Visual EM

Point-of-care Ultrasound for the Diagnosis of Ovarian and Fallopian Tube Torsion

Tushank Chadha, BS^*, Maili Alexandria Drachman, MD^{^}, Michelle Bui, BS^* and Amal Shafi, BS^*

DOI: https://doi.org/10.21980/J8D06KIssue 3:4 No ratings yet.

The ultrasound video clip demonstrates a transverse view of the pelvis using the endocavitary probe. The bladder can be seen on the anterior portion of the scan (yellow arrow), while the uterus with an intrauterine pregnancy is visible posteriorly (blue arrow). The thickened appearance of the uterine wall is also indicative of pregnancy. A large, anechoic cystic structure measuring approximately 5 cm is seen in the vicinity of the patient’s left adnexa (pink arrow), which raises concerns for ovarian torsion.

Ob/Gyn Visual EM

Subcutaneous Emphysema After Chest Trauma

Ronald Goubert, BS^* and Alisa Wray, MD, MAEd^*

DOI: https://doi.org/10.21980/J8864NIssue 3:4 No ratings yet.

Plain film anteroposterior (AP) radiography of the chest shows left-sided subcutaneous emphysema (red arrow) with overlapping muscle striations of the pectoralis major (green arrow). After chest tube placement (blue arrow), AP chest radiography shows persistent left-sided subcutaneous emphysema (red arrow). CT of the chest shows pneumomediastinum (blue arrow), left apical pneumothorax (pink arrow), and subcutaneous emphysema (red arrow) at the level of T2. At the level of T6, rib fractures can be visualized on the CT (yellow arrow). At the level of T8, left sided pneumothorax is also seen (pink arrow) as the absence of lung tissue on CT.

Trauma Respiratory Visual EM

An Unusual Case of Hematemesis

Amanda Amen, BA^*, Jane Xiao, MD^{^}, Julie Parks-Bortel, MD^† and Shanna Jones, MD^†

DOI: https://doi.org/10.21980/J84H00Issue 3:4 No ratings yet.

The patient’schest X-ray revealed a prominent mediastinum and opacification in the left middle and lower lung fields. The CT showed an aortic aneurysm extending from the thorax to the abdomen with rupture near T7 (blue arrow). It also showed periaortic hemorrhage with active extravasation (green arrow) likely secondary to a penetrating ulcer and bilateral pulmonary opacities concerning for hemothorax (pink arrow).

Cardiology/Vascular Visual EM

Extensive Aortic Dissection with Normal Vital Signs

Meryl Abrams, MD^*, Nicole Pagliuso, EMT^* and Xiao Chi Zhang, MD, MS^*

DOI: https://doi.org/10.21980/J80S6SIssue 3:4 No ratings yet.

The patient was found to have a Stanford type A dissection (see yellow arrow) with visible false lumen starting at aortic arch (see green circle). The dissection extended into the descending aorta (see blue circle) as shown by the false lumen (red highlighted area) visible on CT. The radiologist performed a reconstruction of the aorta, which showed that the left kidney was not being perfused, making the kidney not visible on the reconstruction.

Cardiology/Vascular Visual EM

Croup

Victor Cisneros, MD, MPH^*, Joseph Zakaria, BS^* and Wirachin Hoonpongsimanont, MD^*

DOI: https://doi.org/10.21980/J8W05JIssue 3:4 No ratings yet.

The anteroposterior X-ray reveals the classic steeple sign (blue outline) indicative of subglottic edema leading to tracheal narrowing, consistent with croup. The lateral x-ray shows narrowing of the subglottic region (green outline and arrows).

Pediatrics Respiratory Visual EM

Various Degrees of Thermal Burns

Hamid Ehsani-Nia, DO^*, Mohammad I Ehsani-Nia, BS^* and John Collins, MD^*

DOI: https://doi.org/10.21980/J8R91WIssue 3:4 No ratings yet.

On exam,there is a large swath of skin with evidence of thermal injury involving the neck, shoulder, chest, and face, including damage to the ear, external nostril, and lips. Burns exhibit varying degrees of severity and total approximately 4.5% of the body surface area. Several areas are charred and insensate to pinprick. The left earlobe is partially burned off. Patient's airway is patent with no evidence of thermal injury or obstruction to the oropharynx or nasal vestibule.

Trauma Visual EM

Pemphigoid Gestationis

Michael Niechayev, BS^* and Lauren Sylwanowicz, MD^*

DOI: https://doi.org/10.21980/J8MG9DIssue 3:4 No ratings yet.

Physical exam findings were significant for 1-3 cm diameter well-demarcated superficial ulcers on the patient’s abdomen and extremities, with mucosal sparing. Several small tense bullae were present on the bilateral inner thighs and numerous small reddish plaques were scattered over the patient’s back. Nikolsky’s sign was negative. No lymphadenopathy was noted.

Dermatology Visual EM

Don’t Forget the Pacemaker – A Rare Complication

Amanda Esposito, MD^*, Kenneth Rapp, MD^* and Albert Ritter, MD^*

DOI: https://doi.org/10.21980/J8GS7HIssue 3:4 No ratings yet.

The ECG demonstrated the presence of pacemaker spikes without appropriate capture (green arrows) and a ventricular escape rhythm which can be identified by an absence of P waves prior to the QRS complex (purple arrows). The portable chest X- demonstrated displaced pacemaker leads (red arrows) that were coiled around the pulse generator (blue arrow).

Cardiology/Vascular Visual EM

Bedside Ultrasound of Retinal Detachment in a 19-year-old

Rami San Gabriel, BS^*, Maili Alvarado, MD^* and Vy Han, MD^*

DOI: https://doi.org/10.21980/J80W6TIssue 3:3 No ratings yet.

The ocular point of care ultrasound (POCUS) utilizing a high frequency linear probe shows a retinal detachment (RD) with a thick, hyperechoic undulating membrane in the vitreous humor that is anchored at the ora serrata anteriorly and the optic disc posteriorly. Note that the retina is detached all the way to the optic disc making it "mac off." The macula, and more specifically the fovea, is located in the central retina and contains a high concentration of cone photoreceptors responsible for central, high resolution, color vision. In a "mac on" RD, the retina detaches in the periphery but remains intact centrally. This is an ophthalmologic emergency and timely diagnosis and intervention can be vision saving. This patient also has evidence of a posterior vitreous hemorrhage which has a characteristic swirling appearance with kinetic exam on real-time imaging. The detached vitreous body is not as well defined and is not anchored posteriorly to the optic disc.

Ophthalmology Visual EM

Bullous Emphysema

Valerie Lew, MD^*, John Costumbrado, MD, MPH^{^} and Steven Kim, MD^{^}

DOI: https://doi.org/10.21980/J8W62GIssue 3:3 No ratings yet.

The upright chest X-ray shows a large lucent area in the left lower lung field without lung markings, with associated curvilinear opacities (yellow arrows) consistent with a large air-filled bulla. The bulla is large enough to compress adjacent lung tissue as shown by the visible pleural line (blue line). The discontinuity of the pleural line and presence of lung markings superiorly makes these findings more consistent with bulla than pneumothorax. The chest computed tomography (CT) confirmed a large left hemithorax bulla.

Respiratory Visual EM