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

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
Go to ripe cheese odor 

Branched chain amino acids - valine, leucine and isoleucine

Image from Wikimedia Commons

Image from Wikimedia Commons

Image from Wikimedia Commons

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



Caseous (cheesy) necrosis

White soft tissue resulting from cell death (necrosis) resembles cheese in appearance. This caseous (cheesy) necrosis is a feature of tissue destruction by tuberculosis (TB); however other illness can also cause caseous necrosis.

TB is mainly caused by the non-motile bacterium Mycobacterium tuberculosis which grows inside cells particularly in regions with high oxygen content such as the lungs. Spread of TB is by inhaling minute droplets resulting from coughing by an individual with active TB.

TB is more common in areas with overcrowding, under nutrition, low income, HIV and so on; essentially among the poor. Poverty predisposes to TB and TB worsens poverty – a vicious cycle

A third of the world’s population is estimated to be infected with TB (latent); however the vast majority of infected people do not develop active TB for largely unknown reasons.

Reference:

Ahmad S: Pathogenesis, Immunology, and Diagnosis of Latent Mycobacterium tuberculosis Infection. Clin Dev Immunol, 2011; 2011: 814943. Go to reference

Cheese

Image from Wikimedia Commons

Blueberry muffin baby

In adult life, red blood cell production takes place in the bone marrow; however, during normal development of the unborn - in the uterus - formation of red blood cells occurs in organs such as the liver, spleen and skin. Under certain circumstances such as in infection with the rubella virus or cytomegalovirus, red blood cell formation in the skin continues abnormally after birth giving the skin blotches that seem like blueberries on a muffin – blueberry muffin baby/rash.

Additionally, certain cancers and vessel abnormalities may also give the blueberry muffin baby appearance.

Reference

Mehta V, Balachandran C, Lonikar V: Blueberry muffin baby: A pictoral differential diagnosis. Dermatol Online J, 2008 14(2):8. Go to reference

Blueberry muffin appearance of neuroblastoma (a cancer) and a muffin

Image from Wikimedia Commons

Image from Wikimedia Commons 

Honeycomb lung

Lung scarring (fibrosis) with irregular air spaces interspersed between the areas of scarring gives the lung a look akin to a honeycomb – honeycomb lung.

Lung (pulmonary) fibrosis is the final consequence of a different group of diseases caused for example by infections, inhaled mineral dusts, drugs, etc. Sometimes, the cause of lung fibrosis is not known and this situation is known as idiopathic (cryptogenic) lung fibrosis.

In pulmonary fibrosis, the lung becomes less distensible due to scar tissue and its space for air becomes reduced.

The affected individual generally develops progressive shortness of breath.

Reference:

Heppleston AG: The Pathology of Honeycomb Lung. Thorax, 1956 11(2):77–93. Go to reference 

Honeycomb lung

Image from Wikimedia Commons

Honey-colored crusts

Impetigo is a highly contagious superficial skin disease more common in children caused by bacteria usually Staphylococcus aureus and at times Streptococcus pyogenes. In impetigo, the lesions begin as a red skin area, blister formation follows; next, the blisters rupture and the drying blister contents leave distinctive honey-colored crusts.

Impetigo lesions usually heal without treatment and without scarring.

Reference:

Cole C, Gazewood J: Diagnosis and Treatment of Impetigo. Am Fam Physician, 2007  15;75(6):859-64. Go to reference

Impetigo

  Image from Wikimedia Commons 

Nutmeg liver

In heart failure, when the heart can longer pump blood forward effectively, the blood tends to stagnate and dams backwards congesting organs such as the liver - congestive hepatopathy. The sites in the liver surrounding veins containing this stagnant dammed blood appear red-brown while the other areas of normal liver look yellow. When seen with the naked eye, this speckling of red-brown against a yellow background gives the liver an appearance similar to that of a grated nutmeg – nutmeg liver.

Reference:

Bayraktar UD, Seren S, Bayraktar Y: Hepatic venous outflow obstruction: Three similar syndromes. World J Gastroenterol, 2007 7;13(13):1912-1927.Go to reference

Placenta – flat cake

In humans, the placenta (afterbirth) is disc shaped and it is so named because of this discoid shape – the word placenta originates from the Latin root for a flat cake.

During pregnancy, the placenta functions to supply nutrients and oxygen from the mother to the fetus and to remove wastes from the fetus to the mother. Additionally, the placenta produces hormones (chemical substances) which among other actions regulate optimal uptake of nutrients from the mother to the fetus. The placenta also protects the fetus from the mother’s immune system since the fetus is a foreign body and would normally be attacked by the mother’s immune system.

Reference:

Kliman HJ. From Trophoblast to Human Placenta (from the Encyclopedia of Reproduction). Available http://med.yale.edu/obgyn/kliman/placenta/articles/EOR_Placenta/Trophtoplacenta.html. Accessed 23-03-2011. Go to reference

Human placenta - flat cake

 Image from Wikimedia Commons

Fried egg-like cells

Oligodendrogliomas are tumors thought to arise from oligodendrocytes, which are cells that insulate neurons in the brain and spinal cord thereby facilitating efficient transmission of nerve impulses.

When viewed under the microscope, the cells of oligodendrogliomas resemble fried eggs in appearance – fried egg-like cells.

Reference:

Vesper J et al: Retrospective analysis of treatment outcome in 315 patients with oligodendroglial brain tumors. BMC Neurol, 2009 16(9):33. Link

Fried egg-like cells

Image from Wikimedia Commons