Medical Images
The Crystal Crown
A 74-year-old man with a history of acute myeloid leukemia presented with right shoulder and neck pain and fever of 2-day's duration. Physical examination revealed a temperature of 39°C (102.2°F), right shoulder joint tenderness, and negative Kernig and Brudzinski signs. Workup revealed leukopenia with an absolute neutrophil count of 0.29 x 109/L (1.56 to 6.45 x 109/L). Head and cervical vertebrae computed tomography (CT) scan results were reported to be negative. He was started on vancomycin and cefepime for neutropenic fever.Lymphatic Plastic Bronchitis Secondary to Thoracic Duct Stenosis
A 42-year-old male presented with cough productive of thick secretions that had the appearance of branching airway casts (Figures 1 and 2). Symptoms were worse upon consumption of foods with a high fat content and conversely, improved with a low fat diet. Bronchoscopy with bronchoalveolar lavage revealed milky fluid return from the right middle and lower lobes with bronchial casts in the right middle lobe. The bronchoalveolar lavage triglyceride level was 479 mg/dL and histopathologic analysis of the casts with Oil Red O staining showed 76% lipid-laden macrophages consistent with chyloptysis.
