Sthanu Profile picture
Feb 12 6 tweets 3 min read
Long standing abdominal bloating and malabsorption

Diagnosis? Sign?
Scleroderma - small bowel involvement

This patient had known long standing scleroderma and demonstrates characteristic small bowel follow-though appearances.
Hide-bound sign

👉 is seen on barium studies of the small bowel in patients with scleroderma.

👉 sign describes a narrow separation between valvulae conniventes of normal thickness despite dilatation of the bowel lumen
Hide-bound sign

Although the term hide-bound is used specifically to describe scleroderma, the same appearance may also be seen in sprue.
The term hide-bound sign was coined by Alfred Horowitz and Morton Meyers in a study published in 1973, although according to their article the appearance had been described prior to that

The term hide-bound was originally used to describe emaciated cattle.
Reference:

link.springer.com/article/10.100…
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radiopaedia.org/cases/9597/stu…
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Radiology classroom
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Radiopedia

by Evyn Arnfield

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More from @Sthanu5

Feb 14
Question:

34 year old male with h/o ulcerative colitis is admitted to ICU with dehydration secondary to diarrhea.

Initial lab testing is consistent with electrolyte abnormality but marked elevation of alkaline phosphatase.

What is your concern? Image
Answer: Primary sclerosing cholangitis (PSC) Image
Patients with UC are at very high risk of developing PSC.

Pathology is thought to be same i.e autoimmunity. Image
Read 8 tweets
Feb 14
A 37-year-old woman

👉symptoms consistent with allergic conjunctivitis,

👉 found to have this incidental finding.

What is the diagnosis?

Aniridia

Prominent iris collarette

Coloboma of the iris

Granulomatous iritis

Persistent pupillary membranes Image
The diagnosis is a protruding or prominent iris collarette.
👉 finding was detected on slit-lamp examination.
♦️
The iris collarette is a landmark that separates the central pupillary zone from the peripheral ciliary zone.
♦️
It is typically flat but can be prominent, as seen here
Read 5 tweets
Feb 13
Now,this...
***
Previous laparotomy and incisional hernia repair.

Distended abdomen and vomiting.

60 years
Female

Diagnosis? Image
Small bowel obstruction

The plain radiograph appearances are classical for a distal small bowel obstruction:

a. Dilated small bowel

b. The location is central within the abdomen
c. Large bowel at the periphery is collapsed

d. The valvulae conniventes can be identified across the full width of the dilated loops confirming it to be small (not large) bowel.
Read 4 tweets
Feb 13
What is the rule here? Image
Here.... Image
The 3-6-9 Rule Image
Read 6 tweets
Feb 13
What is Buttonhole sign? Image
Buttonhole sign

In type 1 neurofibromatosis (Von-Recklinghausen's disease)

👉neurofibromas can be invaginated with the tip of index finger back into the subcutis and again reappear after release of pressure. Image
Buttonhole sign Image
Read 8 tweets
Feb 13
What’s the likely diagnosis?

(A) Norwegian scabies

(B) Tripe palms, acanthosis nigricans

(C) Hyperkeratotic eczema

(D) Tinea manuum Image
A 73-year-old woman

👉 smoking history of 30 pack-years

👉 pruritic and painful lesions on the palms of her hands that had first appeared 9 months earlier
👉 reported a cough that had been present for 1 year

👉 weight loss of 5 kg over the past 4 months

👉 examination revealed sharp demarcation of the folds in the lines of her hands

👉 a velvety appearance of palmar surfaces and ridging of the skin (Panel A).
Read 8 tweets

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