Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.
Abdominal Injuries ; complications ; Adult ; Asymptomatic Diseases ; Humans ; Male ; Spleen ; injuries ; Splenectomy ; Splenosis ; diagnosis ; etiology ; pathology ; surgery ; Thoracic Diseases ; diagnosis ; etiology ; pathology ; surgery ; Thoracic Injuries ; complications ; Thoracotomy ; Unnecessary Procedures

PURPOSE: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images. METHODS: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chi-square test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant. RESULTS: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients). CONCLUSION The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.
Adolescent ; Child ; Child, Preschool ; Cohort Studies ; Cystography ; methods ; Female ; Fractures, Bone ; diagnostic imaging ; Humans ; Infant ; Male ; Pelvic Bones ; diagnostic imaging ; injuries ; Risk ; Tomography, X-Ray Computed ; methods ; Unnecessary Procedures ; Urinary Bladder ; diagnostic imaging ; injuries

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

OBJECTIVE: Recent studies demonstrated that core needle biopsy (CNB) can effectively reduce the possibility of inconclusive results and prevent unnecessary diagnostic surgery. However, the effectiveness of CNB in patients with suspicious thyroid nodules has not been fully evaluated. This prospective study aimed to determine the potential of CNB to assess thyroid nodules with suspicious ultrasound (US) features. MATERIALS AND METHODS: Patients undergoing CNB for thyroid nodules with suspicious features on US were enrolled between May and August 2016. Diagnostic performance and the incidence of non-diagnostic results, inconclusive results, conclusive results, malignancy, unnecessary surgery, and complications were analyzed. Subgroup analysis according to nodule size was performed. The risk factors associated with inconclusive results were evaluated using multivariate logistic regression analysis. RESULTS: A total of 93 patients (102 thyroid nodules) were evaluated. All samples obtained from CNB were adequate for diagnosis. Inconclusive results were seen in 12.7% of cases. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for diagnosis of malignancy were 93.8%, 100%, 100%, 78.9%, and 95%, respectively. None of the patients underwent unnecessary surgery. The diagnostic performance was not significantly different according to nodule size. On multivariate logistic regression analysis, larger nodule size and shorter needle length were independent risk factors associated with inconclusive results. CONCLUSION: Samples obtained by CNB were sufficient for diagnosis in all cases and resulted in high diagnostic values and conclusive results in the evaluation of suspicious thyroid nodules. These findings indicated that CNB is a promising diagnostic tool for suspicious thyroid nodules.
Biopsy, Fine-Needle ; Biopsy, Large-Core Needle* ; Diagnosis ; Humans ; Incidence ; Logistic Models ; Needles ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography* ; Unnecessary Procedures

The increasing discovery of pancreatic cystic neoplasm is a recent trend because of the widespread use and development of imaging techniques. Physicians have to recognize the different characteristics of the cystic neoplasms so that a determination may be selected regarding the potential for malignancy. Appropriate evaluation of pancreatic cystic lesion includes a multidisciplinary approach involving gastroenterologists with experience in endoscopic ultrasound, radiologist, and pancreatic surgeons. The selective approach is important in management of this neoplasm with minimizing incorrect diagnosis and unnecessary surgery. Considering the characteristic features of pancreatic cystic neoplasm, the clinical decision should be tailored according to needs and conditions of the individual patients.
Diagnosis ; Follow-Up Studies ; Humans ; Pancreatic Cyst ; Surgeons ; Ultrasonography ; Unnecessary Procedures

Anisakidosis is a term that collectively refers to a human infection caused by larvae of the family Anisakidae. Because Anisakis simplex was the main cause, it was originally called anisakiasis or anisakiosis, but since other parasites such as Pseudoterranova decipiens also cause similar diseases, the family name is now used as the diagnostic name. Anisakidosis cases have been increasing steadily owing to the propagation of the Japanese raw-fish-eating culture, such as sushi and sashimi, around the world; the traditional raw-fish-eating habits of individual countries; the establishment of marine mammal protection laws; and the development of endoscopic diagnostic techniques. The disease continues to occur in Korea, where most human parasites are believed to have been eradicated and is probably the most common parasitic disease encountered in clinical practice. Anisakidosis is a disease associated with acute abdominal pain. Anisakid larvae can invade the entire digestive tract and abdominal cavity and cause abdominal pain and a variety of digestive system symptoms. Thus, the history of eating raw fish is very important for its differential diagnosis. The lack of a precise understanding of the pathogenesis and clinical course of this disease may lead to unnecessary surgery. Anisakidosis may also manifest as allergic symptoms. Therefore, it is necessary to understand anisakidosis from the perspective of public health, food hygiene, and preventive medicine.
Abdominal Cavity ; Abdominal Pain ; Anisakiasis ; Anisakis ; Asian Continental Ancestry Group ; Diagnosis, Differential ; Digestive System ; Eating ; Food Hypersensitivity ; Gastrointestinal Tract ; Host-Parasite Interactions ; Humans ; Hygiene ; Jurisprudence ; Korea ; Larva ; Mammals ; Parasites ; Parasitic Diseases ; Preventive Medicine ; Public Health ; Raw Foods ; Unnecessary Procedures

Type I autoimmune pancreatitis (AIP), a form of chronic pancreatitis, is included within the spectrum of immunoglobulin G4-related diseases (IgG4-RD). IgG4-RD can involve the salivary glands, bile ducts, kidneys and retroperitoneum, and the pancreas, and responds well to corticosteroid treatment. However, gastric involvement in IgG4-RD has been rarely reported. Here we report the case of a 56-year-old man with type I autoimmune pancreatitis who presented with a giant gastric ulcer mimicking advanced gastric cancer, which was subsequently determined to be IgG4-RD. Both the patient' symptoms and his ulcerative lesions in the stomach responded to steroid treatment, which obviated the need for major surgery such as gastrectomy. Our case demonstrates the importance of recognizing potential gastric involvement in IgG4-RD, especially in a patient with concurrent AIP/IgG4-RD or a history of the disease, who is evaluated for an intractable and/or atypical gastric ulcer. A prompt diagnosis and proper management will avoid unnecessary surgery.
Bile Ducts ; Diagnosis ; Gastrectomy ; Humans ; Immunoglobulins ; Kidney ; Middle Aged ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic ; Salivary Glands ; Stomach Neoplasms ; Stomach Ulcer ; Stomach ; Ulcer ; Unnecessary Procedures

Degenerating nodules (DNs), which primarily manifest as benign thyroid nodules, are one of the main causes of discordance in ultrasonography (US) and cytological assessments. Intranodular hemorrhage is one of the mechanisms contributing to discordant nodules, and an impaired blood supply may explain further DN shrinkage and infarction. The surgical specimens can be divided into acute and chronic stages based on the histological changes, which usually mimic the US features of malignant tumors. Serial US follow-up should be recommended instead of other unnecessary procedures. However, repeated fine-needle aspiration, diagnostic surgery, or core-needle biopsy may still be necessary for indeterminable or highly suspicious DNs.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Infarction ; Thyroid Gland ; Thyroid Nodule ; Ultrasonography ; Unnecessary Procedures

INTRODUCTION: Developmental dysplasia of the hip (DDH) is a common orthopaedic condition at birth. Non-surgical management with the Pavlik harness can effectively treat DDH in the newborn by providing an early clinical diagnosis, but open surgeries continue to be performed. We aimed to elucidate the reasons for this. METHODS: A retrospective review was performed of all open surgeries related to DDH from 2006 to 2016. Patients were either born at our institution (Group 1) or outside of it (Group 2). All Group 1 newborns were routinely screened for DDH at birth. RESULTS: 27 patients (Group 1: n = 5, Group 2: n = 22) presented at age 25 ± 19 months. Left-sided DDH (n = 21, 77.8%) and female infants (n = 22, 81.5%) were more common. The mean age at surgery was 40 ± 31 months. The most commonly performed procedure was soft tissue release open reduction with acetabuloplasty (n = 20, 74.1%). Gender, site, median age at presentation and at surgery, and prevalence of risk factors were similar for both groups. Both groups were mostly made up of late presenters (> 3 months; p = 0.34). A few patients had undergone prior treatment (p = 0.64). Newborn screening was the only significantly different variable between the groups (p < 0.01). CONCLUSION Lack of institutionalised newborn clinical screening appears to be the root cause of late presentation of DDH leading to open surgery for its management. We recommend quality institutionalised newborn clinical screening to reduce the number of late presentations.
Acetabuloplasty ; adverse effects ; methods ; Child ; Child, Preschool ; Early Diagnosis ; Female ; Hip Dislocation, Congenital ; surgery ; Hip Joint ; surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Neonatal Screening ; methods ; Orthotic Devices ; Prevalence ; Retrospective Studies ; Risk Factors ; 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