Extrammamary pagets disease, vulva
EMPD is histologically identical to PD of the nipple. It is characterized by white, hyperkeratotic plaques on a erythematous background.
Extrammamary pagets disease, vulva
EMPD is histologically identical to PD of the nipple. It is characterized by white, hyperkeratotic plaques on a erythematous background.
Fat embolism, petechial rash
These occur classically after fractures of long bones and present clinically with respiratory distress, fever, tachycardia tachypnea. A distinguishing feature from respiratory distress syndrome or pulmonary contusion, at least on exams, is the characteristic petechial rash on the chest. Fundoscopy and urine may also show evidence of fat embolism in the form of intra-arterial fat globules or fat droplets respectively.
Sail sign, CXR
In infants, the thymus is very large organ relative to the thoracic cavity and its radiographic shadow may be mistaken for cardiomegaly or pulmonary infiltrate. The thymus continues to grow until puberty, when it atrophies. It is a primary immune organ involved in T cell differentiation and thus cell mediated immunity. Thymic aplasia occurs in DiGeorge syndrome.
Trichinosis, muscle biopsy
Trichinosis is a parasitic infection secondary to consuming undercooked pork. The condition manifests in three phases; (1) the ingested larvae penetrate the intestinal wall, causing nausea, vomiting, diarrhea and abdominal pain (2) as the larvae migrate a systemic hypersensitivity response occurs in the form of conjunctival hemorrhages, periorbital edema, splinter hemorrhages (don’t confuse for infective endocarditis) and chemosis. (3) the last phase occurs when larvae invade skeletal muscle causing muscle pain and weakness. CBC may show eosinophilia.
Serous otitis media
SOM occurs when auditory tube obstruction causes middle ear effusion with no infectious signs or symptoms. The tympanic membrane appears dull, hypomobile and sometimes is retracted as shown in the image. An air-fluid meniscus may also be seen. SOM commonly occurs in HIV patients with lymphadenopathy induced eustachian tube obstruction.
Iron poisoning, abdominal x-ray
Iron poisoning presents with GI symptoms (nausea, vomiting, hematemesis, diarrhea) due to the iron induced damage to the GI mucosa. Toxic iron levels also cause hypoperfusion (veno/capillary dilation) and mitochondrial damage, both causing a metabolic acidosis. Since iron tablets are radio-opaque they can be seen in the stomach on AXR. Diagnosis with serum iron levels and treat with an iron chelator such as deferoxamine.
Nursemaid elbow, x-ray
NE (or babysitter’s elbow, pulled elbow, radial head subluxation)occurs when the radial head slips under the annular ligament and is displaced downward. This ligament is weaker in children and consequently increases the risk of radial head subluxation, as seen in the image. NE is a common childhood injury that occurs when a child’s arm is pulled up and out. Classic history is a child with no history of trauma who suddenly refuses to use one arm, though bilateral cases can occur. The joint can typically be easily reduced and should result in an immediate return to normal function.
Ichthyosis vulgaris
IV is a common inherited skin disorder. it presents with normal skin at birth with progression to severely dry, scaled skin that worsens in the winter. It is inherited in an autosomal dominant pattern.
Retinal detachment occurs when the retinal layer separates from the surrounding tissue. It can occur after ocular trauma, such as cataract surgery. Patients often report a sensation of flashing lights (photopsia) which occurs as the detached layer tugs on the neural plexus. Floaters are often reported as debris is kicked up into the humor. Classically patients report the sensation of a curtain coming down across their field of vision. Laser and cryotherapy can be used to create permanent adhesions between the separated layers.
