Tuesday, January 31, 2017

Tooth Subluxation

A 27 year old male was seen in the emergency department following a trauma and bleeding from the mouth. On examination he was found to have teeth subluxation due to the trauma.

Tooth Subluxation. Note the presence of blood along the crevice of the gingival margin of both central incisors—an indication of subluxation following trauma. Mild displacement of the subluxated teeth is noted

Case Discussion: 
Tooth subluxation, the loosening of a tooth in its alveolar socket, is most commonly secondary to trauma; however, infection and periodontal disease may also produce subluxation.
Gingival lacerations and alveolar fractures are associated with dental subluxations. Gentle pressure to the teeth with a tongue blade or fingertip may produce movement, mild displacement, or blood along the crevice of the gingiva, all signs of subluxation.

Monday, January 30, 2017

Radiological Findings In Multiple Myeloma

An 87 years old male came to radiology department for X-ray chest with history of bone pains, lethargy and cough.

The above X ray shows generalized reduction in bone density with wide spread destructive foci. The lesions are more prominent and larger in size in the left clavicle and proximal part of humerus. In
view of destructive bone lesions, patient was subjected to X-ray skull.

Chest X-ray shows prominent and large size destructive foci in the left clavicle and proximal part of humerus (arrows). X-ray skull (inset) shows multiple wide spread osteolytic rounded circular
defects of varying diameter from 2 mm to 15 mm with no surrounding bone reaction or sclerosis. The disseminated or generalized form of plasma cell infiltration of bone marrow is known as multiple myelomatosis. It is much more common for the widespread form to present radiologically as a fully developed entity over 40 years of age. 
Men are affected twice as common as women. Persistent bone pain or a pathological fracture is usually the first complaint.

Clinical Discussion: The two cardinal features in multiple myeloma are generalized reduction in bone

Normal Fundoscopic Examination

Normal Fundus. The disk has sharp margins and is normal in color, with a small central cup. Arterioles and venules have normal color, sheen, and course. Background is in normal color. The macula is enclosed by arching temporal vessels. The fovea is located by a central pit.

Introduction. Fundoscopic examination should be a part of routine physical examination and it is important to know the normal findings in order to detect the abnormalities. Here a brief discussion is given about normal finding on fundoscopic examination.

Disk: The disk is pale pink, approximately 1.5 mm in diameter, with sharp, flat margins. The physiologic cup is located within the disk and usually measures less than six-tenths the disk diameter. The cups should be approximately equal in both eyes.

Vessels:The central retinal artery and central retinal vein travel within the optic nerve, branching near the surface into the inferior and superior branches of arterioles and venules, respectively. Normally the walls of the vessels are not visible; the column of blood within the walls is visualized. The venules are seen as branching, dark red lines. The arterioles are seen as bright red branching lines, approximately two-thirds or three-fourths the diameter of the venules.

Management Of Pressure Ulcers

A 85-year-old debilitated nursing home resident was found to have pressure ulcers. He has no evidence of bacteremia or osteomyelitis. Which of the following is an acceptable treatment?
A) Application of povidone-iodine gauze two times per day
B) Application of hydrogen peroxide 3 times per day
C) Systemic antibiotics for 7 to 10 days
D) Keeping the area clean and dry until granulation tissue forms
E) Surgical debridement

The answer is

Sunday, January 29, 2017

Neonatal Conjunctivitis - A Brief Discussion

Neonatal conjunctivitis is acquired either during birth with passage through the mother’s cervix and vagina, or from cross-infection in the neonatal period.

Etiologies: More common etiologies include Chlamydia trachomatis, viruses (herpes simplex), and bacteria (Staphylococcus aureus, Streptococcal pneumoniae, Haemophilus species).

Clinical Features: 

  • Presenting symptoms for Neisseria gonorrhoeae infection include a hyperacute bilateral conjunctivitis with copious purulent discharge, lid swelling, chemosis, and preauricular adenopathy.

            Thick purulent drainage in a newborn diagnosed with neonatal gonococcal conjunctivitis.

  • For chlamydial conjunctivitis, the clinical features range from mild swelling with a watery discharge to marked lid swelling with a red and thickened conjunctiva with a blood-stained discharge. 
  • Fluorescein staining of herpes simplex conjunctivitis demonstrates epithelial dendrites.
  • Blindness can result from gonococcal eye infection in the neonate because the organism can invade the cornea. It is one of the few emergency conjunctival infections.
  •  Nasolacrimal duct obstruction is common (up to 20%) in newborns and may present with findings suggestive of conjunctivitis. It is a diagnosis of exclusion in the neonate.

A Lipoma On The Chest Wall

A 54 years old male presents with a history of a large painless chest wall swelling on right side, which is there for the last seven years and has gradually increased in size. It was soft in consistency and non-adherent to the underlying ribs.

                                                 the swelling as seen from the back. 

An X ray chest was done which is shown below:

Chest X-ray shows a homogeneous soft tissue mass lesion without any calcification arising from the right lateral chest wall. The underlying ribs are normal; they show no erosion or pressure effect.

Diagnosis: History, clinical finding and X-ray chest are suggestive of lipoma.

Discussion: Ideally, CT is important as it provides a definitive diagnosis of lipoma but the patient

Saturday, January 28, 2017

Basilar Skull Fracture

Introduction: The skull “base” comprises the frontal bone, occiput, occipital condyles, clivus, carotid canals, petrous portion of the temporal bones, and the posterior sphenoid wall. A basilar skull fracture is basically a linear fracture of the skull base.

Clinical Features: Trauma resulting in fractures to this area typically does not have localizing symptoms.
Indirect signs of the injury may include visible evidence of bleeding from the fracture into surrounding soft tissue, such as a Battle sign or “raccoon eyes.” (see picture shown below)

Battle Sign. A striking Battle sign is seen in this patient with head trauma. This finding may take hours to days to develop.

Bleeding into other structures—including hemotympanum or blood in the sphenoid sinus seen as an air-fluid level on computed tomography (CT)—may also be seen. Cerebrospinal fluid (CSF) leaks may also be evident and noted as clear or pink rhinorrhea. If CSF is present, a dextrose stick test may be positive. The fluid can be placed on filter paper and a “halo” or double ring may be seen.

A 38-year-old man presents with rapid hair loss that has occurred over the last few weeks.

A 38-year-old man presents with rapid hair loss that has occurred over the last few weeks. He reports that his father had a similar condition.
The picture is shown below:

The most likely diagnosis is
A) Alopecia areata
B) Androgenic alopecia
C) Tinea capitis
D) Trichotillomania
E) Secondary syphilis

The answer is

X ray Chest Showing Fracture Of The Left Clavicle.

A 56 years old female came to radiology department for X-ray chest with history of hypertension and pain in chest. She had a history of fall few days back but came to medical attention today.

Her X ray is shown below:

Description: X-ray chest shows normal lung fields. The examination of the film is not complete until the bones and soft tissues have also been surveyed. There is a fracture through the mid diaphysis of left clavicle with overlap of the bony fragments.

Clinical Discussion: Once the fractures of the clavicle is seen on X-ray chest,

SARS- Severe Acute Respiratory Syndrome -- Charts

A Brief Description Of Burns

A burn is defined as any damage to the body's tissues caused by heat, chemicals, electricity, sunlight, or radiation. 
Scalds from hot liquids and steam, building fires and flammable liquids and gases are the most common causes of burns.
Burns are characterized by severe skin damage that causes the affected skin cells to die.

Types Of Burns: There are three types of burns:
  • First-degree burns damage only the outer layer of skin
  • Second-degree burns damage the outer layer and the layer underneath
  • Third-degree burns damage or destroy the deepest layer of skin and tissues underneath.
There is also a fourth-degree burns. This type of burn includes all of the symptoms of a third-degree burn and also extends beyond the skin into tendons and bones.

Clinical Features: Burns can cause swelling, blistering, scarring and, in serious cases, shock, and even death. They also can lead to infections because they damage your skin's protective barrier.
  • In first-degree burns: red, nonblistered skin
  • Second-degree burns: blisters and some thickening of the skin
  • Third-degree burns: widespread thickness with a white, leathery appearance

Friday, January 27, 2017

Poland Syndrome- A Rare Congenital Disorder.

A 13 years old male came to radiology department for X-ray chest with history of cough for one month. His X- Ray is shown below:

Description: Chest X-ray  shows relative translucency of left hemithorax (or increased whiteness of right hemithorax) with mild scoliosis and pseudodextrocardia.

A CT scan was advised which is shown below:

Description: CT chest shows deficient muscle mass (pectoralis major muscle) in left hemithorax (white arrow) as the cause of abnormal X-ray chest and was diagnosed as Poland’s disease. The pectoralis muscle mass is normal on right side (black arrow).

Case Discussion:

Poland Syndrome: In Poland’s syndrome the etiology is not known and is described as an absence or hypoplasia of the pectoralis muscle on one side of the body with cutaneous syndactyly (webbing of the fingers) of the hand on the same side. Rib anomalies may also be associated.
It is a rare congenital condition.

Description Of Common Injection Sites

A Patient With Black Discoloration of The Tongue

You are examining a a patient and discover the findings seen on the picture above. Which of the following conditions is this associated with?
A) Prolonged antibiotic use
B) Sjogren’s syndrome
C) Addison’s disease
D) Chronic gastroesophageal reflux
E) Malignant melanoma

The answer is

Monday, January 23, 2017

Guinea worm disease (Dracunculiasis) - A Rare Case

A 36 years old male came to radiology department for X-ray chest with history of cough since one week. His X ray shows a rare finding in which the lung fields are clear, however, there are a string
like linear high density calcified guinea worms in the right axillary soft tissues. The X ray is shown below:

X-ray right knees (shown below) was done which shows calcified guinea worms in the soft tissues of the distal posterior aspect of thigh.

Case Discussion: Transmission of dracunculiasis has been eradicated all over the world except only a few African countries. Man acquires infection by drinking water containing infected cyclops. In the stomach these cyclops are digested by gastric juice and the parasites are released.

Measles - A Quick Review -- Charts

Sunday, January 22, 2017

A Young Woman Presents With Painful Ulcers On Her Lower Lip

An 18-year-old sexually active woman presents with a two small ulcers located on the lower lip which are painful. She is a smoker and has noticed that the ulcers have been recurrent and correlate with the onset of menses. The most likely diagnosis is
A) Kawasaki disease
B) Aphthous stomatitis
C) Squamous cell carcinoma of the lip
D) Syphilis
E) Koplik’s spot

The answer is

Seroma Chest Wall.

A 17 years old male was operated for a left lateral chest wall lesion which on histopathology was a benign cystic lesion.
On 3rd postoperative day the patient developed a gradually increasing swelling under the sutures
on left chest wall without pain or discharge and there was no fever.  The swelling is shown in picture below:

He was sent for a chest X ray and it is shown below;

Chicken Pox -- Charts

Sprengel Deformity As Seen On Chest X Ray

A 25 years old male came to radiology department for X-ray chest with history of cough over few days. His X ray is shown below:

Comments On the Above X ray: Chest X-ray shows Sprengel deformity on left side, 2nd dorsal vertebra is hemivertebra with bilateral 3rd and 4th bifid ribs on both sides.

Sprengel deformity is failure of descent of scapula secondary to fibrous or osseous omovertebral connection; it may be associated with Klippel- Feil syndrome, renal anomalies, and webbed neck. It results in elevation and medial rotation of scapula. It may be associated with Gorlin basal cell nevus syndrome.

Clinical Discussion:

Hypertensive Retinopathy. -- Charts

Thursday, January 19, 2017

Chest X Ray Showing Depressed Sternum (Pectus Excavatum)

A 48 years old male came to radiology department for X-ray chest with history of cough over several days. His chest X ray is shown below:

X-ray chest PA and lateral view show depressed sternum or pectus excavatum (arrow), otherwise lung fields are clear.

Discussion: Pectus excavatum or depressed sternum is a congenital condition in which the sternum is caved-in along with the ribs and on X-ray chest the heart may be a little more on right side because of rotation. It can be present at birth. It is also known as cobbler’s chest, sunken chest or funnel chest.
In this, the anterior ribs being more vertical and the posterior ribs being horizontal than normal.

Common Drug Antidotes - Chart

Seborrheic Keratoses- Management

                                             Seborrheic keratoses seen in an Elderly man 

An 82-year-old nursing home resident is seen on monthly rounds. The floor nurse points out the skin lesions shown here. The patient is asymptomatic. Appropriate management includes
A) Punch biopsy
B) Topical 5-fluorouracil cream
C) Cryotherapy
D) Hydrocortisone cream
E) Observation

Answer: The answer is E. (Observation)

Discussion: Seborrheic keratoses are common skin lesions that affect the elderly. They tend to run in families. The average diameter is 1 cm, but they can grow to 3 cm in diameter. The lesions are brown or black, oval in shape, raised, and have a “stuck on” appearance.

Wednesday, January 18, 2017

Calcium Antagonist - Mnemonic

Costochondral Calcification Seen On Chest X-Ray

A 64 years old male came to radiology department for X-ray chest with history of cough and cold.

The X- Ray is shown below:

1. Describe the radiological signs in the above given X ray?

Answer: X-ray chest shows normal lung fields with normal cardiac configuration. Calcification of upper and lower margins of costal cartilages is seen.

2. Comment and Explain the calcification of the costal cartilages?

Congestive Heart Failure - Signs And Symptoms (Mnemonic)

A 16-year-old girl who just returned from a camping trip reports an intensely pruritic vesicular rash.

A 16-year-old girl who just returned from a camping trip reports an intensely pruritic vesicular rash. The most likely diagnosis is
A) Rhus dermatitis
B) Lyme disease
C) Chigger bite
D) Brown recluse spider bite
E) Black widow spider bite

The answer is A. (Rhus dermatitis)


Monday, January 16, 2017

Simplified Approach To Reading Chest X- Rays.

A good understanding of normal anatomy and variations is essential for the interpretation of chest
radiographs.Here is given a simplified approach to reading chest x -rays.
Most commonly the chest x rays are in a PA (posterio anterior) view in which the X-ray beam first
enters the patient from the back and then passes through the patient to the film that is placed anterior to the patient‘s chest. It uses 80–120 kV and focus film distance of 6 feet.

                                                 A Normal Chest X-Ray (PA view)

                                     A Chest X-Ray (PA view) showing Mediastinal Borders

On a PA film, lung is divided radiologically into three zones: