Port-wine amniotic fluid

Untimely detachment of a normally sited placenta from the uterus before birth of the baby is termed placental abruption or abruptio placenta. This premature placental separation results in decreased supply of nutrients and oxygen to the fetus as well as bleeding at the site of placental separation. Consequently, the fetus may become distressed or if the abruption is severe, fetal death ensues. The mother may develop life threatening shock (decreased oxygen content at the tissue level) because of the bleeding.

The amniotic fluid – bag of waters – can become stained with blood coming from the detached placenta resulting in the amniotic fluid looking like Port-wine – Port-wine amniotic fluid.

Risk factors for placental abruption include using cocaine, alcohol, cigarettes, having hypertension as well as sustaining abdominal trauma during pregnancy.

Reference:

Norwitz ER, Schorge JO, 2010, Obstetrics and Gynecology at a Glance. 3rd edition. Wiley-Blackwell. page 119. Go to reference

Port-wine

Image from Wikimedia Commons

Omental cake

Ovarian cancer is difficult to discover because victims tend initially to have vague complaints such as feeling bloated, having urinary and bowel troubles.

Invasion of the peritoneum – a double layered membrane - that lines some of the intra-abdominal and pelvic organs by ovarian cancer cells can occur. Widespread peritoneal infiltration by these cancer cells may be seen for example on ultrasound scan and computed tomography images. In appearance, the infiltrated regions look like a cake – omental cake.
The omentum is part of the peritonuem.

Besides ovarian cancer, other cancers and conditions can cause omental cake.
Reference:

Wang KY, Lee WJ, Lin HJ. Omental cake. Int J Emerg Med, 2010 ;3(4):477-8 Go to reference

Ovarian cancer, peritoneum (red & blue)

Image from Wikimedia Commons

Image from Wikimedia Commons

Red currant jelly sputum

Sputum consists of mucus and other material originating from the airways that is expectorated through the mouth.

In pneumonia which is generally defined as lung inflammation, there is a response of the lung(s) to harmful agents such as bacteria, viruses, fungi, parasites and so on.

The non-motile bacterium Klebsiella pneumoniae can result in sputum tinged with blood giving it a look not unlike red currant jelly – red currant jelly sputum.

Underlying conditions such as diabetes mellitus, alcohol misuse, long standing lung disease, etc. predispose to Klebsiella pneumonia.

Clinical manifestations of pneumonia include a cough, feeling lethargic, having a hot body, difficulty breathing, sputum production, chest pain, etc. Treatment for pneumonia usually includes antibiotics.

Reference:

Johnson AL, Hampson DF, Hampson NB. Sputum color: potential implications for clinical practice. Respir Care, 2008 53(4):450-4. Go to reference

Symptoms of pneumonia, Klebsiella pneumoniae

Image from Wikimedia Commons

Image from Wikimedia Commons

Hot potato voice

Tonsils commonly refer to tissues located at the throats’ back that are involved in guarding against infection.

Sometimes, an abscess (which is a collection of pus - composed of dead tissues, foreign material such as bacteria and white blood cells) forms in the space between the tonsil and its capsule resulting in a peritonsillar abscess (quinsy).

In addition to fever, malaise, sore throat, etc patients with a peritonsillar abscess may have a muffled voice which has been said to resemble the voice of someone speaking with a hot potato in their mouth – hot potato voice.

As peritonsillar abscesses are caused by various bacteria (polymicrobial infection) their treatment includes antibiotics and drainage of the abscess.

The hot potato voice can also occur for example with throat tumors and in epiglottitis (inflammation of the epiglottis), which is a tissue flap found in the throat that helps prevent food and drink go into the airways.

Reference:

Galioto NJ. Peritonsillar abscess. Am Fam Physician. 2008, 15;77(2):199-202.  Go to reference

“Hot potato voice” in peritonsillitis: a misnomer.

Tonsils, right quinsy (peritonsillar abscess)

Image from Wikimedia Commons

Image from Wikimedia Commons

Pea soup stool

The motile bacterium Salmonella typhi, which is known to infect only humans, is spread by ingestion of food, drink or other material contaminated by this organism. Inadequate sanitation and hygiene cause human feces contaminated with this bacterium to end up in food, drink and other material which is then ingested. About 2 weeks after infection with Salmonella typhi, most people suffering from typhoid develop a yellow-green foul liquid stool that resembles pea soup in appearance – pea soup stool.

Good sanitation and hygiene as well as antibiotic treatment for typhoid and vaccination are important measures to curb this multisystem disease.

Reference:

Brusch JL, Garvey T, Corales R, Schmitt SK. Typhoid Fever Clinical Presentation. Medscape reference. Accessed 26-11-2011. Available http://emedicine.medscape.com/article/231135-clinical.

Electron microscope image of Salmonella typhimurium invading human cells

 Image from Wikimedia Commons

Bread and butter pericarditis

Inflammation is not a disease but a normal response of tissues to injury. Inflammation aims to remove, dilute, wall off, etc. injurious agents such as viruses, bacteria, toxins, etc. while setting the scene for healing to occur. With no inflammation, wounds would not heal.

The pericardium; peri, ‘around’, cardium ‘heart’ is a bag with two layers that surrounds the heart as well as the big blood vessels leaving and entering the heart. Normally, between the two layers of the pericardium is a little lubricating fluid which allows efficient heart contraction.

The pericardium can become inflamed – pericarditis – itis being the suffix denoting an inflammatory process. During pericarditis, the protein fibrin forms a mesh that acts as a scaffold to trap, remove, wall off, etc. the injurious agent. When the heart is seen after death (autopsy) in a person who had fibrinous pericarditis the fibrin over the pericardium looks like bread and butter – bread and butter pericarditis.

Reference:

Cohen MB. Cross your heart: Some historical comments about fibrinous pericarditis. Hum Pathol, 2004, 35(2):147-9. Go to reference

Bread and butter pericarditis, heart

Image from Wikimedia Commons

Image from Wikimedia Commons

Word salad

Word salad for instance, “Colorless green ideas sleep furiously”, where phrases are grammatically correct but have no known meaning is a feature of mental illnesses such as schizophrenia and dementia. Word salad is so named to highlight the apparently random mixture of words that resembles the random mixture of vegetables, fruits, meats, etc. in a salad - word salad.

Schizophrenia is a psychiatric disorder that is difficult to define and describe, however some of its features include delusions, hallucinations and interference with speech and thinking which lead to significant social and occupational dysfunction. Delusions are fixed false firm beliefs unaltered by evidence to the contrary e.g. that everyone in the world is watching one; a hallucination is perception without a stimulus e.g. hearing voices of dead people giving one instructions; interference with speech and thinking e.g. word salad.

Dementia is not a single disease but a state characterized by overall impairment of intellect, memory and personality without loss of conscious that can be caused for example by infection, trauma, toxins, cancer, and so on.

Noam Chomsky (born 1928) an American intellectual originated the above quoted sentence for illustrative purposes.

Reference:

Portnoff LA. Schizophrenia and semantic aphasia: a clinical comparison. Int J Neuroscience, 1982 16(3-4):189-97. Go to reference

Salad

Image from Wikimedia Commons

Image from Wikimedia Commons

Blackcurrant rash

DNA (Deoxyribonucleic acid), the genetic code, sustains damage daily from for instance chemicals and sunlight. Normally, the damaged DNA is excised and replaced with new DNA during the ongoing natural process of DNA repair. Failure to repair damaged DNA leads to the accumulation of genetic mutations that may cause cancer.

In xeroderma pigmentosum (XP), a rare inherited disease, there is failure of DNA repair following exposure to sunlight, and sufferers develop skin cancers and can also become blind. Xeroderma stands for dry skin and pigmentosum means pigmented, denoting the finding of dry pigmented skin in this condition. Skin lesions in XP resemble blackcurrants – blackcurrant rash.

Avoiding sunlight assists XP patients.

Reference:

Orosco RK, Wang T, Byrne PJ. Xeroderma pigmentosum in an African-American. ORL J Otorhinolaryngol Relat Spec, 2011 73(3):162-5. Go to reference 

DNA and DNA repair

Image from Wikimedia Commons

Image from Wikimedia Commons

Plucked chicken skin appearance

Pseudoxanthoma elasticum (PXE) is a relatively rare disease in which there is progressive mineralization and fragmentation of elastic fibers.

The skin, eye, blood vessels and heart contain elastic fibers and are consequently affected in PXE.

PXE is also known as Grönblad-Strandberg syndrome, named after a Swedish eye doctor and a Swedish skin doctor respectively who described the disease during the first half of the 20th century.

In PXE one may find yellow raised skin lesions that resemble plucked chicken skin in appearance. These lesions are located particularly in the neck, armpit, groin, elbow, knee and umbilical region.

In the eye one may see a peau d’orange (orange peel) appearance.

Reference:

Goral V et al. Pseudoxantoma elasticum, as a repetitive upper gastrointestinal hemorrhage cause in a pregnant woman. World J Gastroenterol, 2007 13(28):3897-9. Go to reference

Plucked chicken skin appearance of neck

Image from Wikimedia Commons

Apple green sputum

Cigarette smoking causes damage to the lungs resulting in for example chronic bronchitis which is defined as an individual coughing with sputum production for at least 3 months per year, 2 years in a row.  Bronchi are airway passages.

Another consequence of tobacco smoking is emphysema where there is irreversible abnormal dilatation of the air sacs with destruction of their walls. Sufferers develop shortness of breath for instance.

Chronic bronchitis and emphysema often occur simultaneously making up an entity known as chronic obstructive pulmonary disease (COPD).

Patients with COPD have a tendency of developing sudden worsening (exacerbations) of their disease triggered for example by infection with bacteria such as Moraxella catarrhalis. This bacterium is said to result in characteristic apple green sputum.

Sputum is material originating from the respiratory tract such as mucus, phlegm, pus, etc. that is either coughed up or swallowed.

Reference:

Capewell S et al. Pneumonia due to Branhamella catarrhalis. Thorax, 1988 43(11):929-30. Go to reference

Cigarettes; emphysematous lung typical of smoking tobacco

Image from Wikimedia Commons

Image from Wikimedia Commons

Dinner fork deformity

When attempting to break a fall with the outstretched hand, the force of impact may cause a fracture of the main forearm bone, the radius, near the wrist. The fracture fragment adjacent to the wrist joint may become displaced backwards such that when the wrist is viewed from the side or on X-ray, a bend resembling the bend in a dinner fork is noticeable – dinner fork deformity.

This fracture with the dinner fork deformity, common in postmenopausal women with osteoporosis, is known as Colles fracture; so named in honor of the Irish surgeon who described it.

Reference:

Roche CJ et al. Selections from the Buffet of Food Signs in Radiology. Radiographics. 2002, 22(6):1369-84. Go to reference
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X-ray of the wrist showing dinner fork deformity

Image from Wikimedia Commons

Strawberry hemangioma

Capillary hemangiomas are red-blue non-life threatening blood vessel tumors usually found in the head region of children that typically disappear with time. In appearance, capillary hemangiomas seem like strawberries – strawberry hemangioma.

Reference:

Tokuda Y, et al: Giant Congenital Capillary Hemangioma of Pericranium. Neurol Med Chir (Tokyo), 1990 30(13):1029-1033. Go to reference

Capillary hemangioma 

Image from Wikimedia Commons

Strawberry gums

In Wegener’s granulomatosis (granulomatosis with polyangiitis), a disease that affects multiple organs such as the lungs, kidneys and blood vessels, tissue death may result in enlarged, red gums that appear like strawberries – strawberry gums.

There is a shift away from the use of Wegener because Dr Friedrich Wegener (1907 – 1990) who made descriptions of this disease was a member of the Nazi Party.

Reference:

Paul R, Moran N: Strawberry gums in Wegener's granulomatosis: a rare presentation. Oral Surgery, 2008 1:50–52. Go to reference

Antineutrophil cytoplasmic antibodies (ANCAs) in Wegener’s granulomatosis

Image from Wikimedia Commons

Redcurrant jelly - postmortem clot (deeper layer)

When blood becomes stagnant, its solidification by coagulation begins. In stagnant blood, by gravity, the heavier red blood cells settle preferentially to the deeper layer instead of the lighter platelets. This makes the deeper gelatinous layer of a clot that formed after death (when blood is stagnant) red – it resembles redcurrant jelly in appearance.

Reference:

Underwood JCE and Cross SS (eds.), 2009, General and Systematic Pathology, 5th edition, Churchill Livingstone, Edinburgh, page 149. Go to reference

Red blood cell (erythrocyte), platelet (thrombocyte) and white blood cell (leukocyte)

Image from Wikimedia Commons

Amygdaloid nucleus - almond-shaped

The brain is a complex organ that contains several billion neurons (nerve cells) connected to each other by thousands of synapses (connections). In the adult, the brain on average weighs 1.5kg (approximately 2% of body weight). At rest, the brain receives about 15% of the body’s blood and it consumes about 20% of the body’s oxygen.

The amygdaloid nucleus originating from the Greek amydale (almond) eidos (like) is an almond-shaped group of nuclei (localized collection of neurons) within the brain that is associated with emotions, learning, memory, attention and perception.

Reference

Baxter MG, Murray EA: The amygdala and reward. Nat Rev Neurosci, 2002 3(7):563-73. Go to reference

Position of amygdaloid nucleus in brain

Image from Wikimedia Commons

Image from Wikimedia Commons

Maple syrup urine disease

Maple syrup urine disease is an inherited disorder in which there is a deficiency of the enzyme(s) responsible for the breakdown of certain amino acids. These particular amino acids and their byproducts consequently accumulate causing toxic damage to the brain. Urine from patients with this disease may contain these amino acids and their byproducts giving it a sweet odor that is reminiscent of maple syrup – maple syrup urine disease (MSUD).

Amino acids are the building blocks of proteins.

Reference:

Podebrad F et al. 4,5-dimethyl-3-hydroxy-2[5H]-furanone (sotolone)--the odour of maple syrup urine disease. J Inherit Metab Dis 1999 22(2):107-14. Go to reference
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Branched chain amino acids - valine, leucine and isoleucine

Image from Wikimedia Commons

Image from Wikimedia Commons

Image from Wikimedia Commons

Ice-cream cone sign

The ear functions to capture sound waves from the environment and to convert them into nerve impulses for transmission to the brain. Anatomically, the ear can be divided into three parts, the outer ear which captures sound waves, the middle ear which amplifies and transmits these waves to the inner ear that then converts them into nerve impulses.

The middle ear is an air-filled space that contains the body’s smallest bones, the malleus (hammer), incus (anvil) and stapes (stirrup). These tiny bones (ossicles) transmit sound waves from the outer to inner ear.

When viewed with high resolution computed tomography (HRCT) scanning – a specialized type of X-ray imaging technique – the head of the malleus and the body of the incus resemble an ice-cream cone – ice-cream cone sign.

The ear also functions as an organ of balance.

Reference:

Chavan GB, Shroff MM: Twenty classic signs in neuroradiology: A pictorial essay. Indian J Radiol Imaging, 2009 19(2): 135–145. Go to reference

Human ear anatomy

Ice-cream cone sign A (arrow)

Image from Wikimedia Commons

Image reproduced with kind permission from the Indian Journal of Radiology and Imaging

Diabetes mellitus – siphon honey

Diabetes mellitus (DM) is a serious condition with complications that include stroke, blindness, heart disease, kidney failure and possible amputation of limbs. DM is not a single disease but a group of entities characterised by persistently high blood sugar (chronic hyperglycemia) and abnormality in the metabolism (handling) of carbohydrates, proteins and fats within the body. DM occurs due to lack of the blood sugar lowering pancreatic hormone insulin or insulin’s ineffectiveness or both.

Diabetes arises from the Greek designation for siphon because people with diabetes can pass lots of urine and mellitus arises from the Latin term for honey as the urine is sweet.

In the 17th century, the English doctor, Thomas Willis described DM thus: “pissing evil” …  “the urine is wonderfully sweet, as if it were imbued with honey or sugar.”

The sweet urine of DM had been previously described by the ancient Hindus and others.

Reference:

Sanders LJ. From Thebes to Toronto and the 21st Century: An Incredible Journey. Diabetes Spectrum, 2001 15:56-60. Go to reference

Major symptoms of DM

Image from Wikimedia Commons



Lemon sign

On ultrasound scan performed prior to birth usually before 24 weeks of pregnancy, the babies skull may appear like a lemon. This lemon sign may indicate the presence of spina bifida where the neural tube, the precursor of the central nervous system (brain & spinal cord), has failed to close, usually in the lower back region.

Normally, the fetal skull frontal bones curve outwards (convex), however with spina bifida and other conditions, the frontal bones curve inwards (concave) making the skull look like a lemon in shape.

In the common form of spina bifida – myelomeningocele – patients may have bladder and bowel dysfunction, loss of sensation below the level of the lesion as well as an excess of cerebrospinal fluid in the brain’s ventricles (hydrocephalus).

Reference:

Thomas M: The lemon sign. Radiology, 2003 228(1):206-7. Go to reference

Lemon sign A, Spina bifida B

Image reproduced with kind permission from the Indian Journal of Radiology and Imaging

Red as a beet

Processes important for life such as sexual arousal, salivation, lacrimation (tearing), urination, digestion, defecation (passing stool) - remembered by the mnemonic SSLUDD - are largely regulated automatically and involuntarily by the parasympathetic nervous system (PSNS).

The drug atropine blocks some of the activities of the PSNS by interacting with muscarinic receptors, which are the main receptors targeted in tissues regulated by the PSNS.

Atropine overdose causes hot dry skin due to reduced sweating, red skin due to blood vessel dilatation, dryness from reduced tearing and sweating, visual disturbance because of pupillary dilatation as well as inability to focus and confusion due to effects on the brain. These changes may be summarized as, ‘hot as a hare, red as a beet, dry as a bone, blind as a bat and mad as a hatter’.

Control of the aforementioned processes and others also involves the sympathetic nervous system (SNS) which along with the PSNS by and large constitutes the autonomic nervous system.

Reference:

Ramjan KA, Williams AJ, Isbister GK, Elliot EJ: 'Red as a beet and blind as a bat' Anticholinergic delirium in adolescents: lessons for the paediatrician. J Paediatr Child Health, 2007 43(11):779-80. Go to reference

Autonomic nervous system: PSNS = blue, SNS = red

Atropine

 

Image from Wikimedia Commons

 Image from Wikimedia Commons

Anchovy paste

Entamoeba histolytica is a single-celled organism, spread predominantly by ingestion of material contaminated with human feces tainted by this creature. Infection may lead to the formation of liver abscess(es) which contain a soft yellow-brown substance resembling anchovy paste.

Reference:

Pritt BS, Clark CG: Amebiasis. Mayo Clin Proc, 2008 83(10):1154-9. Go to reference

Entamoeba histolytica life cycle

Image from Wikimedia Commons

Bean shaped G-spot

The G-spot named for Ernst Gräfenberg, a German born gynecologist is a controversial thing. In 1950, Gräfenberg in his article entitled ‘The Role of Urethra in Female Orgasm’ he highlighted an erogenous (sexually sensitive) area located along the urethra on the anterior (front) vaginal wall.

In females, the urethra is the channel for urine from the urinary bladder to the outside world; the urethra’s opening is located between the clitoris and vagina.

Stimulation of the bean shaped G spot is said to produce heightened sexual arousal, strong orgasm and female ejaculation (fluid discharged from the urethra during sexual arousal). It is important to note that the exact anatomy of different women differs as well as their response(s) to sexual stimulation (a woman’s individual response also differs at different times).

The term G-spot was introduced to the mass media and public by the bestselling book The G Spot: And Other Discoveries About Human Sexuality published in 1982.

Reference:

Puppo V: Embryology and anatomy of the vulva: the female orgasm and women's sexual health. Eur J Obstet Gynecol Reprod Biol, 2011 154(1):3-8. Go to reference
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Bean shaped G-spot

Image from Wikimedia Commons