Medical Art used to Describe Anatomy of Size or the Goldilocks Principle
Ashley Davidoff MD Copyright 2015
The normal size of a structure is key to its health as depicted in Art In Anatomy’s medical art. In the field of pathology, radiology and clinical medicine we evaluate the size of structure and use such terms as cardiomegaly, hepatomegaly and acromegaly to define enlargement of the relevant organ, and microcephaly, microhematuria, hypothyroidism, atrophy to define reduction in size or function.
Goldilocks?…. not too big and not too small …. but just right. Sometimes disease and disorder is caused by excess, and other times caused by too little. When the size is “just right”, health and order prevails in the cell, the organ, the body, and the society. Size of course is one of only many determinants of structural health.
“Goldilocks principle; order and disorder – health and disease“
shows the principle of “just right” for health and too big or too small for disorder and disease. In the above case the white PENTANGLE sitting on top of the image, needs the shape of the circle, rectangle or triangle to fit within its confines. All the structures in the first row would be too big, those in the middle row would be too small, but all the structures in the third row would fit. Goldilocks would say; not too big nor too small – it has to be just right. This principle applies to the cell, biology, the person, and society.
The Cell
In a cancerous cell there is an increase in the nuclear to cytoplasmic ratio. This means that the nucleus is too big for the cytoplasm.
“Small Nucleus, Health – Big Nucleus, Cancer”
shows the a normal nucleus of the cell (turquoise structure left image) associated with a “thumbs up” and reflects health. The normal sized nucleus provides functional space to enable the organelles in the cytoplasm to develop to full potential. The nucleus serves as master and servant to the cell. On the other hand the large nucleus (right sided red structure) causes disease since it compresses and stifles the members of the society residing in the cytoplasm. The “master” dominates the “server” in this scenario.
The Society
“Small Nucleus – Good Government; Big Nucleus – Bad Government”
shows the normal turquoise nucleus in the US Capitol associated with a “thumbs up” reflecting health. In the right hand image government is too big (big red nucleus and a fat US Capitol) with its role as master dominating the role of server, and is given the “thumbs down” reflecting a disease state. A healthy nucleus pays attention to the past present and adapts for the future and is a balance of master and servant.
Big and Small in the Organs
The Lungs
Emphysema is a disease of the lungs caused by cigarette smoking which reduces the elasticity of the small structures of the lungs. As a result the small airways in the centrilobular region get larger and cannot rid themselves of the stale air. This disease has a characteristic appearance on a CT scan
“Emphysema; the lungs and small airways are too big”
The left sided image is a CT scan that shows normal lung architecture. The right image is a CT scan showing the ravages of a disease called emphysema caused by smoking. In emphysema the small airways and alveoli lose their elasticity and get stretched resulting in larger and larger centrilobular structures. These small airways appear as big black holes in the lung on the CT scan (right image).
“Emphysema; respiratory bronchioles and alveoli are too big”
is an artistic rendering of the microscopic structures of the lung correlating correlating with the features on the image above. It again shows the principle of structures which lose function when they become too big as a result of the loss of elasticity related to smoking. The lungs therefore cannot perform their function to exchange gases optimally. The left sided image is an artistic rendering of the normal terminal bronchioles and alveoli and shows normal lung architecture. The right image is is an artistic rendering showing the ravages of emphysema. In this disease the small airways and alveoli lose their elasticity and get stretched evolving into larger and larger structures. Stale air hangs around in the large dilated structures and the body cannot get fresh air.
The Liver
“Liver Cirrhosis; small pickled liver from alcohol abuse”
shows the principle of structures whose size is too small as a result of increased scar tissue related to alcohol abuse. The liver therefore cannot perform its function as the metabolic workhorse of the body. The left sided image shows the CT scan of a normal liver. The liver is the biggest structure that you can appreciate on the CT scan – to the left side. It is triangular in shape. The message of the left image is that a social drink – in this case having a beer in moderation with a friend enjoying the beauty of the lake, is healthy. The right image is an artistic rendering showing the ravages of the disease called cirrhosis caused by the excesses of alcohol. The drinking habit when an addiction is usually a lonely event, leading to a miserable life and the downfall of the “liver” and the person. The alcohol pickles the liver and makes it look like a shrunken prune – all scarred and knobbly.
The Heart
reveals the principle of structures that are too big and as a result cannot function optimally. The left sided image shows an athlete who has a normal sized heart as depicted as a cut out from a normal CT scan of the heart . The right image is a photograph of an elderly man whose heart (CT scan of cardiomyopathy) is too large . He cannot walk far distances, climb stairs, nor sleep flat. His lungs and legs are filled with fluid because his heart cannot pump out what it receives and hence the backup. The context of the word “big heart” is relevant since culturally we use the word “big heart” to describe a generous person. In medicine unfortunately a large heart is a diseased heart.
The Body
“Body – not too big, nor too small, but just right”
depicts the variations of the size of the body portrayed in the chest and abdomen. The image on the left demonstrates obesity, the middle image shows cachexia, and the right image shows the “just right” torso.
The art pieces displayed in this blog are just a few examples of how size is relevant in the culture of the cell, the organs, the body, and our society.
The fairy tale of the Goldilocks principle speaks loud, and rings true in the real world–not too big, not too small but just right!
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