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Diagnosis

A straight-forward stroke?

6 Feb, 15 | by Kristy Ebanks

A typical presentation of type A aortic dissection

We have some very interesting images for you but, can you answer the questions below?

fig_3 (6) fig_2 (6) fig_1 (8)

1. How common is non-carotid disease stroke?
2. How would you routinely investigate a patient who presents with stroke?
3. Which patients benefit from anti-coagulation to prevent a first stroke?

If you don’t know the answers or want to know more read ’A straight-forward stroke? May be not: atypical presentation of type A aortic dissection

Too young for cancer. Case in the media highlights challenge of diagnosis

28 May, 14 | by Dr Dean Jenkins

The case of a 29 year old scientist who died of bowel cancer has been highlighted in the press because her brother is planning to raise funds for the World Cancer Research Fund.

A doctor who was told she was too young to get bowel cancer died after being sent home and misdiagnosed with bowel disease.” Doctor, 29, died of cancer after being told she was too young to have disease. Daily Telegraph, May 27th 2014

After suffering from stomach pains so severe she was forced to miss part of her brother’s wedding day, Suzanne was initially told by doctors she could not be suffering from bowel cancer as she was so young. She was instead diagnosed with an inflammatory bowel condition.” Tragic former Chatham pupil Dr Suzanne Gould died of bowel cancer after being told she was too young to have disease. Kent Online May 27th 2014

Tragic Suzanne Gould badgered family doctors for six months because of severe stomach pain but was told she had Crohn’s disease. In fact, she had terminal bowel cancer and died 18 months later.”  Brother of tragic doctor ‘too young for cancer at 29’ to raise money in her memory. Daily Express, May 28th 2014.

In 2012, my sister Suzanne, started to have bad stomach pains and other ailments. The doctors refused to believe she had bowel cancer because she was too young, however in November 2012 she was rushed to A&E where a cancerous tumor was removed, and her fight to get better began.” Rob Newton’s JustGiving page.

PhD, married, with kitten called Poppy, fighting bowel cancer previously misdiagnosed as Crohns disease. Hoping to raise awareness in the relatively young” @Dr_SooziG Twitter profile.

These types of cases – and others reported in BMJ Case Reports(1,2,3) – of younger patients presenting with symptoms where the underlying cause is malignancy are a challenge for diagnosis and there is no simple way of addressing it. Clinical examination may be normal which may lead the practitioner to be less likely to investigate. “Raising awareness” is often a phrase that is mentioned when these cases are presented at medical meetings. It helps, but by itself it doesn’t seem sufficient. Fine-tuning your “Index of suspicion” is something that can be achieved by reading more case reports … and seeing more, listening to and learning from patients in your clinical practice.

1. Raghunath Prabhu, Neha Kumar, Sunil Krishna, Rajgopal Shenoy. Primary colonic signet ring cell carcinoma in a young patient. BMJ Case Reports 2014:published online 20 March 2014, doi:10.1136/bcr-2013-200587

2. Syed Tausif Ahmed, Sudipto Kumar Singh, Tanmoy Mukherjee, Manju Banerjee. Breast carcinoma in a prepubertal girl. BMJ Case Reports 2014:published online 15 April 2014, doi:10.1136/bcr-2013-203251

3. Anna Freeman, David Weeden, Jane Wilkinson, Ramesh J Kurukulaaratchy. An unusual bronchial obstruction in a fit young man. BMJ Case Reports 2013:published online 9 January 2013, doi:10.1136/bcr-2012-007766

The case of bilateral eruption cysts

2 May, 14 | by Kristy Ebanks

Bilateral eruption cysts associated with primary molars

We have some very interesting images for you but, can you answer the questions below?

Figure_4 (2) Figure_7 Figure_1 (17)

1. What would be your differential diagnosis?
2. Which ancillary exams would you recommend?
3. What sort of approach would you endorse given the age of the patient?

If you don’t know the answers or want to know more read ’A Rare Case of Bilateral Eruption Cysts Associated With Primary Molars in both the jaws

The case of a Forgotten Diagnosis

17 Apr, 14 | by Kristy Ebanks

An AIDS-defining neoplasm on highly active antiretroviral therapy

We have some very interesting images for you but, can you answer the questions below?

fig_3_PET_Transverse fig_1_CT_Transverse fig_2_MR_T2_transverse_fat_sat_2_Slice

1. What is the differential diagnosis of a lump in the groin?
2. How would you investigate this patient?
3. What are the options for treatment?

If you don’t know the answers or want to know more read ’An AIDS-defining neoplasm in a 30-year-old man on highly active antiretroviral therapy: a forgotten diagnosis?

The case of a Nasopalatine duct cyst Vs. a Radicular cyst

21 Mar, 14 | by Kristy Ebanks

A clinical report distinguishing a nasopalatine duct cyst from a radicular cyst

We have some very interesting images for you but, can you answer the questions below?

Postoperative_radiograph_Figure_3 (1) Figure_2_Histopathology (1) Preoperative_radiograph_Figure_1 (1)
1. What is your clinical diagnosis?
2. What is your differential diagnosis?
3. Would you consider different treatment options based on the histology?
If you don’t know the answers or want to know more read ’A clinical report demonstrating the significance of distinguishing a nasopalatine duct cyst from a radicular cyst

The case of chest pain

7 Feb, 14 | by Kristy Ebanks

A Trojan Horse Saddle stuck in the Lung

We have a very interesting image for you but, can you answer the questions below?

saddle

1. What is your differential diagnosis for chest pain and dyspnoea?
2. What abnormality is seen on the CT scan and ECG?
3.What is the gold standard for investigation of this condition?

If you don’t know the answers or want to know more read A Trojan Horse Saddle stuck in the Lung !!

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