2022 AMI Online Salon

Primary Amenorrhea

Project Details

  • Entrant Name:  Daniel Muller
  • Client: NEJM Evidence
  • Copyright: Massachusetts Medical Society, 2022
  • Medium/software used: Adobe Illustrator
  • Final presentation format: Medical Online Journal and PDF format
  • Primary Audience: Physicians and other clinicians practicing in all types of settings, trainees, residents and fellows, hospitalists, academic clinicians, clinical trialists, basic scientists, and people in the pharmaceutical industry

Project Description

The illustrations were created for a Morning Report article published in NEJM Evidence. This type of article presents a medical case with a discussion, diagnostic, management, and follow-up. This specific case was about a 13-year-old girl with primary amenorrhea. Figure 1A demonstrates how to perform examination of external genitalia to assess for the presence of vaginal opening and patency, using gentle downward and outward finger traction; 1B illustrates how a mini cotton tip applicator can be placed at the hymenal opening to assess vaginal length; and 1C shows the patient’s vaginal agenesis with a fibrous opening instead of a patent hymen. Figure 2 depicts normal internal anatomy with its typical Müllerian and urogenital development origin, as well as several examples of obstructive anomalies. Due to the article’s delicate topic and to maximize clarity, the illustrations were entirely done in Adobe Illustrator in a more diagrammatic and less realistic rendering. In figure 1, blue gloves were purposely used to reinforce that such examinations should always be done with gloves. In figure 2, Sim Daltonism was used to pick 2 color-blind safe colors to help differentiate between the 2 developmental origins. Faded normal anatomy was used in the lower diagrams to allow easy comparison between the anatomical anomalies and normal anatomy. To increase legibility, labels are solid black and when displayed over anatomical structures, usage of a white blurs was used.