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Quiz Case 1
Stephen J. Wall, MD, PhD;
Kenneth H. Lee, MD, PhD;
J. D. Alvarez, MD, PhD;
Douglas C. Bigelow, MD
Philadelphia, Pa (Drs Wall, Alvarez, and Bigelow) and St Louis, Mo (Dr Lee)
Arch Otolaryngol Head Neck Surg. 2000;126:236-239.
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A 43-YEAR-OLD white woman with diabetes and chronic myelogenous leukemia underwent allogenic bone marrow transplantation. Her immediate posttransplantation course was complicated by neutropenia, a hypercoagulable state, and respiratory and hepatorenal failure. She underwent therapy with tissue plasminogen activator and heparin for treatment of veno-occlusive disease, without success. An area of ecchymosis that was noted on the right pinna was initially attributed to trauma from a digital thermometer. Over the first 24 hours, the ecchymotic area enlarged and a greenish discoloration was noted centrally (Figure 1). The primary service expressed concern regarding a thromboembolic phenomenon vs trauma-induced hemorrhage associated with the patient's therapy. On otolaryngologic examination, the ear was cool to the touch and the lobule exhibited poor capillary refill (>4 seconds). Otoscopy demonstrated bleeding and blebs involving the external . . . [Full Text of this Article]
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
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The Importance of a Thorough Physical Examination
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Arch Otolaryngol Head Neck Surg 2000;126:1169-1169.
FULL TEXT
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