Interesting or Different Anatomy:What have you encountered?

[nursefrances]

We recently had an adult patient that was born with one ventricle. He had surgery to correct this as a baby, but I found it very interesting. If I was a pediatric cardiology nurse I may see this more often, but not in ophthalmology.

I also "have a friend" who has a dual chamber, unihorn uterus. Many jokes during pregnancy of being like a cow (the chambers).

I was just curious what you have seen while out and about in our wonderful world that is Nursing. Please share.

[Chaya, ASN, RN]

Not all that unusual but had a gentleman with hypospadia; his urethral opening was on the underside of his member about an inch or 2 below the tip. He had a foley but we had a policy of d/c'ing catheters before sending patients to a SNF. He also had a little blind indentation at the tip. We got a call from the SNF that he went to asking how we had catheterized him. Yep-they were poking at the little blind "eye" at the tip-poor man! Shows you need to include those little details in your discharge notes!

[amoLucia]

Peau d'orange skin and crepitus (bone and chest). Both occur infrequently, but are interesting if observed. If you do observe it once, you'll not forget it.

[meljonumd]

I learned after a lap for endometriosis that I have a unicornuate uterus: only have the Left half. When I later got pregnant, I was on bedrest for 6 weeks and had a C-section because my little guy could never "turn" in the 3rd trimester, and stayed pretty much frank breech. (that head was quite jammed up under my ribs, lol!). Some of the high-risk OBs were a bit skeptical: "well, the uterus is designed to stretch, so this shouldn't be a problem." Yeah, well read the literature.

Also, I met a fascinating guy who has congenital Vit D deficiency, leading to essentially massive bone deformities. Over the years, he's had many ortho surgeries, both preventative and corrective. But when was admitted to my hospital, he hadn't left his apartment "for a while."

The IM rod in his femur was sticking OUT about midshaft, and had been "for a few months." The femur itself was essentially a 90degree angle, and at first glance it looked like his knee was misplaced. But no, his leg just bent in the wrong place. His other leg was also a hot mess, but that Left leg was just so strikingly amazing. To have an IM rod just jutting out from his leg, for a few months, and NOT seeking medical attention, because he didn't feel like leaving his apartment; that's real life.

(he was admitted with "a cough.")

[Esme12, ASN, BSN, RN]

I had a patient with true Dextrocardia or Dextrocardia situs inversus...all his organs, including the heart, were on opposite sides. Came into the ED as a trauma.....when we were assessing him nothing made sense the EKG was CRAZY....when the stat CXR came back we were AMAZED at what we saw.....everything heart...liver.....spleen....completely switched.

The patient had no idea.

[dirtyhippiegirl, BSN, RN]

the only interesting thing I've seen so far is a man who had a systemic reaction to chemotherapy and developed Stevens-Johnsons syndrome...the poor man sloughed from neck to toes including his member and testicles....2 hours and 5 nurses to do dressing changes (in isolation no less)

I work on burn and we get all the SJS/TEN patients or at least have to do their hours-long dressings off the unit. (Sigh.) Anyway. I'd say chemo is probably the second most common cause that we see of SJS/TEN. First would be bactrim although the reactions tend to be less severe.

Worst TEN case we ever had - the guy did end up surviving but wasn't supposed to - was triggered by OTC motrin. Scary thought, huh?

[KelRN215, BSN, RN]

Lots of them are seen in pediatrics. I have seen an infant with hydroanencephaly who had no nose. I currently have a baby with hypoplastic left heart syndrome who was also born with a double outlet right ventricle (thus eliminating the need for the stage I Norwood procedure these infants usually undergo at birth), asplenia, heterotaxy and malrotated intestines. I also once had a patient who didn't have full situs inversus but her heart was on the right. I've seen lots of polydactyly in children whose parents were consanguineous (usually 1st cousins). Lots of other congenital anomalies too... gastroschisis where the intestines protrude through an abdominal wall defect, congenital diaphragmatic hernia where the intestines herniate through the diaphragm into the lungs and basically any brain/spine malformations you can think of.

[DoeRN]

Peau d'orange skin and crepitus (bone and chest). Both occur infrequently but are interesting if observed. If you do observe it once, you'll not forget it.[/quote']

Unfortunately I've seen a lot of peau d' orange when I am floated to the oncology floors. Usually the breast cancer patients. And crepitus only once when an orthopedic doc came in to evaluate a patient and I heard it. I said what was that noise and he told me.

Sent from my iPhone using allnurses.com

[nursel56]

Mine were pediatric also. We had a baby with truly ambiguous genitalia, conjoined twins, biliary atresia, Ritter's disease and a little 3 yr old girl who came to see the FP when I worked in a clinic who found a third kidney nobody knew about!(ultrasounds v.primitive back then :-))

[Twinmom06, ASN, APN]

I work on burn and we get all the SJS/TEN patients or at least have to do their hours-long dressings off the unit. (Sigh.) Anyway. I'd say chemo is probably the second most common cause that we see of SJS/TEN. First would be bactrim although the reactions tend to be less severe.

Worst TEN case we ever had - the guy did end up surviving but wasn't supposed to - was triggered by OTC motrin. Scary thought, huh?

interesting about bactrim…what is TEN? I saw a medical show where a girl survived SJS after taking OTC cold medicine...

[dianah, ASN]

Have been in on one (ONE, in 35 yr!!) cardiac cath on a pt with dextrocardia.

The Cardiologist performing the cath did the usual, only backwards. :)

Two weeks ago heard a man showed up in clinic with a BiVAD device, after having his heart removed.

Didn't get a chance to see him or the device, unfortunately.

Have seen dual collecting systems to a kidney on a renogram (not that rare, but still).

Bluish skin tinge from long-term tx with amiodarone.

Recently while prepping a pt for his cardiac cath, found a tattoo right where his umbilicus should have been -- but there was no umbilicus!

He said as an infant he'd had surgery for some condition and it had disappeared with the incision.

So later he got a tat on that spot (a target, or somesuch).

Said it's how he met his wife.

Sitting in a bar, met her and they were making conversation when he said,

"I can show you something you've never seen before."

lol lol lol

Very sad: occluded distal aorta, before the bifurcation.

Pain in the buttocks when walking, so we were supposed to do an angiogram to outline vascular anatomy

There were no fem pulses, so we did the angio from the axillary artery.

Images showed only collaterals feeding the legs.

Have seen many cardiac caths with anomalous vessel origins.

[netglow, ASN, RN]

This is a totally awesome thread!!

[NRSKarenRN, BSN, RN]

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