Lymphomatoid granulomatosis physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Common physical examination findings of Lymomatoid granulomatosis include Wheezing, Rales and Rhonchi
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
===Vital Signs===


*High-grade / low-grade fever
Physical examination of patients with Lymphomatoid granulomatosis is usually remarkable for Wheezing, Rales and Rhonchi
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
In the case of cutaneous Lymphomatoid granulomatosis patients can present with following:
OR
*[[Rash|Erythematous rash]]<ref name="pmid27051739">{{cite journal| author=Shaigany S, Weitz NA, Husain S, Geskin L, Grossman ME| title=A case of lymphomatoid granulomatosis presenting with cutaneous lesions. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 4 | pages= 234-7 | pmid=27051739 | doi=10.1016/j.jdcr.2015.05.008 | pmc=4808726 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27051739  }} </ref>
*[[Cyanosis]]  
*[[Macule|Macules]] <ref name="Carlson1991">{{cite journal|last1=Carlson|first1=Keith C.|title=Cutaneous Signs of Lymphomatoid Granulomatosis|journal=Archives of Dermatology|volume=127|issue=11|year=1991|pages=1693|issn=0003-987X|doi=10.1001/archderm.1991.01680100093011}}</ref>
*[[Jaundice]]
*[[Papule|Papules]]<ref name="pmid27051739">{{cite journal| author=Shaigany S, Weitz NA, Husain S, Geskin L, Grossman ME| title=A case of lymphomatoid granulomatosis presenting with cutaneous lesions. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 4 | pages= 234-7 | pmid=27051739 | doi=10.1016/j.jdcr.2015.05.008 | pmc=4808726 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27051739  }} </ref><ref name="Minars1975">{{cite journal|last1=Minars|first1=Norman|title=Lymphomatoid Granulomatosis of the Skin|journal=Archives of Dermatology|volume=111|issue=4|year=1975|pages=493|issn=0003-987X|doi=10.1001/archderm.1975.01630160083009}}</ref>
* [[Pallor]]
*[[Plaque|Plaques]] <ref name="RysgaardStone2015">{{cite journal|last1=Rysgaard|first1=Carolyn D.|last2=Stone|first2=Mary Seabury|title=Lymphomatoid granulomatosis presenting with cutaneous involvement: a case report and review of the literature|journal=Journal of Cutaneous Pathology|volume=42|issue=3|year=2015|pages=188–193|issn=03036987|doi=10.1111/cup.12402}}</ref>
* Bruises
*[[Nodule (medicine)|Subcutaneous nodules]]<ref name="pmid27051739">{{cite journal| author=Shaigany S, Weitz NA, Husain S, Geskin L, Grossman ME| title=A case of lymphomatoid granulomatosis presenting with cutaneous lesions. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 4 | pages= 234-7 | pmid=27051739 | doi=10.1016/j.jdcr.2015.05.008 | pmc=4808726 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27051739  }} </ref><ref name="Prieto Herman ReinehrCorrêa Martins2017">{{cite journal|last1=Prieto Herman Reinehr|first1=Clarissa|last2=Corrêa Martins|first2=Carla|last3=Trein Cunha|first3=Vivian|last4=Elen Lira|first4=Franci|last5=Sprinz|first5=Eduardo|last6=Cartell|first6=André|last7=Bakos|first7=Renato Marchiori|title=Cutaneous human immunodeficiency virus (HIV)-associated lymphomatoid granulomatosis: complete regression following antiretroviral therapy|journal=International Journal of Dermatology|volume=56|issue=5|year=2017|pages=e100–e102|issn=00119059|doi=10.1111/ijd.13551}}</ref>
 
*[[Nodules|Larger ulcerated nodules]]<ref name="pmid27051739">{{cite journal| author=Shaigany S, Weitz NA, Husain S, Geskin L, Grossman ME| title=A case of lymphomatoid granulomatosis presenting with cutaneous lesions. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 4 | pages= 234-7 | pmid=27051739 | doi=10.1016/j.jdcr.2015.05.008 | pmc=4808726 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27051739  }} </ref><ref name="LeeNamuduri2018">{{cite journal|last1=Lee|first1=Lynette Y.|last2=Namuduri|first2=Rama|last3=Chan|first3=Michelle M. F.|last4=Quek|first4=Jeffrey K. S.|last5=Koh|first5=Mark J.-A.|title=Epstein-Barr virus positive diffuse large B-cell lymphoma presenting with vaginal sloughing and ulcerated skin nodule|journal=Journal of Cutaneous Pathology|volume=45|issue=2|year=2018|pages=162–166|issn=03036987|doi=10.1111/cup.13074}}</ref>
<gallery widths="150px">
The differentials are the following [[Polymyositis and dermatomyositis|Dermatomyositis]], and [[Psoriasis]]<ref name="BertiFelicetti2018">{{cite journal|last1=Berti|first1=Alvise|last2=Felicetti|first2=Mara|last3=Peccatori|first3=Susanna|last4=Bortolotti|first4=Roberto|last5=Guella|first5=Anna|last6=Vivaldi|first6=Paolo|last7=Morelli|first7=Luca|last8=Barabareschi|first8=Mattia|last9=Paolazzi|first9=Giuseppe|title=EBV-induced lymphoproliferative disorders in rheumatic patients: A systematic review of the literature|journal=Joint Bone Spine|volume=85|issue=1|year=2018|pages=35–40|issn=1297319X|doi=10.1016/j.jbspin.2017.01.006}}</ref><ref name="pmid26966605">{{cite journal| author=O'Brien S, Schmidt P| title=Lymphomatoid Granulomatosis with Paraneoplastic Polymyositis: A Rare Malignancy with Rare Complication. | journal=Case Rep Rheumatol | year= 2016 | volume= 2016 | issue=  | pages= 8242597 | pmid=26966605 | doi=10.1155/2016/8242597 | pmc=4757691 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26966605  }} </ref>
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
*[[Headache|Headaches]]<ref name="pmid21559262">{{cite journal| author=Castrale C, El Haggan W, Chapon F, Reman O, Lobbedez T, Ryckelynck JP et al.| title=Lymphomatoid granulomatosis treated successfully with rituximab in a renal transplant patient. | journal=J Transplant | year= 2011 | volume= 2011 | issue=  | pages= 865957 | pmid=21559262 | doi=10.1155/2011/865957 | pmc=3087939 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21559262  }} </ref>
OR
*[[Seizure|Seizures]]<ref name="LiuChen2014">{{cite journal|last1=Liu|first1=Hongli|last2=Chen|first2=Jing|last3=Yu|first3=Dandan|last4=Hu|first4=Jianli|title=Lymphomatoid granulomatosis involving the central nervous system: A case report and review of the literature|journal=Oncology Letters|volume=7|issue=6|year=2014|pages=1843–1846|issn=1792-1074|doi=10.3892/ol.2014.2002}}</ref>
*Patient is usually oriented to persons, place, and time
*[[Hemiparesis]]<ref name="PatsalidesAtac2005">{{cite journal|last1=Patsalides|first1=Athos D.|last2=Atac|first2=Gokce|last3=Hedge|first3=Upendra|last4=Janik|first4=John|last5=Grant|first5=Nicole|last6=Jaffe|first6=Elaine S.|last7=Dwyer|first7=Andrew|last8=Patronas|first8=Nicholas J.|last9=Wilson|first9=Wyndham H.|title=Lymphomatoid Granulomatosis: Abnormalities of the Brain at MR Imaging|journal=Radiology|volume=237|issue=1|year=2005|pages=265–273|issn=0033-8419|doi=10.1148/radiol.2371041087}}</ref>
* Altered mental status
*[[Ataxia]]<ref name="CarginiCivica2014">{{cite journal|last1=Cargini|first1=Pasqualino|last2=Civica|first2=Maria|last3=Sollima|first3=Laura|last4=Di Cola|first4=Emanuela|last5=Pontecorvi|first5=Emanuele|last6=Cutilli|first6=Tommaso|title=Oral lymphomatoid granulomatosis, the first sign of a ‘rare disease’: a case report|journal=Journal of Medical Case Reports|volume=8|issue=1|year=2014|issn=1752-1947|doi=10.1186/1752-1947-8-152}}</ref>
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]  
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 15:14, 12 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Common physical examination findings of Lymomatoid granulomatosis include Wheezing, Rales and Rhonchi

Physical Examination

Physical examination of patients with Lymphomatoid granulomatosis is usually remarkable for Wheezing, Rales and Rhonchi

Skin

In the case of cutaneous Lymphomatoid granulomatosis patients can present with following:

The differentials are the following Dermatomyositis, and Psoriasis[7][8]

Lungs

Neuromuscular

References

  1. ↑ 1.0 1.1 1.2 1.3 Shaigany S, Weitz NA, Husain S, Geskin L, Grossman ME (2015). "A case of lymphomatoid granulomatosis presenting with cutaneous lesions". JAAD Case Rep. 1 (4): 234–7. doi:10.1016/j.jdcr.2015.05.008. PMC 4808726. PMID 27051739.
  2. ↑ Carlson, Keith C. (1991). "Cutaneous Signs of Lymphomatoid Granulomatosis". Archives of Dermatology. 127 (11): 1693. doi:10.1001/archderm.1991.01680100093011. ISSN 0003-987X.
  3. ↑ Minars, Norman (1975). "Lymphomatoid Granulomatosis of the Skin". Archives of Dermatology. 111 (4): 493. doi:10.1001/archderm.1975.01630160083009. ISSN 0003-987X.
  4. ↑ Rysgaard, Carolyn D.; Stone, Mary Seabury (2015). "Lymphomatoid granulomatosis presenting with cutaneous involvement: a case report and review of the literature". Journal of Cutaneous Pathology. 42 (3): 188–193. doi:10.1111/cup.12402. ISSN 0303-6987.
  5. ↑ Prieto Herman Reinehr, Clarissa; Corrêa Martins, Carla; Trein Cunha, Vivian; Elen Lira, Franci; Sprinz, Eduardo; Cartell, André; Bakos, Renato Marchiori (2017). "Cutaneous human immunodeficiency virus (HIV)-associated lymphomatoid granulomatosis: complete regression following antiretroviral therapy". International Journal of Dermatology. 56 (5): e100–e102. doi:10.1111/ijd.13551. ISSN 0011-9059.
  6. ↑ Lee, Lynette Y.; Namuduri, Rama; Chan, Michelle M. F.; Quek, Jeffrey K. S.; Koh, Mark J.-A. (2018). "Epstein-Barr virus positive diffuse large B-cell lymphoma presenting with vaginal sloughing and ulcerated skin nodule". Journal of Cutaneous Pathology. 45 (2): 162–166. doi:10.1111/cup.13074. ISSN 0303-6987.
  7. ↑ Berti, Alvise; Felicetti, Mara; Peccatori, Susanna; Bortolotti, Roberto; Guella, Anna; Vivaldi, Paolo; Morelli, Luca; Barabareschi, Mattia; Paolazzi, Giuseppe (2018). "EBV-induced lymphoproliferative disorders in rheumatic patients: A systematic review of the literature". Joint Bone Spine. 85 (1): 35–40. doi:10.1016/j.jbspin.2017.01.006. ISSN 1297-319X.
  8. ↑ O'Brien S, Schmidt P (2016). "Lymphomatoid Granulomatosis with Paraneoplastic Polymyositis: A Rare Malignancy with Rare Complication". Case Rep Rheumatol. 2016: 8242597. doi:10.1155/2016/8242597. PMC 4757691. PMID 26966605.
  9. ↑ Castrale C, El Haggan W, Chapon F, Reman O, Lobbedez T, Ryckelynck JP; et al. (2011). "Lymphomatoid granulomatosis treated successfully with rituximab in a renal transplant patient". J Transplant. 2011: 865957. doi:10.1155/2011/865957. PMC 3087939. PMID 21559262.
  10. ↑ Liu, Hongli; Chen, Jing; Yu, Dandan; Hu, Jianli (2014). "Lymphomatoid granulomatosis involving the central nervous system: A case report and review of the literature". Oncology Letters. 7 (6): 1843–1846. doi:10.3892/ol.2014.2002. ISSN 1792-1074.
  11. ↑ Patsalides, Athos D.; Atac, Gokce; Hedge, Upendra; Janik, John; Grant, Nicole; Jaffe, Elaine S.; Dwyer, Andrew; Patronas, Nicholas J.; Wilson, Wyndham H. (2005). "Lymphomatoid Granulomatosis: Abnormalities of the Brain at MR Imaging". Radiology. 237 (1): 265–273. doi:10.1148/radiol.2371041087. ISSN 0033-8419.
  12. ↑ Cargini, Pasqualino; Civica, Maria; Sollima, Laura; Di Cola, Emanuela; Pontecorvi, Emanuele; Cutilli, Tommaso (2014). "Oral lymphomatoid granulomatosis, the first sign of a 'rare disease': a case report". Journal of Medical Case Reports. 8 (1). doi:10.1186/1752-1947-8-152. ISSN 1752-1947.

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