July was a great month for clinical case discussions on MedShr. Doctors, medical students and healthcare professionals alike used the MedShr app to snap an image, add a description and share with colleagues instantly. We wanted to take a look back over the past month and highlight five of the most interesting cases seen on MedShr in July. We hope you enjoy reading them! Be sure to MedShr a case this month for a chance to make it into our top 5 cases in August.

5: Intratumoral radial nerve entrapment - What are your thoughts on the management?

This patient had presented with intratumoral radial nerve entrapment. This was secondary to a Desmoid tumor - a rare and aggressive fibromatosis. View the radiological and surgical images on MedShr. What are your thoughts on the management? Click here to join the discussion!

4: A successful case of IV tPA and mechanical thrombectomy in a 103-year-old woman with severe acute ischemic stroke.

A 103-year-old woman presented with progressive dizziness, slurred speech and was comatose. She was functioning independent and last seen normal talking with her daughter just 24 mins prior. An emergent non-contrast CT confirmed acute ischemic stroke was confirmed, and t-PA was given. What do you think of the management? Click here to read the full case!

3: Stroke in valvular heart disease patient - What are your thoughts?

This patient is a 55-year-old male who had a history of metallic valve prosthesis in 1997 for MS with AS. Since then, he has been taking Warfarin 5mg 0+0+1 and 0+0+1/2 on alternate days. Around 1 month ago, he had an ischaemic stroke. His INR was 1.16 at the time, and his Warfarin was increased to 5mg 1 tab daily. But 1 week ago he developed hemorrhagic stroke. His INR is now 3.5. How would you manage this patient? Click here to join the discussion!

2: Short bowel syndrome

A 48 year-old-male presented with pain in his abdomen and distension for 3 days. On exploratory laparotomy, the whole of the ileum and distal jejunum were ischemic with an absence of any peristaltic activity. Resection of ischemic gut and double barrel ileostomy completed. The patient developed high output stoma postoperative and initially managed with TPN over 1 month. Now, after 42 days, the patient has lost around 12 KG weight, tolerating orally but stoma is still around 1L per day. How would you manage this patient? Click here to join the discussion!

1: Abdominal mass - Your thoughts?

A 35-year-old lady presented with a painful lower abdominal mass (Lf.iliac fossa) of 3 weeks duration. She showed no other constitutional symptoms. On examination, the mass was round, and blood tests were normal. The mass is fixed and tender. CT abdomen (native) was shown. What are the differential diagnoses and how would you investigate further? Click here to join the discussion!

MedShr thanks everyone who shared a case in July! We look forward to seeing your next cases. If you'd like to become a member and discover more cases like these, download the MedShr app for free from the App Store or Google Play. Alternatively, you can register on the website.

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