Physicians Academy
Established in December 2006 by the Kashmir Academy Of Private Physicians
Table Of Contents
Editorial :
 The Real Paradigm Shift in Management of T2DM
Article 1 :
 Introduction of DMS irrigation to heal Endo–Perio lesions and Cysts
Article 2 :
 Alagille Syndrome in a Neonate
Picture of The Month :
 POTM-April 2018
Drug Update :
 SEGLUROMET (ertugliflozin+metformin)
Abstracts from Other Journals :
 Abstracts from Other Journals-April 2018

Locations of visitors to this page
Apr 2018 ( Volume -12 Number -4)

Picture of The Month
POTM-April 2018
Sarosh Ahmed Khan, MBBS; MD; FACP
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APRIL 2018

Picture of The Month

Sarosh Ahmed Khan, MBBS; MD; FACP

This is the right foot of a 48 years old female suffering from Type 2 DM for last one decade. She had a blister on it which became painful and grayish four days after it erupted. She had used a hot water bottle at night to tackle the extreme cold in winter in Kashmir.

Can you guess what has happened?

Contributed by:

Dr. Sarosh A. Khan is Senior Consultant, Internal Medicine and Director, Naseem Medical Center, Baghe-Mehtab, Srinagar, Kashmir, India. Pin: 190019. Affiliations: Governing Council Member of American College of Physicians (India Chapter) from 2014-2017. Email:

Send your answer to us on Rapid Response.

Answer to last month’s POTM March 2018

The patient is a 78 year old lady who is a known case of Diabetes Mellitus, Hypertension, and old CABG done, and presented to our Emergency Department with abdominal pain of one month duration. She had multiple visits to various hospitals in the past few weeks without any relief. Abdominal examination revealed a faint pulsatile mass in the umbilical area. An urgent CT Scan was done which revealed the following (See Fig 1-3): What is the diagnosis?


The Correct Answer:

Primary aortic non-occlusive thrombus, in which a thrombus is adhered to the wall without intimal dissection, is a rare entity and not commonly encountered in routine practice. These thrombi may be associated with atherosclerotic plaques or may evolve de novo in the aorta. Historically it was seen as a paradoxical effect with heparin treatment. In patients with established atherosclerotic disease upon which the thrombus is superimposed, this disease may pursue a more aggressive course. In patients where thrombus is the only finding, an underlying hypercoagulable state due to protein deficiencies has been postulated. In a few cases blunt trauma has been a cause. Mural thrombosis is a potential source of peripheral embolism and many cases have been discovered after such events. Diagnosis is with Ultrasound, CT scan or Magnetic Resonance. The therapeutic treatment for aortic mural thrombosis is debatable and can be medical or surgical.

Author Information:

Dr. Murtaza Rashid M.D is working in the Department Of Emergency Medicine, Royal Commission Hospital, Jubail, 31961, Saudi Arabia. Email:

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