be seen in affected individuals due to segmental involvement of GCA. Because of skip lesions, various studies suggest that biopsy specimens of at least 2 cm in width should be obtained.10