Tracheopathia osteoplastica is a rare benign disorder of the trachea and major bronchi. It is characterized by multiple cartilaginous or osseous submucosal nodules that project into the tracheobronchial lumen. Awareness of the condition is important to avoid unnecessary surgery. We report here on the CT and bronchoscopic findings of tracheopathia osteoplastica associated with anthracofibrosis in a 67-year old woman, and we will then discuss our findings.
Aged ; Bronchi ; Female ; Humans ; Trachea ; Unnecessary Procedures

Acute appendicitis is the most common reason for non-obstetric abdominal surgery during pregnancy. The diagnosis of appendicitis in pregnancy is difficult due to the blunting of signs and symptoms during pregnancy along with a migration of appendiceal location. When appendicitis in pregnancy is suspected, the physician must balance the risk of delaying surgery and incurring the morbidity of delay against acting hastily and performing unnecessary surgery. Eleven patients who underwent appendectomy during pregnancy from April 1995 through February 1997 were reviewed. Seven patients were proven to be acute appendicitis at laparotomy and by subsequent histopathology. There were no significant differences between patients with positive and negative laparotomies regarding frequency of presenting symptoms and signs or laboratory results. Two cases of preform(25 and 31 weeks) deliveries occurred, one with a perforated appendicitis and the other with negative laparotomy.
Appendectomy ; Appendicitis* ; Diagnosis ; Humans ; Laparotomy ; Pregnancy* ; Unnecessary Procedures

Congenital megacalyces is a congenital renal disease characterized by hypoplasia of the medulla and a non-obstructive dilatation of the calyces. More than 100 cases have been reported in the literature after first described by Puigvert in 1963, but it has been reported only three cases (two cases of adults and one case of child) in the literatures in Korea. The etiology of the congenital megacalyces is unknown. Renal pelvis and ureter are mostly normal in size and there is no urinary obstruction or reflux. Renal medulla of congenital megacalyces is thinner than that of normal kidney but renal cortex retains its normal thickness and function. This is features that help to distinguish megacalyces from obstructive atropy. The calyces are polygonal in shape and the majority of kidney with megacalyces have increased number of calyces. Since congenital megacalyces is a non-progressive lesion, it is important to recognize the clinical entity and avoid unnecessary surgery. We report one case of congenital megacalyces without urinary obstruction or reflux with a brief review of related literatures.
Adult ; Dilatation ; Humans ; Kidney ; Kidney Pelvis ; Korea ; Unnecessary Procedures ; Ureter

Perforated appendicitis with an abscess formation is known to be the most common cause of tender mass in right lower abdomen. The differential diagnosis of a tender mass in right lower abdomen, however, is broad and includesvarious intraabdominal and intrapelvic lesions in origin. Preoperative accurate diagnosis is essential in order toavoid unnecessary surgery or complications resulting from delayed surgery. The purpose of this pictorial essay isto illustrate examples of various causes and methods to differentiate them with ultrasonography and CT.
Abdomen* ; Abscess ; Appendicitis ; Diagnosis ; Diagnosis, Differential ; Ultrasonography ; Unnecessary Procedures

Intraoperative fracture in total knee arthroplasty (TKA) is a rare complication. However, when it happens, additional surgery to fix the fracture site is needed. Therefore, it is important to diagnose intraoperative fractures in TKA exactly. The authors experienced two cases of cortical perforation of medial femoral condyle misidentified as the fracture in TKA. Cortical perforation could be misdiagnosed as the fracture, which could lead to unnecessary surgery. This is the first report about cortical perforation in TKA. We report two cases of intraoperative cortical perforations and describe the radiological characteristics.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Femur ; Knee ; Unnecessary Procedures

Endoscopic biopsy is the most popular diagnostic procedure for gastric epithelial neoplasm. However, discrepancy between biopsy and endoscopic resection diagnosis occasionally occurs and leads to an unnecessary procedure. A negative pathologic diagnosis following endoscopic resection is particularly problematic. In this context, we reviewed factors that may be associated with a diagnostic discrepancy between endoscopic biopsy and endoscopic resection, with focus on crypt dysplasia.
Biopsy ; Diagnosis ; Neoplasms, Glandular and Epithelial ; Stomach ; Unnecessary Procedures

The prevalence of lumbar spinal pain rose significantly over 10 years. With respect to clinical management of lumbar spinal pain, the most important things are to understand the definition of terms related to lumbar spinal pain. Despite the efforts of the International Association for the Study of Pain, misuse and confusion still continue among clinicians about the definition of terms related to lumbar spinal pain; back pain, referred pain, radicular pain, radiculopathy, and sciatica. Failure to distinguish one type of lumbar spinal pain from the others may lead to unnecessary tests, misdiagnosis, and mismanagement such as an unnecessary surgery. This confusion also exists in developing animal models of lumbar spinal pain by basic scientists. Thus, the exact understandings of definition and physiology of terms related to lumbar spinal pain are essential to manage patients and research the lumbar spinal pain properly.
Back Pain ; Diagnostic Errors ; Humans ; Models, Animal ; Pain, Referred ; Prevalence ; Radiculopathy ; Sciatica ; Unnecessary Procedures

Pancreatitis is a rare manifestation of adult Henoch-Schonlein purpura (HSP). We describe here a 53-year-old man who presented with acute pancreatitis as a complication of adult HSP. Pancreatic involvement in HSP is self-limiting and benign. Prompt resolution can be achieved by treatment with steroids. Elevated serum amylase and lipase concentrations may be early diagnostic indicators of HSP pancreatitis. Patients with HSP who have abdominal pain should be evaluated for pancreatitis by measuring serum amylase and lipase concentrations and by abdominal computed tomography scan, to plan specific treatment and avoid unnecessary surgery.
Abdominal Pain ; Adult ; Amylases ; Humans ; Lipase ; Middle Aged ; Pancreatitis ; Purpura, Schoenlein-Henoch ; Steroids ; Unnecessary Procedures ; Vasculitis

The differentiation of mass-forming autoimmune pancreatitis (AIP) from pancreatic cancer is critical because AIP can be successfully treated with steroid therapy and unnecessary surgery avoided. We herein report a case of 69-year-old male with a prior history of recurrent AIP who developed a pancreatic body mass with upstream duct dilatation. Laboratory findings were nonspecific for AIP or pancreatic cancer, although an endoscopic ultrasonography-guided biopsy revealed chronic inflammation. To differentiate mass-forming AIP from pancreatic cancer, we administered oral steroids for 2 weeks. After steroid therapy, a computed tomography scan revealed a decrease in the pancreatic mass size and improvement in dilatation of the upstream duct. So we could differentiate mass-forming AIP from pancreatic cancer; thereafter resolution of pancreatic lesion could be achieved with further steroid therapy. In conclusion, a 2-week steroid trial followed by radiologic imaging was helpful to differentiate mass-forming AIP from pancreatic cancer.
Aged ; Biopsy ; Dilatation ; Humans ; Inflammation ; Male ; Pancreatic Neoplasms* ; Pancreatitis* ; Steroids ; Unnecessary Procedures

We report a case of an 86-year-old man diagnosed with bilateral elastofibroma dorsi who was managed conservatively after a two year follow-up. An elastofibroma dorsi is a benign, slow-growing tumor that is most often located in the inferior periscapular area in elderly patients. It should be considered to differentiate them from other soft tissue tumors located at the inferior periscapular region. Increased awareness of these characteristics will decrease the incidence of a misdiagnosis of elastofibroma dorsi as a malignancy and avoid unnecessary surgery.
Aged ; Aged, 80 and over ; Diagnostic Errors ; Follow-Up Studies ; Humans ; Incidence ; Shoulder* ; Unnecessary Procedures