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Photograph of the patient's face shows bilateral periorbital ecchymosis (raccoon eye appearance).

Raccoon Eye Appearance: Amyloidosis

To the Editor: An 82-year-old woman presented to our outpatient clinic with a 6-month history of recurrent internal bleeding near the eyes. The patient had a history of type 2 diabetes mellitus, but had no significant medical history including traumatic injuries. Physical examination revealed bilateral periorbital ecchymosis and large tongue (Figure). Serum protein electrophoresis revealed […]

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(A) Ultrasound imaging of the patient's right shoulder, shown here in this panoramic view, revealed multiple, round, mass-type lesions with homogenous echoes (arrows) and irregularly scattered hyperechoic plaques with acoustic shadows. (B) Ultrasound-guided aspiration was performed using the direct in-plane technique. The arrowheads indicate the needle.

Big Gain, No Pain: Tumoral Calcinosis

A patient’s odd physical presentation was the result of what could be termed a mineral deposit. The 40-year-old man reported that his right shoulder had been swelling progressively for more than 6 months. His medical history was significant for chronic kidney failure, and he had been undergoing hemodialysis for the previous 10 years. He had […]

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Headache

Headache, an almost universal human experience, is one of the most common complaints encountered in medicine and neurology. Described and categorized since antiquity, with the first classification by Aretaeus of Cappadocia, other classifications followed. The evaluation of this condition may be straightforward or challenging, and, though often benign, headache may prove to be an ominous […]

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Still frame of long-axis parasternal view on 2-dimensional color flow transthoracic echocardiogram showing severe aortic regurgitation. as depicted by arrow. The thick arrow at the bottom depicts the point of recording of the diastolic frame. AO = ascending aorta; LA = left atrium; LV = left ventricle.

‘Landolfi’s Sign’—Eyes Don’t See What the Mind Does Not Know!

To the Editor: A 60-year-old woman was admitted with progressively worsening dyspnea on exertion associated with intermittent lightheadedness and palpitations. On physical examination, a 3/6 diastolic decrescendo murmur was audible along the left sternal border. The murmur was most prominently heard in the left third intercostal space at end expiration with the patient in the […]

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Teaching Diagnostic Reasoning in the Digital Age: The Role of the Mentor

Each case has its lesson—a lesson that may be, but is not always, learnt, for clinical wisdom is not the equivalent of experience. A man who has seen 500 cases of pneumonia may not have the understanding of the disease which comes with an intelligent study of a score of cases, so different are knowledge […]

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Dorsum of tongue showing erythematous patches with white borders (black arrows).

Geographic Tongue

A 45-year-old female patient presented to our clinic with a painless, erythematous lesion on her tongue. Medical history was negative, with absence of any allergies or habits. The patient recalled that she had a similar lesion on her tongue 6 months earlier, which resolved spontaneously. Clinical examination of the dorsal surface of the tongue revealed […]

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