Abdominal/Gastroenterology
Acute Dysphagia in a 25-Year-Old Male
DOI: https://doi.org/10.21980/J83P8FAfter an unremarkable chest radiograph was obtained, a computed tomography (CT) scan of the chest was obtained due to possible co-ingestion of bones to rule out perforation. The CT scan demonstrated focal distention of the mid-esophagus due to an impacted food bolus (white arrow). An aberrant right subclavian artery (yellow arrow) was located just distal to the impaction site with partial compression of the esophagus (red arrow).
Woman Swallows a “Handful of Pills”
DOI: https://doi.org/10.21980/J8V64XSoft tissue lateral X-ray of neck was performed. The lateral soft tissue X-ray of the neck showed a metallic foreign body at the level cricoid.
Incidental Hiatal Hernia on Chest X-ray
DOI: https://doi.org/10.21980/J8KP8SThe two-view chest X-ray shows mild opacification of the bilateral lower lobes concerning for pneumonia (red arrows). Incidental retrocardiac opacity with air-fluid level consistent with large hiatal hernia is also observed (green arrow).
Button Battery in Esophagus
DOI: https://doi.org/10.21980/J8FW6VChest radiograph showed the presence of a round radiopaque foreign body in the mid-chest. It was suspected to be in the esophagus rather than in the trachea due to the en-face positioning of the foreign body. The foreign body demonstrated two concentric ring circles concerning for a “double ring” or “halo" sign, which was suggestive of the presence of a button battery rather than a coin.
Achalasia: An Uncommon Presentation with Classic Imaging
DOI: https://doi.org/10.21980/J86D2BThe chest X-ray demonstrated a markedly widened mediastinum (red brackets), raising concern for thoracic aortic aneurysm/aortic dissection, which prompted labs and contrast-enhanced computed tomography (CT) of the chest. The CT revealed a dilated proximal esophagus that narrowed distally (yellow tracing and red arrow), with particulate material, mass-effect on the trachea (purple outline), and bilateral patchy opacities suggesting aspiration. Barium esophagram showed a drastically dilated esophagus filled with contrast (yellow arrow), terminating into the classic “bird’s beak sign” (red arrow) at the lower esophageal sphincter (LES). Esophageal manometry later confirmed achalasia, proving that widened mediastina can have unexpected etiologies.
Point of Care Ultrasound Illustrating Small Bowel Obstruction
DOI: https://doi.org/10.21980/J8T637POCUS of the small bowel illustrated significantly dilated loops of bowel (white line), thickened bowel wall (white arrow) and to-and-fro peristalsis, consistent with small bowel obstruction.
Sepsis Secondary to an Abdominal Wound Infection
DOI: https://doi.org/10.21980/J8PS60At completion of this case learners should be able to: 1) Recognize and differentiate between systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. 2) Prepare an appropriate differential diagnosis for a patient with sepsis. 3) Demonstrate appropriate fluid resuscitation and antibiotic therapy for a septic patient. 4) Demonstrate appropriate vasopressor therapy for a septic patient. 5) Understand and apply the Surviving Sepsis Guidelines.
Intussusception
DOI: https://doi.org/10.21980/J8SH0WA segment of bowel within the right abdomen that measured approximately 1.6 x 1.5 cm transaxially. It demonstrated a hypoechoic edematous outer loop of bowel (blue arrow) and hyperechoic compressed loop of bowel telescoping within (red star), this is known as the "target sign."