Differential diagnosis of a thyroid mass, facial malar rash and ptosis on the flora in the primavera by Sandro Botticelli (1445-1510).

The Primavera is considered amongst the greatest and controversial artistic masterpieces worldwide painted by renaissance artist Sandro Botticelli. The aim was to identify any underlying medical foundations for the painting. Observational study. The painting reveals, a 'butterfly' malar rash, bilateral ptosis and a clear neck swelling consistent with a goitre in the figure of Flora. This could be explained by concomitant Graves' disease and systemic lupus erythematosus, or other presentations of multiple autoimmune syndrome. These findings highlight the likely presentation of the earliest pictorial depictions of thyroid disease with systemic lupus erythematosus and emphasize the exactitude of depiction demonstrated by Botticelli in renaissance era.

Ashrafian H 《-》

Sandro Botticelli's Madonna of the Pomegranate: the hidden cardiac anatomy.

Sandro Botticelli was one of the most renowned artists of the 15th century. He was based in Florence during the flourishing of the Renaissance, a time when anatomical knowledge of ancient times was reclaimed through cadaveric dissection. This report proposes that such knowledge enabled Botticelli to enhance the iconography of his masterpieces, Madonna of the Pomegranate, by incorporating a concealed image of the heart and cardiac anatomy within it.

Lazzeri D ，Al-Mousawi A ，Nicoli F 《-》

Goiters in the Renaissance era: Multiple cases of thyroid autoimmunity and iodine deficiency.

The Renaissance is recognised as an inflection point in history that led to the dissemination of innovation, science, philosophy, and the arts to spearhead a leap for global civilisation. Many of the greatest outputs from the Renaissance were presented in artwork which was able to champion elements of naturalism and realism, and therefore moved away from preconceived ideas. This included the portrayal of anatomy and pathology with an exactitude previously unseen in art. I note novel identification of goiters in multiple paintings of the foremost Renaissance genius artists and their originating artistic schools, those of Verrocchio, Lippi and Ferrara. These can be categorised through the proposed (i) 'da Vinci Sign' after Leonardo da Vinci, where the goitre is artistically presented as a loss or shallowing of the suprasternal notch recess or (ii) the 'Botticelli Sign' after Sandro Botticelli, where there is demonstrable cranio-cervical neck flexion that forward projects the visceral compartment of the neck that includes the thyroid to accentuate a recognisable thyroid enlargement. These are notable in the works of genius artists that include Verrocchio, Lorenzo di Credi, Filippo Lippi, Cosimo Tura and Francesco Cossa. Together, the work of these artistic geniuses add to the corpus of notable endocrine pathology in the Renaissance deriving from endemic iodine deficiency and autoimmunity. They demonstrate this profound extent of pathology within their artistic masterpieces and extend our admiration of the wider experience of Renaissance artists into the current era and beyond.

Ashrafian H 《-》

Probable depiction of juvenile arthritis by Sandro Botticelli.

Alarcón-Segovia D ，Laffón A ，Alcocer-Varela J 《ARTHRITIS AND RHEUMATISM》

The depiction of lungs and cardiac silhouette in the Saint Francis of Assisi with Angels by Sandro Botticelli (1445-1510).

Ashrafian H 《-》