(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 woman in her 50s reported a 2-year history of brachialgia with a radicular radiation of pain into the right digits I-III for about 5 weeks. Neurological examination revealed hyperactive deep tendon reflexes of the right upper limb and the lower limbs, sustained clonus in the left ankle, gait ataxia, paresis of the right biceps muscle and of the interosseous muscles of the right hand and hypesthesia in the right C6 segment. X-ray examination of the spine showed enlargement of the right-sided C5-6 neural foramen with bone erosion. Spinal MRI disclosed here a club-shaped intra- and extraspinal mass lesion with intradural growth through the enlarged neural foramen (Figure 1A). The mass lesion measured approximately 4.5 x 2 cm with a large intraspinal part of about 1.5 cm in diameter. It caused compression and midline shift of the cervical spinal cord (Figures 1A, 1B). It was isointense in T1-weighted images and showed strong contrast enhancement (Figures 1A, 1B). The mass was hyperintense in T2-weighted images and here, signal intensity of the compressed cervical spinal cord was slightly increased. No additional remarkable anamnestic data and no pathologic dermatological or cardiac findings were reported. A preoperatively diagnosed hyperthyroidism was supposed to be caused by autoimmune thyroiditis and responded to thyreostatic drug therapy. No additional signs of endocrinological dysfunction were recorded.

(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 woman approximately 50 years of age with type I diabetes mellitus with end-organ damage (peripheral neuropathy and nephropathy status post renal transplant), peripheral vascular disease and hypothyroidism presented with progressively worsening left-sided numbness, weakness and leg pain for the past 2 to 3 months. Additionally over the past week, her right leg had become numb from the knee down. Around the same time, her left hand also became weak. She denied symptoms in the right arm and any spine pain. Physical exam revealed decreased strength in the left upper and lower extremities and decreased sensation in the lower extremities.

(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.)

Physical examination showed normal vital signs. There was no difficulty breathing, chest pain, or headache. Neurologic evaluation demonstrated an awake and alert, right-handed female oriented to person, place, and time. She was noted to have persistent word finding difficulty and was unable to name a pen and a watch. At the time of neurological testing, the patient's motor and sensory function had essentially returned to normal. Cranial nerves were intact bilaterally and deep tendon reflexes were symmetric and slightly reduced. Her gait was unremarkable and Romberg testing was negative.

(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 woman in her late 50s experienced sudden onset of horizontal binocular diplopia and right-sided facial paresthesias. The patient was in her usual state of good health until one week before, when she began complaining of severe occipital headaches. She was able to continue her routine activities although her diplopia did not subside. At work, her colleagues thought her right face drooped. The patient had a past medical history that was significant for hypertension, non-insulin dependent diabetes mellitus, coronary artery disease, hypothyroidism and dental implants placed four weeks before the onset of symptoms.

(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 60-year-old post-menopausal female underwent an exploratory laparotomy and bilateral salpingo-oophorectomy for a 30.0 cm mass of the right adnexa, which was found to be a fibrothecoma of the right ovary with cystic degeneration. On gross examination, the left ovary was somewhat obscured by adhesions and measured approximately 4.5 x 3.0 x 1.2 cm by palpation. The left fallopian tube and two simple paratubal cysts, up to 0.5 cm in diameter, were also identified. The cut surface of the ovary was tan with a few white and light yellow nodules. Representative cross sections, to include ovary and adhered fallopian tube, were submitted for microscopic evaluation.

(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 woman in her 70s with a remote history of hysterectomy and unilateral salpingo-oophorectomy for "likely benign disease" presented with dull and progressively worsening lower abdominal pain, followed by hematuria.

(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 woman in her seventies who began experiencing exertional dyspnea ten years ago. Since her initial presentation, her dyspnea has become progressively more severe, with supplemental oxygen requirements reaching 12 liters at rest and up to 18 liters with activity. She is admitted for a double lung transplant.

(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 woman in her 70s presented with a lumbosacral plexopathy secondary to hip surgery. During her initial investigations, a CT head scan had been requested and this had demonstrated an asymptomatic incidental meningeal tumour in the left occipital region. MRI (Fig 1A, T1-weighted MRI after gadolinium enhancement) showed an enhancing mass consistent with a benign meningioma and the patient was managed conservatively.

She presented 6 months later, with a 6-week history of headache, dizziness and right homonymous hemianopia. CT scans showed enlargement of the tumour. At craniotomy, a vascular tumour was found in the left parieto-occipital region adherent to the sagittal sinus. It was excised completely.

(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 woman in her late 70s. Her chief complaints were headache, memory changes and sleep disturbance for 4 months. She had fallen down when she tried to stand up after waking up during the night one week prior to admission. Her family took her to the local hospital. Computed tomography and magnetic resonance image showed a large cystic mass in the right frontal lobe with heterogenicity and an enhancing border.

(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 woman in her 80s presented after two weeks of intermittent generalized abdominal pain. Symptoms worsened over a 48-hour period with no bowel movements, severe pain, and nausea and vomiting. In the emergency department, physical examination was significant for abdominal distention and tenderness.

(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 baby boy with postnatal onset microcephaly had speech impairment and global developmental delay that were noted at 12 months of age. He also had feeding problems which included gagging, choking and frequent drooling. He was born by Cesarean section for breech presentation to a 28-year-old G1P1 subsequent to an unremarkable pregnancy. There is no family history of developmental delay or neurological problems.

(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 23-year-old Hispanic male who suffered a first time, complex partial seizure followed by generalized tonic-clonic seizure. He was admitted to the hospital and was found to have right arm and leg weakness and dysesthesias. A CT scan of the head, performed soon after admission, showed a hemorrhagic left frontal lobe brain lesion. MRI scan demonstrated a slightly bilobed, 3 cm. in diameter lesion which was bright on pre-contrast T1-weighted scans and was located in the vertex of the left frontal lobe (Figure 1). The lesion did not enhance and had rings of low signal on T2-weighted scans, most consistent with a subacute to chronic intraparenchymal hematoma into which "bleeding may have occurred on more than one occasion" (Figure 2). The amount of edema was considered somewhat excessive given the size of the hematoma, but there was no midline shift (Figure 2). The MR angiogram failed to show any large feeding or draining vessels and there was no evidence of vascular abnormality or neoplasm. The circle of Willis showed a 1-2 mm. aneurysm in the proximal right middle cerebral artery before the bifurcation and there was thought to be duplication or fenestration of the anterior communicating artery.

(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 25-year old obese male presented to the emergency room via ambulance after a sudden change in mental status. He was previously well with multiple "sick-contacts" over the previous week and a history of hypertension. While in the emergency room, he developed worsening respiratory status with an increased oxygen demand.

(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 Caucasian female in her 30's who is followed closely by her dermatologist after an in-situ melanoma was diagnosed on her lower extremity approximately 2 years prior. A relatively large scalp nodule was bothersome to the patient despite the fact that it had been present for several years. Clinically, the nodule was firm and indurated and measured 2 cm in greatest dimension. The lesion was thought to be a cyst and was not of serious clinical concern. It was "shelled-out" and submitted for pathologic examination with the pre-operative differential diagnosis of epidermal inclusion cyst or pilar cyst.

(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 78 year old lady with a past medical history of rheumatoid arthritis, bronchiectasis, hypertension, gastro-oesophageal reflux disease and paroxysmal atrial fibrillation was admitted to hospital following a mechanical fall whilst at a dance class. After the fall she had difficulty putting her weight on her left leg and her friend took her to the Emergency Department. On examination her left leg was shortened and externally rotated.

(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 61 year-old male with a history of colitis who presented to the emergency department after sustaining abdominal trauma secondary to falling. As part of his workup, the patient underwent a CT scan which revealed a non-contrast enhancing low attenuation focus within the uncinate process of the pancreatic head measuring 2.5 x 2.3 cm. The patient subsequently underwent an endoscopic ultrasound which revealed an oval 33mm by 21mm well demarcated mixed solid and cystic mass with 2 hyperechoic foci seen in the head of the pancreas. The lesion was extensively sampled with a 25g needle for cytologic evaluation.

(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 4 month old male infant with an uneventful antenatal and natal history, presented with persistent vomiting and recurrent right-sided focal seizures of one month duration. He was seen by a pediatrician and found to have wide bulging fontanels and a large head circumference (46 cm, above 90 percentile), with limited movement in the right upper limb. Brain US showed a left sided brain mass. Brain MRI was requested and showed a large mainly cystic septated mass, with a thin non-enhancing wall and a relatively large vividly enhancing mural nodule. The mass involved the left parieto-occipital lobes and was deeply located in close relation to the left lateral ventricular trigone. Extensive associated white matter edema was noted. He underwent emergency craniotomy and complete resection of the tumor was attempted. Post operative brain MRI showed a large cystic lesion measuring about 4.7x5 cm at the site of surgery with no evidence of enhancement. He was seizure free with no weakness post 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.)

NV is an 84 year old male with relevant past medical history including atrial fibrillation controlled on coumadin, and a remote left hip replacement surgery thirteen years ago. He fell while pulling a sweater over his head very early in the morning and landed awkwardly on his left leg. He presented to the emergency department and subsequent left femur x-ray showed a displaced fracture of mid-femoral diaphysis with medial angulation of the distal fragment (figure 1). At the same time he had a negative chest x-ray (figure 2), a negative pelvic x-ray, and a negative head CT. He was seen by orthopaedics and scheduled for ORIF repair. However, at the time of presentation his INR was 2.9 so he received two units of fresh frozen plasma (FFP) to reverse the anticoagulation before proceeding with the surgical repair of his fracture. Upon receiving the first two units of FFP he developed hives with no additional symptoms, a simple allergic reaction to transfusion. Mid-morning his INR was decreased to 1.9, and four additional units of FFP were ordered. In light of previous allergic reaction, he was pre-medicated with steroids and Benadryl, and received the four units at 2:40PM, 3:10PM, 3:20PM, and 3:25PM respectively. At approximately 4:00PM, the patient developed acute respiratory distress, hypoxia requiring intubation, and an elevation in blood pressure to 173/120 mmHg. A chest x-ray at this time showed a white-out picture with extensive bilateral airspace opacification and consolidation in upper and lower lobes (figure 3). A spiral CT was done which ruled out pulmonary embolism as a cause of his acute respiratory decompensation.

(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 is a 41 year old male inmate with a past medical history reported from an outside hospital of hypertension and HIV (both of which the patient denied and subsequent HIV testing was negative). He presented to the prison physician with complaints of chest pain (6/10) and shortness of breath that began the prior evening while playing softball. At that time, his symptoms were also associated with nausea and vomiting so the patient attributed this combination of symptoms to acid reflux. An ECG done at the prison showed ST elevations and he was transferred to an outside hospital for further evaluation. Cardiac catheterization showed 100% proximal occlusion of the left anterior descending coronary artery (LAD). The patient was hemodynamically stable upon transfer to UPMC Presbyterian for further treatment.

(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 female in her mid 80's who underwent emergent esophagectomy after an attempt at routine esophageal dilatation for stricture resulted in perforation. The patient had no significant medical history; specifically of a hematolymphoid malignancy.