Struma ovarii physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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]. 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 of patients with Struma ovarii is usually remarkable for:
- Palpable lower abdominal mass
- Pelvic pressure related to a pelvic mass
- Struma ovarii appears to occur more frequently (68.8%) in the right adnexa and CA-125 level appears within normal limits. [1]
- Clinical features in struma ovarii are generally non-specific and resemble ovarian malignancy. [2]
- Pre-operative radiological diagnosis is essential inorder to avoid ovarian cancer type surgery (bilateral salpingo-oophorectomy, hysterectomy, omentectomy and occasionally appendectomy). [2]
- Advanced MRI may be helpful in identifying and to determine the unusual ovarian mass. [2]
- Occasionally Struma ovarii may present as a purely cystic lesion. [2]
Appearance of the Patient
- Patients with Struma ovarii usually appear asymptomatic and some may experience discomfort in the abdomen due to pelvic pressure related to a pelvic mass.
Vital Signs
- Vital signs in a patient with Struma ovarii appear to be normal.
Skin
- There haven't been any skin manifestations reported associated with Struma ovarii.
HEENT
- There are no significant findings associated with Struma ovarii.
Neck
- There are no significant findings associated with Struma ovarii.
Lungs
- In malignant struma ovarii, distant metastases to the lungs have been observed. [3]
- In some cases of Struma ovarii, hydrothorax has been observed. [4]
Heart
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- 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 otoscope
Abdomen
- Abdominal distention
- 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
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Altered mental status
- 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
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
References
- ↑ Zalel Y, Seidman DS, Oren M, Achiron R, Gotlieb W, Mashiach S, Goldenberg M (2000). "Sonographic and clinical characteristics of struma ovarii". J Ultrasound Med. 19 (12): 857–61. PMID 11127011.
- ↑ 2.0 2.1 2.2 2.3 Dujardin MI, Sekhri P, Turnbull LW (2014). "Struma ovarii: role of imaging?". Insights Imaging. 5 (1): 41–51. doi:10.1007/s13244-013-0303-3. PMC 3948908. PMID 24357453.
- ↑ Selvaggi F, Risio D, Waku M, Simo D, Angelucci D, D'Aulerio A, Cotellese R, Innocenti P (2012). "Struma ovarii with follicular thyroid-type carcinoma and neuroendocrine component: case report". World J Surg Oncol. 10: 93. doi:10.1186/1477-7819-10-93. PMC 3586957. PMID 22613573.
- ↑ Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS (2008). "Clinical characteristics of struma ovarii". J Gynecol Oncol. 19 (2): 135–8. doi:10.3802/jgo.2008.19.2.135. PMC 2676458. PMID 19471561.