International Medical Case Presentation Channel

Chest x-ray showing miliary tuberculosis

Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis.

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The kidney tumor

Multifocal / multicentric tumor with little renal parenchyma remaining between the nodules.

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Supraclavicular lymph nodes are lymph nodes found above the clavicle, that can be felt in the supraclavicular fossa. The supraclavicular lymph nodes on the left side are called Virchow's nodes. It leads to an appreciable mass that can be recognized clinically, called Troisier sign.
Virchow's node is a lymph node and is a part of the lymphatic system. It is the thoracic duct end node. It receives afferent lymphatic drainage from the left head, neck, chest, abdomen, pelvis, and bilateral lower extremities, which eventually drains into the jugulo-subclavian venous junction via the thoracic duct.

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A gallstone is a stone formed within the gallbladder from precipitated bile components. Gallstone disease refers to the condition where gallstones are either in the gallbladder or common bile duct. The presence of stones in the gallbladder is referred to as cholelithiasis. The presence of gallstones in the common bile duct is called choledocholithiasis.
Diagnosis is typically confirmed by abdominal ultrasound. Other imaging techniques used are ERCP and MRCP. Gallstone complications may be detected on blood tests.

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Lamellar ichthyosis, also known as ichthyosis lamellaris and nonbullous congenital ichthyosis, is a rare inherited skin disorder. Affected babies are born in a collodion membrane, a shiny, waxy-appearing outer layer to the skin. This is shed 10-14 days after birth, revealing the main symptom of the disease, extensive scaling of the skin caused by hyperkeratosis. With increasing age, the scaling tends to be concentrated around joints in areas such as the groin, the armpits, the inside of the elbow and the neck. Ichthyosis lamellaris has an autosomal recessive pattern of inheritance.

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An ovarian cyst is a fluid-filled sac within the ovary. Often they cause no symptoms.
Ovarian cysts are common findings usually discovered incidentally on physical examination or imaging. Ovarian cysts can cause complications, including rupture, hemorrhage, and torsion, which are considered gynecological emergencies. Therefore, it is essential to promptly diagnose and treat them. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. This may result in vomiting or feeling faint, and even cause headaches.
Most ovarian cysts are related to ovulation, being either follicular cysts or corpus luteum cysts. Other types include cysts due to endometriosis, dermoid cysts, and cystadenomas. Many small cysts occur in both ovaries in polycystic ovary syndrome (PCOS). Rarely, cysts may be a form of ovarian cancer. The majority of cysts are harmless.

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Purple urine bag syndrome is a medical syndrome where purple discoloration of urine occurs in people with urinary catheters and co-existent urinary tract infection. Bacteria in the urine produce the enzyme indoxyl sulfatase. This converts indoxyl sulfate in the urine into the red and blue colored compounds indirubin and indigo. The most commonly implicated bacteria are Providencia stuartii, Providencia rettgeri, Klebsiella pneumoniae, Proteus mirabilis, Escherichia coli, Morganella morganii, and Pseudomonas aeruginosa.
Tryptophan in the diet is metabolized by bacteria in the gastrointestinal tract to produce indole. Indole is absorbed into the blood by the intestine and passes to the liver. There, indole is converted to indoxyl sulfate, which is then excreted in the urine. In purple urine bag syndrome, bacteria that colonize the urinary catheter convert indoxyl sulfate to the colored compounds indirubin and indigo.

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Leprosy is a long-term infection by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damage may result in a lack of ability to feel pain, which can lead to the loss of parts of a person's extremities from repeated injuries or infection through unnoticed wounds. An infected person may also experience muscle weakness and poor eyesight. Leprosy symptoms may begin within one year, but, for some people, symptoms may take 20 years or more to occur.
Leprosy is spread between people, although extensive contact is necessary. Leprosy has a low pathogenicity, and 95% of people who contract M. leprae do not develop the disease. Spread is thought to occur through a cough or contact with fluid from the nose of a person infected by leprosy. Genetic factors and immune function play a role in how easily a person catches the disease.

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Primary pleural hydatid cysts

The patient underwent thoracotomy and the findings of numerous cystic lesions within the pleura confirming the diagnosis of hydatid cysts.
Primary pleural hydatid cyst is a rare disease. It is defined as a hydatid cyst within or dependent of the pleural space that has not been produced by rupture from another location and/or does not appear simultaneously or is preceded by another cyst, liver or lung.

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A person with a two hour history of phlegmasia cerulea dolens

Phlegmasia cerulea dolens (PCD) is an uncommon severe form of lower extremity deep venous thrombosis (DVT) that obstructs blood outflow from a vein. PCD results from extensive thrombotic occlusion of extremity veins, most commonly an "iliofemoral" DVT of the iliac vein and/or common femoral vein. It is a medical emergency requiring immediate evaluation and treatment.
When a thrombus occludes an extremity vein, pressure backs up in the venous system leading plasma fluid to leak out into the interstitium of the affected limb. This increases the pressure of that limb compartment, which can collapse the arteries and lead to acute ischemia, gangrene, hypovolemia, and hemodynamic instability.

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A squamous-cell lung carcinoma developing in the bronchius

Squamous-cell carcinoma of the lung is a histologic type of non-small-cell lung carcinoma (NSCLC). It is the second most prevalent type of lung cancer after lung adenocarcinoma and it originates in the bronchi. Its tumor cells are characterized by a squamous appearance, similar to the one observed in epidermal cells. Squamous-cell carcinoma of the lung is strongly associated with tobacco smoking, more than any other forms of NSCLC.

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Cirrhosis of liver. Micro and macronodular cirrhosis

This image shows a coarsely tuberous liver cirrhosis. The 30-year-old male patient this was removed from received a healthy liver transplant and has been living for more than 10 years without any negative side effects. He had Wilson's Disease, one of the most frequent hereditary metabolic diseases. His liver was insufficiently capable of disposing of copper and accumulated it instead.

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Idiopathic interstitial fibrosis of the lungs

Idiopathic pulmonary fibrosis (IPF) is a serious chronic disease that affects the tissue surrounding the air sacs, or alveoli, in the lungs. This condition develops when that lung tissue becomes thick and stiff for unknown reasons. Over time, these changes can cause permanent scarring in the lungs, called fibrosis, that makes it progressively more difficult to breathe.

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Vocal cord polyp

Vocal cord polyps are benign lesions that are generally unilateral. Their shape can be classified as sessile or peduncular, and their histological characteristics as gelatinous or translucent, fibrous or organized, and angiomatous or hemorrhagic.
The origin of the vocal cord polyp is phonotraumatic. Other irritating processes, however, may contribute to the emergence of polyps, such as gastroesophageal reflux, smoking, aspiration of aggressive chemical substances, or intense respiratory activities. The main signs and symptoms in individuals with vocal fold polyps are hoarseness or breathiness and vocal fatigue. Surgery is normally adopted for vocal cord polyp. However, some recent studies demonstrated the importance of speech therapy as a primary treatment of polyps, with total or partial lesion regression, followed by surgery when the lesions are persistent or if the patients are dissatisfied with their vocal quality.

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Medullary thyroid carcinoma

Medullary thyroid cancer is a form of thyroid carcinoma which originates from the parafollicular cells (C cells), which produce the hormone calcitonin.
Medullary thyroid cancer produces calcitonin, and elevated calcitonin level is an essential feature of this tumor. Diagnosis is primarily performed via fine needle aspiration of the lesion of the thyroid to distinguish it from other types of thyroid lesions. Microscopic examination will show an amyloid stroma with hyperplasia of parafollicular cells. Surgery and radiation therapy have been the major treatments for medullary thyroid carcinoma.

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Bone metastasis (Cancer spread to bones)

Bone metastasis occurs when cancer cells break away from the original tumor and spread to the bones, where they begin to multiply. Prostate, breast, and lung cancers are most likely to spread to the bone. However, other cancers are not excluded. Bone metastases do not begin from the bones but move there from the primary tumor.

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Spider angioma, also known as spider naevus or spider telangiectasia, is a vascular lesion characterized by anomalous dilatation of end vasculature found just beneath the skin surface. The lesion contains a central, red spot and reddish extensions which radiate outward like a spider's web. They may appear as multiple or solitary lesions. A spider angioma has 3 features: a body, legs, and surrounding erythema. The body appears as a 1 to 10 mm central arteriole visible as a punctum or eminence. It is typically painless, resembles a spider's body), and is surrounded by attenuated capillaries radiating in a spider-legged fashion, decreasing in size toward the margins.
Spider angiomas are usually benign but often can be suggestive of an underlying systemic disease such as cirrhosis, rheumatoid arthritis, or thyrotoxicosis. Solitary spider angiomas are seen in 15% of young adults who usually have fewer than 3 lesions.

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Aplasia cutis congenita is a condition in which there is congenital (present from birth) absence of skin, with or without the absence of underlying structures such as bone. It most commonly affects the scalp, but any location of the body can be affected. While most people with Aplasia cutis congenita have no other abnormalities, some people have congenital malformations involving the cardiovascular, gastrointestinal, genitourinary, and central nervous systems. The cause of this condition is unclear and appears to be multifactorial; contributing factors may include teratogens, genes, trauma, and compromised blood flow to the skin.

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Aquagenic urticaria is a rare form of physical urticaria in which hives develop on the skin after contact with water, regardless of its temperature. It is sometimes described as an allergy, although it is not a true histamine-releasing allergic reaction like some other forms of urticaria. The condition typically results from contact with water of any type, temperature or additive.
The main symptom of aquagenic urticaria is the development of physical hives, which may or may not itch.
The hives associated with aquagenic urticaria are typically small (approximately 1–3 mm), red- or skin-colored welts (called wheals) with clearly defined edges. It most commonly develops on the neck, upper trunk and arms, although it can occur anywhere on the body. Once the water source is removed, the rash generally fades within 30 to 60 minutes.
Water in all forms, such as tap or sea water, swimming pool water, sweat, tears, and saliva can induce the lesions.

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Nevus comedonicus (also known as a comedo nevus) is characterized by closely arranged, grouped, often linear, slightly elevated papules that have at their center keratinous plugs resembling comedones.
Nevus comedonicus comprises of groups of pits filled with black keratinous plugs resembling blackheads, with inflammatory acne lesions developing later. Nevus comedonicus is caused by a defect in the development of the hair follicle. Lesions may develop any time from birth to middle age.

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