Infarction differential diagnosis

HBD is a biochemical rather than electrophoretic assessment of the LD isoenzyme which is associated with heart. All five isoenzymes of LD exhibit some activity toward cx-hydroxy-butyrate as substrate, but heart LD shows the greatest activity. Serum HBD measurement is not as valuable as the electrophoretic determination of heart LD isoenzyme. High HBD activity has also been found in diseases of the liver. Rises associated with the hepatic effects of congestive heart failure can be disconcerting in the differential diagnosis of myocardial infarction. Wilkinson has used the serum HBD/LD ratio for the differentiation of myocardial disease from other disorders in which HBD activity is elevated, whereas Rosalki has not found the ratio to be helpful (39). 

Suggested Alternatives for Differential Diagnosis Acute respiratory distress syndrome, plague, congestive heart failure and pulmonary edema, HIV infection and AIDS, pneumonia, shock, phosgene, influenza, tularemia, phosphine toxicity, anthrax, silent myocardial infarction, and salicylate toxicity with pulmonary edema. 

It seems to be important that in myocardial infarction no increase of GSSGR activity could be found (K6, LI), thus representing the possibility for differential diagnosis in connection with other enzyme tests. 

Atropine can be used in the differential diagnosis of S-A node dysfunction. If sinus bradycardia is due to extracardiac causes, atropine can generally elicit a tachy-cardic response, whereas it cannot elicit tachycardia if the bradycardia results from intrinsic causes. Under certain conditions, atropine may be useful in the treatment of acute myocardial infarction. Bradycardia frequently occurs after acute myocardial infarction, especially in the first few hours, and this probably results from excessive vagal tone. The increased tone and bradycardia... 

In most cases of the thoracolumbar infarction, the swollen cord shows peripheral enhancement of the central gray matter. The concomitant enhancement of the cauda equina was reported first by Friedman and Flanders in 1992 (Fig. 17.8). This phenomenon is a characteristic finding in the course of spinal cord ischemia which might involve the cord itself and the ventral cauda equina as well, which is composed of motor fibre bundles (Amano et al. 1998). It indicates disruption of the blood-cord barrier as well as reactive hyperemia (Friedman and Flanders 1992 Amano et al. 1998). The differential diagnosis of contrast enhancement of the cauda equina includes transverse myelitis, bacterial or viral meningitis, and spinal metastasis. 

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

Differential diagnosis of an infarction Q wave Q wave or equivalent without Ml (Figures 5.41-5.43)... 

After the consensus of ESC/ACC was reported (Alpert et al, 2000), the differential diagnosis between UA and non-Q-wave infarction has been especially based on the rise of troponines. Nevertheless, it should be borne in mind that a small number of patients with ST-segment depression may end up with a Q wave infarction (Figure 8.2). 

The exact nature of pontine lesions classified as capillary malformations will remain speculative in the vast majority of patients. Beside vascular malformations, the differential diagnosis of an enhancing pontine lesion might include neoplasm, demyelin-ating disease, infection, infarction, or, rarely, central pontine myelinolysis. The absence of mass effect or significant T2 prolongation, however, argues... 

Marked alterations in the patterns of glycogen phosphorylase isoenzymes have been observed in a series of transplanted rat hepatomas. The binding site of rabbit-muscle phosphorylase b is thought to be hydrophobic. A test for the early differential diagnosis of acute myocardial infarction has been devised, based on the levels of glycogen phosphorylase in blood sera. ... 

Goldberger AL. Myocardial infarction electrocardiographic differential diagnosis. 4th ed. St. Louis, MO Mosby Year Book, 1991 49... 

The differential diagnosis for focal liver lesions includes benign and malignant lesions (metastatic, recurrent or primary) and the parenchymal manifestations of arterial abnormalities, infarcts, and abscesses. Infarcts usually appear as round or geographic solid lesions, with central hypoechoic necrotic areas. Abscesses have thick walls and central hypoechoic areas. Infarcts and abscesses may contain intraparenchymal gas (Fig. 4.2.16). 

Singer et al. (1998) 39 Clinical diagnosis of acute subcortical infarction DWI has accuracy of 94.6% for acute subcortical infarction and differentiates acute from non-acute lesions... 

Diagnosis of cerebrovascular disease and differentiation of focal abnormalities in CBF typical in multi-infarct dementia and degenerative dementia... 

Clinically, ruptured ovarian cysts may resemble ovarian torsion. In a patient with acute pelvic pain, a hemorrhagic lesion within a normal size ovary is typically a ruptured ovarian cyst. Furthermore, unlike in most cases of ovarian torsion, clotted blood may be detected in the lesser pelvis. Wall edema of an adnexal mass, engorged adnexal vessels or dilatation of the fallopian tube are missing. TUboovarian abscess and hydrosalpinx may resemble advanced adnexal torsion. Lack of enhancement supports the diagnosis of ovarian torsion. In children, sonography usually allows the diagnosis of appendicitis as a cause of acute pelvic pain. In case of a suspected abscess or an ovarian mass, MRI may aid in further assessment of the adnexa. Rarely, a calcified mass may result from chronic infarction which cannot reliably be differentiated from a calcified ovarian tumor [19]. 

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