(BMJ) - An 80-yo man on warfarin for atrial fibrillation tripped on a curb, striking his head w/o LOC. Exam: abrasion on R temple, R eye chemosis, and decreased vision but no afferent pupillary defect. CT scan confirmed the diagnosis. What is it?
Ruptured orbit
Traumatic glaucoma
Subconjunctival emphysema
Graves ophthalmopathy
Retrobulbar hematoma
You are correct. The patient had subconjunctival emphysema due to orbital wall fracture through the lamina papyracea diagnosed by CT. The scan showed no evidence of retrobulbar or intracranial hemorrhage, though this diagnosis was of primary concern in a patient on warfarin with head and facial trauma. An afferent pupillary defect is often seen with retrobulbar hematoma but wouldn't be expected with subconjunctival emphysema. This condition is self-limited. He was treated conservatively with lubricant drops.
(BMJ) - A woman presented with a chin lesion for >1 year that intermittently drained pus. Exam: purulent lesion, poor dentition. What is the diagnosis?
Granuloma annulare
Folliculitis
Thyroglossal cyst
Dental sinus
Tertiary syphilis gumma
You are correct. The patient was referred to a dentist who confirmed dental sinus and initiated treatment. The lesion did not look typical of any common skin cancer. Dental sinus should be suspected in lesions around the mandible.