Visual EM
A Case Report on Detecting Porcelain Gallbladder form Wall-Echo-Shadow Sign on Point-of-Care Ultrasound
DOI: https://doi.org/10.21980/J8164GPoint-of-care ultrasound (POCUS) was performed by the emergency physician. Gallbladder ultrasound (US) should be performed using a curvilinear probe. If the patient’s body habitus does not allow for the use of a curvilinear probe, a phased array probe may be used. To find the gallbladder with ultrasonography, two approaches are commonly used. Many physicians prefer the “subcostal sweep” in which the probe is placed on the xiphoid process in a sagittal plane and swept along the inferior costal margin until the gallbladder is visualized. If this does not adequately locate the gallbladder, the “X minus 7” approach may be used. In this approach, the probe is placed on the xiphoid (X) process in a transverse view and moved 7 centimeters (minus 7) to the patient’s right. This technique is useful for patients with a larger body habitus. If the gallbladder is still not visualized, placing the patient in left lateral decubitus position or asking them to take a deep breath and hold may help the ultrasonographer locate the gallbladder. The US revealed mild hepatic biliary duct dilation with cholelithiasis and sludge, but no additional evidence to suggest cholecystitis. The US image showed a dilated common bile duct at 0.94 cm and calcifications. Visualization of the gallbladder wall is essential in differentiating between a positive wall-echo-shadow (WES) sign and a porcelain gallbladder. While a hypoechoic gallbladder wall is indicative of a WES sign, a hyperechoic wall layer will indicate a calcified gallbladder wall, suggesting a porcelain gallbladder. In image 1, the hyperechoic gallbladder wall can be visualized (white arrow), suggesting the presence of porcelain gallbladder and distinguishing it from a positive WES sign.
Auricular Perichondritis after a “High Ear Piercing:” A Case Report
DOI: https://doi.org/10.21980/J8WH16On physical examination, there was erythema, swelling, warmth, and general exquisite tenderness of the superior aspect of the left pinna (the outer ear) but excluding the ear canal, lobe, tragus, and crus. There was no facial involvement. There was no fluctuance about the ear and no drainage of fluid. The preauricular lymph nodes were enlarged and tender, but the anterior cervical lymph nodes were not tender. There was no mastoid tenderness, protrusion of the ear, or interruption of the postauricular crease.
Case Report of Thrombotic Thrombocytopenic Purpura in a Previously Healthy Adult
DOI: https://doi.org/10.21980/J8VK9MThe physical exam revealed globalized pallor of his skin as well as conjunctival pallor. Mucous membranes were found to be dry and pale with dried gingival hemorrhages apparent between teeth (image). Additionally, mild hepatosplenomegaly was noted. While in the ED, the patient’s urine was dark reddish-brown, which he then reported had been similarly discolored for the past 7 days.
A Case Report of Posterior Communicating Artery Aneurysm Presenting as Cranial Nerve 3 Palsy in a Young Female Patient with Migraines
DOI: https://doi.org/10.21980/J8QW83Physical exam revealed a right pupil that was dilated compared to the left pupil, though both pupils were reactive. The patient also had impaired medial gaze on the right and ptosis of the right eyelid. Exam was otherwise unremarkable.
Pulmonary Arteriovenous Malformation in a Patient with Suspected Hereditary Hemorrhagic Telangiectasia: A Case Report
DOI: https://doi.org/10.21980/J8M353Initial vital signs were unremarkable, including oxygen saturation of 98% on room air. The patient did not exhibit any signs of respiratory distress, and the lungs were clear to auscultation bilaterally. Labs were obtained, which showed normal hemoglobin at 15.8. Computed tomography (CT) of the chest (Video 1) showed a large left upper lobe arteriovenous malformation (AVM) with large feeding arteries and tortuous dilated draining veins (red arrow) measuring up to 3.8cm. Imaging also demonstrated nonspecific multifocal ground-glass opacities, which may have represented pulmonary hemorrhage (blue outline) from AVM without evidence of contrast extravasation to suggest active bleeding.
Case Report: Not Your Typical Kidney Stone
DOI: https://doi.org/10.21980/J8GD2TThe 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.
A Case Report of a Transected Carotid Artery Caused by a Stab Wound to the Neck
DOI: https://doi.org/10.21980/J8BP8MThe post intubation chest x-ray (CXR) showed severe rightward displacement of the trachea (purple arrow). The computed tomography angiogram (CTA) showed transection of the left common carotid artery (LCCA), extensive neck hematoma without extravasation and severe tracheal deviation to the right (blue arrow). The intravenous (IV) contrasted chest computed tomography (CT) image showed a lateral contrast projection from the aortic arch at the level of the isthmus (green and pink arrows). There were no other significant injuries reported on the CT scans of the chest, abdomen and pelvis.
Case Report of COVID-19 Positive Male with Late-Onset Full Body Maculopapular Rash
DOI: https://doi.org/10.21980/J86W72The images demonstrate a diffuse, flat, maculopapular exanthema along the torso, bilateral upper and lower extremities, and neck without edema consistent with reported cutaneous manifestations of COVID-19. There are no surrounding bullae, vesicles, or draining. On palpation, there was blanching of the rash. Sensation to light touch was intact in all extremities. The findings were also apparent on the face with no mucosal involvement.