Funtabulously Frivolous Friday Five 102

Erb’s palsy

Albrecht Durer painted Madonna and Child depicting an infant with an Erb’s palsy. Other differentials include amyoplasia congenita, anterior horn cell lesions, hereditary brachial plexus neuropathy and pseudoparalysis

On closer inspection there appears to be a lump by the child’s left clavicle suggesting a clavicular fracture thus pseudoparesis is the most likely diagnosis. Could this child have been a shoulder dystocia requiring the mid wife to fracture his clavicle?

Ramachandran M, Aronson JK. The diagnosis of art: Albrecht Dürer and the Christ Child’s drooped shoulder. J R Soc Med. 2008 Feb; 101(2): 87–88.

Repeated finger-snapping at discos

Painful purulent infection (felon) at the end of a finger. Disco Felon (or Disco finger was first recorded in the NEJM in 1979 and in the Spokane Daily Chronicle in the same year.

• Walker FW, Lillemoe KD, Farquharson RR. Disco felon. N Engl J Med. 1979 Jul 19;301(3):166-7.

Osteopoikilosis is a benign, asymptomatic sclerosing dysplasia

Most commonly seen in early 20’s, but can be seen at any age. Cutaneous lesions in 25%. Etiology unknown. Inherited and spontaneous cases occur.

X-rays demonstrate sclerotic circular or ovoid lesions symmetrically distributed in a periarticular location. Must be differentiated from blastic metastasis, which can also present radiographically as white densities interspersed throughout bone.

Blastic metastasis:

• tend to present with larger and more irregular densities in less of a uniform pattern.
• mostly affect older people (osteopoikilosis most common in people 20 years of age and younger)

Melioidosis

Also known as Vietnamese time-bomb and Nightcliff Gardener’s disease

Disease caused by infection with Burkholderia (formerly Pseudomonas) pseudomallei

It is of public health importance in endemic areas, particularly in Thailand and Northern Australia.

Melioidosis exists in acute and chronic forms. Symptoms may include chest pain, bones and/or joints; cough; skin infections, lung nodules and pneumonia.

• CCC. Meliodosis
• Melioidosis a disease of surprises
• Melioidosis – Lab without walls

Auenbrugger Sign

Josef Leopold Auenbrugger (1722 – 1809)  was an Austrian physician who invented percussion as a diagnostic technique. The legend goes that he observed his father checking the wine barrels at the hotel by tapping.

Auenbrugger first described a ‘bulging of the epigastrium’ in the presence of a large pericardial effusion extending subxiphoid.

He is considered one of the founders of modern medicine and inspired René Laennec (1781-1826) to discover the stethoscope and auscultation. He performed experiments on cadavers by filling the pleural cavity with fluid and percussing to great effect. He published his work but nobody paid any attention, it was only later in his life (a year before he died) that the work of Jean-Nicolas Corvisart (1755-1821) popularised his examination technique.