Beruflich Dokumente
Kultur Dokumente
RAJENDRANSINSTITUTEOFMEDICALEDUCATION
EXPLANATIONTOPICTUREQUIZ020316SWELLINGOFBOTHPAROTIDGLANDS
Ans:B,giveprednisone.
DiagnosisHeerfordt'ssyndrome.Thisisarareformofsarcoidosisinwhichthecompressionofthefacialnerve
resultsinpalsy.
Thereisbilateralhilar(whitearrows)andrightparatrachealadenopathy(yellowarrow),acharacteristic
patternoflymphadenopathyforsarcoid.
CTshowsincreaseduniformcontrastenhancementofthebothparotidglands.
HEERFORDTSYNDROME
,oruveoparotidfever,isanuncommonacutepresentationofsarcoidosismanifesting
asfever,parotidandlacrimalglandenlargement,uveitis,bilateralhilaradenopathy,andoftencranial
neuropathies.Corticosteroids(prednisone)arethemainstayoftherapy.
Hilarand/ormediastinallymphadenopathyisfoundinthemajorityofpatientswithsarcoidosis;thisisthe
mostcommonfinding.Themostfrequentpresentationisbilateralhilarandrightparatracheal
lymphadenopathy.Leftparatrachealandaortopulmonarywindowlymphnodesarealsofrequentlyinvolved,
buttheymaybedifficulttodetectonastandardposteroanteriorchestradiograph.
Radiographicevidenceofanteriormediastinaladenopathyisseeninlessthan10%ofcases.Theposterior
mediastinumisleastcommonlyinvolved.Isolatedunilateralhilarlymphadenopathyisanunusual
manifestationofsarcoidosis,occurringinonly13%ofpatients.
HIVELISA
InpatientsinwhomHIVinfectionissuspected,thebestinitialtestisELISA(alsoreferredtoasenzyme
immunoassay).ELISAtestsarescoredaspositive(highlyreactive),negative(nonreactive),orindeterminate
(partiallyreactive).WhiletheEIAisanextremelysensitivetest,itisnotoptimalwithregardtospecificity.This
isparticularlytrueinstudiesoflowriskindividuals.Inthelowriskpopulation,only10%ofEIApositive
individualsaresubsequentlyconfirmedtohaveHIVinfection.
IftheELISAisindeterminateorpositive,repeatthetest.Iftherepeattestisnegativeontwooccasions,HIV
infectionisruledout.Iftheresultisnegative,thediagnosisisruledoutunlessearlyHIVinfection(withinthe
previous3months)issuspected.Then,performretestingasclinicallyindicated.
MEDIASTINAL(THYMIC)LARGEBCELLLYMPHOMA
Thisisadiseasethatcanbebulkyinsizebutusuallyremainsconfinedtothemediastinum.Itcanpresentwith
arapidgrowingmediastinalmasscausingdifficultybreathing,aswellaspleuraland/orpericardialeffusions,or
superiorvenacavasyndrome.Aboutonethirdofpatientsdeveloppleuraleffusions,and510%can
disseminatewidelytokidney,adrenal,liver,skin,andevenbrain.
Thefirststepinevaluatingamediastinalmassistoplaceitinoneofthethreemediastinalcompartments,
sinceeachhasdifferentcharacteristiclesions.Themostcommonlesionsintheanteriormediastinumare
thymomas,lymphomas,teratomatousneoplasms,andthyroidmasses.Themostcommonmassesinthe
middlemediastinumarevascularmasses,lymphnodeenlargementfrommetastasesorgranulomatous
disease,andpleuropericardialandbronchogeniccysts.Intheposteriormediastinum,neurogenictumors,
meningoceles,meningomyeloceles,gastroentericcysts,andesophagealdiverticulaarecommonlyfound.See
tablebelow.
TheThreeCompartmentsoftheMediastinum
Anatomical
boundaries
Contents
Anterior
Compartment
Manubriumandsternum
anteriorly,pericardium,
aorta,and
brachiocephalicvessels
posteriorly
Thymusgland,anterior
mediastinallymph
MiddleCompartment
Anteriormediastinumanteriorly,
posteriormediastinum
posteriorly
Posterior
Compartment
Pericardiumandtrachea
anteriorlyvertebral
columnposteriorly
Pericardium,heart,ascending
andtransversearchofaorta,
Descendingthoracic
aorta,esophagus,
nodes,internal
mammaryarteriesand
veins
Common
abnormalitie
s
Thymoma,lymphomas,
teratomatousneoplasms,
thyroidmasses,
parathyroidmasses,
mesenchymaltumors,
giantlymphnode
hyperplasia,hernia
throughforamenof
Morgagni
superiorandinferiorvenacavae,
brachiocephalicarteriesand
veins,phrenicnerves,trachea,
andmainbronchiandtheir
contiguouslymphnodes,
pulmonaryarteries,andveins
Metastaticlymphnode
enlargement,granulomatous
lymphnodeenlargement,
pleuropericardialcysts,
bronchogeniccysts,massesof
vascularorigin
thoracicduct,azygos
andhemiazygosveins,
sympatheticchains,and
theposteriorgroupof
mediastinallymphnodes
Neurogenictumors,
meningocele,
meningomyelocele,
gastroentericcysts,
esophagealdiverticula,
herniathroughforamen
ofBochdalek,
extramedullary
hematopoiesis
Erythemanodosum
(EN)isanacute,nodular,erythematouseruptionthatusuallyislimitedtotheextensor
aspectsofthelowerlegs.Erythemanodosumisahypersensitivityreactionandmayoccurinassociationwith
severalsystemicdiseasesordrugtherapies,oritmaybeidiopathic.Hilaradenopathymaydevelopaspartof
thehypersensitivityreactionoferythemanodosum.Bilateralhilarlymphadenopathyisassociatedwith
sarcoidosis,whileunilateralchangesmayoccurwithinfectionsandmalignancy.