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An unusual cause of pulmonary nodules in the emergency department.

Yu R, Ferri M - Case Rep Emerg Med (2015)

Bottom Line: Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML).BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic.When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada L8S 4L8.

ABSTRACT
We report a 51-year-old woman who presented to the emergency department with left-sided pleuritic chest pain 2 weeks after subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus. Computed tomography scan of the chest revealed bilateral pulmonary nodules. Biopsy showed cytologically bland spindle cells without overt malignant features. Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML). BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic. When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors. Emergent presentations of BML are reviewed.

No MeSH data available.


Related in: MedlinePlus

CT pulmonary angiogram performed the same day as the chest radiograph. (a) Axial image (lung windows): left lower lobe soft tissue nodule corresponding to the abnormality on the CXR (arrow) demonstrates no internal calcification or cavitation. Six other similar-appearing nodules of varied sizes were scattered throughout the lungs. (b) Coronal MIP image (soft tissue windows): two well-circumscribed left lower lobe nodules (arrows).
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fig2: CT pulmonary angiogram performed the same day as the chest radiograph. (a) Axial image (lung windows): left lower lobe soft tissue nodule corresponding to the abnormality on the CXR (arrow) demonstrates no internal calcification or cavitation. Six other similar-appearing nodules of varied sizes were scattered throughout the lungs. (b) Coronal MIP image (soft tissue windows): two well-circumscribed left lower lobe nodules (arrows).

Mentions: A 51-year-old woman, gravida 2 para 2, presented to the emergency department with a 2-day history of left-sided pleuritic chest pain. Two weeks prior, she underwent subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus which was approximately the size of a 12-week gravid uterus. Ten years prior, she underwent a hysteroscopic myomectomy for a submucous leiomyoma. Her medical history was further remarkable for endometriosis, primary biliary cirrhosis, chronic cholecystitis, hypertension, hypercholesterolemia, and transient ischemic attack. On physical examination in the emergency department, she was afebrile with a blood pressure of 150/87, heart rate 60/min, respiratory rate 18/min, and oxygen saturation 99% on room air. She had a BMI of 33, normal heart sounds, and clear chest on auscultation. ECG was normal. ABG showed pH 7.41 and pCO2 39 mmHg. She had a normal complete blood count, basic metabolic panel, and troponin. D-dimer was 1.2 μg/mL FEU (reference: less than 0.5 μg/mL FEU). Chest radiograph showed a 1.3 cm nodule in the left lower lobe (Figure 1) compared with a chest radiograph performed 4 years earlier which was clear. CT pulmonary angiogram (CTPA) showed bilateral, well-circumscribed, noncalcified, and noncavitated pulmonary nodules (Figures 2(a) and 2(b)) concerning for metastatic deposits. The nodules were not present on a chest CT performed 8 years earlier for the same indication. She was referred for thoracic surgery consultation.


An unusual cause of pulmonary nodules in the emergency department.

Yu R, Ferri M - Case Rep Emerg Med (2015)

CT pulmonary angiogram performed the same day as the chest radiograph. (a) Axial image (lung windows): left lower lobe soft tissue nodule corresponding to the abnormality on the CXR (arrow) demonstrates no internal calcification or cavitation. Six other similar-appearing nodules of varied sizes were scattered throughout the lungs. (b) Coronal MIP image (soft tissue windows): two well-circumscribed left lower lobe nodules (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

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fig2: CT pulmonary angiogram performed the same day as the chest radiograph. (a) Axial image (lung windows): left lower lobe soft tissue nodule corresponding to the abnormality on the CXR (arrow) demonstrates no internal calcification or cavitation. Six other similar-appearing nodules of varied sizes were scattered throughout the lungs. (b) Coronal MIP image (soft tissue windows): two well-circumscribed left lower lobe nodules (arrows).
Mentions: A 51-year-old woman, gravida 2 para 2, presented to the emergency department with a 2-day history of left-sided pleuritic chest pain. Two weeks prior, she underwent subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus which was approximately the size of a 12-week gravid uterus. Ten years prior, she underwent a hysteroscopic myomectomy for a submucous leiomyoma. Her medical history was further remarkable for endometriosis, primary biliary cirrhosis, chronic cholecystitis, hypertension, hypercholesterolemia, and transient ischemic attack. On physical examination in the emergency department, she was afebrile with a blood pressure of 150/87, heart rate 60/min, respiratory rate 18/min, and oxygen saturation 99% on room air. She had a BMI of 33, normal heart sounds, and clear chest on auscultation. ECG was normal. ABG showed pH 7.41 and pCO2 39 mmHg. She had a normal complete blood count, basic metabolic panel, and troponin. D-dimer was 1.2 μg/mL FEU (reference: less than 0.5 μg/mL FEU). Chest radiograph showed a 1.3 cm nodule in the left lower lobe (Figure 1) compared with a chest radiograph performed 4 years earlier which was clear. CT pulmonary angiogram (CTPA) showed bilateral, well-circumscribed, noncalcified, and noncavitated pulmonary nodules (Figures 2(a) and 2(b)) concerning for metastatic deposits. The nodules were not present on a chest CT performed 8 years earlier for the same indication. She was referred for thoracic surgery consultation.

Bottom Line: Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML).BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic.When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada L8S 4L8.

ABSTRACT
We report a 51-year-old woman who presented to the emergency department with left-sided pleuritic chest pain 2 weeks after subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus. Computed tomography scan of the chest revealed bilateral pulmonary nodules. Biopsy showed cytologically bland spindle cells without overt malignant features. Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML). BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic. When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors. Emergent presentations of BML are reviewed.

No MeSH data available.


Related in: MedlinePlus