Tag Archives: diagnostic dilemma
Computed tomography (venous phase) of the abdomen and pelvis shows a large thick-walled, centrally hypodense, cystic mass (arrow) in the left portion of the horseshoe kidney.

Not Your Typical Renal Cyst

A 32-year-old man with no significant past medical or family history presented to his primary care physician with lower back and abdominal pain. Renal function tests and urinalysis were unremarkable. Computed tomography scan demonstrated a mixed cystic solid renal lesion with focal wall thickening and contrast enhancement within the left portion of a horseshoe kidney. […]

Read more
The patient had dorsal edema and purpura on both hands.

Four Cancers and a Rash: Henoch–Schönlein Purpura

A patient who had a history of 4 primary malignancies developed a rash that is usually seen among children. The 65-year-old man presented with a 2-day history of anasarca, painless skin lesions, and new arthralgias in both hands. He had a previous diagnosis of amyotrophic dermatomyositis, and although he had none of the typical skin […]

Read more
Esophagogastroduodenoscopy demonstrated white plaque lesions that extended from the gastroesophageal junction to the midesophagus.

Not so Obvious: Acute Herpes Esophagitis

  The gross examination immediately suggested infection with Candida species, but biopsy results pointed to a different culprit. A 29-year-old woman sought care in the emergency department after experiencing sharp epigastric pain over 2 days. She was initially seen at an urgent care center and empirically treated for gastritis with omeprazole. However, her pain progressively worsened and […]

Read more
Hyperkeratotic thin papules and plaques were identified. A, The periumbilical area was marked. B, Lesions were also seen in the interdigital webbing.

More than a Mite Contagious: Crusted Scabies

Although an extensive skin infestation might be expected to cause serious discomfort, this is not always the case. A holiday visit sparked concern among family members when they saw that their relative, a 53-year-old woman who lived alone, was unable to perform routine daily activities. They brought her to the hospital to be evaluated for […]

Read more
(A) Digital subtraction angiography (DSA) demonstrated focal stenosis of V2 segment of left vertebral artery (yellow arrow). (B) DSA revealed that the posterior circulation of the brain was otherwise normal beyond the level of stenosis.

Provoked Dizziness from Bow Hunter’s Syndrome

  A 62-year-old man was experiencing debilitating bouts of dizziness provoked by head rotation until ultimately finding relief with cervical spine fixation. He had a history of coronary artery disease, human immunodeficiency virus, tobacco use disorder, and generalized anxiety, and initially presented to a routine primary care visit with 3 weeks of episodic dizziness. During […]

Read more
Pertinent findings at autopsy included (A) the heart showing multiple foci of subepicardial acute infarction (gross image) and (B) platelet fibrin thrombi in the coronary microvasculature (hematoxylin & eosin stain, 400×).

An Unusual Presentation of Thrombotic Thrombocytopenic Purpura

  We describe a patient with sudden and severe postoperative thrombocytopenia whose diagnosis was delayed. The patient was a 58-year-old black man with diabetes mellitus type 2, hypertension, and chronic kidney disease, who presented to our institution with 4 days of abdominal pain. He had a history of remote exploratory laparotomy for an abdominal gunshot […]

Read more
UA-42320404-1