The Happy Hospitalist - Latest Comments in http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

Re: http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

JunkMD — Fri, 25 Jul 2008 17:06:00 -0000

Happy,
Do we have a diagnosis yet?

Re: http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

igloodoc — Mon, 21 Jul 2008 00:05:00 -0000

I am probably over-reading the picture, but it looked like there was either an edema or cellulitis component with the ecchymosis.

The one I saw (long ago) presented with the same kind of history, and ecchymosis with edema. It was a partial cavernous sinus thrombosis, and the swelling went away with position. I assumed that you CT facial bones to rule out an occult LeFort fracture or broken nose.

I suggest a MRI/MRA if it is not getting better...

Re: http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

igloodoc — Sun, 20 Jul 2008 21:34:00 -0000

Cavernous sinus thrombosis?

Any nerve palsy?
MRI/MRA show anything?

Re: http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

Bianca Castafiore — Sun, 20 Jul 2008 17:22:00 -0000

What would you expect to see in a head CT were the patient
*falling or
*being abused
to the extent necessary for production of bilateral periorbital ecchymosis?
Also, is there significance to the bilaterality?

Re: http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

Frank Drackman — Sun, 20 Jul 2008 08:21:00 -0000

Saw that happen in an F-16 pilot who had pulled like 8Gs. Tell Grandma to ease up on the Stick.

Re: http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

yay — Sun, 20 Jul 2008 01:18:00 -0000

There's a picture that looks a lot like that in my clinical examination book (Talley & O'Connor).

Hmmm... it says that with amyloidosis causing macroglossia, bilateral periorbital purpura following a proctoscopic examination is characteristic, albeit rare.

Don't quite see how that fits into lying down or falling though :p

Re: http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

JunkMD — Sat, 19 Jul 2008 23:26:00 -0000

Possible differential:
Hypothyroidism?
Pertussis?
Renal Failure?

Re: http://thehappyhospitalist.blogspot.com/2008/07/differential-diagnosis.html

Anonymous — Sat, 19 Jul 2008 18:00:00 -0000

Multiple myeloma? Amyloidosis?