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In 2014, healthcare professionals shared thousands of medical cases on Figure 1. These images included both common and rare conditions in specialties ranging from emergency medicine to radiology to dentistry. Each week, our team selected the top teaching case as the “Image of the Week”. This week, we sat down to decide on five of the most interesting cases from 2014.

1. Pediatric Heart Transplant

This moving image provides a rare look into a pediatric heart transplant procedure. The recipient in this case was a 13 month-old patient with congenital heart disease (CHD). Most programs now report that more than 70% of pediatric heart transplant recipients survive at least 5 years. However, some patients have survived beyond 20 years. Last year, 115 heart transplants were reported internationally for patients between 1 and 5 years old.

View this case on Figure 1: Pediatric Heart Transplant

2. Caput Medusae

Caput Medusae is the term used to describe these tortuous veins when they become prominent on the surface of the abdomen. It is classically associated with portal hypertension and cirrhosis. The differential diagnosis for this particular case also included Inferior Vena Cava Obstruction (IVCO). To distinguish between Caput Medusae or IVCO, occlusion of the vein is required. If blood flows towards the legs, Caput Medusae is more likely. If blood flows towards the head, IVCO is more likely.

View this case on Figure 1: Caput Medusae

3. Teal-colored Urine

This patient’s catheter urine output and saliva were bright teal, and because of a miscommunication in the patient’s chart, the cause was initially a mystery. It was later revealed that the patient had received methylene blue, a medical dye that is sometimes used in surgical procedures. One effect of methylene blue is that it discolors urine and other bodily fluids.

View this case on Figure 1: Teal-colored Urine

4. Hypertrophic Pulmonary Osteoarthropathy

These scans were taken of a 49 year-old female smoker with lung cancer. The tumor was seen in the right lower lobe on the chest X-Ray. Unexpectedly, a bone scan demonstrated a rare finding — hypertrophic pulmonary osteoarthropathy, a syndrome defined by the presence of clubbing and periosteal proliferation of the tubular bones.

View this case on Figure 1: Hypertrophic Pulmonary Osteoarthropathy

5. Jackstone

The specimen pictured here is a rare form of bladder stone known as a jackstone. This variety is referred to as a “jack” stone because of its resemblance to the metal objects in the children’s game, Jacks. Jackstones occur most often in the urinary bladder and less frequently in the upper urinary tract. These stones are often composed of calcium oxalate, and they form in the crevices and trabeculations of the urinary bladder. As they grow, new minerals are deposited on the irregular shape, forming larger and larger spicules.

View this case on Figure 1: Jackstone

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