10 thoughts on “Medical Quiz- Seelan

  1. Interesting X ray Seelan. This patient has Penile prosthesis. I see tiny tubes – cannulae going into the balloon like structure which may be the reservoir to inflate the prosthesis. The Right femoral head has degenerative changes. Acetabulum shows degenerative changes as well. Osteonecrosis of R Hip due to Sickle cell disease. ? candidate for total right Hip – is he with sickle cell anaemia.

    Radio opaque objects. Penile prosthesis , Reservoir for the prosthesis, Scrotal area – testicular prosthesis.

    You have to forgive me I have not looked at X rays critically in 40 + years

    Nisantha

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    • Dear Nisantha,
      Of course, Seelan is the maestro!
      And I thought you are an anaesthetist!
      Your powers of observation and interpretation of X’rays are excellent.
      Simone and yourself do not seem to get bowled easily.
      I am very proud of the versatility and knowledge of our batch
      Well done my mates
      Ariya

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  2. Radio opaque Acetabula metal implanta ,and prosthetics for impotence
    Complication AVN and impotence

    AVN due to HB SS,impotence due to ED due to fibrosis due to episodes of priapism

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  3. Derar Narme, Seelan and all
    Please don’t worry about the joke at my expense. I loved reading the comments as I know that all these are written for a laugh. Though educated at Holy Family I am not that holy and ever ready for a joke without getting offended. In fact I was happy that there were so many interactions following that. Keep going…I enjoy the jokes unlike Ranjit who is more serious. Praxy

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  4. DISCUSSION:-

    Both Nisantha & Rani are correct.
    Rani got the side wrong- the affected side is the Right side.
    Also, there is no Acetabular prosthesis. The entire radio-opaque F.B in the x ray belongs to a 3 Piece penile implant. For the benefit of those who haven’t seen one, I have sent a diagram of the device to Sam for inclusion in this posting. (The 3 pieces are:-1) Reservoir 2)Pump 3)penile cylinders).
    Pump it up – for erection & press the valve above the pump,to deflate – the cylinders go flaccid – no one will notice !

    The two radiological findings are : 1) Three piece penile implant indicating that the patient has Impotence
    2) Fragmentation & destruction of Right femoral head indicating Avascular Necrosis.

    Sickle cell disease is a genetic disorder which alters the structure of the Hemoglobin causing reduced oxygen carrying capacity of the blood to the tissues. The abnormal Hb tend to clump together making the RBC Sickle-shaped & rigid and unable to pass through small vessels causing vascular occlusion leading to necrosis. Eg: AVN of Fem. head.

    The 2nd complication in this case, is Impotence :- Blood flow out of an erect penis is blocked by “sickling”, prolonging the erection which is called Priapism. Prolonged erection of more than 3-4 Hrs is a surgical emergency. If untreated, causes permanent damage & leads to erectile dysfunction. Treatment of Priapism caused by Sickle cell disease(low flow ischemic type)includes aspiration, saline irrigation, analgesia, oxygenation, adrenaline injection & sometimes transfusion. However about 50% of patients with Priapism will have persisting impotence. The above patient is one of them & treated with the prosthesis.
    Thanks for participating.
    Seelan

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