Doctor / Detective

Today I spent with Dr. K, who is a female doctor I spent a 1/2 day with the other day. We had some interesting cases today - with unknown answers. I am looking forward to getting some test results back to help us narrow down our differential diagnosis for the issues. I'll just mention a few of them:

1. Female patient 48 yrs old came into the office today for a follow up. A few weeks ago she presented with lower abdominal pain and pressure. They ruled out a UTI with 2 negative urinalysis, next on the docs differential was diverticulosis and she had a CT of the abdomen done. This showed now diverticulosis, but it did reveal a globular uterus and a left ovary that had drifted over to the right side. The patient was prescribed an antibiotic prior to the CT and her abdominal symptoms resolved. The interesting part is that this patient had a hysterectomy and oopherectomy (L ovary removed) a few years ago. So...... one wonders why according to radiology she still has a globular uterus and a L ovary?????
The patient does have a history of endometriosis - which is when the lining of the uterus (endometrium - that is shed every month) proliferates, sometimes in spots where it's not supposed to - like outside the uterus. It usually gets out via the fallopian tubes. Endometriosis can cause irregular bleeding. Well, our patient had irregular bleeding post-hysterectomy which shouldn't happen. She still has her cervix (which they may or may not take w/ a hysterectomy) - and with the abnormal bleeding they used some sort of treatment that basically cauterized her cervix (which is questionable from my and Dr. K's perspective). Anyway - we sent her to see her gynecologist and for an ultrasound to check this out. It could very easily be endometrial tissue that was left after the hysterectomy - that has proliferated. Not sure.

2. Another 48 year old woman presents with a "lump" in the back upper arm, near the axilla, but not in the axilla. It's more the back of the arm rather than in the armpit. This "lump" - is more of a fullness in the back of the arm, it's movable and I describe it as grainy. Dr. K and I are not worried about breast origin because it's more the back of the arm rather than axilla and the patient had a clear mammogram in Jan. The mass is not connected to muscle and does not feel like a swollen lymph node. It has been present for a week and has not grown according to the patient. I was stumped at first, but the current differential is a soft tissue mass - probable lipoma. The next step according to radiology (because Dr. K called to ask what the best imaging studies would be) - 1st step is x-ray to rule out any bony abnormalities and then if that is clear MRI. So we shall see....

So..these cases and a few others (these being the most exciting) - make me feel like a detective trying to figure out what's going on. We slowly gather more evidence for or against our proposed hypothesis.

http://en.wikipedia.org/wiki/Endometriosis
http://en.wikipedia.org/wiki/Lipoma