The Clinical Problem Solvers

Episode 325: Rafael Medina Subspecialty Series – Facial Swelling

Mar 19, 2024

In this podcast, they discuss a complex case of facial swelling post-COVID infection, delving into differential diagnoses like sarcoidosis and TB. They explore challenging cases of periorbital edema, chronic weight loss, vasculitis, and Vexas syndrome. They also cover a newly described autoinflammatory syndrome, emphasizing the importance of detailed workups and diagnostic challenges.

55:08

Creator website

Episode guests

Mark Heslin

Tony Breu

AI Summary

AI Chapters

Episode notes

Podcast summary created with Snipd AI

Quick takeaways

Localized facial swelling may indicate infectious causes like cellulitis, necessitating thorough examination and imaging.

Consider underlying inflammatory conditions like angioedema in complex presentations of localized swelling.

Challenges in diagnosing rare conditions highlighted by the discovery of Vexas syndrome after extensive tests.

Deep dives

Diagnosis of Facial Swelling Case

A 66-year-old male presented with one-day history of jaw pain and left-sided peri-orbital facial swelling, progressively worsening to involve the left eye with fever and photophobia, indicating an acute onset localized inflammatory condition. The emphasis on the specific site of swelling and its consequences suggests considerations for an infectious cause like periorbital cellulitis or septal cellulitis.

Introduction

3min

Unraveling a Complex Medical Case

26min

Unraveling a Complex Medical Mystery

6min

Diagnostic Challenges and Considerations for Chronic Weight Loss

5min

Uncovering a Complex Case of Vasculitis

6min

Unraveling the Mystery of Vexas Syndrome

5min

Exploration of a Newly Described Autoinflammatory Syndrome and Its Clinical Relevance

4min

In this clinical reasoning Rafael Medina Subspecialty episode, Dr. Mark Heslin presents a case to Dr. Tony Breu of a man presenting with facial swelling.

Session facilitator: Youssef Saklawi

The goal of this series is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.

Case Discussant: Anthony C. Breu, MD is the Director of Resident Education at the Veterans Affairs Boston Healthcare System and an Assistant Professor of Medicine at Harvard Medical School. He is also core faculty at the Center for Bioethics at Harvard Medical School. He completed his undergraduate degree in biomedical ethics at Brown University, where he also received his medical degree.

Case Presenter: Mark Heslin is a third-year internal medicine resident at the University of Pennsylvania. This summer, he will be starting his career as an academic hospitalist at Stanford. His clinical interests include medical education, clinical reasoning, diagnostic error, and the use of innovative technology to disseminate the teaching of clinical reasoning.