IMPACT FACTOR: 2.1
Short Name: J Clin Images
ISSN: 2690-8662
Publisher: MedDocs Publishers LLC
Enter cutaneous fistulas constitute one of the most complicated problems that the surgeon must face and involves the application of knowledge such as fluid and electrolyte management, metabolic and nutritional support, and complex diagnostic and surgical techniques [1,2].
Penile calciphylaxis is an extremely rare disease. It affects the penis by the build-up of intimal fibrosis and medial calcifications of the small arteries and causing gangrene of the tissue. It is frequently seen in patients with uncontrolled diabetes and end stage renal failure.
A 24 years old female presented with intermittent headache of one year duration. Otherwise, she has no other pertinent history. There is well defined hypodense fat attenuating, curvilinear, pericallosal lesion with lobulated surface (yellow arrow in figure 5).
An 11-year-old girl presented with alteration of consciousness, fever, and cachexia. Her Glasgow coma score was E2V1M4. Both pupils were dilated and sluggishly reactive to light. Nuchal rigidity was found. Chest X-ray showed bilateral infiltration, and sputum AFB test was positive. An initial CT scan of the head revealed massive hydrocephalus without any obvious obstructive lesion. Immediate
Since decades panoramic x-rays and lateral cephalograms are Conventional Orthodontic Radiographs (COR). Lately, cone beam CT (CBCT) is becoming increasingly popular, but is still highly debated due to its higher radiation exposure when compared to COR.
A 28 -year-old unmarried promiscuous bisexual man with a history of HIV infection for past 2 years on triple drug regimen Efavirenz / Emtricitabine / Tenofovir Disoproxil Fumarate but highly irregular, now on anti-tuberculosis drugs for pulmonary tuberculosis for past 4 months, presented with linear pigmented band on right middle finger nail for past 8 months.
A 34-year-old woman presented with a giant, painless tumour of the right breast that had been growing rapidly for three months. Physical examination showed evident asymmetry of the mammary glands with a right breast measuring 35 x 40 cm. There were two lumps and haemorrhagic ulcerations on the external part associated with orange peel skin (Figure 1 a and b).
On a normal lung ultrasound, the gas present in the airways and alveoli is a poor ultrasound conductor. Thus, the imaging window does not extend deep into the thorax. However, if ultrasound conductive pleural fluid is present, the ultrasound beam is able to penetrate deep into the thoracic cavity allowing visualization of the thoracic vertebrae.
Left Ventricular Non-Compaction (LVNC) is a congenital cardiomyopathy characterized by an alteration of myocardium structure secondary to incomplete embryogenesis. Usually the Left Ventricle (LV) is dilated and hypokinetic with a spongy appearance of the myocardium, consisting in protruding trabeculae separated by crypts, located at the apex and lateral wall [1].
Introduction: The frozen section procedure is a pathological laboratory procedure to perform rapid microscopic analysis of a specimen. It is used most often in oncological surgery. The technical name for this procedure is cryo-section.
Purpose: To evaluate associations between the therapeutic outcomes of lenvatinib for advanced Hepatocellular Carcinoma (HCC), and Diffusion Weighted Imaging (DWI) and Intravoxel Incoherent Motion (IVIM) Magnetic Resonance Imaging (MRI) parameters.
A 44-year-old male, non-smoker, with no previous medical comorbidities, presented to the otorhinolaryngology department with 3 days history of severe sore throat, acute odynophagia, fatigue, and poor oral intake. Oral examination revealed no abnormality in his oropharynx. However, the laryngofiberscopic findings showed erythematous and white coating from the epiglottis laryngeal surface of the epiglottis to the arytenoid and pseudo vocal folds.
A destroyed elbow with severely limited-without function and/or pain in adolescents can be treated by resection arthroplasty but not always the results are satisfactory like espected, because joint surfaces remain painful, incongruent and instable. The question should be: could be reasonable to implant a prosthesis?. We refer three cases treated in this manner considering other alternatives not available.
Spinal cord injury (SCI) patients are susceptible to an increased risk of intraurethral catheter balloon inflation due to diminished sensation below the level of their injury. A 65-year-old male was admitted to the intensive care unit following polytrauma. He sustained numerous injuries including complex, multilevel lower thoracic spine fractures, with complete spinal cord injury.
The patient was born full term to a then 21yo G2P1 (1001) mother via spontaneous vaginal delivery, with no noted feto-maternal complications. At one-month-old, the patient had acholic stools and dark urine, as well as generalized jaundice and abdominal enlargement.
A 62-year-old man with a history of poorly controlled diabetes mellitus presented with left loin pain of 2 weeks’ duration, initially misdiagnosed as ureteric colic, and failed to respond to the traditional non-steroidal anti-inflammatory drugs. The patient continues to experience lancinating and burning pain, primarily on the left loin, and he reported feeling pain even with a light touch of the clothes.
Increased transaminase levels are frequently detected in patients with Coronavirus disease 19 (COVID 19) and are associated with worse outcome. The association with abdominal radiological signs and severity grading, however, remains to be elucidated. Our aim was to evaluate the long term effects of COVID 19 infection on liver ultrasound features and in particular on liver steatosis and liver stiffness (LS).
A six-month-old female patient was admitted to the hospital due to history of vomiting with blood streaks in the past month. CBC showed a hemoglobin level of 9.4, trombocitosis of 1.000.000 and no other signs of infection. Mild inspiratory stridor was noted on admission and the pediatric otorhinolaryngology team was called for evaluation.
Normal Pressure Hydrocephalus (NPH) is a pathology preferentially affecting an elderly population. Sleep apnea syndrome (SA) is a pathology that alters venous circulation by altering intrathoracic pressure during sleep. Phase-Contrast MRI (PCMRI) allows a quantitative analysis of craniospinal hemohydrodynamics and an analysis of the interactions between arterial blood, venous blood volume exchanges and cerebrospinal fluid (CSF) oscillations. We present the case of a patient with NPH-like symptomatology associated with AS.
Bladder amyloidosis is a heterogeneous disease. The AL protein is the most common bladder amyloidosis type and familial aggregation in AL-type had not been described until now. Patients with bladder amyloidosis diagnosed at our hospital between 1990 and 2022 were included.
Intra-cycle motion correction (SnapShot Freeze, SSF, GE Healthcare) has been an invaluable tool to correct for coronary motion in cardiac CT data acquired from a single rotation. Recently, a second-generation intracycle motion correction algorithm (SnapShot Freeze 2, SSF 2, GE Healthcare) has been introduced which provides wholeheart motion correction – including both coronary motion as well as motion in other cardiac structures (e.g., valves, chambers, great vessels). The purpose of this study was to evaluate the performance of this algorithm in correcting for motion across the cardiac structures.
We report a 64-year-old Chinese male with locally advanced gastric adenocarcinoma achieving a significant reduction of tumor after neoadjuvant chemotherapy with transcatheter left gastric artery and gastroduodenal artery infusion chemotherapy combined with systemic chemotherapy, which showed promising efficacy and acceptable toxicity...
For the past 8 months, a 38-year-old HIV-positive male patient has complained of right knee swelling, dull aching, and limitation of movement (Figure 1 A). For the previous six years, he had been taking antiretroviral medications (tenofovir, lamivudine, and efavirenz). His CD4+ T cell count was 450 cells per litre, with a viral load of 556 copies per millilitre...
A 5-year-old boy presented with complaints of fever, pain abdomen for 1 month and periorbital rash for 7 days. Symptoms were preceded by poor weight gain over the last 6 months and recent weight loss of 2 kgs. The periorbital rash was bilaterally symmetrical, violet tinged, non-pruritic with visible thin veins and the vision was un-affected with no scleritis, had no similar rash elsewhere on the body. Family and past history was normal...
A 47-year-old patient, without any particular pathologic antecedents was admitted to our hospital for a change in optical correction. On the biomicroscopic examination, we noticed two lacrimal meatus on the lower eyelid of the left eye (Figure 1). Verification of the lacrimal ducts demonstrates that the external point is functional and communicates with the lacrimal sac, while the second internal meatus is not communicating with the lacrimal sac...
Sarcomatoid carcinoma describes a heterogenous group of Non-Small Cell Lung Carcinomas (NSCLCs) with malignant potential and features that suggest sarcomas. We report on a case of sarcomatoid (giant cell) carcinoma that went into remission after only two-doses of pembrolizumab. The patient is an asymptomatic 86 year old male with a past medical history significant for adenocarcinoma of the prostate on enzalutamide who was noted to have an incidental mass at the right lung base which was noted during work-up for another incidental renal cell mass that was subsequently evaluated as benign...
The patient is a 58-year-old female with no significant past medical history who presented with left neck swelling to her primary care physician. Physical examination was significant for left neck cervical adenopathy. Initial imaging showed bilateral cervical adenopathy and the patient was referred to Medical Oncology. She underwent excisional biopsy of a left sided cervical lymph node that showed the nodal architecture was effaced by a small lymphocytic proliferation...
This case report is a rare situation seen on diagnostic imaging. It is about the anatomical description of a preterm sacciform dilatation (black arrow) fed by a feeder artery (green arrow), and drained by a draining vein (blue arrow) in a 36-year-old woman, who was diagnosed as an arteriovenous malformation on angio-CT scan...
Xanthogranulomatous pyelonephritis is a chronic granulomatous process from chronic infection resulting in an incomplete immune response. We present a classic case of xanthogranulomatous pyelonephritis in an adult cerebral palsy patient as a result of recurrent urinary tract infections and renal stones.
Pericardial effusion is an infrequent (5% to 24%) initial presentation of patients with Hodgkin’s Lymphoma. The underlying pathophysiology is thought to be due to impedance of lymphatic and venous return from mass effect in the mediastinum or pericardial metastasis[1]. Lymphomas especially, can block the lymphatic channels in the visceral pericardium which combine to form a single outlet for drainage at the aortic root [2,3]...
Takayasu Arteritis (TA) is a rare chronic inflammatory vascular disorder, which is prevalent in the Asian population. TA is predominantly seen to affect large arteries of the body, of which subclavian arteries also commonly bear this insult. In this distinctive case, a young patient, presented with gradually progressive pain in the left upper limb. Arterial doppler showed 90% stenosis of Right Subclavian Artery (RSA) with triphasic flow of the mid-RSA...
A 29-year-old man with a history of mesenteric thrombosis, non-lithiasic pancreatitis and autoimmune disease (hepatitis, internal ear involvement, probable vasculitis) under immunosuppressive therapy, was admitted to the hospital with a 3-week history of fever, significant weight loss, anorexia, night sweats and abdominal pain.
A 56-year-old female from Ukraine presented with enlarging mass on her left cheek. Mass had appeared one year ago and significantly increased in size over the last three months. Physical exam demonstrated a large, friable, firm, exophytic mass, 8-10 cm in size on the left cheek with surrounding erythema extending up to eyelid and nasal ala. There was no palpable lymphadenopathy. On CT neck with contrast, mass was seen to extend from left maxillary sinus to the left anterior mandible measuring 8.8 cm...
Percutaneous Left Atrial Appendage (LAA) occlusion for non-valvular atrial fibrillation has become the standard of care in patients with an elevated CHA2DS2-VASc score and with contraindications to anticoagulation. Given the hypercoagulable state (in the setting of atrial fibrillation) and the absence of anticoagulation, there is a high proportion of patients with pre-existing or developing thrombus in the LAA...
Lymphoma is the general name for many related subtypes of cancer that arise from a type of white blood cell called a “lymphocyte.” Lymphoma is divided into two major categories: Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL).
NHL is progressive clonal expansion of B cells or T cells and/or NK cells arising from an accumulation of lesions affecting proto-oncogenes or tumor suppressor genes, resulting in cell immortalization leading to accumulation in the lymph nodes.
A 3-year-old girl was referred to the Emergency Room (ER) of Brookdale Hospital Medical Center, NY for an evaluation of suspected lead intoxication. She was found to have venous blood lead level 37 mcg/dl on a routine well child visit. There was no history of abdominal pain, constipation, vomiting, anemia, intellectual disability, seizures, and encephalopathy. She lives with parents and 2 siblings in old NYC city apartment...
Allergic responses to stinging vary from localized cutaneous reactions to systemic anaphylaxis. Systemic allergic responses to insects are attributed to IgE (immunoglobulin E) antibody -mediated responses, which are caused primarily by stings. Systemic reactions are identical to anaphylaxis from other triggers and may include symptoms of generalised urticaria, laryngeal edema, bronchospasm and hypotension...
An 83-year-old man was diagnosed with stage IIIA follicular small-cleaved cell lymphoma in June 2021. Treatment with rituximab x 4 weekly was initiated. Routine CT scanning was obtained in August 2021 to determine response to treatment. A right-sided indirect inguinal hernia was encountered at this time, which had not been present upon prior examinations...
In recent years, the incidence of toxicity from nitrous oxide abuse, also known as “whippet” or “laughing gas”, has increased significantly. Nitrous oxide use can lead to vitamin B12 deficiency resulting in disabling neurological complications. We are presenting the case of a young man and his wife who were hospitalized with progressive paresthesia and gait instability...
This is a case about a 60 years old female that presented with seizures, troponins leakage and prolonged QT on Electrocardiogram (ECG). On further investigation, she turned out to be hypocalcaemia secondary to hypoparathyroidism. She was administered calcium and vitamin D supplementation orally, which saw the QT segment returning to normal with cessation of any further episodes of seizures and troponins leakage...
A 77-year-old woman was diagnosed with advanced cancer of the pancreatic head. At staging, she had locoregional lymph nodes involvement and several liver metastases. No treatment was started. Two months later, she presented to the emergency department with a 3-day history of nausea and vomiting. She was not only unable to eat but also to drink. Clinical examination revealed considerable painless abdominal distention but was otherwise unremarkable...
A 44-year-old man presented to the emergency department after falling down and hitting his neck directly to the shaft of a tractor. He complained of hoarseness, odynophagia and difficulty breathing. On physical examination, he had normal vital signs. His neck was swollen without crepitus, stridor or pharyngeal erythema. Cervical ultrasonography revealed soft tissue swelling on the left aryepiglottic fold and decreased mobility of the left vocal cord (Figure 1 and video 1)...
Background: Dilatation of the Inferior Vena Cava (IVC) is used as the ultrasonic diagnostic feature in patients suspected of congestive heart failure. The IVC diameter has being reported to vary among the various Body Mass Indexes (BMI) and Body Shape Indexes (ABSI). Knowledge of these variations is useful in precision diagnoses of CHF by imaging scientists...
The coronavirus disease 2019 (COVID-19) pandemic was declared by the World Health Organization on 11th March 2020. The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing the disease was mainly associated with pulmonary manifestations. But according to the neuroinvasive properties of prior coronaviruses and the similarity of neuropsychological conditions, it appears that patients can develop injurious long-term cognitive events post-COVID-19 infection...
Introduction: Jaundice is when clinically there is an increase in the amount of bilirubin in the serum rising above 85mmol/l (5mg/dl). When in utero, unconjugated bilirubin is cleared in the placenta to produce cord serum bilirubin of approximately 35mmol/L (2mg/dl). After birth, jaundice is a reflection of the bilirubin present in the liver, the rate of hepatic excretion and the ability to bind to serum proteins to retain the bilirubin present in the plasma...
Background: Dilatation of the Inferior Vena Cava (IVC) is used as the ultrasonic diagnostic feature in patients suspected of congestive heart failure. The IVC diameter has being reported to vary among the various Body Surface Area (BSA) Knowledge of these variations is useful in precision diagnoses of CHF by imaging scientists.
Pathological Skin Picking (PSP) is a disabling disorder characterized by dysfunctional, repetitive, and compulsive picking of the skin that causes physical injury [1]. The medical sequelae of this type of body-focused repetitive behavior can include lesions, localized infections, septicemia, scarring, tissue damage requiring plastic surgery and even potentially life-threatening outcomes [2-4]. Moreover, significant functional, social, and emotional impairment frequently accompany this disease...
Background: The coronavirus infection ravages the World for a second year now, with millions of people infected many of whom lost their lives. It is well known that SARS-CoV-2 affects predominantly the respiratory system but other organs and systems, including the cardiovascular system, could also be damaged. Analyses indicate that in almost all critically ill patients (98%) and in a large proportion of those who were not in critical condition (78.3%) an alteration of the myocardial function is observed...
A 73 year old man with a history of bradycardia with prior pacemaker implantation, mitral regurgitation with prior bioprosthetic mitral valve replacement, tricuspid valve repair, non-ischemic cardiomyopathy and recurrent pleural effusions was admitted from clinic due to worsening fatigue, abdominal distension, and leg swelling. Upon arrival, he was fluid overloaded on exam with markedly elevated B-type natriuretic peptide (3317 ng/dL).
Hodgkin lymphoma represents 10% of all lymphomas, with nodular sclerosis subtype being the most common. Direct involvement of the central nervous system as a complication of Hodgkin lymphoma is rare, it has been described in 0.5% of patients, indirect involvement can manifest itself as paraneoplastic, infectious or inflammatory
58-year-old-male presented to the emergency department with an injury to his non-dominant left ring finger. Patient slipped off a stool in his garage, instinctively reaching with his left hand to prevent falling. The ring on his ring finger became rigidly caught on a shelf, and the downward force of body weight resulted in a 360o avulsion, Urbaniak Class III (Panel A and B)...
A 48-year-old male presented with bilaterally painful protruding eyes and reducing vision over last few weeks. On examination there was proptosis, lid retraction, chemosis and exposure keratopathy. Visual acuity was reduced to finger counting in both eyes. Biochemically he was hyperthyroid.
After a diagnosis of Graves' ophthalmopathy intravenous methylprednisolone was started followed by bilateral orbital decompression. After initial improvement the eye disease relapsed when another course of methylprednisolone was subsequently followed by rituximab due to lack of response to steroids...
COVID-19 is characterized in some patients by a strong dysregulation of the host’s immune system, which lead to an exaggerated hyperinflammatory response [1,2]. About 20% of patients develop severe manifestations and 5-10% require mechanical ventilation and admission to an Intensive Care Unit (ICU) [1,3]. As the pandemic progresses and the number of cases increases, other symptoms besides the respiratory ones have become relevant. Dermatological symptoms are not an exception.
A 33 year old male patient had severe covid-19 pneumonia. Mechanically ventilated and hospitalized for 48 days and discharged 3 weeks ago. Patient presented with noise breathing. On examination biphasic stridor was present. Computed Tomography (CT) neck was done showed focal narrowing of the trachea at T2-T3 (thoracic spine) level; stenotic segment measures 20milimeter (mm) in length and lumen 6X6mm at the narrowest part...
A 26-year-old male presented to the emergency department after motor vehicle accident. Multiple abrasion wounds were noted over bilateral elbows, hands, knees. He also complained mild limited range of motion of right wrist and swelling. Right wrist X-ray revealed uneven articular surface of 5th carpometacarpal joint (Figure 1) and Computed Tomography (CT) was subsequently performed (Figure 2).
Dentinogenic ghost cell tumor is a rare benign but locally aggressive neoplasm characterized by biphasic morphology consisting of a predominant ameloblastomatous proliferation and a less prominent component of basaloid to stellate reticulum cells. The tumour characteristically contains aberrant keratinization, with a variable number of ghost cells and material morphologically resembling dentinoid or osteodentin. DGCT is the rarest of the ghost cell lesions, accounting for < 3% of all cases...
A 32-year-old man with a history of intravenous heroin use presented with altered mental status, facial asymmetry, and left-sided dense hemiplegia. He was subsequently found to have an acute right middle cerebral artery stroke. Multiple blood cultures on admission grew Enterococcus faecalis. A Transesophageal Echocardiogram (TEE) showed a unicuspid- unicommisural aortic valve with thickening suggestive of vegetation, associated with severe regurgitation...
A 65-year-old male with extensive history of tobacco use (50-pack-year) presented with progressively worsening shortness of breath and cough. He worked in a factory where he was involved in grinding metals. In addition, he reported possible exposure to asbestos in the past at a previous job. Computed Tomography (CT) chest with contrast showed asymmetric nodular thickening of pleura, along with parenchymal nodules, most prominently involving the right upper along with mediastinal and lymphadenopathy...
A 24-year-old female with active tuberculosis presented to the ED with worsening respiratory symptoms, rapid weight loss, and chronic constipation. She had no recent solid PO intake and did not recall her last bowel movement. She appeared significantly cachectic with a BMI of 10kg/m2. Patient had a scaphoid abdomen with no localized distension or tenderness. She was ultimately found to have multi-organ failure secondary to disseminated tuberculosis; as well as stercoral colitis...
A 33-year-old female with no past medical history presented with a 3-month history of cough, slowly progressive dysphagia, and recent onset noisy breathing. The patient denied any loss of weight, hematemesis, or family history of malignancy. Physical exam was notable for mild inspiratory stridor and was otherwise unremarkable. CT neck showed a smooth hypodense fatty mass extending from the hypopharynx into the cervical esophagus. The radiological appearance of the mass was consistent with a lipoma...
A 42-year-old male was transferred to the intensive care unit from a peripheral ER, after he was intubated emergently for respiratory distress, at night. History was limited on arrival. Initial CXR showed complete opacification of left hemithorax with mediastinal shift (Figure 1). CT chest showed complete filling of left hemithorax by a heterogenous mass (Figure 2, notice density similar to liver tissue). Interpretation of these radiological findings was puzzling in the absence of history and medical records. Next morning, we were able to obtain patient’s medical records...
A 53 year old female presented with complains of fever, vomiting, and right sided flank pain. She has been diagnosed as type 2 diabetes mellitus one month back. On admission to hospital she had leukocytosis with WBC of 17800 per cubic percubic millimeter. The blood urea nitrogen 108 mg perdeciliter, creatinine 6.2 mg per deciliter, C-reactive protein level 37.8 mg per deciliter. Her abdominal radiography (Figure 1) revealed gas collection in the renal parenchyma and computed tomography (Figure 2) revealed air fluid level in parenchyma and perinephric space of right kidney...
A 45-year-old non atopic woman with persistent asymptomatic i.e non itchy dermographism since childhood was referred for evaluation of urticaria of 9-month duration specifically occurring on cold-exposed areas, associated with pharyngeal dysesthesia triggered by contact with cold beverages or food. She reported cold weather-related occurrence of pruritus with linear lesions, but failed to remember whether the lesions appeared or not on scratched areas...
A 56 years old woman presented for a routine checkup in medicine OPD. There were no symptoms suggestive of any underlying disease. Her physical examinations were also normal. Hematological, biochemical investigation reports were within normal limit. Ultra-sonogram of whole abdomen showed a mass in the upper abdomen adjacent to left lobe of the liver. Differentials were accessory left lobe of liver, left adrenal mass, carcinoma of the colon...
A 62-year-old man was hospitalized for stenosing esophageal neoplasia. He was started on Peripheral Parenteral Nutrition (PPN) through left basilic vein, while waiting for prosthesis placement. During the night, a large amount of nutrition overflowed. The following day, he presented with exuberant inflammatory signs of the entire left upper limb, with tense vesicular lesions, with a serous content, and areas of clean base epidermolysis and regular borders...
This imaging case is about a rare case of Aorto-pulmonary window [1] and anomaly of the origin of the left pulmonary artery trunk, discover on Angio-CT scan in a 29 years old woman.
The Axial view of the Angio CT-scan showed a communication between the ascendant Aorta and the pulmonary artery trunk (Figure 1).
Background: Ectopic pregnancy is a common condition, with a reported incidence of approximately 2% among all pregnancies [1], Fallopian tubes represent the most involved implantation's site (>98%). However, advanced ectopic tubal pregnancy is uncommon, and might be life-threatening [2].
Case presentation: A 40 years women presented to the emergency department with abdominal pain and a history of irregular menstrual cycles. Upon physical examination, she had stable vital signs with abdominal tenderness...
Iatrogenic aorto-coronary dissections following Percutaneous Coronary Interventions (PCI) represent rare but potentially life threatening complications. If procedural complication is clinically, suspected Computed Tomographic (CT) angiography is a very helpful diagnostic and follow-up tool. We present a case of iatrogenic type a dissection successfully diagnosed and treated intraprocedure with his CT angiography correlation and follow-up.
Chronic Unilateral Hematuria (CUH) is defined as unilateral hematuria seen on flexible cystoscopy with normal standard biochemical and radiological investigations. An 18-year-old gentleman was referred to our department for unilateral painless CUH secondary to mid and distal ureteric telangiectasia. He was a smoker but did not have a personal or family history of cancer or bleeding diathesis.
Chronic Unilateral Hematuria (CUH) is defined as unilateral hematuria seen on flexible cystoscopy with normal standard biochemical and radiological investigations. An 18-year-old gentleman was referred to our department for unilateral painless CUH secondary to mid and distal ureteric telangiectasia. He was a smoker but did not have a personal or family history of cancer or bleeding diathesis.
37 years male operated for pleomorphic adenoma superficial lobe of right parotid gland. Facial nerve identified at stylomastoid region. Nerve lie 1cm deep and inferior to tragal pointer. 1- Temporal branch, 2- zygomatic branch, 3a-superior labial branch, 3b-inferior labial branch, 4- marginal mandibular nerve, 5-cervical branch.
A 4-year-old girl was brought with history of global developmental delay, failure to thrive, and generalised tonic seizures and myoclonic jerks from age of 1 year. She had bilateral cataracts aspirated at the age of six months and an atrial septal defect detected at the age of 1 year. On examination, she had microcephaly with severe wasting and stunting. Dysmorphic facies with low set ears, short nasal bridge with upturned nostrils, long philtrum and short neck were noted...
A female term newborn was admitted to the neonatal intensive care unit in her first 24 hours of life due to cyanosis and respiratory difficulty. On physical exam, she weighed 3.8 kg, was 50 cm long, had a heart rate of 170 beats per minute, a respiratory rate of 48 breaths per minute, central cyanosis with 82% saturation on room air, a hyperdynamic right sternal impulse, an intensified split second sound, and a systolic murmur at the right sternal border...
A 53-year-old asymptomatic male presented with a fracture and aspiration of his polyvinyl chloride (portex) tracheostomy tube, diagnosed on X-ray (Figure 1) and CT scan (Figure 2). A therapeutic transoral bronchoscopy was not possible due to glottic carcinoma. The foreign body was removed under sedation using a rigid bronchoscope introduced through the tracheostomy stoma. The 8 cm long fractured piece of tracheostomy tube was removed in toto (Figure 3) without any complications and the patient had an uneventful postoperative recovery.
A 71-year-old man, hospitalized for bilateral pneumonia due to COVID-19 infection. His condition was improving with corticotherapy and oxygen therapy but, on day 16 of his hospital stay, the patient presented right pleuritic chest pain. Lung Ultrasound (LUS) showed a pleural-based, echo-poor triangular consolidations of at least 1 cm with a central hyperechoic structure consistent with a pulmonary infarct, surrounded by a pleural effusion with punctiform internal echoes mobile and whirling in real-time...
A 67-year-old male patient who was circumcised was admitted to our national institute of oncology with a scrotum mass. His medical history revealed no multiple sexual partners or sexually transmitted disease, or previous surgery. He was on regular medical treatment for cardiopathy disease. Physical examination revealed an 8 cm budding ulcerative mass located in the left testicle extended to the base of the penis Figure. Their examination had shown also, multiple warts scattered across...
A 55-year-old gentleman, psychiatrist by profession, presented with burning micturition, decrease in urine output and generalized weakness of 1-week duration. There was no associated fever or flank pain. He had diabetes and hypertension for last 15 years and had history of urinary tract infection one-year back. Imaging studies revealed gas collection in the renal parenchyma, and gas and fluid collection in perinephric space of the left kidney..
Exophthalmos is a protrusion of the eyeball in front of the orbit linked to an increase in the content of the orbit. Several causes can be at the origin of an exophthalmos. Tumor of the lacrimal glands is one of them. According to V Francerie and al, they represent 5% of the tumor causes of exophthalmos, far behind lymphomas which represent 18% [1]. The scanner has a role in etiological research.
A 32-year-old man presented to the Emergency Department (ER) with a whiplash injury. He was thrown, following a traffic accident, by his right arm and landed on top of his head. The patient has no significant medical history or a history of head or neck trauma. The physical examination revealed a conscious young man with a rigid cervical collar in place. The vital signs were all within normal limits. His head was atraumatic.
This is a 63-year-old male with his right eye diagnosed as Primary Open Angle Glaucoma (POAG). He underwent a complete ophthalmologic examination, Visual Field (VF) testing by standard automated perimetry, Spectral-Domain optical coherence tomography imaging and Optical Coherence Tomography Angiography (OCTA) imaging.
A 70-year-old woman who had surgery for peptic ulcer disease (40-years ago), presented with a 3-year history of progressive dysphagia for solid foods and 20 kg weight loss. Examination revealed a weight of 50 kg, conjunctival pallor, glossitis, and koilonychia. Her haemoglobin concentration was 7.7 g/dL (normal range: 10.5-15.0 g/dL) and mean corpuscular volume was 61 fL (normal range: 81-96 fL).
A 53-year-old female and her 20-year-old daughter presented with neck pain after a traffic accident. They were diagnosed with a cervical sprain injury. Radiography of the neck incidentally revealed bilateral cervical ribs on the seventh cervical vertebra in both patients.
A 41-year-old male, with no prior medical-surgical history, presented to the emergency department for total hematuria following a wheel-crushing trauma to a wagon with a lumbar impact point. On admission, he was in good general condition with a blood pressure of 120/70 mmHg, a heart rate of 87 beats per minute, but he had left lumbar ecchymosis and total hematuria.
A 57-year-old patient presented to the radiotherapy simulation consultation for a large tumor of the frontal, nasal and left palpebral region, rapidly increasing in volume. A biopsy was done in favor of moderately differentiated and infiltrating squamous cell carcinoma.
A 73-year-old man with history of basal cell carcinoma of the right eyelid was brought to the emergency department after being found unresponsive at home by a neighbor. He was diagnosed seven years ago with locally advanced BCC which was resected. The patient had an 8-month period of no growth. Recurrence prompted chemo and radiation treatment, to which the cancer was refractory.
83-year-old woman, with known chronic rotator cuff rupture in the left shoulder, presented at our department with a tumefaction over the Acromioclavicular Joint (ACJ) that appeared 3 months before. Physical examination revealed a soft, rounded and slightly compressible nodule, without inflammatory signs and she had restriction on active range of movement of the shoulder which elicited pain.
A 54-year-old developmentally delayed male exhibiting aggressive eye rubbing behavior presented to the Wills Eye Hospital comprehensive ophthalmology clinic for an eye examination. The patient had a known history of keratoconus and diabetes. Due to behavioral limitations, we were unable to determine the patient’s visual acuity in the outpatient clinic.
A 58 years male patient presented with history of colicky right abdominal pain since 3 months, along with history of intermittent jaundice. On examination patient was hemodynamically stable, per abdomen was soft non – tender and no distension. Per rectal was normal. Laboratory findings showed evelated ALP-189 (42-128 U/L), previous bilirubin was 4.7 but on presentation it was normal.
Pictured here are subcutaneous nodules of the right lower extremity of a 74-year-old patient with a past medical history of prostate cancer and Freon inhalation since his mid-30’s. These nodules have been sporadically and progressively enlarging since the patient first noticed them in 2010. They are non-tender and have no associated overlying skin changes aside from dry skin and resulting pruritus.
A 75-year-old woman with a past medical history of hypertension was referred because moderate effort dyspnea, Right Bundle Branch Block (RBBB) and frequent supraventricular premature beats. Cardiac Magnetic Resonance (CMR) revealed a dilated RV (iEDV 97ml/m2) with normal ejection fraction (RVEF 64%), and without Atrial Septal Defects (ASD). By phase contrast sequence we obtained a Qp: Qs=2:1 (augmented).
27-year-old male with musculoskeletal features of Marfan syndrome presented to Surgery Outpatient Department for abdominal pain. On investigation he was found to have multiple intestinal diverticula without any complications. He was managed for his symptoms. He also had other features like high arch palate. Thumb sign in Marfan syndrome is because of combination of hypermobility of thumb and longer thumb than usual. Similarly, Wrist sign is because of thin wrist and loner fingers.
Pyoderma Gangrenosum (PG) is a rare neutrophilic dermatosis which exhibits an intense dermal inflammatory infiltrate composed mostly of neutrophils with little or no evidence of primary vasculitis. The condition is diagnosed clinically as there are no specific serologic or histologic markers. Typically, it presents as a superficial ulceration of the pretibial region of the legs. We present the case of a patient where a chronic leg ulcer preceded the diagnosis of a chronic myeloproliferative disorder.
A 54 year old man with past medical history of chronic alcohol abuse, who presented to the ER with sudden onset of hematemesis and altered mental status, visual and auditory hallucinations suggesting a possible delirium tremens. On physical examination the patient was hypotensive and somnolescent. Laboratory studies showed severe hyponatremia, hyperkalemia, and hypomagnesemia.
A 25 year old lady with 32 weeks of twin pregnancy came to the Gynecology and Obstetric department at Owaisi Hospital, Hyderabad for regular antenatal checkup in August 2019. She was asked to take up Ultrasound Growth scan. On ultrasound it showed discordant growth of the twins. Antenatal doppler was suggestive of twin B demise.
Male patient aged 78 with no relevant medical history who attends because of right rib pain after accidental trauma. Thoracic CT shows a Bochdalek diaphragmatic hernia, which is the reason of absence of left kidney in its natural position, perirenal fat and mild left basilar subsegmental atelectasis. The absence of respiratory symptoms and preserved renal function, a conservative attitude was chosen.
A 35-year-old man presented with a 10 years history of headache, excessive sweating and growth of extremities. He doesn’t have snoring, any visual complains or any weakness. Examination revealed typical facial dysmorphism with coarse features, large lips, frontal ridges, separated teeth and prognathism (Figure 1, 2 & 3), fingers and toes appeared large and broad (Figure 4), visual and systemic examination was normal.
61 year-old Caucasian Male presenting with rectal bleeding, tenesmus, anasarca, intermittent confusion found to have metastatic rectal adenocarcinoma to liver, possible small lung metastatic subcentimeter nodules and marked parenchymal replacement by infiltrating metastatic liver disease seen on PET/CT. Subsequent NGS testing revealed KRAS/NRAS wild type tumor.
Cervical paragangliomas are rare and generally benign tumors. Their incidence is low between 1/30000 and 1/100000. Two clinical forms are individualized: carotid paragangliomas don’t have an encounter with carotid dissection and vaginal paragangliomas willingly parapharyngeal and with high basal cranial extension.
Pancreatic lipomas are rare non-ductal mesenchymal tumours. With the recent advances in imaging more of these are getting identified and reported even though the actual incidence is till controversial. These are intriguing incidentalomas with their detection completely dependent on the radiologist. We report a case of an incidentaloma of the pancreas which proved to be a classical lipoma on subsequent imaging.
A 9-year-old girl was started on induction chemotherapy for Pre-B Acute lymphoblastic leukemia. 2 weeks into treatment she developed fever and hematemesis. Computerized Tomographic scans (CT) of sinus, chest and abdomen demonstrated esophagitis, colitis and pancreatitis, else unremarkable. Esophageal biopsy showed numerous fungal yeast and hyphae.
An interesting atypical case of aortic dissection, patient presented with severe right flank pain as the main presenting symptom, good history taking identified the sudden onset tearing character of the pain, risk factors and associated symptoms, with the help of investigations the diagnosis was more clear, medical treatment started immediately but unfortunately the outcome was bad.
Neurofibromatosis is a clinically heterogeneous neurocutaneous genetic disorder characterized by coffee-milk spots, Lisch’s iris nodules, freckles in the armpit or groin and multiple neurofibromas. A 70-year-old woman comes to visit for a reported generalized skin blemish.
Hydatid cyst disease is an endemic infestation caused by Echinococcus Granulosus parasite, it is a public health problem in mediterranean region, liver and lungs are affected sites of predilection but muscle localization is very rare. A 38-year-old female presented with painless swelling of right gluteus region, ultrasonography demonstrated a large subcutaneous multivesicular hydatid cyst measuring approximately 150 × 110 mm.
A 27-years-old female was referred to the neurological clinic for evaluation due to difficulty in walking by psychatric service. Depressive symptoms had started 3 months before the neurological complaint associated with visual hallucinations. The patient’s neurological examination showed space and time disorientation, normal muscle tonus and muscle strength.
Guillain-Barre Syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy characterized by rapidly progressive paresis and sensory disturbances. Laparoscopic Sleeve Gastrectomy (LSG), used of morbid obesity, is the standard surgical treatment method for Bariatric Surgery (BS).
Eccrine porocarcinoma is a rare type of adnexal carcinoma with a proclivity towards the intraepidermal portion of the eccrine sweat gland and most commonly affects the lower extremity. This malignant tumor typically grows slowly and may arise de novo or evolve from a pre-existing benign eccrine poroma.
We report an infrequent case of focal myocardial calcification in an asymptomatic 56-year-old male, with controlled arterial hypertension and hypercholesterolemia, there was no history of impaired calcium metabolism, or impaired renal function. Although the different study methods were negative for myocardial infarction, it could be classified as idiopathic, however, we thought it would be a diastrophic calcification mechanism, as explained in the description.
It is a malformation of the ears with bilateral deafness in a 10 days old newborn. A petrous scanner with fine section and in double fenestration was carried out, having shown several malformation anomalies, let us quote: hypoplasia of the two pavilions of the two ears or microtia grade III, which are well represented by volume reconstruction, as well as the absence of external acoustic meatus.
A 16-year-old girl was taken in charge, presenting a symptomatology characterized by history of oligomenorrhea, recurrent episodes of colic-type pain with the presence of hematuria. On clinical examination, the patient was awake and oriented, symptomatic for diffuse abdominal pain, even with irradiation in the back, especially from her localized in hypogastric level, well breathing and apyretic. Tender abdomen, painful while palpating.
A 62-year old woman presented with recurrent attacks of fainting to neurology department at the Azadi Teaching Hospital in Duhok, Iraqi Kurdistan for the previous two month. She had no remarkable history of medical or surgical conditions. The physical examination revealed sinus rhythm of 82 beats per minute.
A thirty-year-old woman had bilateral LASIK surgery for moderate myopia (3 Diopters) two months ago without any problem. She recovered excellent vision the day after and had artificial tears and antibiotics drops for one month after the surgery. She was asked not to do any sport and not to rub her eyes for one month.
A 41-year-old man, 21 pack/year smoker, weaned two years ago, immunocompetent, presented an ulcerative, hemorrhagic and necrotic tumor, 25 cm in diameter of the right axillary region. The tumour is accompanied by homolateral, white, painful, bucket-grasping edema of the right upper limb, with difficulty in mobilizing the fingers, without sensory deficit.
A 37-year-old female with a history of a Roux-en-Y gastric bypass and intussusception presented to the emergency department with two weeks of constipation and one week of non-bloody, nonbilious vomiting. She had not passed flatus or a bowel movement for one week.
Li Zhuxian, 78 years old, Chinese woman, got admitted to the hospital with the complain of pain, swelling and restricted movement in the right lower limb for about 8 hours. The patient stated that she fall down from the bed carelessly in the morning, thereafter she was suffering from the pain, swelling, restricted movement also Dark coloration of skin on the affected site.
Li Tingxin, 26, is a Chinese female. In 11 years she got admitted in the hospital for several times because of “repeated left femoral fracture with deformity and limited activity”. The patient was diagnosed as osteogenesisimperfecta and multiple skeletal malformations.
Mrs Afroza, 48 years old, housewife came to the outpatient department with a 3 days history of central chest pain & the pain was also radiating to left shoulder & neck. She is diabetic (type 2) for last 8 years & hypertensive for 13 yrs & she was pre-echlamptic during her first pregnancy.
A 57-year-old male patient, former smoker, native of Misiones (Argentina), was presented to the Emergency Department of the Clinical Hospital of Buenos Aires, Argentina, with a worsening oxygen requirement, chronic cough, shortness of breath and vomiting of 1 week of evolution. He suffered from stage 3-4 squamous cell carcinoma of the tonsil since 2 years, treated with chemotherapy with paclitaxel, 5FU, cisplatin).
Double ureter is the result of early splitting of the ureteric bud into two parts before penetrating the metanephric blastema causing partial or sub-total duplication of ureter. It can be complete or incomplete duplication. A prevalence of 0.1% to 4% has been reported in literature.
A 37-year-old man without any symptoms was found to have an abnormal shadow on chest X-ray. While the abnormal shadow had been found a year earlier, he didn’t visit a hospital. Compared to the image taken a year before, the lesion had not progressed rapidly.
Pinworm at base of appendix from a 14-year-old boy admitted with abdominal pain for presumed appendicitis. Pinworms are a parasite of the roundworm family Enterobius vermicularis (EV) and are the most common worm in the UK. Up to 40% of school children will suffer with this parasite infection at some time in their lives.
A 55-year-old male presented with inflammatory polyarthritis of one month duration. He had history of inflammatory low back pain for 25 years, and intermittent inflammatory arthritis of various joints for 12 years, with each episode occurring every two years, involving one or two joints and lasting for about three weeks. He was using intermittent analgesics for back pain, and alternative therapy during arthritis episodes.
It’s a 36 years old female patient treated 7 years ago for an osteochondroma of the upper third of the left humerus by surgery alone. She was under follow-up since then. Five months ago, she presented a mass in the same previous location. CT scan showed a localy advanced tumor of the left humerus.
Dengue is an infectious disease caused by dengue virus, belonging to the genus flavivirus and transmitted by mosquitoes, mainly Aedes aegypti. The disease is in three stages: Feverish, critical and recovery.
A 69-year-old man known case of diabetes mellitus, hypertension and chronic kidney disease presented to the hospital emergency with dizziness and slurred speech. The patient undergone brain computed tomography and lateral medullary infarction was revealed in the imaging.
A 70-year-old right-handed female presented with slowly progressive blurred vision in the last four years. She had difficulty walking downstairs as each step appeared at the same level. The level of the steps became more apparent when applying color label tapes on the steps.
A 37 year old Indian male, non smoker, teacher by occupation presented to the out -patient department with a 15 day history of pleuritic chest pain, fever and dry cough. He had no significant past medical illness, tuberculosis contact or a history of weight loss.
A 70 years old man, consulted for management of lesion on the right temporal level. The dermatological examination found a 3 cm ulcerous budding tumor on the right temporal level, surmounted by yellowish scaly skin. Histology had confirmed a metatypic basal cell carcinoma. we report a new dermoscopic image of basal cell carcinoma.
This study reports the case of a 32-year-old white woman (IV gravida/III para) diagnosed with the rectus sheath hematoma during caesarean section (C-section). Before being referred to the antenatal ward, she was initially admitted to the medical ward at the gestational age of 33 + 0 weeks with pulmonary embolism and was treated with the anticoagulant tinzaparin. She was then referred to the antenatal ward at 33 + 3 weeks with severe right-sided abdominal pain for ruling out the pregnancy-related complications which could cause the pain.
During an upper gastrointestinal series to evaluate for gastric outlet obstruction, a 79-year-old man aspirated barium sulfate contrast which was visualized in the right lung. Testing was aborted and he was managed conservatively. He remained stable and without respiratory symptoms until hospital discharge.
Urethral bulking agents are a recommended treatment option for women with uncomplicated Stress Urinary Incontinence (SUI). They are particularly used in women where other surgical procedures, such as a mid-urethral sling or colposuspension are not appropriate or acceptable to the woman.
There has been a resurgence in use of autologous fascial slings following the Food and Drug Administration ban on the use of synthetic mid-urethral slings for the management of stress urinary incontinence. Three-Dimensional Endovaginal Ultrasound (3D EVUS) is a validated technique that can be used to map the full distribution of synthetic mid urethral slings in real time.
Supernumerary nipples or polythelias are frequent malformations of mammary tissues. They can be hereditary or occur sporadically. They are sometimes associated with congenital diseases, namely cardiac, vertebral, central nervous system and dental abnormalities. We report a case of sporadic supernumerary nipples in a 16-year-old boy...
A 26 years-old women, without any pathological history, admitted to the emergency after appearance of itchy lesions on the eyebrows after application of “Harkous” a plant used for tattooing eyebrows...
A 30-year old woman, was evaluated for a pruritic erythematous lesions on the right distal extremitie that was occured one day after a stay in a hotel in Paris causing sleep disturbance. She was otherwise healthy...
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