(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old female presented with low back pain radiating to her left leg. The pain started several years ago, and recently getting worse. The pain was intermittent, shooting quality that usually worsened after lying supine for a long time. She denied any bowel or bladder symptoms. Her past medical history and family history was unremarkable. Her physical exam was normal except for left lower extremity was 4+/5 for knee and ankle extension/flexion. She also had mild decreased light-touch sensation in the left L4 and L5 distribution with 2-beat clonus in her left leg. Her big toe was equivocal on the left and downgoing on the right.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

An otherwise healthy 55-year-old male presents to the emergency department following a firecracker exploding in his right hand. He was found to have a large open fracture and a laceration extending to the wrist with exposed bone and partial amputation of the thumb. Later, he developed pulsatile bleeding of the radial artery controlled with direct pressure. He was urgently taken to the OR for debridement and reconstruction. Skin, subcutaneous tissue, muscle, and tendon specimens were sent to the microbiology department for culture.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

This 55 year-old white male had chronic obstructive pulmonary disease, cor pulmonale and left heart failure with a left ventricular ejection fraction of 30%. He had a 48 pack-year smoking history and a remote history of IV cocaine abuse. Prior to his death the patient suffered from recurrent spontaneous pneumothoraces.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

This 55 year-old gentleman is status-post laryngectomy for squamous cell carcinoma of the larynx diagnosed in 2010, complicated by a tracheostomy occlusion, leading to cardiopulmonary arrest and subsequent hypoxic brain injury. He was admitted with new-onset altered mental status, after weakness for approximately 6 months. On admission he was found to be severely malnourished.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old man presented for a routine preoperative chest x-ray in preparation for a knee replacement. Imaging revealed an extrapleural paraspinal mass in the region of T8. Fine needle aspiration of the mass was interpreted as melanoma. Neurologic examination was unremarkable. Total body skin examination failed to reveal any suspicious pigmented lesions. The mass was in close connection with the exiting T8 nerve root and somewhat adherent to the sympathetic chain. The mass was removed within an intact capsule. Immunohistochemical staining and electron microscopy of the resected specimen revealed a malignant melanotic schwannoma. The features of melanotic schwannoma, both benign and malignant variants, and their distinction from melanoma are discussed.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 55-year-old man who presented to the ED with gradual worsening of weakness. The patient reports that he had been fatigued for one month, having to rest constantly after work, and feeling exhausted with minimal exertion. He also reported feeling lightheaded with rising, as well as having epigastric abdominal pain, which was not associated with food. Four days prior to the presentation, the patient began to have black, tarry stools. He was evaluated in his primary care physician's office the day prior, and was found to have hemoglobin of 6.5 g/dL. His prior baseline from two weeks ago was 15.3 g/dL. He was subsequently referred to the ED.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old African American man with an eight month history of poorly controlled seizures and longstanding history of cirrhosis, diabetes and hypertension was brought to the emergency department for progressively worsening confusion, memory loss and increasing frequency of seizures. On the day of presentation, the patient had a prolonged generalized tonic-clonic seizure. The patient was being treated for a hepatic encephalopathy with lactulose. Within the last eight months he had had a transjugular intrahepatic portal system shunt for management of his end stage liver disease and was awaiting a liver transplant. A non-contrast CT of the head revealed no acute intracranial process. An MRI was subsequently obtained. After admission, the patient's mental status continued to decline and ultimately progressed to multisystem organ failure. He suffered a cardiopulmonary arrest and expired.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 56-year old man with past medical history of surgery for congenital pulmonary valve disease, transient ischemic attack without sequelae, meningitis with brain abscess, hyperuricaemia and atrial fibrillation presented with recently increased tiredness, loss of strength and headache. Physical examination revealed dysarthria, and paresthesia in the left hand. No lymphadenopathies, fever, or weight loss were detected. CT-scan of the chest, abdomen and pelvis revealed no abnormalities, and HIV test was negative. On MRI, two intra-axial masses, hyperintense on T1, with contrast ring enhancement in right thalamo-capsular area, and frontal convexity, were visualized (Fig 1). A stereotactic biopsy of the thalamic lesion was performed. Three weeks later, a grayish, soft mass was resected from the frontal lesion through a right fronto-parietal craniotomy.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 56-year-old woman with history of poorly differentiated squamous cell carcinoma of the esophagus, treated with neoadjuvant chemoradiation and esophagectomy. Approximately three years later, she presented with pancytopenia and was diagnosed with therapy-related myelodysplasia, consistent with refractory anemia with excess blasts-1 (RAEB-1). She was treated with induction (daunorubicin, cytarabine, and cladribine) and consolidation (daunorubicin and cytarabine) chemotherapy. She then received reduced intensity conditioning (fludarabine, cyclophosphamide, and total body irradiation) prior to undergoing double umbilical cord stem cell transplant. On day 35 post-transplant, she developed progressive bilateral loss of vision.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 56 year old G5P1223 female who presented to the hospital 10 years post menopause, complaining of recent nausea, vomiting, lower abdominal pain, and vaginal spotting. Five days prior to presentation (PTP), the patient developed nausea accompanied by occasional episodes of non-bloody, non-bilious vomiting. Three days PTP, she developed midline lower abdominal pain and remarked that she "felt pregnant." The pain was sharp, diffuse, and radiated to her lower back. Two days PTP, she began experiencing scant vaginal blood spotting. The patient reported engaging in unprotected sexual intercourse four months PTP, but no additional sexual encounters since that time.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 56-year-old female with a history of IgG-kappa multiple myeloma diagnosed initially at an outside institution. She received conventional chemotherapy and autologous peripheral blood stem cell transplant in the following year. Five years after initial diagnosis, she presents to our institution with anemia (Hgb 8.9 g/dl, Hct 25.6%) and leukocytosis (WBC 22.5 x 109/L).

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient was 56 year old female with a pancreatic mass, who had undergone a Whipple procedure to remove the tumor. A more detailed clinical history is not available.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 56-year-old male presented with a 2-3 week history of left-sided weakness and intermittent loss of balance. Past medical history was significant for bone marrow biopsy-proven IgG lambda light chain multiple myeloma (MM), Durie-Salmon stage IIIB with complex hyperdiploid karyotype diagnosed in 02/2004. He had measurable serum (4.0g/dl) and urine (463.7mg/dl) paraprotein, increased calcium at 10.4mg/dl (Normal reference range: 8.6-10.2mg/dl), high creatinine at 4.5mg/dl (Normal reference range: 0.7-1.3mg/dl), high BUN at 78mg/dl (Normal reference range: 8-22mg/dl) and low hematocrit at 30% (Normal reference range: 42-52%). Our patient also had multiple lytic bone lesions, ascites, and splenomegaly at presentation. He was treated with tandem autologous bone marrow transplants in June and September of 2004; was maintained on thalidomide and prednisone. He relapsed in July 2006 with subcutaneous lumps in the left elbow and left flank and a large left sided perinephric mass. The subcutaneous lesions were confirmed on biopsy to be extramedullary myeloma. On motor exam he had mild spasticity in the left upper and lower extremities with a left pronator drift. Strength was 4-5/5 in the left upper and lower extremities. He had diffuse lower extremity deficits in light touch sensation and left-sided dysmetria.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 56-year-old female patient was admitted to the department of neurological surgery of the University Hospital Hamburg Eppendorf because of a chronic, severe left-sided headache. The neurological examination did not reveal any pathological findings. Further medical history included idiopathic arterial hypertension and hypercholesteremia. A cranial CT scan showed an osteolytic lesion (~1,5cm) within the lateral wing of the left sphenoid bone (Fig. 1). Further diagnostic work-up with a cranial MRI scan revealed a 2 x 1,5 x 1,3cm contrast-enhancing, extradural tumor eroding the left wing of the sphenoid bone without apparent infiltration or substantial compression of the cerebrum (Figs. 2, 3; T1 sequence with contrast). A gross total resection of the tumor along with some adjacent bone was performed. The resulting bone defect was reconstructed using bone cement. Intraoperatively, dural infiltration of the tumor was not seen. The patient went through an uneventful postoperative period. No neurological deficits occurred. The headache ameliorated, wound-healing was without any signs of infection or other disturbances. The patient was recurrence-free on a 12 month follow-up.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 57 y/o female presented with sudden onset of transient right homonymous hemianopsia while driving. Later the same day she also reported a 3-4 hour period of decreased cognitive ability, being unable to perform calculations. She was seen in the emergency room and underwent neuroimaging studies. MRI demonstrated a 25.9 x 23.6 x 21.3 mm round, slightly lobulated, mass within the suprasellar cistern with significant mass effect. A preoperative T1-weighted sagittal image without contrast showed a suprasellar mass, isointense to the brain cortex with compression and superior displacement of the optic chiasm and floor of the third ventricle (Fig. 1a). The inferior margin of the mass was in contact with the dorsum sella and posterior aspect of the diaphragm sella. No intrasellar extension was seen. The posterior margin extended into the region of interpeduncular cistern with associated splaying of the cerebral peduncle. T1-weighted gadolinium-enhanced sagittal images demonstrated homogenous enhancement. Normal pituitary gland is seen within the sella turcica, independent of the lesion. There is no enlargement of the sella turcica (Fig. 1b) T2-weighted coronal image shows low signal intensity of the mass (Fig. 1c). The patient underwent a right fronto-temporo-parietal stereotactic craniotomy for resection of the lesion.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 57-year-old woman with past medical history of a uterine leiomyosarcoma was referred to the department of Neurology due to recurrent episodes of nausea and vomiting, as well as instability during walking. In particular, the patient had underwent a hysterectomy and oophorectomy 8 months ago. Neurological physical examination revealed disorientation, horizontal nystagmus, equilibrium imbalance and ataxia. On CT scan, an extra-axial calcified mass, located in the left cerebellar hemisphere, accompanied with mild edema and measuring 4.5 cm in maximum diameter, was visualized (Figures 1, 2). A suboccipital craniectomy with segmental surgical excision of the lesion was subsequently performed.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The 57-year-old female patient presented to a neurologist with chronic cephalgia since three years. She had had no previous rhinologic history. A contrast enhanced computer tomography was performed and revealed an isolated unilateral opacification within the left ethmoid sinus (Fig. 1). There were no signs of chronic sinusitis but thinning of the bone surrounding the tumor (arrow). Under the suspicion of a mucocele functional endoscopic sinus surgery was performed. Reddish tumor mass was found instead of mucus within the bulla ethmoidalis and anterior ethmoid sinus. After complete tumor removal the endoscopic view revealed destruction of the lamina papiracea induced by volume pressure of the tumor without invasive growth into the bone of the skull base or soft tissue of the orbita.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 57 year-old female who presented to her physician with an actively growing right neck mass that had been present for approximately six months. Additionally, she reported hoarseness and pain that radiated towards the back of her neck. She had a previous history of a goiter approximately 30 years ago, having undergone a left partial thyroidectomy in 1982. She denied ever having a history of hyper- or hypo-thyroidism. She denied any shortness of breath, chest pain, nausea, vomiting, or diarrhea.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

Chief Complaint

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient was a 57-year-old gentleman with a 2 week history of nausea, vomiting, abdominal pain and distention who presented with fever, chills, and sharp pain radiating to both groins. The initial CT scan showed a large heterogeneous pelvic soft tissue mass partially encasing bilateral common iliac vessels, rectum, anus, and sigmoid colon with deviation of the urinary bladder but no evidence of colonic obstruction.