Soft tissue abscess caused by tuberculosis infection _2172 nine cases of misdiag

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Soft tissue abscess caused by tuberculosis infection nine cases of misdiagnosis
 
 
Hu, Li Lei Zhen, Li Songkai. Synovium of children misdiagnosis of 19 cases of tuberculosis [J]. Clinical misdiagnosis and mistreatment, 2004,17 (12): 877 ~ 78. (Received Time :2007-12-12) to cancer myasthenic syndrome as the first symptom of lung cancer misdiagnosed as cervical spondylosis Zhaoyan Xian, Zhang Jintao (PLA 88 Hospital, Taian 271000, China) Keywords: lung cancer; gravis; concurrent disease; misdiagnosed; cervical spondylosis Key words: R734.2; R746.9 Document code: B Article ID :1002 -3429 (2008) 05-0033-011 clinical data male, 58 years old. Progressive weakness for 5 months, adding 10 with mild asthmatic Heaven hospital. A history of smoking for 35 years. No numbness in the course of the disease,You are not allowed to view links. Register or Login, cough, sputum, hemoptysis,You are not allowed to view links. Register or Login, in many hospitals, cervical spine CT examinations showed bone hyperplasia, degeneration, diagnosed as cervical spondylosis, but the corresponding treatment less effective. Physical examination: body temperature of 36.6 ~ C, pulse 95/min, respiration 24/min, blood pressure 150/100mmHg. Clear awareness of mental difference, language clear. Bilateral and other large and round pupil, light reflex sensitivity, double eyelid closure weakness, I no abnormal neurological examination. Lower right lung breath sounds can be heard and a small amount of dry 哕 tone, and abnormal left lung is not known. No expansion of the heart dullness, heart rate 95/min, law Qi, the valve auscultation area and the noise is not heard. 3 upper limbs, lower limbs muscle strength two, head thrown back flexion weakness, low muscle tone. The depth of feeling normal limbs and trunk, bilateral biceps, triceps tendon reflexes,You are not allowed to view links. Register or Login, normal bilateral knee tendon reflex, bilateral Babinski sign, Chaddock sign was negative. Brain MRI showed: bilateral centrum ovale, lateral side, the right cerebellar hemisphere with multiple cerebral infarction. Report of the chest CT examination: the right lung with central lung cancer mediastinal lymph node metastasis; bronchoscopy biopsy diagnosed as small cell neuroendocrine carcinoma. Serum IgG32.09g / L, IgA9.53g / L, Tumor 164U/mL. 3 days after admission, suddenly breathing in patients with superficial, frequency 5/min, low lung breath sounds by respiratory stimulants, endotracheal intubation and ventilation, died a death. Death Diagnosis: cancer, muscle weakness, small cell lung cancer. 2 to discuss the mechanism of cancer 2.1 myasthenic syndrome, also known as Lambert-Ea-ton myasthenic syndrome, 80% caused by small cell lung cancer. The syndrome is an immune-mediated neuromuscular dysfunction, cancer epitopes on the presynaptic nerve terminals with the calcium channel protein cross-immunity, antibodies at the neuromuscular junction with voltage-dependent calcium muscle weakness caused by the reaction channel. MG is a malignant cancer on the body distant organizations, non-metastatic organ damage, collectively, mainly involving the cerebral hemispheres, cerebellum, spinal cord, sensory-motor nerve, neuromuscular junction, muscle and other parts ¨. 2.2 The main clinical manifestations of clinical manifestations of progressive symmetrical proximal limb and trunk muscle weakness, pathological fatigue, lower extremity weight in the upper limb, with a break can not be alleviated, muscle weakness after a brief muscle contraction force but temporary improvement, and sustained contraction was sick and tired, sore muscles, eye muscles less affected, some patients may have impaired sensation, ptosis, respiratory failure. Early in the disease in this case that there is weakness, but no sense of loss, the long-term does not appear pulmonary symptoms,You are not allowed to view links. Register or Login, and cervical spine CT with disease, so long misdiagnosed as cervical spondylosis. Lacunar infarction MRI check the performance of the primary disease interfering with the judgments of lung cancer, more than half a year delay in treatment. In addition to limb muscles involved in this case, also involving the neck and respiratory muscles, thus eventually leading to respiratory failure and death. Most lethal malignant tumor itself,You are not allowed to view links. Register or Login, mostly, and myasthenic syndrome due to cancer of the respiratory muscle paralysis to respiratory failure and death were reported less domestic. 2.3 Clinical Implications of the case suggest that cancer can cause myasthenic syndrome patients died of respiratory muscle weakness, so the unexplained limb weakness, sensory disorders should be carried out the necessary checks to detect malignant potential of suspicious organ invasion and periodic review, to prevent misdiagnosis. Of myasthenia gravis complicated by cervical lesions, cerebral infarction without reflectors sensory dysfunction and pathology, with particular attention to the possibility of cancer, muscle weakness syndrome.