Images in medicine

When sitting down hurts

04.04.2022

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...

When intracranial pressure is low

22.11.2021

22.11.2021: The images show the neuraxis in a previously healthy woman in her thirties. The sagittal T1-weighted image of the head (Image A) shows an enlarged pituitary gland (white arrow) and downward displacement of the brain stem and cerebellar tonsils to the foramen magnum (dotted black arrow). The sagittal fat-suppressed T2-weighted image of the cervicothoracic spine (Image B) shows an epidural fluid collection at T4–T9 (white arrow). Meningeal thickening was also detected (not shown here) (FLAIR sequence), as well as a subdural fluid collection with blood products along the tentorium (susceptibility...

Brown serum

25.10.2021

25.10.2021: The picture shows tubes with brown and normal-coloured serum. The brown sample was taken from a man in his thirties who was admitted with infection and graft failure after an allogeneic haematopoietic stem cell transplantation for acute myelogenous leukaemia. Brown-coloured serum is normally caused by serious conditions such as massive intravascular haemolysis or methemoglobinaemia. In intravascular haemolysis, haemoglobin from the erythrocytes will be released and bind to haptoglobin in the circulation. Haemoglobin-haptoglobin complexes are formed, but rapidly eliminated by monocytes and...

Unilateral erythema or unilateral pallor?

06.09.2021

06.09.2021: The photograph shows miosis, ptosis and hemifacial anhidrosis with pallor on the left side in a previously healthy woman in her thirties. The photograph and video were taken following an exercise session. The patient was referred to a neurologist due to a two-month history of unilateral facial flushing. Clinical examination revealed mild miosis, ptosis, anhidrosis and pallor on the left side of the face, with a sharp midline border. She had no other focal neurological deficits. Activity would cause her right cheek to redden, but not her left. A thorough work-up with repeated clinical testing...

Zebra lines

26.07.2021

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...

Panner's disease

24.06.2021

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...

Hamate bone fractures

01.02.2021

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...

Kissing naevus

07.01.2021

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...

Magnets in the bowel

11.12.2020

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...

Scabies burrow under a dermatoscope

26.10.2020

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...