Visual EM

Traumatic Diaphragmatic Rupture – A Case Report

Vincent Hussey, MS^* and Claire Thomas, MD^*

DOI: https://doi.org/10.21980/J8G64H Issue 4:4 No ratings yet.

Chest X-ray showed an elevated left hemi-diaphragm with superior displacement of a portion of intra-abdominal contents presumed to be the stomach (green arrowheads) with associated rightward mediastinal shift (yellow arrows). The diagnosis was confirmed by CT. Computed tomography imaging of the chest showed a large, left diaphragmatic defect measuring approximately 5.5 cm with herniation of the upper half of the stomach through the defect. The fundus of the stomach (blue arrow) herniated superiorly through the ruptured diaphragm (red arrow).

Classic Slipped Capital Femoral Epiphysis: A Case Report

James Webley, MD^*

DOI: https://doi.org/10.21980/J8BD16 Issue 4:4 No ratings yet.

The pelvis X-ray demonstrates a widened right capital femoral epiphysis (more than 2 mm) that is typical of a slipped capital femoral epiphysis (SCFE).1 The yellow highlight outlines this area of widening. The classic Klein’s line (orange lines) is often inaccurate and even difficult to draw with certainty.1 Nevertheless, in this X-ray, one has a sense that the right capital femoral epiphysis does not align with the femoral neck in the same way as it does on the left side, suggesting slippage.

Orthopedics 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

Right Upper Quadrant Pain in a World Explorer

Julia Hutchison, DO^* and Nur-Ain Nadir, MD, MHPE^*

DOI: https://doi.org/10.21980/J8QP9D Issue 4:4 No ratings yet.

The ultrasound images show the abscess, which is a large, circular, hypoechoic mass outlined in blue in the center of the image. The abscess is surrounded by the hyperechoic and heterogeneous liver tissue. For better delineation of the abscess, a CT was ordered. The axial CT scan image shows the liver abscess, which appears as a hypodense, ovoid, intrahepatic fluid collection within the liver parenchyma. The size of the abscess has been annotated with a dotted line measuring 194.9 mm x 166.2 mm.

Abdominal/Gastroenterology Visual EM

Point-Of-Care Ultrasound for the Diagnosis of Extensor Tenosynovitis

James A Frank, MD^*, Joshua Lupton, MD^* and Bryson Hicks, MD^*

DOI: https://doi.org/10.21980/J8Q050Issue 4:3 No ratings yet.

Point-of-care ultrasound of the dorsal aspect of the left hand reveals a heterogenous hypoechoic fluid collection surrounding the extensor tendons (axial view) within the retinaculum consistent with edema. Longitudinal view shows anechoic fluid within the tenosynovium which is located between the anisotropic extensor tendon and linear hyperechoic synovial sheath. Longitudinal view also shows some cobblestoning, or tissue edema, superficial to the anisotropic extensor tendon. The patient’s contralateral right dorsal hand was scanned in a longitudinal view and shows no cobblestoning or hypoechoic fluid under the synovial sheath. The patient was diagnosed with tenosynovitis, and started on intravenous antibiotics.

Orthopedics Infectious Disease Ultrasound Visual EM

Point-of-care Ultrasound in the Diagnosis and Monitoring of Bladder Hematoma vs. Hemorrhage

Esther Kim, BS^* and Shadi Lahham, MD, MS^*

DOI: https://doi.org/10.21980/J8092FIssue 4:3 No ratings yet.

Bladder POCUS demonstrated 500mL of post void residual fluid, indicative of retention. Half of the volume is hyperechoic (red circle); this is likely the bladder wall hematoma. Could also consider sonographic artifact, bladder mass, or cystitis.1-2

Genitourinary Ultrasound Visual EM

Asymptomatic CT Iodinated Contrast Extravasation of the Upper Extremity

Eric Liao, MD^* and John Costumbrado, MD, MPH^*

DOI: https://doi.org/10.21980/J8VK87 Issue 4:3 No ratings yet.

The two radiographs demonstrate extravasation of radiopaque iodinated contrast in the lower left upper extremity with most seen in the left antecubital fossa and left proximal forearm. Extravasation is seen in the subcutaneous and subfascial tissue.

Visual EM Orthopedics

Oral Herpes Zoster

Daniel Polvino, MD^*, Grant Wei, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J8QS69Issue 4:3 No ratings yet.

Physical exam findings revealed vesicular lesions on the lip, hard and soft palates which did not cross the midline. The lesions appeared in the distribution of the maxillary branch (V2) of the trigeminal nerve, consistent with herpes zoster.

Dermatology Infectious Disease Visual EM

Ruptured AAA Presenting with Unresponsiveness and Cardiac Arrest

Lana S Shaker, MD^*, Michael W Ullo, MD^* and Aislinn Black, DO, MPH^*

DOI: https://doi.org/10.21980/J8M34QIssue 4:3 No ratings yet.

Axial CT images from the CT chest, abdomen and pelvis revealed a large infra-renal abdominal aortic aneurysm measuring 7.3 x 8.2 x 10 cm with extensive mural thrombus (single white arrow) that has ruptured, with active extravasation (black arrow) of contrast into the aneurysm sac and retroperitoneum with large right retroperitoneal hematoma (multiple white arrows).

Cardiology/Vascular Visual EM

Spontaneous Intracranial Hemorrhage in Severe Hemophilia A: A Rare Cause of Seizure in a Young Child

Sharon Kook Won, MD^* and Andrea T Cruz, MD, MPH^*

DOI: https://doi.org/10.21980/J8G91D Issue 4:3 No ratings yet.

A computed tomography (CT) scan of the head without contrast was obtained out of concern for intracranial pathology due to the patient’s young age and the witnessed focal seizure. The CT showed a 4.2 x 1.2 x 1.5 cm acute extra-axial intracranial right frontoparietal hemorrhage favoring epidural over subdural hemorrhage given its lenticular shape. There was no underlying fracture, herniation or midline shift identified.

Hematology/Oncology Neurology Visual EM