Category: Visual Diagnosis
Posted: 4/13/2015 by Haney Mallemat, MD
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Patient presents with leg and ankle pain after a fall 3 weeks earlier. Initial ankle Xrays were negative. Patient presents today with persistent leg and ankle pain. What's the diagnosis and what other imaging would you perform and why?
Proximal fibula fracture; have a high-clinical suspicion for a Maisonneuve fracture and consider CT scan of the ankle
Maisonneuve fracture
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Category: Visual Diagnosis
Posted: 4/6/2015 by Haney Mallemat, MD
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25 year-old male with the acute onset of right flank pain. Ultrasound of the right flank is shown. What's the diagnosis?
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Category: Visual Diagnosis
Posted: 3/30/2015 by Haney Mallemat, MD
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35 year-old male presents with increasing difficulty swallowing and tenderness in the floor of him mouth. What's the diagnosis?
Ludwig's angina
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Category: Visual Diagnosis
Posted: 3/23/2015 by Haney Mallemat, MD
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25 year-old male with autoimmune enteropathy presents with intractable vomiting and diarrhea for 7 days. What's the diagnosis?
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Category: Visual Diagnosis
Posted: 3/16/2015 by Haney Mallemat, MD
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How many abnormalities can you find below?
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Category: Visual Diagnosis
Posted: 3/9/2015 by Haney Mallemat, MD
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35 year-old female presents with acute leg pain and swelling. What's the diagnosis?
Phlegmasia cerulea dolens; there was extensive clot found in the left external iliac, common femoral, superficial femoral, and popliteal veins.
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Category: Visual Diagnosis
Posted: 3/2/2015 by Haney Mallemat, MD
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6 day-old child is brought in by parents with 1 day of reduced oral intake and 4 hours of rapid breathing. The child has no fever and no significant birth history. The child is tachycardic, hypotensive, and hypoxic. What’s the diagnosis?
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Category: Visual Diagnosis
Posted: 2/23/2015 by Haney Mallemat, MD
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45 year-old male complains of pleuritic chest pain following a "long" flight. What's the diagnosis and what's this sign called?
First described by Dr. Aubrey Hampton in 1940, hampton hump is a peripheral (pleural) based opacification found on chest X-ray; it occurs secondary to infarction of the lung
Although commonly associated pulmonary embolism it may occur secondary to other causes of lung infarction
Here are some other infrequent, but not rare signs, of pulmonary embolism on chest X-ray:
Category: Visual Diagnosis
Posted: 2/16/2015 by Haney Mallemat, MD
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Reference
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Category: Visual Diagnosis
Posted: 2/2/2015 by Haney Mallemat, MD
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Patient presents with right shoulder pain following minor trauma. What's the diagnosis....and what's the Cunningham technique?
Anterior shoulder dislocation
Cunningham Technique
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Category: Visual Diagnosis
Posted: 1/26/2015 by Haney Mallemat, MD
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Elderly male presents with the skin findings below. He is also on a medication for atrial fibrillation. What's the diagnosis?
Severe ecchymosis from coumadin overdose
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Category: Visual Diagnosis
Posted: 1/19/2015 by Haney Mallemat, MD
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60 year-old male presents with 6 months of weight loss,epistaxis, and increased headache when bending over. What's the diagnosis?
SVC Syndrome
Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). Jan 2006;85(1):37-42.
Nunnelee JD. Superior vena cava syndrome. J Vasc Nurs. Mar 2007;25(1):2-5
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Category: Visual Diagnosis
Posted: 1/12/2015 by Haney Mallemat, MD
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60 year-old male presents with rhinorrhea, body aches, and dry cough for two days. He recently moved here from Kentucky. What’s the diagnosis (please note that there are several differentials based on CXR)?
Answer Histoplasmosis
Histoplasma capsulatum is the fungus that causes histoplamosis, and is endemic to soil in the “Histo belt” of the U.S. (including all of Arkansas, Kentucky, Missouri, Tennessee, and West Virginia and parts Alabama, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Mississippi, Nebraska, Ohio, Oklahoma, Texas, and Virginia); it is found internationally as well.
Outbreaks have occurred following digging up the ground at construction at sites where this yeast lives in the soil, but spores can also become airborne and inoculate people.
Most cases are asymptomatic, but it is associated with a variety of pulmonary syndromes and can have extrapulmonary findings such as splenic calcifications. Disseminated disease typically occurs in immunocompromised patients
Treatment includes itraconazole for mild to moderate disease and amphotericin for disease that is severe or widespread disease.
Differentials:
- Blastomycosis
- Septic emboli
- Sarcoidosis
- Tuberculosis (milliary)
- Aspergillosis
- Carcinoid lung tumor
- Atypical or viral pneumonias
Category: Visual Diagnosis
Posted: 1/5/2015 by Haney Mallemat, MD
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A male patient presents with right lower quadrant pain. The ultrasound is shown at the point of maximal tenderness. The diameter of the structure (image on right) is about 0.94cm. What is this structure and what's the diagnosis?
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Category: Visual Diagnosis
Posted: 12/29/2014 by Haney Mallemat, MD
(Emailed: 12/30/2014)
(Updated: 12/30/2014)
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19 year-old male complaining of left arm pain one week after injecting anabolic steroids into his sholder. What's the diagnosis?
Myositis of the deltoid muscle
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Category: Visual Diagnosis
Posted: 12/21/2014 by Haney Mallemat, MD
(Emailed: 12/23/2014)
(Updated: 12/23/2014)
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Hand pain following fist versus face. What's the diagnosis and what nerve block would you use?
Boxer's fracture. Read more here.
Pain control can be achieved with an ulnar nerve block (e.g., reducation if if angulated). A video for the technique using ultrasound can be found here.
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Category: Visual Diagnosis
Posted: 12/15/2014 by Haney Mallemat, MD
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A patient is intubated for respiratory failure and the post-intubation CXR is shown on the left. 30 minutes later the patient desaturates and another CXR is obtained (the one on the right). What’s the diagnosis and what should you do?
Mucus plug
There are several conditions to consider when patients are having difficultly being ventilated. The approach to such a patient can be remembered with a mnemonic found here.
In this case, conditions to consider are:
Treating mucus plugs can usually be treated as follows:
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Category: Visual Diagnosis
Posted: 12/8/2014 by Haney Mallemat, MD
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Patient was found in a house fire and was given a certain medication in the Emergency Room. The patient’s urine turned this color (red), what’s the diagnosis?
Hydroxocobalamin (i.e., Cyanokit)
Cyanide toxicity
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Category: Visual Diagnosis
Posted: 12/1/2014 by Haney Mallemat, MD
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Patient presents with dyspnea. What's the diagnosis and name three potential causes (can be specific to the case or in general)?
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Category: Visual Diagnosis
Posted: 11/23/2014 by Haney Mallemat, MD
(Emailed: 11/24/2014)
(Updated: 11/25/2014)
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Patient with syncope and then falls down the stairs. What's the diagnosis? (hint: be very,very careful)
Right subdural hematoma and left subarachnoid hemorrhage
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