An Aunt Minnie in Hand Injury

​An afebrile diabetic patient came in a week after a drawer was slammed on his hand. He insisted that his hand wasn't broken but hurt much more now than it did when it was initially injured. Do you know the disposition just by looking at the picture?I did. It was an Aunt Minnie. I gave him IV antibiotics, admitted him, and arranged a visit to the operating room for him.The origin of the term Aunt Minnie is somewhat unclear, but it definitely came from radiology. The literature claims that Edward B. D. Neuhauser, MD, a chief radiologist at Boston Children's Hospital, coined this term to mean something so visually distinctive that it can't be anything else. (AJR Am J Roentgenol 2008;191[4]:1272.) Benjamin Felson, MD, later spread the concept in his radiology book, Fundamentals of Chest Roentgenology. (Philadelphia: W.B. Saunders; 1960.)The idea is that once you have seen something, you know it each time. An Aunt Minnie in my medical training was any disease process that could be immediately perceived. This extends to symptoms from the proptotic eyes in hyperthyroidism to the distinctive rash of Lyme disease.What makes this an Aunt Minnie?His hand seemed to be attempting a permanent Vulcan salute with splayed ring and long fingers. One process catapulted to mind, and a volar exam confirmed that I was right.This was a collar button abscess, an hour-glass shaped, deep web space infection that spreads dorsally and volarly. The abducted adjacent fingers are the clue not to...
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