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An obese 56-year-old woman was hospitalized after 2 days of chest pain, shortness of breath, and palpitations. Physical examination revealed no abnormalities, and serial cardiac enzyme studies and an ECG ruled out myocardial infarction. However, transesophageal echocardiography showed a lesion in the mediastinum.

Mediastinal Lipomatosis


These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite.

These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite. What creature did the biting?

Swollen Hands-What’s Biting?

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

Clinical Topics

What's This "Red Spot"?

This image of the dorsum of the tongue of a 42-year-old African American woman shows parallel linear black coatings.

After a “swig” of  Kaopectate, this patient noticed tongue discoloration. Is this coincidental, or is there a clinical connection? 

Black Coating on a Woman’s Tongue

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2½ weeks earlier, when he was hit in the face by a baseball.

Is this lesion the result of an injury, as the boy’s mother suspected, or something else?

Scaly Plaque on the Nose

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months.

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months. Your diagnosis?

“Swimsuit Area” Rash: Your Dx?

A 32-year-old man presents with dysphagia to solid foods. His symptoms have increased in frequency during the past 6 months. He has taken to eating much more slowly and needs water to help swallow food. His history is remarkable for seasonal allergies, for which nasal fluticasone is prescribed. He undergoes an upper endoscopy, which demonstrates diffuse rings, longitudinal furrows, and white plaques. Esophageal biopsies reveal dense eosinophilia throughout.

A. Start swallowed topical corticosteroids

B. Refer to allergist for skin prick testing

C. Begin treatment with an acid suppressant

These endoscopic findings help explain worsening dysphagia in a 32-year-old man. Esophageal biopsies prove positive for eosinophilia. How would you proceed? 

Esophageal Rings, Furrows, and Plaques: What Next?

Ashwani Bhardwaj, MD

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