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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

Diagnostic algorithm for pleuritic chest pain (modified from Kass et al. [18] and Cuker [21]).
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Related In: Results  -  Collection


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fig4: Diagnostic algorithm for pleuritic chest pain (modified from Kass et al. [18] and Cuker [21]).

Mentions: Investigation and management in the emergency department must be tailored to the particular BML presentation. As mentioned, BML involving the lung is usually asymptomatic. Its presentation as pleuritic chest pain is uncommon and invokes a broad differential diagnosis [18], the most critical of which include pneumothorax, myocardial infarction, and pulmonary embolus (PE) (Figure 4). In this case, the patient's risk of PE was low/intermediate by Wells score [19]. Without evidence of PE on CTPA, her elevated D-dimer most likely reflects the normal process of recovery after hysterectomy. In current practice, a normal D-dimer (i.e., below a cut-off value of 500 μg/L) may allow the exclusion of PE. However, alternative D-dimer cut-offs may exclude PE more reliably in clinical settings where D-dimer may be elevated for another reason(s), such as older patients [20, 21], postsurgery, and malignancy.


An unusual cause of pulmonary nodules in the emergency department.

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

Diagnostic algorithm for pleuritic chest pain (modified from Kass et al. [18] and Cuker [21]).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352908&req=5

fig4: Diagnostic algorithm for pleuritic chest pain (modified from Kass et al. [18] and Cuker [21]).
Mentions: Investigation and management in the emergency department must be tailored to the particular BML presentation. As mentioned, BML involving the lung is usually asymptomatic. Its presentation as pleuritic chest pain is uncommon and invokes a broad differential diagnosis [18], the most critical of which include pneumothorax, myocardial infarction, and pulmonary embolus (PE) (Figure 4). In this case, the patient's risk of PE was low/intermediate by Wells score [19]. Without evidence of PE on CTPA, her elevated D-dimer most likely reflects the normal process of recovery after hysterectomy. In current practice, a normal D-dimer (i.e., below a cut-off value of 500 μg/L) may allow the exclusion of PE. However, alternative D-dimer cut-offs may exclude PE more reliably in clinical settings where D-dimer may be elevated for another reason(s), such as older patients [20, 21], postsurgery, and malignancy.

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