Raveena Reddy

Gadolinium-associated plaques: a new, distinctive clinical entity.

IMPORTANCE A new condition, gadolinium-associated plaques (GAP), is reported in 2 patients. It is related to a particular type of gadolinium (gadodiamide) used for contrast-enhanced radiologic studies. OBSERVATIONS Erythematous plaques, 0.5 to 2.5 cm in diameter, were pruritic in one case and asymptomatic in a second case. Findings from the histopathologic examination revealed eosinophilic, collagenous, round or ovoid bodies (sclerotic bodies) in various stages of calcification. Previously, these sclerotic bodies were thought to be pathognomonic for nephrogenic systemic fibrosis (NSF) in the setting of chronic renal disease with associated gadolinium exposure. Neither patient had NSF, while only 1 of these patients had renal disease. The patient who did not have renal disease received high doses of gadolinium. CONCLUSIONS AND RELEVANCE Physicians should be aware that GAP can occur without NSF or renal disease and is associated with the use of radiologic dyes. Sclerotic bodies have been reported only in association with gadolinium exposure (eg, gadodiamide) either in the sclerotic skin in NSF or in GAP.

Sodium polystyrene sulfate–associated gastric ulceration (with video)

radiologist then oversaw the acquisition of sequential fluoroscopic images as the patient was repositioned (Fig. 3). No significant lesions were identified in the stomach or proximal duodenum, and no procedure-related complications occurred at 1-month follow-up. The patient subsequently underwent a repeat CT scan during an episode of pain, which revealed intussusception at the jejunojejunostomy that ultimately required surgical revision.

Grouped Hemorrhagic Vesicles

An 8-year-old girl presented to the dermatology clinic for further evaluation of a lesion over the right posterior thigh (Figure, A). Her mother reported the lesion appeared at age 3 months, was previously diagnosed as a hemangioma, and was treated with observation. She also reported the lesion originated as a “cystlike papule” that had continuously expanded. In addition to causing cosmetic concerns, the lesion seemed to be irritated by clothing and would occasionally bleed and swell. The patient denied pain or itching associated with the lesion. Since its appearance at 3 months of age, several abscesses formed underneath the region of concern requiring incision and drainage. Medical history revealed no other medical problems. On physical examination, at the proximal posterior thigh, there was an 11 × 10-cm cobblestoned, gray plaque composed of numerous purplish, vesicular papules with surrounding satellite papules. No swelling was present. A 4-mm punch biopsy was performed (Figure, B and C). Quiz at jamapediatrics.com WHAT IS YOUR DIAGNOSIS?