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Feb 13 • 8 tweets • 3 min read

What is Buttonhole sign?

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.

Buttonhole sign

Other condition where one can find positive buttonhole sign are

anetoderma

dermatofibroma.

Dermatofibroma

👉 commonly occurring cutaneous entity usually centered within the skin's dermis

👉 benign fibrous histiocytomas of the skin, superficial/cutaneous benign fibrous histiocytomas, or common fibrous histiocytoma

Anetoderma, also known as macular atrophy

👉 uncommon disorder of elastic tissue

👉 clinically characterized by wrinkled and atrophic depressions or saccular outpouchings of the skin

👉 these may herniate upon digital pressure

slideshare.net/DrArulSelvan/s…

emedicine.medscape.com/article/111200…

Von-Recklinghausen's disease

https://twitter.com/OnSquares/status/1325029157777104896?t=jfLRck7FIuL9L8Ap7-lczA&s=09

Von-Recklinghausen's disease

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More from @Sthanu5

Sthanu

@Sthanu5

Feb 15

68-year-old man with ILD

What is the most likely diagnosis?

Amyopathic dermatomyositis

Leprosy

Diffuse cutaneous systemic sclerosis

Subacute cutaneous lupus erythematosus

Adult-onset Still’s disease

👉 skin changes characterized by alternating areas of hypopigmentation and hyperpigmentation on sclerotic skin.
♦️
Answe

Diffuse cutaneous systemic sclerosis

“Salt-and-pepper” dyspigmentation on the chest, along with interstitial lung disease, is most characteristic of diffuse cutaneous systemic sclerosis

Read 6 tweets

Sthanu

@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?

Answer: Primary sclerosing cholangitis (PSC)

Patients with UC are at very high risk of developing PSC.

Pathology is thought to be same i.e autoimmunity.

Read 8 tweets

Sthanu

@Sthanu5

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

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

Sthanu

@Sthanu5

Feb 13

Now,this...
***
Previous laparotomy and incisional hernia repair.

Distended abdomen and vomiting.

60 years
Female

Diagnosis?

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

Sthanu

@Sthanu5

Feb 13

What is the rule here?

Here....

The 3-6-9 Rule

Read 6 tweets

Sthanu

@Sthanu5

Feb 13

What’s the likely diagnosis?

(A) Norwegian scabies

(B) Tripe palms, acanthosis nigricans

(C) Hyperkeratotic eczema

(D) Tinea manuum

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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