CHURCHILL’S POCKETBOOK OF Differential Diagnosis tahir99 - UnitedVRG vip.persianss.ir SECTION A tahir99 - UnitedVRG vip.persianss.ir tahir99 - UnitedVRG vip.persianss.ir Content Strategist: Laurence Hunter Content Development Specialist: Sheila Black Project Managers: Lucia Perez, Caroline Jones Designer: Miles Hitchen tahir99 - UnitedVRG vip.persianss.ir CHURCHILL’S POCKETBOOK OF Differential Diagnosis Andrew T. Raftery BSc MB ChB(Hons) MD FRCS(Eng) FRCS(Ed) Clinical Anatomist, Honorary Teaching Fellow, Hull York Medical School; Formerly Consultant Surgeon, Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield; Member (formerly Chairman), Court of Examiners, Royal College of Surgeons of England; Formerly Member of Panel of Examiners, Intercollegiate Speciality Board in General Surgery; Formerly Member of Council, Royal College of Surgeons of England; Formerly Honorary Clinical Senior Lecturer in Surgery, University of Sheffield, UK Eric Lim MB ChB MD MSc FRCS(C-Th) Consultant Thoracic Surgeon, Royal Brompton Hospital, London; Senior Lecturer, National Heart and Lung Institute, Imperial College, London, UK Andrew J. K. Östör MB BS FRACP Consultant Rheumatologist and Associate Lecturer, Addenbrooke’s Hospital, Cambridge; Director, Rheumatology Clinical Research Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK tahir99 - UnitedVRG FOURTH EDITION vip.persianss.ir SECTION A EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTOtahir99 2014 - UnitedVRG vip.persianss.ir © 2014 Elsevier Ltd. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). First edition 2001 Second edition 2005 Third edition 2010 Fourth edition 2014 ISBN 978-0-7020-5402-0 International ISBN 978-0-7020-5403-7 E-book ISBN 978-0-7020-5404-4 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, tahir99and to take all appropriate - safety UnitedVRG precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the materialvip.persianss.ir herein. Printed in China tahir99 - UnitedVRG vip.persianss.ir PREFACE We are grateful to the publishers, Elsevier, for the invitation to produce a fourth edition of the Pocketbook of Differential Diagnosis. The text has been updated and some further conditions added. We have been pleased by the comments from our readership, who have suggested additions and corrections, and these have been taken into account when writing this new edition. The introduction of the colour coding system in the third edition was favourably received and has been retained in this edition, with a few modifications in the grading of the relative frequency of some conditions. A number of our readers felt that the addition of illustrations would be helpful and to that end, we have added these to some of the chapters where we thought it appropriate. Readers and reviewers also suggested that the addition of management of diseases would be helpful but this book is a manual of differential diagnosis; treatment of the various conditions is outside the scope of this book. We are pleased with the way that previous editions have sold and that, in these days of self-directed problem-based learning, medical students still see the need for a book offering a didactic approach. Indeed, we believe that the book will be particularly helpful to those on problem-based learning courses. We hope this book will continue to help you on the wards and in the clinics – and in examinations! A.T.R. Sheffield E.L. London A.J.K.O. Cambridge 2014 tahir99 - UnitedVRG vip.persianss.ir SECTION A tahir99 - UnitedVRG vip.persianss.ir viACKNOWLEDGEMENTS We are extremely grateful to Elsevier and, in particular, to Laurence Hunter, Senior Content Strategist, and Sheila Black, Content Development Specialist, for their support and help with this project. We wish to thank all those who have contributed to the successive editions of this book. We would particularly like to express our thanks to our junior staff and medical students who have suggested corrections, amendments and improvements to the book. Any errors that may have occurred remain our responsibility. We are also indebted to our consultant radiologist colleagues at the Sheffield Teaching Hospitals NHS Foundation Trust who provided images: Matthew Bull, Michael Collins, Peter Brown, Tim Hodgson and Adrian Highland and to Angela Lord for permission to use figure 58. We would also like to thank our wives for their patience and encouragement shown throughout the production of this fourth edition. Mr Raftery would like to thank his secretary, Mrs Denise Smith, for the hard work and long hours she has put into typing and re-typing the manuscript into its final form for publication (Mr Raftery cannot use a word processor!). FIGURE ACKNOWLEDGEMENTS The following images are reproduced, with kind permission, from other Elsevier titles: Burkitt, Quick, Reed and Deakin: Essential Surgery – Problems, Diagnosis and Management, Fourth Edition Figures 3, 8, 19, 20, 24, 29, 38, 44, 51, 55, 57, 61, 66 Cross: Underwood’s Pathology – a clinical approach, Sixth Edition Figure 54 Forbes and Jackson: Color Atlas and Text of Clinical Medicine, Third Edition Figures 18, 21, 22, 28, 32, 42, 45, 49A&B, 63, 67A&B, 68 Adam and Dixon: Grainger and Allison’s Diagnostic Radiology, Fifth Edition Figure 30 Henry and Thompson: Clinical Surgery, Third Edition Figure 17 Lim, Loke and Thompson: Medicine and Surgery – An integrated Textbook Figures 6, 7, 9, 10, 12, 14, 23, 25, 26, 31, 33, 37, 43, 46, 50, 59, 64, 65 Raftery, Delbridge and Wagstaff: Churchill’s Pocketbook of Surgery, Fourth Edition Figures 1, 13, 15, 34, 36, 39, 40, 41, 48 Swartz: Textbook of Physical Diagnosis: History and Examination, Sixth Edition tahir99 - UnitedVRG Figure 16 vip.persianss.ir HOW TO USE THIS BOOK This book has been written in three sections: Clinical Presentations, Biochemical Presentations and Haematological Presentations. In the Clinical Presentations section (Section A), we have attempted to indicate the relative frequency of the conditions causing the various symptoms and signs by colour coding them in green, orange and red, according to whether they are considered common, occasional or rare, respectively. l A common cause of the symptom or sign l Might occasionally give rise to the symptom or sign l Will only rarely cause the symptom or sign This has been no easy task (and indeed in the Biochemical Presentations and Haematological Presentations sections, we found it so difficult that we abandoned it) but we hope that it will indicate to readers whether they are dealing with a common, occasional or rare disorder. It is appreciated that some conditions may be common in the UK and rare in other parts of the world (and vice versa). Where this is the case, the appropriate colour coding is indicated in brackets, e.g. Campylobacter is a common cause of diarrhoea in the UK and therefore coded green but rare in tropical Africa and therefore coded red and in brackets. We have tried to indicate the importance of the condition, not only in causing a particular symptom or sign, but also in its overall incidence, e.g. diverticular disease is a common condition and is a common cause of pain in the left iliac fossa and is therefore coded green. It is only an occasional cause of large bowel obstruction and in this context, is coded