(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 the unfortunate story of a 45-year-old female who been in good health up until 2000, at which point she donated a kidney for her daughter. She was doing well until 2004, when she developed abdominal pain and was found to have a ruptured splenic artery, which necessitated splenectomy. Several days later she developed ischemia of the large bowel and required a subtotal colectomy. After this she suffered from ischemia of the gallbladder and small bowel, and require removal of these organs as well. As the patient is from out of state, she was transferred to a hospital back home, where further evaluation for the ischemia showed positive tests for heparin-induced thrombocytopenia. She required several additional procedures for fistulae formation and adhesions, and soon after also developed short-gut syndrome and liver failure. She was then referred in October 2004 for evaluation for transplantation.

(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 79-year-old man with stage IV mantle cell lymphoma, previously untransfused, presented to a peripheral hospital with symptomatic anemia (Hgb=7 g/dL, Hct=23%). A type and screen revealed that he was group AB with no unexpected antibodies (Table 1).

(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.)

We present 2 cases of cerebellar mass of male infants. Case 1 is a 15-month-old male infant presented with irritability, poor oral intake and vomiting. Brain magnetic resonance (MR) imaging revealed a 5.2×4.4 cm-sized mass in the left cerebellar hemisphere. The tumor showed robust gadolinium-enhancement and a mixed solid and cystic architecture without intratumoral hemorrhage (Fig 1A). The elective tumor resection was performed through paramedian suboccipital approach. The tumor was huge and hypervascular but friable. The tumor was well-demarcated and removed totally. The patient had no additional neurological deficit postoperatively. The baby received adjuvant chemotherapy. He has lived without neurological deficit or tumor recurrence for 17 months of 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.)

We present 2 cases of intraventricular hemorrhage (IVH) in young patients. Case 1 is a 33 year old man who presented with collapse after acute onset occipital headache. On admission to hospital brainstem activity was absent. CT brain (Fig. 1) showed a large acute intraventricular hemorrhage, underlying intraventricular mass and obstructive hydrocephalus. Autopsy examination confirmed massive intraventricular hemorrhage. Coronal section of the brain (Fig. 2) shows destruction of the diencephalon and underlying tumor fragments. Case 2 is a 28 year old woman who presented with recent onset headache. T1W MR post contrast (Fig. 3) showed an enhancing tumor involving the 3rd ventricle and right thalamus. She underwent burrhole biopsy during which there was significant intra-tumoral hemorrhage. She did not regain consciousness post-operatively and imaging confirmed a large thalamic hemorrhage.

(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 70 year old female with a past medical history of degenerative scoliosis, hypertension, and anxiety. The patient's social history was negative for alcohol and tobacco. Her medications included Zoloft, Percocet, Metoprolol, Cymbalta, Amlodipine, and Lyrica. The patient had spinal fusion surgery for her degenerative scoliosis. During the surgery, the patient lost three liters of blood. The patient was group O positive with a negative antibody screen and received crossmatched blood products including 7 units of RBCS, 3 units FFP, one 6 units of whole blood platelet concentrates, as well as 7 liters of crystalloid, and 675 ml from the cell saver. Days following the surgery, the patient was recovering well and plans for discharge were being made.

(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.)

CASE 1

(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 6 year-old male presented with early pubarche and was evaluated for premature puberty. Skeletal evaluation at that time revealed a bone age of 9 years. The results of a leuprolide challenge test are shown in the top portion of Table 1. Shortly thereafter, the patient was lost to follow-up. At age 10, the patient returned to clinical attention after a pediatrician found he was Tanner stage III and repeat skeletal evaluation suggested a bone age of 14 years. The results of a second leuprolide challenge test are shown in the bottom portion of Table 1.

(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 9 year old female child was discovered dead in bed by her caregiver. For two months prior to death, the child had been complaining of right-sided body weakness. She was treated at a local hospital with Prednisone after being diagnosed with Bell's Palsy, as a right-sided cranial nerve VII palsy was observed during clinical examination. No imaging was conducted at this hospital visit. This weakness progressively worsened to involve the left side of the body. On the day of death, the child had vomited once and complained of headache before falling asleep. Due to the death being sudden and unexpected, a medico-legal autopsy was indicated. No injuries or signs of trauma were present. Internal examination revealed a swollen brain with a large tumor mass in the pontine area.

(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 16-month-old boy presented to his pediatrician following a 3 week history of left head tilt and a 3 day history of cessation of crawling. Developmental history was significant for delays in sitting independently (8 months) and crawling (12 months), necessitating physical therapy for delayed gross motor milestones. Birth history and all other past medical history were unremarkable. Neurologic examination was positive for a mild left head tilt and lower extremity proximal muscle weakness on ventral suspension. Muscle bulk, tone, sensation, reflexes, and coordination were all within normal limits. MRI of the spine showed an expansile, enhancing, intramedullary mass from C2-T3 with an associated syrinx above and below the lesion (Fig 1). He subsequently underwent complete C3 to T3 laminectomies for spinal cord decompression and tumor resection.

(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 24 year-old G1P0 woman at 36 weeks and 2 days presents to her obstetrician for a routine perinatal visit with no new complaints. The patient has no significant past surgical or medical history and currently only takes a prenatal vitamin. Her pregnancy has been without incident. She is a nonsmoker, with no history of drug use, and has one sexual partner. She immigrated to the United States from Jamaica 2 years ago. A routine rectal/vaginal culture was taken.

(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 aged 24 years presented with ataxia, visual obscurations, and headaches over 4 weeks. She had no significant past medical history, and was taking no medication. MR imaging revealed an enhancing mass in the fourth ventricle, which was removed at neurosurgery. Macroscopic examination revealed soft gray tissue measuring 10x5x5mm and several fragments of beige / gray tissue measuring 5x5x4mm, all of which were submitted for histopathological examination.

(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 Caucasian male in his early 20's presented with a cutaneous, soft tissue mass of the right lower extremity as well as vascular abnormalities of the mid-3rd phalange. Subsequent pathologic fracture of the proximal 2nd phalange, led to the discovery of multiple osseous lesions of the left foot (below). Excision of the lesions showed similar histologic features in both the soft tissue and bone sites. Long-term follow up was characterized by multiple bone (tibia) and soft tissue recurrences within the tissues of the right lower limb.

(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 27-year-old male presenting with acute carpopedal spasm, tachypnea and pain in all the extremities. The patient has a history of difficulty speaking. The patient has a history of generalized myalgia and weakness of the body. There is no history of change in his vision or hearing. The patient has no ongoing nausea, vomiting or diarrhea. There are no urinary symptoms and no history of recent head injury. On initial examination, the patient was noted to be alert and oriented and somewhat dysarthric.

(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 68 year-old Caucasian woman with a history of chronic intermittent diarrhea, acroparesthesias, inflammatory polyarthritis, tinnitus, asthma, osteoarthritis, hypothyroidism, Raynaud' s phenomenon, anemia with thrombocytosis, and atypical mycobacterial lung disease. She is status post Nissen fundoplication and right hip arthroplasty. She presents with complaints of polyuria and increased thirst. Physical exam reveals ankle edema.

(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 woman in her 80's with a history of solitary plasmacytoma and elevated serum kappa light chain. The solitary plasmacytoma occurred at the cervical spine 10 years ago and then at the right supraclavicular area 3 years ago, and were treated by radiation therapy both times. Her bone marrow biopsy showed a small cluster of kappa-restricted plasma cells consisting of less than 5% of total cellularity after her second radiation therapy. She has been followed up routinely by PET/CT scan, serum protein electrophoresis (SPE) and immunofixation electrophoresis (IFE). SPE and IFE on serum samples have not detected monoclonal antibodies to date.

(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 fully immunized toddler boy presented with fever and right-sided neck swelling for few days. The investigations revealed elevated inflammatory markers and right level II lymphadenitis without abscess. He was given a 14-day course of augmentin for possible suppurative lymphadenitis.

(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.)

We present a case of a female in her 60s with what turned out to be an uncommon condition. The patient was admitted at an outside hospital with an abdominal pelvic mass. She underwent a bilateral salpingo-oophorectomy with biopsy of the omentum. A frozen section diagnosis of a "'small blue cell tumor', differential includes carcinoma, stromal tumor and lymphoma" was rendered. There were no known preexisting conditions.

(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 teenage boy with recently diagnosed Alström syndrome presents for direct admission for coordinated care among multiple subspecialties. His diagnosis was made via whole exome sequencing that revealed a novel homozygous disease-causing mutation in the ALMS1 gene. No other pathologic or likely pathologic variants were detected. His parents are first degree relatives. A previously performed single nucleotide polymorphism (SNP) array demonstrated homozygosity of 30%. His past medical history is extensive and includes the following: failure to thrive, oblong facies, recession of hair, sunken eyes, prominent ears, retained primary teeth, persistent proteinuria, hepatic steatosis, hypothyroidism, short stature, hyperlipidemia, developmental delay, intellectual disability, autistic-spectrum disorder, progressive retinal dystrophy, sensorineural hearing loss, undescended testes, allergies, lung infections, elevated IgE, asthma, and eosinophilic esophagitis. During admission, he underwent a liver and renal biopsy for evaluation of Alstrom syndrome.

(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 who was referred to a head and neck surgeon for evaluation of a left thyroid nodule. On ultrasound, the nodule measured 2.3 cm with calcifications. She subsequently underwent fine needle aspiration biopsy and specimens were sent for cytology, the result of which prompted molecular testing on the FNA specimen.

(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 an adult female who presents to the emergency department with complaints of nausea over the past few days and one day of non-bloody, non-bilious emesis. The patient was recently pregnant and delivered a baby girl a few months ago. Although she has been having difficulty keeping food and fluids down, she is continuing to breast feed her daughter. The patient endorses having a cold about a week ago, but denies any new foods, recent travel, sick contacts, diarrhea, illicit drug use, or toxic ingestions. Physical exam is notable for dry mucous membranes and tachycardia. The patient is otherwise afebrile, with a blood pressure of 120/80 mmHg, heart rate of 126 beats per minute, respiratory rate of 16 breaths per minute, and an oxygen saturation of 100% on room air.