hemangioma

A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs.

Causes, incidence, and risk factors

About 30% of hemangiomas are present at birth. The rest appear in the first several months of life.
The hemangioma may be:
  • In the top skin layers (capillary hemangioma)
  • Deeper in the skin (cavernous hemangioma)
  • A mixture of both

Symptoms

  • A red to reddish-purple, raised sore (lesion) on the skin
  • A massive, raised tumor with blood vessels
Most hemangiomas are on the face and neck.

Signs and tests

Hemangiomas are diagnosed by a physical examination. In the case of deep or mixed lesions, a CT or MRI scan may be performed.
Occasionally, a hemangioma may occur with other rare conditions. Additional tests may be done for these syndromes.

Treatment

Superficial or "strawberry" hemangiomas often are not treated. When they are allowed to disappear on their own, the result is usually normal-appearing skin. In some cases, a laser may be used to remove the small vessels.
Cavernous hemangiomas that involve the eyelid and block vision are generally treated with steroid injections or laser treatments. These quickly reduce the size of the lesions, allowing vision to develop normally. Large cavernous hemangiomas or mixed hemangiomas may be treated with oral steroids and injections of steroids directly into the hemangioma.
Recently, lasers have been used to reduce the size of the hemangiomas. Lasers that emit yellow light damage the vessels in the hemangioma without damaging the skin over it. Some physicians use a combination of steroid injection and laser therapy.

Expectations (prognosis)

Small, superficial hemangiomas often disappear on their own. About 50% go away by age 5, and 90% are gone by age 9.

Complications

  • Bleeding (especially if the hemangioma is injured)
  • Problems with breathing and eating
  • Psychological problems, from skin appearance
  • Visible changes in the skin
  • Vision problems (amblyopiastrabismus)

Calling your health care provider

All birthmarks, including hemangiomas, should be evaluated by the health care provider during a routine examination.
Hemangiomas of the eyelid may interfere with the development of normal vision and must be treated in the first few months of life. Hemangiomas that interfere with breathing, feeding, or other vital functions should also be treated early.

Prevention

There is no known way to prevent hemangiomas.



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Empyema Necessitans

Empyema Necessitans.
Empyema necessitans is a rare complication of pleural space infections and occurs when the infected fluid dissects spontaneously into the chest wall from the pleural space. This process may result from bronchopleural extension of a peripheral lung infection. These cases result from inadequate treatment of an empyema and usually occur after a necrotizing pneumonia or pulmonary abscess.

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graves

Examination :
Hands - Tremor, onycholysis, Acropashy, Warm sweaty palms
Pulse rate, Irregular to suggest AF ?

Proximal myopathy

Eyes - Exopthalmos, proptosis, Lid lag, lid retraction, Extraocular movements, chemosis

Neck - Scar, Goitre - Inspect, palpate for ? single nodule, multinodular, diffuse(most likely diffuse in Graves), percuss for retrosternal extension, auscultate for bruit

Limb - Pretibial myxedema, tendon reflexes

Well, if you got all those, I guess medical students can do all that.

So, you need to mention whether the disease is active or not.
Signs of activity - tremor, warm&sweaty palms, Thyroid bruit, Tachycardia

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vitiligo



this patient has areas of depigmentation around the mouth, the upper limb, legs and trunk. He has vilitigo.


Vitiligo affects 1% of the population. Equal between males and females, although more females present to the skin clinic. Family history in 1/3 of patients.
They have Koebner's phenomenon - lesion appearing on the site of lesion.This patient has areas of depigmentation around the mouth, the upper limb, legs and trunk. He has vilitigo.
When


Vitiligo affects 1% of the population. Equal between males and females, although more females present to the skin clinic. Family history in 1/3 of patients.
They have Koebner's phenomenon - lesion appearing on the site of lesion.
When you see a patient like this, look for other features of autoimmune


Thyroid disorder - Hashimoto's thyroiditis, Graves' disease
Pallor - Pernicious anaemia
Pigmentation of buccal, skin crease, hypotension - Addison's disease
Tetany, cramps, paraesthesia, Chvostek's and Trousseau's sign - Idiopathic hypoparathyroidism
Fundus - diabetes mellitus
Lungs (fine crepts) - Fibrosing alveolitis
Jaundice - Chronic active hepatitis
Excoriation marks, xanthalesma, pigmentation - primary biliary cirrhosis
rash, arthritis, prox weakness - SLE, RA, dermatomyositis, polymyositis
Thyroid disorder - Hashimoto's thyroiditis, Graves' d


Vitiligo affects 1% of the population. Equal between males and females, although more females present to the skin clinic. Family history in 1/3 of patients.
They have Koebner's phenomenon - lesion appearing on the site of lesion.
When you see a patient like this, look for other features of autoimmune


Thyroid disorder - Hashimoto's thyroiditis, Graves' disease
Pallor - Pernicious anaemia
Pigmentation of buccal, skin crease, hypotension - Addison's disease
Tetany, cramps, paraesthesia, Chvostek's and Trousseau's sign - Idiopathic hypoparathyroidism
Fundus - diabetes mellitus
Lungs (fine crepts) - Fibrosing alveolitis
Jaundice - Chronic active hepatitis
Excoriation marks, xanthalesma, pigmentation - primary biliary cirrhosis
rash, arthritis, prox weakness - SLE, RA, dermatomyositis, polymyositis
isease
Pallor - Pernicious anaemia
Pigmentation of buccal, skin crease, hypotension - Addison's disease
Tetany, cramps, paraesthesia, Chvostek's and Trousseau's sign - Idiopathic hypoparathyroidism
Fundus - diabetes mellitus
Lungs (fine crepts) - Fibrosing alveolitis
Jaundice - Chronic active hepatitis
Excoriation marks, xanthalesma, pigmentation - primary biliary cirrhosis
rash, arthritis, prox weakness - SLE, RA, dermatomyositis, polymyositis

T
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shingles

Shingles, or herpes zoster, is caused by the same virus that causes chickenpox. The virus can lie dormant in the body for many years and re-emerge as shingles. Shingles appear as a painful rash. It consists of red patches of skin with small blisters (vesicles) that look very similar to early chickenpox. Shingles usually clears in 2 to 3 weeks and rarely recurs.

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diagnose this?

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retinitis pigmentosa

Retinitis pigmentosa showing the typical bone spicules pigmentary changes.
There are multiple bone-spicules hyperpigmentation in the peripheral retina. In advanced cases, 
the posterior pole is also involved. The retinal vessels are attenuated and the optic disc is pale. 
The macula may show cellophane, atrophic or cystoid maculopathy. The condition is bilateral.Other features to look for:
  • drusen in the optic disc
  • cells in the vitreous
  • cataract typically posterior subcapsular cataract
  • keratoconus 
  • trabeculectomy (3% of  RP develop glaucoma)
Look for associated features which may provide clue to diagnosis:
  • hearing aids (Usher's syndrome but beware that patients with syphilis or congenital rubella 
  • may also have deafness and pigmentary changes in the retina)


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