04.04.2022: The image shows a unilocular cyst with a smooth and even inner wall, containing an abundance of spherical sebaceous and hair-like structures (Image 1). It was removed in toto and entirely without rupture. A preoperative sagittal CT scan of the pelvis showed a large, unilocular cystic mass in the left ischioanal fossa, giving rise to minor cranial displacement of the levator ani muscle (Image 2). The lesion was 16.3 × 9.8 × 8.8 cm in size. Postoperative histological examination revealed a cyst covered in squamous epithelium with underlying hair follicles with arrector pili muscles as well as...

26.07.2021: This X-ray shows the knee of a teenage boy with multiple, transverse, sclerotic (white) bands in the tibial and femoral metaphyses. The patient has similar bands in several other joints. He has been diagnosed with osteogenesis imperfecta type 1 and has been receiving treatment with intravenous zoledronic acid (bisphosphonate) for five years. Each of the transverse bands corresponds to a treatment cycle/injection of bisphosphonate. More frequent injections result in shorter band intervals. The bands are most common in the metaphyses, but can also occur in the epiphyses and apophyses. The...

24.06.2021: This X-ray radiograph of the left elbow shows elevation of the fat pads as a sign of joint effusion (marked with asterisks), but no visible fracture or luxation. A thin strip of reduced subchondral bone density can be seen in the ventral capitulum (black arrow); on the CT scan, this strip corresponds to several small gas bubbles in the same location – the so-called vacuum phenomenon. The articular contour of the ventral capitulum is also irregular. These findings are typical of Panner's disease. The images are from a girl of late kindergarten age who was brought to the doctor after four days...

01.02.2021: The image shows a longitudinal fracture in the body of the hamate with subluxation of the fifth carpometacarpal joint in a man in his forties after a fall. Hamate fractures are rare, accounting for about 2–4 % of all carpal fractures (1). Diagnosis and treatment are often delayed because clinical findings are limited and the fracture may be difficult to detect on conventional X-ray images. CT is therefore recommended in the case of continued pain in the ulnar region of the wrist following a negative X-ray (1, 2). Fractures are divided into fractures of the body and of the hook. Injuries are...

07.01.2021: The picture shows a divided melanocytic naevus along the margins of the upper and lower eyelid of a teenage boy. He was referred because of two congenital pigmented naevi located opposite to each other, laterally on the right eyelids. During his childhood and adolescent years, they had gradually grown larger and caused cosmetic problems, discomfort with foreign body sensation, and stickiness of the eyelids. The naevi were therefore removed surgically under general anaesthesia by means of a full-thickness pentagonal excision of both the upper and the lower eyelid. A histological examination...

11.12.2020: The X-ray shows a ring of circular foreign bodies inside the abdomen of a one-year-old child. The patient had been admitted with a two-day history of vomiting. Clinical examination revealed mild abdominal tenderness but no rebound tenderness. Blood tests were normal, with the exception of mild hypochloremic alkalosis and CRP of 25 mg/L (reference range 0–4 mg/L). The patient's mother was shown the X-ray and thought that the object in question might be magnetic beads belonging to a sibling. The patient underwent laparotomy. A ring of magnetic beads was found in the small intestine about 70 cm...

26.10.2020: The dermatoscope is the dermatologist's stethoscope. It is used for diagnosing pigmented lesions, benign and malignant tumours and inflammatory dermatoses, and in connection with infestations. The dermatoscope may also be useful to general practitioners, amongst other things for scabies diagnosis (1, 2). A scabies mite is 0.2–0.5 mm in diameter. It burrows a track in the epidermis, in the stratum corneum, where it lays its eggs. Both mite and burrows are easily visualised with a dermatoscope which provides x 10 magnification. Once we have found a possible or definite scabies track under the...

26.10.2020: The image shows microscopy of a scabies mite – Sarcoptes scabiei. It was extracted with a dental probe from a scabies track on a patient. Several generations of family members were infected. A total of about ten persons were treated according to the current guidelines of the Norwegian Institute of Public Health (1). The incidence of scabies in Norway is increasing sharply, with a tripling of the number of cases diagnosed in general practice from 2012 to 2018 (2). This tendency is continuing, and has been reported from all over the country. Scabies can be seen in all age groups, but most...

20.08.2020: The picture shows an infant with clearly yellow skin along with a relative with normally pale skin. A three-month-old child was referred to the paediatric department by a health centre clinician owing to yellow-coloured skin. The paediatrician who attended to the patient found an apparently healthy child with yellow skin and pale sclerae (photo). Serum bilirubin was 12 µmol/l (reference < 20 µmol/l). The child had been fully breastfed with normal weight gain. Stools and urine were normal in colour. It was concluded that the child was healthy and no diagnosis was made. At six months of age, the...

01.07.2020: The image on the left shows a blood smear with normal neutrophil granulocytes, stained with May-Grünvald-Giemsa stain. It was taken from a patient with COVID-19 on the day of admission. The image to the right was taken five days later and shows that all the granulocytes have developed a notably abnormal morphology. A few days later, the cell image had normalised again. Today's haematology instruments are programmed to identify a number of abnormal findings in blood cells. When abnormal morphology is detected, the instrument will prepare and stain blood smears and perform automated cell...

06.01.2020: This brain MRI was taken 24 hours after lumbar puncture and intrathecal injection of an MRI contrast agent (0.5 ml gadobutrol). The patient was undergoing tests in the neurosurgical department owing to a suspected cranial cerebrospinal fluid leak. However, no leak could be detected in either the image taken after 24 hours or those that had been taken previously. In this image, which is based on T1-weighted MRI, we have used a colour scale to visualise the percentage increase in signal intensity in brain tissue as a result of contrast enhancement. The image shows that a small and water-soluble...

18.11.2019: The image and video show a striking phenomenon that can occur during contrast-enhanced ultrasound of the liver. A man was referred for contrast-enhanced ultrasound-guided biopsy of a suspected liver metastasis. After the biopsy, the liver was scanned with conventional greyscale ultrasonography (high acoustic energy). An echo-rich/light wave then emerged that seemed to roll back and forth through the hepatic tissue. The similarity to the northern lights was striking. Contrast medium that is administered intravenously contains numerous bubbles of gas that are roughly equal in size to blood cells...

28.10.2019: This image shows paradoxical brain herniation in a patient with known renal failure, hypertension and coronary artery disease who had undergone a hemicraniectomy a few months earlier. Paradoxical brain herniation is a rare, and potentially life-threatening, complication following removal of a large area of the skull. One of the roles of the skull is to protect the brain from the difference in intracranial pressure relative to atmospheric pressure. In larger craniectomies, the atmospheric pressure may exceed the intracranial pressure, causing displacement of underlying brain tissue and, at...

23.09.2019: A previously healthy girl of junior school age visited an ophthalmologist because of reading difficulties and an increasing number of "homework errors" that were due to small, rapid, horizontal eye movements that occurred when she focused her gaze in order to concentrate. A clinical examination revealed bilateral, rapid, horizontal nystagmus with near focusing that disappeared with distance focusing. The patient had neither double vision nor other eye motility disorders. An MRI examination revealed a contrast-enhancing mass corresponding to the posterior horn of the right lateral ventricle...

28.01.2019: Foreign bodies in the urinary bladder are generally introduced via the urethra, through a puncture or migration from neighbouring organs. It is essential to consider foreign bodies in the urinary bladder as a rare cause of pain and inflammation in the bladder region (1, 2). A boy of primary school age from an African country was referred to the paediatric outpatient clinic soon after his arrival in Norway. It emerged that two years previously, he had been seriously injured by a bomb explosion in his home country. Following this accident, he had severe pain when urinating and passing stools. He...

30.11.2018: Massive infestation of the large intestinal roundworm (Ascaris lumbricoides) in the small bowel may cause mechanical ileus when a large quantity of worms forms a cluster and obstructs the intestinal lumen. A ten-year-old boy was admitted as an emergency patient to a hospital in a poor region of Nepal. He had significant growth retardation, and had suffered from stomach pain, vomiting and a distended abdomen for the previous three days. He had not produced any stool but had excreted two live roundworms per rectum. Erect abdominal x-ray (x-ray image) showed distended intestinal loops (arrow 1)...

15.11.2018: The thalamus is normally supplied with blood on both sides by small branches leading from the ipsilateral posterior communicating artery, as well as P1 and P2 segments of the posterior cerebral artery. The most frequent cause of injury in the thalamus is thrombosis in parts of the posterior cerebral artery. In 1973, the French neurologist Gérard Percheron (1930–2011) described a rare anatomical variant in which a single trunk from the posterior cerebral artery supplies medial parts of the thalamus and ventral parts of the mesencephalon bilaterally (1). This anatomical variant is called the...

10.10.2018: A woman in her late thirties was hospitalised owing to cough and dyspnoea. She had previously been examined by her general practitioner, who suspected bronchial asthma. Upon admission, she was judged to have infection-induced asthma exacerbation, and antibiotic and anti-obstructive treatment were initiated. Shortly afterwards she developed severe respiratory failure, and was intubated and transferred to the intensive care department of a university hospital. Owing to difficulty in achieving adequate mechanical ventilation, veno-venous extracorporeal membrane oxygenation (ECMO) was started...

14.08.2018: Eagle syndrome, also known as stylalgia, is a rare pain syndrome associated with an elongated styloid process or calcified stylohyoid ligament. A previously healthy woman in her thirties developed a paroxysmal, painful and spasmodic sensation in the left side of her neck, throat and face with accompanying global headache and ipsilateral tinnitus. She also had pain and numbness in the ipsilateral half of the tongue, but no hearing loss, dysphagia or dysphonia. Her symptoms first appeared following repetitive weightlifting. The symptoms were triggered and exacerbated by leaning or rotating the...

26.06.2018: Spontaneous pneumomediastinum is an uncommon but benign and self-limiting condition that most often presents with chest pain, sometimes combined with dyspnoea, in young men. Chest radiography is usually sufficient for the diagnosis, and further diagnostic procedures are generally not necessary. Spontaneous pneumomediastinum is usually caused by alveolar rupture resulting from a sudden increase in the thoracic pressure, where the air dissects along the bronchovascular structures into the mediastinum. The precipitating factor may be forceful coughing or retching but pneumomediastinum may also...

12.06.2018: A man in his early seventies attended the accident and emergency department with chills and reduced general condition. His temperature was 40.6 °C, and blood tests showed a CRP level of 115 mg/l (< 5) and leukocytes 12.9 . 108 (4.1–9.8 . 108). Two days before, he had undergone electrical cardioversion due to atrial fibrillation, the onset of which occurred five days before the event in question. This condition was already known, but the patient had been symptom-free since an ablation was performed two years previously. Due to clinical suspicion of pneumonia, a chest x-ray was performed (see x...

18.05.2018: A previously healthy woman in her sixties attended the Accident and Emergency department after four days with discomfort and tenderness under her right breast. The skin under the breast tightened whenever she moved her shoulder. Palpation revealed a taut, subcutaneous cord-like induration that extended vertically from the lower part of the right breast to the right side of the abdomen, level with the umbilicus. When the Accident and Emergency doctor palpated the breast, the patient felt the cord snap. She subsequently developed a small subcutaneous haematoma on the right side of the abdomen...

16.10.2017: A woman in her eighties woke one morning with a headache and drooping left eyelid. She had known chronic obstructive pulmonary disorder (COPD) and bilateral carotid stenosis, and had previously undergone a cerebral infarction without sequelae. Upon admission to the department of neurology on the same day, an inspection of the left eye determined ptosis. The eye deviated laterally and downward, and the pupil was dilated and unreactive. Investigation of ocular motility revealed diplopia and paralysis of ocular adduction, elevation and depression. There were no other neurological impairments. The...

04.09.2017: A previously healthy man in his twenties was hospitalised in the general surgical ward with pains located in the central abdomen. Routine blood tests and vital signs were unremarkable. The pains subsided, and he was discharged the same evening with an agreement for open readmission. Following discharge from the hospital, the pains were moderate for the first two days. On the third day he awoke with severe abdominal pain. During hospital examination on the same day, he was nauseated. His abdomen was slightly distended and he had tenderness on palpation of the right iliac fossa. Routine blood...

21.08.2017: Four years before his hospitalisation, a man in his 90s had a left-sided intraparenchymal cerebral haemorrhage parietally with penetration into the subarachnoid space. Following this, the patient was self-reliant but had moderate cognitive impairments. Three months before hospitalisation, the patient underwent a gradual decrease in physical and cognitive function that caused him to be bedridden and needing care. The initial neurological examination did not reveal any definite focal pathology, but the patient appeared confused and aphasic. CT of the head, thorax, abdomen and pelvis were normal...

30.03.2017: A girl of primary school age was hospitalised with a suspected acute soft tissue infection in the left side of her face. She had been generally healthy previously. Upon admission, swelling, pain on palpation, and redness of the skin in the left parotid region and around the left eye were found. An ultrasound examination was performed to assess the formation of an abscess, and this showed artefacts consistent with air. The patient was in good general condition and afebrile. CRP and leukocytes were negative, but antibiotic treatment was nevertheless initiated due to the possibility of severe...