Waldenström's macroglobulinemia physical examination: Difference between revisions
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*Cold urticaria. | *Cold urticaria. | ||
*Firm, flesh-colored skin papules and nodules also called macroglobulinemia cutis.<ref name="pmid10188670">{{cite journal| author=Daoud MS, Lust JA, Kyle RA, Pittelkow MR| title=Monoclonal gammopathies and associated skin disorders. | journal=J Am Acad Dermatol | year= 1999 | volume= 40 | issue= 4 | pages= 507-35; quiz 536-8 | pmid=10188670 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10188670 }} </ref> | *Firm, flesh-colored skin papules and nodules also called macroglobulinemia cutis.<ref name="pmid10188670">{{cite journal| author=Daoud MS, Lust JA, Kyle RA, Pittelkow MR| title=Monoclonal gammopathies and associated skin disorders. | journal=J Am Acad Dermatol | year= 1999 | volume= 40 | issue= 4 | pages= 507-35; quiz 536-8 | pmid=10188670 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10188670 }} </ref> | ||
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[[File:Penile ulcer. wm.png|thumb|250px|none| Lesion measuring 4 centimeters on penis base, with a clear background[https://openi.nlm.nih.gov/detailedresult.php?img=PMC4861576_abd-91-02-0236-g01&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=62 Source: Oliveira CC. et al, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil.]]] | |||
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[[File:Hyperpigmented nodules with hemorrhagic crusting.png|thumb|250px|none| Hyperpigmented nodules with hemorrhagic crusting on the back.[https://openi.nlm.nih.gov/detailedresult.php?img=PMC3886335_CRIM.ONCMED2013-890864.001&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=80 Source: Haider S. et al, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.]]] | |||
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[[File:Ulcers tingling.png|thumb|250px|none|The patient presented with tingling ulcers on the feet. [Copyright: ©2013 Fischer et al.]Figure 1B. On further examination, papules were noted on the knees. [Copyright: ©2013 Fischer et al.]Figure1C. Biopsy from a knee papule showed homogeneous extra-vascular eosinophilic hyaline deposits throughout the papillary and reticular dermis (H&E 40×). [Copyright: ©2013 Fischer et al.]Figure 1D. IgM stain demonstrates the extravascular IgM deposits in the dermis (40×). [Copyright: ©2013 Fischer et al.][https://openi.nlm.nih.gov/detailedresult.php?img=PMC3791964_dp0303a03g001&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=37 Source: Fischer I. et al, Department of Dermatology, Klinikum Schwabing, Munich, Germany.]]] | |||
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===HEENT=== | ===HEENT=== | ||
Revision as of 02:37, 16 February 2019
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Waldenström's macroglobulinemia Microchapters |
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Differentiating Waldenström's macroglobulinemia from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2] Mirdula Sharma, MBBS [3]
Overview
Patients with Waldenström macroglobulinemia usually appear oriented to time, place, and person. Physical examination of patients with Waldenström's macroglobulinemia is usually remarkable for various findings depending on the degree of tissue infiltration by malignant tumor cells, hyperviscosity syndrome, and accumulation of paraprotein.
Physical Examination
General Appearance
Patients with Waldenström macroglobulinemia are generally well-appearing.[1]
Skin
- Maculopapular lesions, plaques, or nodules.[2][3][4]
- Purpura.
- Raynaud phenomenon.
- Petechiae (if platelet count is low).
- Skin ulcers.
- Skin necrosis.
- Cold urticaria.
- Firm, flesh-colored skin papules and nodules also called macroglobulinemia cutis.[3]
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HEENT
- Pallor.
- Papilledema.
- Malignant vitreitis.[5]
- Congestion/sludging of blood in conjunctival vessels.
- Retinitis/retinopathy including dilation, segmentation and tortuosity of retinal vessels, mid-peripheral retinal hemorrhages, serous retinal/macular neurosensory detachment, blurred disc margins and fundal exudates on fundoscopic examination.[6][7][8]
Neck
Respiratory
- Pleural effusion - in 3-5% of patients.[10]
- Rales on auscultation.
- Pulmonary infiltrates, nodules, masses.[10]
Cardiovascular system
Abdomen
- Swollen abdomen/belly.
- Splenomegaly.
- Hepatomegaly.
Extremity
- Raynaud phenomenon.
- Patients may have peripheral edema if disease is complicated by congestive heart failure.
Neuromuscular
- Peripheral neuropathy - distal, symmetric, and sensorimotor.[11]
References
- ↑ Waldenström's macroglobulinemia. MedlinePlus (2015) https://www.nlm.nih.gov/medlineplus/ency/article/000588.htm Accessed on November 15th, 2015
- ↑ Lin P, Bueso-Ramos C, Wilson CS, Mansoor A, Medeiros LJ (2003). "Waldenstrom macroglobulinemia involving extramedullary sites: morphologic and immunophenotypic findings in 44 patients". Am J Surg Pathol. 27 (8): 1104–13. PMID 12883242.
- ↑ 3.0 3.1 Daoud MS, Lust JA, Kyle RA, Pittelkow MR (1999). "Monoclonal gammopathies and associated skin disorders". J Am Acad Dermatol. 40 (4): 507–35, quiz 536-8. PMID 10188670.
- ↑ Veltman GA, van Veen S, Kluin-Nelemans JC, Bruijn JA, van Es LA (1997). "Renal disease in Waldenström's macroglobulinaemia". Nephrol Dial Transplant. 12 (6): 1256–9. PMID 9198063.
- ↑ Orellana J, Friedman AH (1981). "Ocular manifestations of multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy". Surv Ophthalmol. 26 (3): 157–69. PMID 6801795.
- ↑ Pilon AF, Rhee PS, Messner LV (2005). "Bilateral, persistent serous macular detachments with Waldenström's macroglobulinemia". Optom Vis Sci. 82 (7): 573–8. PMID 16044069.
- ↑ Avashia JH, Fath DF (1989). "Bilateral central retinal vein occlusion in Waldenström's macroglobulinemia". J Am Optom Assoc. 60 (9): 657–8. PMID 2507620.
- ↑ Goen TM, Terry JE (1986). "Mid-peripheral hemorrhages secondary to Waldenström's macroglobulinemia". J Am Optom Assoc. 57 (2): 109–12. PMID 3081619.
- ↑ Dimopoulos, Meletios A.; Panayiotidis, Panayiotis; Moulopoulos, Lia A.; Sfikakis, Petros; Dalakas, Marinos (2000). "Waldenström's Macroglobulinemia: Clinical Features, Complications, and Management". Journal of Clinical Oncology. 18 (1): 214–214. doi:10.1200/JCO.2000.18.1.214. ISSN 0732-183X.
- ↑ 10.0 10.1 Fadil A, Taylor DE (1998). "The lung and Waldenström's macroglobulinemia". South Med J. 91 (7): 681–5. PMID 9671845.
- ↑ Coimbra J, Costa AP, Pita F, Rosado P, de Almeida LB (1995). "[Neuropathy in Waldenstrom's macroglobulinemia]". Acta Med Port (in Portuguese). 8 (4): 253–7. PMID 7625222.