Category Archives: Image Challenge

Image Challenge of the Week!

A woman with longstanding diabetes comes to your clinic to establish care. On exam, you note the following skin lesions, which she notes has been present for several months. The lesions are non-painful and non-pruritic but are noted to have ulceration at sites of trauma.

necrobiosis lipoidica
Lancet. 2002 Oct 12;360(9340):1143

What is the diagnosis? Scroll down for answer.

Continue reading Image Challenge of the Week!

Image Challenge of the Week!

What disease is associated with this vitiligo-like depigmentation with sparing of the perifollicular areas?

salt and pepper pigmentation
Indian J Dermatol. 2013 Sep;58(5):406.

Scroll down for answer.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer:

Scleroderma as suggested by salt-and-pepper skin changes

Discussion:

Salt-and-pepper skin changes are characterized by skin depigmentation with sparing of the perifollicular areas. It is associated with scleroderma.

Another example shown in the New England Journal of Medicine is shown here:

nejm salt and pepper
N Engl J Med. 2017 Jul 13;377(2):173.

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.

Continue reading Image Challenge of the Week!

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.

Continue reading Image Challenge of the Week!

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!