오늘 NEJM ‘Postherpetic Abdominal Pseudohernia’ 케이스를 보고 나서 최근에 환자의 진단명이 <abdominal pseudohernia due to herpes zoster>라는 것을 알게 되었습니다. Cleveland Clinic의 케이스와 유사하며 이해를 위해 Cleveland Clinic의 사진을 첨부하여 구성하였습니다. https://www.ccjm.org/content/88/9/480 오늘 NEJM ‘Postherpetic Abdominal Pseudohernia’ 케이스를 보고 나서 최근 환자의 진단명이 <abdominal pseudohernia due to herpes zoster>라는 것을 알게 되었습니다. Cleveland Clinic의 케이스와 유사하며 이해를 위해 Cleveland Clinic의 사진을 첨부하여 구성하였습니다. https://www.ccjm.org/content/88/9/480
대상포진에 의한 복부 가성탈장(Abdominal pseudo hernia due to herpes zoster) 대상포진에 의한 복부 가성탈장(Abdominal pseudo hernia due to herpes zoster)
첫 방문은 60대/남성 오른쪽 옆구리 통증으로 내원하였습니다. 최근 골프를 쳤다고 했고, 외견상 이상 소견도 없고, 피부 발진도 없었습니다. 최근 골프 경력이 있고 피부 이상 소견이 없어 늑골연골염으로 추정했습니다. 그래도 드물지만 늑막의 이상 소견이 있을 가능성이 있어 흉부 엑스레이를 촬영했습니다. (정상) Rx; NSAIDs 두 번째 방문 이틀 후 환자는 오른쪽 옆구리가 튀어나와 왼쪽과 다르다고 내원하였습니다. 여전히 오른쪽 옆구리 통증을 호소했어요. 제 환자는 이보다 더 돌출된 모습으로 우측 옆구리 통증과 복벽의 돌출된 소견으로 보아 복강 내에 뭔가 문제가 있는 것으로 추정되어 타 병원의 복부 CT를 의뢰하였습니다. 첫 방문은 60대/남성 오른쪽 옆구리 통증으로 내원하였습니다. 최근 골프를 쳤다고 했고, 외견상 이상 소견도 없고, 피부 발진도 없었습니다. 최근 골프 경력이 있고 피부 이상 소견이 없어 늑골연골염으로 추정했습니다. 그래도 드물지만 늑막의 이상 소견이 있을 가능성이 있어 흉부 엑스레이를 촬영했습니다. (정상) Rx; NSAIDs 두 번째 방문 이틀 후 환자는 오른쪽 옆구리가 튀어나와 왼쪽과 다르다고 내원하였습니다. 여전히 오른쪽 옆구리 통증을 호소했어요. 제 환자는 이보다 더 돌출된 모습으로 우측 옆구리 통증과 복벽의 돌출된 소견으로 보아 복강 내에 뭔가 문제가 있는 것으로 추정되어 타 병원의 복부 CT를 의뢰하였습니다.
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The third CT visit was taken at another hospital, and there were no lesions that could cause intraperitoneal protrusion. However, it was said that when CT was taken, a rash on the skin was formed later in line with the protruding area, and shingles antiviral drugs were prescribed. The third CT visit was taken at another hospital, and there were no lesions that could cause intraperitoneal protrusion. However, it was said that when CT was taken, a rash on the skin was formed later in line with the protruding area, and shingles antiviral drugs were prescribed.
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The pain in the sides of the conclusion so far was not osteochondritis, but the pain before the rash of shingles. The diagnosis name is shingles because the appearance of blisters running along Dermatome and there was pain before blisters occurred. It is not clear that the abdominal wall of the same part popped out before the blister formed. But it seems to be getting better and better. The pain in the sides of the conclusion so far was not osteochondritis, but the pain before the rash of shingles. The diagnosis name is shingles because the appearance of blisters running along Dermatome and there was pain before blisters occurred. It is not clear that the abdominal wall of the same part popped out before the blister formed. But it seems to be getting better and better.
After looking at the NEJM case After looking at the NEJM case
https://www.nejm.org/doi/full/10.1056/NEJMicm2400595 https://www.ccjm.org/content/88/9/480 The side pain of NEJM case and search conclusion was not rib cartilage inflammation, but shingles before rash. The diagnosis name is shingles because the appearance of blisters running along Dermatome and there was pain before blisters occurred. It is “Abdominal Pseudohernia due to herpes zoster” that the abdominal wall of the same part popped out before blisters appeared. The NEJM case was called “Postherpetic Abdominal Pseudohernia” when the abdominal wall popped out after shingles occurred, and “Cleveland Clinic” refers to prefer “abdominal Pseudohernia due to herpes zoster” rather than this term (10%). In my case, I had difficulty in diagnosing because I had a bulging before the blister occurred. https://www.nejm.org/doi/full/10.1056/NEJMicm2400595 https://www.ccjm.org/content/88/9/480 The side pain of NEJM case and search conclusion was not rib cartilage inflammation, but shingles before rash. The diagnosis name is shingles because the appearance of blisters running along Dermatome and there was pain before blisters occurred. It is “Abdominal Pseudohernia due to herpes zoster” that the abdominal wall of the same part popped out before blisters appeared. The NEJM case was called “Postherpetic Abdominal Pseudohernia” when the abdominal wall popped out after shingles occurred, and “Cleveland Clinic” refers to prefer “abdominal Pseudohernia due to herpes zoster” rather than this term (10%). In my case, I had difficulty in diagnosing because I had a bulging before the blister occurred.
There are several keys to the diagnosis of abdominal false hernia caused by shingles. First, doctors shouldn’t rule it out simply because they don’t have a rash. This condition is often referred to as herpes posterior abdominal pseudo hernia, but 3.4 swelling takes precedence over herpes rashes in almost 10% of patients That’s why I like the word abdominal false hernia caused by shingles. Secondly, targeted history is important to eliminate tick exposure and Borelia-related neurological complications Third, imaging, including magnetic resonance imaging, may be directed to check for mechanical compression of the thoracic nerve root if a detailed follow-up does not reveal delayed herpes rashes. The combination of unilateral abdominal wall swelling and herpes rash indicates abdominal pseudo hernia caused by shingles. It may be beneficial to follow up closely because a rash may appear after swelling. There are several keys to the diagnosis of abdominal false hernia caused by shingles. First, doctors shouldn’t rule it out simply because they don’t have a rash. This condition is often referred to as herpes posterior abdominal pseudo hernia, but 3.4 swelling takes precedence over herpes rashes in almost 10% of patients That’s why I like the word abdominal false hernia caused by shingles. Secondly, targeted history is important to eliminate tick exposure and Borelia-related neurological complications Third, imaging, including magnetic resonance imaging, may be directed to check for mechanical compression of the thoracic nerve root if a detailed follow-up does not reveal delayed herpes rashes. The combination of unilateral abdominal wall swelling and herpes rash indicates abdominal pseudo hernia caused by shingles. It may be beneficial to follow up closely because a rash may appear after swelling.