Bizarre Medical Images

It's back to work again...this week it's back to being the "Night-time Super SAR" (basically the chief admitting resident--I deal with the administrative details of assigning patients to the appropriate team, plus I get to treat the patients who are admitted through the ER late-night), working shifts from 8pm-8am (and, incidentally, marks the 3rd consecutive year that I have been either working or post-call on my birthday, which is coming up on Dec. 8th).

For tonight's blog entry I give you two bizarre medical images...both of which have been admittedly pilfered from the New England Journal of Medicine "Medical Mysteries" section.

The first image is a 10-year-old boy with a brown eye on the right and a blue eye on the left. What's the deal, you might ask? Turns out there is a very mild ptosis (drooping) and more noticeable miosis (the pupil is a little smaller) in the left eye compared to the right eye. It can result from compression of the sympathetic nervous system on the right side and causes an entity known as Horner's Syndrome. In children, the sympathetic nervous system also stimulates the synthesis of melanin, the pigment which makes up the iris. This kid unfortunately had a left-sided paravertebral neuroblastoma (a type of tumor).

The next image is far more gruesome in appearance, but demonstrates some badly disfigured hands. The answer to this "Medical Mystery" has not yet been revealed so I'll just have to guess. I'm going to go with "chronic tophaceous gout", because you can see a ton of nodules scattered about. Other possibilities would include severe rheumatoid arthritis or lepromatous leprosy.