■不常见的疾病通常在初次就诊时不会被怀疑,诊断可能具有挑战性。在这里,我们提出了一种在工伤背景下诊断出的罕见疾病,通过更详细的身体检查强调进一步调查的重要性,影像学研究和其他专业的参与。
■一名21岁的西班牙裔男性,他是一名食品服务人员,在工作相关的右肘挫伤后出现,右肘剧烈疼痛,内侧和前臂肿胀和紫红色瘀伤/变色。身体检查显示肿胀,压痛,右臂和前臂上明显扩张的血管;此外,在右臂上发现了多个红色紫色的散斑,右上胸部前后。他的既往病史为毛细血管血管瘤。他最初受到保守的对待,并受到工作限制;但是,前臂的疼痛持续存在。CT血管造影显示前臂上有多个交织的血管结构,通过MR血管造影进一步成像显示了右上肢和胸部的多个血管畸形。咨询了血管手术,并诊断为Klippel-Trenaunay综合征。
■Klippel-Trenaunay综合征是一种罕见的先天性疾病,可表现为多种体征和症状。任何工伤都必须进行彻底的病史记录和临床检查。当诊断不明确时,应始终考虑进一步的工作和转诊专科医生。或当最初的症状不解决与治疗。
UNASSIGNED: Uncommon diseases are usually not suspected at initial presentation, and the diagnosis might be challenging. Here we present a rare disease diagnosed in a work-related injury setting, highlighting the importance of further investigation by means of a more detail physical exam, imaging studies and involvement of other specialties.
UNASSIGNED: A 21-year-old Hispanic male, who is a food service worker, presented following a work-related right elbow contusion with severe pain to his right elbow associated with swelling and purplish-red bruising/discoloration on its medial side and forearm. Physical exam demonstrated swelling, tenderness, and conspicuous dilated blood vessels across the right arm and forearm; additionally, multiple red-purplish scattered patches were found on the right arm, anterior and posterior right upper chest. His past medical history was significant for Capillary Hemangioma. He was initially treated conservatively and with work restriction; however, the pain in the forearm persisted. CT angiogram showed multiple interweaving vascular structures on the forearm, and further imaging by MR angiography depicted multiple vascular malformations in the right upper extremity and chest. Vascular surgery was consulted, and the diagnosis of Klippel-Trenaunay syndrome was made.
UNASSIGNED: Klippel-Trenaunay syndrome is a rare congenital disorder that could present in a wide-range of signs and symptoms. Thorough history taking and clinical examination is warranted in any work-related injuries. Further work up and referral to specialist should always be considered when diagnosis is unclear, or when initial symptoms do not resolve with treatment.