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Wetread Case 32

Hx: Cough, shortness of breath, fever 😡😡 (yep, I did 😁)

Any pertinent hx questions? 🤔

Feel free to answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Would it help to know that the pt is immunosuppressed?

and NO it's NOT COVID-19! 😁

@RadioGyan @AdamSingerMD @xyzabrz @lala_layla_1
Answer: Kaposi’s Sarcoma

KS is a low-mid grade mesenchymal tumor that involves blood/lymphatic vessels of the skin, lymph nodes, lungs, GI tract, etc.

Not considered a true “sarcoma”

Believed related to human herpes virus type 8 (HHV8)

👏 to @DrAliya85 #chestrad #FOAMrad
Comes in 4 variants:

Classic - generally limited to lower limb w/ purple dermal plaques

Iatrogenic - related to immunosuppression during organ transplantation

AIDS-related - HIV+ patients with CD4 <200 (considered an AIDS defining illness)

Endemic - men in equatorial Africa
Imaging - XR:
- linear interstitial nodules vs fluffy ill-defined nodules often in a peri-hilar to mid/lower lung predominance. +pleural effusion +adenopathy

Different patient:
Imaging - CT:
- flame shaped nodular opacities in a symmetric/perihilar distribution with surrounding glass-glass appearance

- interstitial thickening w/ peribronchovascular nodular pattern

+ pleural effusion
+ adenopathy (can be of high attentuation)

Different patients:
Nuclear Medicine - can be helpful to differentiate from lymphoma

Th-201 - positive in both KS and lymphoma

Ga67 - usually negative in KS but positive in lymphoma/infection

Good luck to all and hoping everyone stays safe!
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Ryan Christie
@RyanChristieMD
Wetread Case 31

Hx: altered mental status, weakness

Venturing into the Neuro realm 😮 CT pending 🤔

Feel free to answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #neurorad
CT finally complete

Does this help? Could you have made the diagnosis on the X-ray?

Hint: it may be long standing 😁

#WetreadCow #FOAMrad #FOAMed #radres #errad #neurorad
Answer: Dyke-Davidoff-Masson Syndrome (DDMS)

Early infection/infarction/insult to one of the cerebral hemispheres -> hemi-cerebral atrophy + homolateral hypertrophy of the skull and sinuses (to fill the space)
Read 5 tweets
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Ryan Christie
@RyanChristieMD
Wetread Case 30

Hx: foot pain

How about something, anything outside of the chest 😂

Feel free to answer with professionally appropriate gif responses only. No spoilers.
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad and no 🤔 or 🤭! 🤣
Answer: Intraosseous lipoma of the calcaneous

but I bet everyone knew that!

Classic appearance = a well circumscribed lytic lesion in the calcaneal body with central Ca++ (aka cockade sign)
Whats a cockade?

= a rosette - a knot of ribbon rolled into a badge.

So central density surrounded by well circumscribed low density area
Read 6 tweets

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Craig Spencer MD MPH
@Craig_A_Spencer
Thank you everyone for your incredible messages of support and encouragement.♥️

Many of you asked what it was like in the ER right now. I want to share a bit with you. Please RT:

A Day in the Life of an ER Doc - A Brief Dispatch from the #COVID19 Frontline:
Wake up at 6:30am. Priority is making a big pot of coffee for the whole day, because the place by the hospital is closed. The Starbucks too. It's all closed.

On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or it's early. Regardless, that's good.
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Mari
@Mari_Knutson
Please share information with everyone. We have to protect ourselves and get informed- our federal government is not going to protect us in the time that is necessary to prevent the loss of many lives. We have to act together as a Community to protect our loved ones.
Restrict travel, avoid crowds, wash hands, sterilize door knobs, light switches, & prepare to be at home for 2 weeks. Restricted travel will slow the spread of the virus, and allow self-quarantined families time to exhibit symptoms and manage their immediate health and welfare.
This is information I am sharing based on my experience from developing symptoms of COVID 19 in King Co. WA. February 9, 2020. I was not allowed to be tested for the virus.
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Daniel Sinclair
@_DanielSinclair
In New Rochelle, the U.S. has a small glimpse into that life under lockdown — where the app economy has dried up, and the food is delivered in rationed bags by a desperate mobilized force. For America, it will be the National Guard — not the cadres.
New Rochelle High School: "This was the scene today at the sprawling campus that was otherwise quiet as thousands of students are kept out of three of the city's schools in an effort to contain the spread of coronavirus." lohud.com/story/news/loc…
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Daniel Sinclair
@_DanielSinclair
"Curbs on transport in Wuhan remain in place, and schools in the province would remain closed until further notice... New infections in Hubei continued to stabilize, with new cases declining for the sixth day. All 13 new cases in Hubei were recorded in Wuhan."
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Daniel Sinclair
@_DanielSinclair
“Mr. Xi’s visit comes as China re­ports a steep de­cline in the num­ber of new cases. On Tues­day, Wuhan shut down the last of the 14 tem­po­rary hos­pi­tals that it had built to ac­com­mo­date the sud­den surge of new pa­tients.”
A signal that China can get back to work:
But, despite this victory lap for the Xi presidency, China is very much not back to normal. Those who can leave Hubei will still need to quarantine. Their Alipay health codes will still be red. They’ll still be shunned from society.
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GMA News
@gmanews
The 4th case is a 48-year old Filipino male with travel history to Haneda, Japan. | via @shailagarde
@shailagarde The 5th case is a 62y/o Filipino male who has been asymptomatic since Feb 25, and was also confirmed positive for the SARS-CoV-2 virus on March 5. | via @shailagarde
@shailagarde Duque: It’s still premature to say that there is local transmission in the country. | via @donamagsino
Read 14 tweets

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