Renal/Electrolytes

Calcinosis Cutis. Prior Elbow XR Lateral. JETem 2025

Metastatic Calcinosis Cutis in the Emergency Department: A Case Report

Christian Hernandez-Zegada, MD^*, Holly Conger, MD^* and Brian Milman, MD^*

DOI: https://doi.org/10.21980/J87Q00 Issue 10:3 No ratings yet.

X-ray imaging was obtained of the left elbow and showed soft tissue calcium deposits. Radiology stated, “massive periarticular calcinosis of renal failure obscures fine osseous detail. Several of the largest calcifications have decompressed since the prior exam and may contribute to the drainage observed clinically. Superimposed infection is not excluded.” X-rays with an asterisk are the comparison images from two months previous to the visit. Areas of decompression are highlighted in blue demonstrating that some of the larger calcified nodules are no longer present.

A Case Report of Calciphylaxis

Kim Hoang, BS^*, Tien Lu, MD^{^}, Alex Dang, MD^{^}, Danielle Matonis, MD^{^}

DOI: https://doi.org/10.21980/J8KW8V Issue 10:3 No ratings yet.

On arrival for this visit, the patient was nontoxic appearing with stable vital signs. The physical exam was notable for deep, ulcerated, bilateral anterior leg wounds with purulent drainage and large areas of eschar (see photographs).

Visual EM Current Issue Dermatology Infectious Disease Renal/Electrolytes

A Patient with Generalized Weakness – A Case Report

Darby Graham, MS^*, Manparbodh Kaur, MD^{^}, John Costumbrado, MD^{*^} and Sassan Ghassemzadeh, MD^{*^}

DOI: https://doi.org/10.21980/J8593C Issue 8:3 No ratings yet.

The CT of the abdomen and pelvis showed evidence of a large subcapsular rim-enhancing fluid collection with multiple gas and air-fluid levels along the right kidney measuring 8 x 4 cm axially and 11 cm craniocaudally (blue outline) with mass effect on the right renal parenchyma (yellow outline). Another suspected fluid collection adjacent to the upper pole of the right kidney measuring 4 x 3.4 cm was noted (red outline). Bilateral pyelonephritis was suggested without hydronephrosis or nephrolithiasis. The findings suggested complicated pyelonephritis with emphysematous abscess and hematoma formation.

Renal/Electrolytes Infectious Disease Visual EM

Case Report of a Pelvic Kidney with Ureteral Obstruction from Inguinal Hernia Entrapment and Concurrent Cryptorchid Testis

Nathan Feil, BS^*, Daniel Kwan, BA^*, Cameron Fateri, BS^*, Lindsey Spiegelman, MD^{^} and Roozbeh Houshyar, MD^*

DOI: https://doi.org/10.21980/J8F345 Issue 7:2 No ratings yet.

The patient was afebrile with normal lactate and white blood cell count. Initial CT imaging showed an ectopic right pelvic kidney with entrapment of his right ureter within an indirect right inguinal hernia causing severe hydronephrosis (coronal: white arrow). Also discovered was an ovoid hypodensity in the right anterior pelvis consistent with right undescended testis (axial: orange arrow; coronal: green arrow) that was previously unknown to the patient, with a normal left scrotal testis (axial: red arrowhead; coronal: blue arrowhead). Other potential etiologies of the patient’s symptoms could include appendicitis or incarcerated inguinal hernia, though the imaging results and absence of systemic inflammatory response syndrome made these causes less likely.

Renal/Electrolytes Visual EM

Case Report of Unusual Facial Swelling in an 8-Month-Old

Amanda E Mulcrone, MD^*, Zobiya Z Momin, MD^{^} and Corrie E Chumpitazi, MD, MS^*

DOI: https://doi.org/10.21980/J8M06F Issue 6:3 No ratings yet.

Facial ultrasound revealed local inflammatory changes such as increased echogenicity and heterogeneity in the soft tissues of the right cheek, suggestive of soft tissue edema. There was evidence of a prominent right parotid gland with increased heterogeneity suggestive of a traumatic injury. Additionally, facial ultrasound demonstrated a 6mm ill-defined anechoic collection within the right cheek without increased doppler flow (green arrow), thought to represent a focal area of edema instead of an abscess.

Pediatrics Renal/Electrolytes Visual EM

Case Report: Not Your Typical Kidney Stone

Laura Kolster, DO* and Danielle Biggs, MD*

DOI: https://doi.org/10.21980/J8GD2T Issue 6:1 No ratings yet.

The CT scan demonstrates nephrolithiasis with associated forniceal rupture. Encircled in the yellow outline is fluid, demonstrating a forniceal rupture. The stone is in the proximal aspect of the ureter, as highlighted by the purple arrow.

Renal/Electrolytes Visual EM

Bladder Diverticulum – A Case Report

Savannah Tan, BS^* and Sangeeta Sakaria, MD, MPH, MST^*

DOI: https://doi.org/10.21980/J8635C Issue 5:4 No ratings yet.

On examination, the patient was alert and oriented but in mild distress. Suprapubic fullness was noted upon abdominal palpation. Point of care ultrasound of the bladder showed two enlarged “bladders” with a central communication. Bedside total bladder volume was measured to be 1288 cm3 (the top “bladder” was measured to be 1011 cm3, while the bottom “diverticulum” was measured to be 277 cm3) by ultrasound. The POCUS stills of the patient’s bladder demonstrated the bladder (red arrow) and bladder diverticulum (yellow arrow) with a central communication (blue arrow) in the transverse and sagittal views.

Renal/Electrolytes Ultrasound Visual EM

Hemorrhagic Renal Cyst

Mary Rometti, MD^*, Christopher Bryczkowski, MD^*and Michael Rohinton Mirza, MD^*

DOI: https://doi.org/10.21980/J8C92V Issue 5:1 No ratings yet.

Bedside renal ultrasound demonstrated a right renal cyst with echogenic debris consistent with a hemorrhagic cyst (red arrow). In addition, a computed tomography (CT) scan of the abdomen and pelvis revealed a 4mm non-obstructing right renal stone and bilateral renal cysts. The CT also confirmed the ultrasound finding of a right renal cyst with mild perinephric stranding possibly consistent with a hemorrhagic cyst.

Renal/Electrolytes Abdominal/Gastroenterology Visual EM

FAST Exam to Diagnose Subcapsular Renal Hematoma

Michelle Sofia Bakardjiev, MD^* and Amanda Esposito, MD^{^}

DOI: https://doi.org/10.21980/J8NP8DIssue 4:4 No ratings yet.

A bedside point of care ultrasound FAST exam was performed revealing a left subcapsular renal hematoma. The hematoma was a non-compressing hematoma, evidenced by preserved renal contour with the hematoma labeled with a red H and the normal renal contour labeled with a green K. Additionally, cortical necrosis and ischemia can be characterized by a dark, hypoechogenic renal cortex on ultrasonography with a decrease in flow to the cortex on color doppler which was not seen on this patient, providing further evidence that the hematoma was non-compressing. The hematoma was concluded to be an acute process due to its hypoechoic appearance with some mixed ultrasonographic echoes caused by the early deposit of fibrin.

Renal/Electrolytes Visual EM

Erectile Dysfunction as a Presenting Symptom for Renal Cell Carcinoma

Frank Mayer III, MBA^*, Jonathan Wooden, MD^* and Megan Stobart-Gallagher, DO^*

DOI: https://doi.org/10.21980/J8563BIssue 4:2 No ratings yet.

The MRI showed extensive spondylotic changes suggestive of malignancy (red arrows) with severe spinal canal stenosis at the lumbar spine L3-L4 (purple arrows) level contributing to clumping of cauda equina nerve roots and severe bilateral neuroforaminal narrowing with diffuse disc bulges abutting the exiting nerve roots at multiple levels. Findings also showed a hypo-attenuated tumor (blue arrow) and hyper-attenuated loculated tumor (green arrow) consistent with renal cell carcinoma (RCC).

Visual EM Renal/Electrolytes