Visual EM

DRUJ Elbow Xray, Lateral. Unannotated. JETem 2020

Case Report of Distal Radioulnar Joint and Posterior Elbow Dislocation

Danielle Matonis, MD^*, Katelyn Wittel, BS^* and Alisa Wray, MD, MAEd^*

DOI: https://doi.org/10.21980/J89S6K Issue 5:4 No ratings yet.

Radiographs of the left elbow and wrist were obtained. Left elbow radiographs showed simple posterolateral dislocation of the olecranon (red) without fracture of the olecranon (red) or trochlea (blue). Left wrist lateral radiographs demonstrated DRUJ dislocation with dorsal displacement of the distal ulna (green) without fracture or widening of the radioulnar joint (purple). Post-reduction radiographs demonstrated appropriate alignment of the elbow with the trochlea seated in the olecranon and improved alignment of the DRUJ.

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

A Case Report of Ogilvie’s Syndrome in a 58-year-old Quadriplegic

Rosie Kumar, BS^*, Brett Cowan, MD^*, Daniel Quesada, MD^* and Sage Wexner, MD^*

DOI: https://doi.org/10.21980/J82922 Issue 5:4 No ratings yet.

Plain radiograph of the patient's abdomen revealed a gaseous distention of the colon. This is demonstrated as noted in the abdominal x-ray as gaseous distention, most notably in the large bowel (arrows) including the rectal region (large circle). Follow up computed tomography (CT) scan affirmed severe pancolonic gaseous distention measuring up to 11.2 cm, compatible with colonic pseudo-obstruction as noted by the large red arrows. No anatomical lesion or mechanical obstruction was observed, as well as no evidence of malignancy or other acute process.

Abdominal/Gastroenterology Visual EM

Cecal Volvulus Diagnosed with a Whirl Sign: A Case Report

Gregory K Sun, DO^* and Brian Walsh, MD^*

DOI: https://doi.org/10.21980/J8XM05 Issue 5:4 No ratings yet.

The CT image demonstrates a “whirl sign” (red arrow) which is indicative of a volvulus. This image occurs when bowel, mesentery and vasculature rotate around a transition point causing an image similar to a hurricane on a weather map. When seen on a CT scan, a whirl sign suggests a high likelihood of either a closed loop bowel obstruction or volvulus in the cecum, sigmoid or midgut. In any of the cases, seeing a whirl sign strongly increases the need for emergent surgical management.

Abdominal/Gastroenterology Visual EM

Paroxysmal Ventricular Standstill—A Case Report of all Ps and no QRS in Ventricular Asystole

Hamid Ehsani-Nia, DO^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J8SS79 Issue 5:4 No ratings yet.

In route, it was proposed that this patient was suffering from a dysrhythmia due to the transient episodes of syncope with lack of ventricular activity on telemetry. Upon close examination of the rhythm strips as well as the ECG, P waves can be visualized without any accompanying QRS complexes lasting multiple seconds (ED ECG blue arrows). Additionally, the rhythm has an intrinsic rate of 100 beats per minute and has a consistent morphology with no evidence of ventricular activity due to the lack of QRS complexes. As a result, the rhythm likely originates in the atria with no passage of impulses into the ventricles through the atrioventricular (AV) node versus an accelerated ventricular rhythm where QRS complexes would be seen.8 These rhythm strips demonstrate an example of VS. There is preserved native atrial automaticity, with an intact sinoatrial (SA) node, with a complete lack of ventricular electrical activity

Cardiology/Vascular Visual EM

Severe Hyperkalemia

Daniel Johnson, DO^* and Dan Wiener, MD^*

DOI: https://doi.org/10.21980/J8KH1D Issue 5:3 No ratings yet.

The initial ECG obtained upon arrival shows what is commonly referred to as a sine wave pattern. This patient does have a biventricular pacemaker which would ordinarily create a wide QRS complex mimicking an intraventricular conduction delay. However, the QRS complex here is exceptionally wide, in excess of 400 milliseconds (normal: less than 120 milliseconds). As the QRS widens, alongside other deflections present on the ECG, it morphologically mimics a mathematical sine wave.

Cardiology/Vascular Visual EM

Is an X-ray a Useful Test for Esophageal Food Boluses? A Case Report

Meryl M Abrams, MD^*, Jennifer L White, MD^* and Jeffrey Gardecki, MD^*

DOI: https://doi.org/10.21980/J8Q639 Issue 5:3 No ratings yet.

The plain film radiograph of the chest demonstrated a fluid level (yellow arrow) in the distal esophagus with dilation of the esophagus proximal to that point (blue line). Neither of these findings were present on the previous visit.

Abdominal/Gastroenterology Visual EM

Case Report: Talar Neck Fracture

Wilson Frasca, MD^* and Nhan Do, MD^*

DOI: https://doi.org/10.21980/J8FP75 Issue 5:3 No ratings yet.

ABSTRACT: This report demonstrates a case of a severe talar neck fracture. Although rare, talar neck fractures have a high potential for morbidity. Typically caused by a high energy injury, this patient’s mechanism of injury was relatively minor, and presentation was not immediately concerning for such a severe fracture. Initial x-rays provided a gross demonstration of the fracture, but a

Orthopedics Visual EM

Case Report of Spontaneous Thyroid Hemorrhage Following LMA Insertion

Gregory Podolej, MD^* and Gary Bhagat, MD^*

DOI: https://doi.org/10.21980/J8XP8W Issue 5:3 No ratings yet.

Two photographs of patients neck, both showcasing no obvious erythema, bruising, or swelling which is noteworthy because there is potential for airway compromise but there was nothing visible to indicate that on exam. CTA of neck showing thyroid nodule and potential thyroid hemorrhage (outlined in orange) on the left without evidence of airway compromise at the time of CT scan. Official read by attending radiologist states there is a “heterogeneous left thyroid nodule measuring 3 cm. Findings are suggestive of multinodular goiter with possible acute hemorrhage. Adjacent tract of soft tissue stranding in the anterior left neck with mild adjacent fascial thickening. This could represent small amount of hemorrhage or could be inflammatory.”

Endocrine Visual EM

Caught on CT! The Case of the Hemodynamically Stable Ruptured Abdominal Aortic Aneurysm

Matthew Patrick Weber, MS, BS^* and Megan Stobart-Gallagher, DO^*

DOI: https://doi.org/10.21980/J8B07B Issue 5:3 No ratings yet.

The associated images demonstrate the transverse, sagittal, and coronal views of a 6.8 cm infrarenal ruptured AAA continuous with a 4 cm right common iliac aneurysm (transverse, sagittal and coronal). Active hemorrhage was seen contained within the aortic wall, and retroperitoneal bleeding can be appreciated with asymmetric enlargement of the left psoas muscle (coronal - red arrow).1 Plaque and calcifications with a residual opacified true lumen is also present (transverse – red star, sagittal – red arrow). Known as the tangential calcium sign, this is a common radiologic finding of AAAs.2

Cardiology/Vascular Visual EM