Category Archives: Image Challenge

Image Challenge of the Week!

Shown below is the chest film a patient with allergic rhinitis and hyperlipidemia on atorvastatin presenting with cough and shortness of breath.

reverse pulmonary edema
Postgrad Med J. 2015 Jul;91(1077):411-2.

What is the classic descriptor of the above chest film and the associated differential diagnosis? Scroll down for answer.

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Image Challenge of the Week!

What is the appropriate treatment for the following finding? What are the complications of delaying or lack of adequate treatment?

staghorn-calculus
Case courtesy of Dr Natalie Yang, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a&gt;. From the case <a href=”https://radiopaedia.org/cases/9733″>rID: 9733</a>

Scroll down for answer.

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Image Challenge of the Week!

A patient presents with the following purpura of several months’ duration with minimal trauma. Platelet count, protime, and partial-thromboplastin time were normal. He takes no medications.

Periocular purpura
Lancet. 2014 Jul 19;384(9939):257.

He has a history of carpal tunnel and recently diagnosed heart failure with preserved ejection fraction.

What diagnosis should be considered in this patient? Scroll down for answer. Continue reading Image Challenge of the Week!

Image Challenge of the Week!

You are leading physical diagnosis rounds with your medical students and encounter a patient with the following finding:

Mechanic's hands
J Am Acad Dermatol. 1998 Dec;39(6):899-920

On closer examination, the skin appears hyperkeratotic with fissuring on the palmar and lateral aspects of the fingers.

What is this finding and classic associated disease states? Scroll down for answer. Continue reading Image Challenge of the Week!

Image Challenge of the Week!

This week’s image challenge is inspired by a recent case presented at Morning Report by Dr. Mehwish Ismaily.

A 68-year old white man is brought in by his daughter for a month of progressive fatigue, fever, headache, and chills. Over the past week, he has become progressively encephalopathic as characterized by disorientation to time and place. He has no past medical history and is not on any medications. He is gainfully employed, lives in Texas, is monogamous with his wife, does not use illicit drugs. He hunts deer. On exam, he is febrile, oriented only to self, is without rash, and has no focal weakness, cranial nerve deficits, or hyperreflexia. Laboratory data is notable for thrombocytopenia, mild leukopenia with left shift, mild transaminase elevation, and mild lactate dehydrogenase elevations. Serum chemistries are otherwise normal. His serum haptoglobin and bilirubin are normal. Thyroid studies are normal. Lumbar puncture was performed after platelet transfusion. This demonstrated lymphocytic pleocytosis and mild CSF protein elevation. The patient was empirically covered with central nervous system dosing of vancomycin, cefepime, ampicillin, and acyclovir with minimal improvement in symptoms over the next two days. Manual evaluation of peripheral blood smear was obtained and the following abnormality was identified. These were described as punctate, deep-blue spherules arranged in a group within a granulocyte. No schistocytes were seen.

Morula ehrlichia
Mod Pathol. 2004 May;17(5):512-7.

 

What is the above finding and in what diseases can they be seen? Scroll down for answer.  Continue reading Image Challenge of the Week!

Image Challenge of the Week!

An 18-year old patient presents to your clinic to establish care. On head and neck exam, you note the following lesions on her tongue and lower aspect of her eyelid:

neuroma
BMJ Case Rep. 2013; 2013: bcr2013201080.
neuroma eyelid
BMJ Case Rep. 2013; 2013: bcr2013201080.

Histologic evaluation of these lesions demonstrate tortuous, abnormal enlargements of nerves at submucosal sites.

neuroma histo
Acta Neuropathol. 2012 Mar; 123(3): 349–367.

Other exam findings include a long thin face, high arched palate, high arm span to height ratio at >1.05, and pes cavus.

What is the suspected diagnosis? Scroll down for answer?

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Image Challenge of the Week!

This week’s image challenge is inspired by a recent case encountered by Dr. Dharam Kumbhani and Dr. Justin Grodin in our Division of Cardiology.

Shown below are simultaneous pressure tracings in the left ventricle and the ascending aorta as well as a rhythm strip. Note the ectopic beat followed by the hemodynamic abnormalities that follow. What is this finding called? What is the associated condition?

BBM
N Engl J Med 1994; 331:238

Scroll below for answer.

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