Visual EM

Elderly female with acute abdominal pain presenting with Superior Mesenteric Artery Thrombus

Sassan Ghassemzadeh, MD^*

DOI: https://doi.org/10.21980/J82W52 Issue 3:2 No ratings yet.

Computed tomography (CT) angiogram of the abdomen and pelvis revealed a superior mesenteric artery (SMA) thrombosis 5 cm from the origin off of the abdominal aorta. As seen in the sagittal view, there does not appear to be any contrast 5 cm past the origin of the SMA. On the axial views, you can trace the SMA until the point that there is no longer any contrast visible which indicates the start of the thrombus. The SMA does not appear to be reconstituted. There was normal flow to the celiac artery. (See annotated images).

Biceps Tendon Rupture

Daniel M Polvino, MD^*and Grant Wei, MD^*

DOI: https://doi.org/10.21980/J8RP8B Issue 3:1 No ratings yet.

Physical exam was significant for ecchymosis and mild swelling of the right bicep. When the right arm was flexed at the elbow, a prominent mass was visible and palpable over the right bicep. Right upper extremity strength was 4/5 with flexion at the elbow.

Orthopedics Visual EM

Hutchinson’s Sign

Lawrence Lau, MD^*, Hannah Mirzakhani, BA^{^} and Nicholas Governatori, MD^*

DOI: https://doi.org/10.21980/J8N040 Issue 3:1 No ratings yet.

The unilateral distribution of vesicular lesions over the patient's left naris, cheek, and upper lip are consistent with Herpes zoster reactivation with Hutchinson's sign. Hutchinson's sign is a herpes zoster vesicle present on the tip or side of the nose.1 It reflects zoster involvement of the 1st branch of the trigeminal nerve, and is concerning for herpes zoster ophthalmicus.1 Herpes zoster vesicles may present as papular lesions or macular vesicles on an erythematous base.2,3 Emergent diagnosis must be made to prevent long-term visual sequelae.4

Infectious Disease Dermatology Visual EM

Viridans streptococci Intracranial Abscess Masquerading as Metastatic Disease

Brandon Ruderman, MD^*, Traci Thoureen, MD^*and Joshua Broder, MD^*

DOI: https://doi.org/10.21980/J8CH05 Issue 3:1 No ratings yet.

A non-contrast CT (Figure 1) revealed a large hypoattenuating left parietal lesion. When the CT was enhanced with intravenous contrast (Figure 2), the same lesion showed peripheral rim enhancement, suggestive of a brain abscess.

Infectious Disease Neurology Visual EM

A Sublingual Mass in a 5-Year-Old Male

Chris A Rees MD, MPH^*, Andrea T Cruz, MD, MPH^{^} and Corrie E Chumpitazi, MD, MS^{^}

DOI: https://doi.org/10.21980/J8H622Issue 3:1 No ratings yet.

Oral ranula. On oral inspection he had a 3 x 1.5 cm, soft, non-tender, mobile, cystic, sublingual mass on the right aspect of the floor of his mouth that did not move with swallowing (Image 1). There was mild associated submandibular swelling on the right side of his face.

ENT Visual EM

Pneumomediastinum After Cervical Stab Wound

Chad Correa, BS^* and Emily Ma, MD^{^}

DOI: https://doi.org/10.21980/J87P79 Issue 3:1 No ratings yet.

Anteroposterior (AP) chest X-ray showed subcutaneous emphysema of the neck, surrounding the trachea (red arrows), right side greater than left, and a streak of gas adjacent to the aortic arch (white arrow). Computed tomography angiogram (CTA) of the neck showed air outside of the trachea, positive for pneumomediastinum (blue arrows).

Trauma Respiratory Visual EM

A Case of Acute Cholecystitis

Chad Correa, BS^* and Lindsey Spiegelman, MD^{^}

DOI: https://doi.org/10.21980/J8405QIssue 3:1 No ratings yet.

Bedside point-of-care ultrasound revealed a distended gallbladder, thickened gallbladder wall, pericholecystic fluid, and a stone in the neck of the gallbladder indicative of acute cholecystitis.

Abdominal/Gastroenterology Visual EM

Computed Tomography and Ultrasound Diagnosis of Spontaneous Subcapsular Renal Hematoma

Samer Assaf, MD^*, Thalia Nguyen^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8062DIssue 3:1 No ratings yet.

Bedside ultrasound was performed and demonstrated a hypoechoic area within the left kidney (images not shown). The non-contrast computed tomography (CT) of the abdomen and pelvis shows a significantly enlarged left kidney and a region of high-attenuation encapsulating the left kidney, concerning for acute hemorrhage.

Renal/Electrolytes Visual EM

Point-of-care Ultrasound for the Diagnosis of a Gluteal Abscess

Kevin Roy, BS^*, Robert Rowe, MD^* and Maili Alvarado, MD^{^}

DOI: https://doi.org/10.21980/J8VH1W Issue 3:1 No ratings yet.

POCUS reveals a large, hypoechoic soft tissue abscess with debris and tracks extending to the bottom of the image. Furthermore, when compressed, movement of the abscess contents is appreciated. There is also superficial cobble-stoning consistent with overlying cellulitis and soft tissue edema.

Ultrasound Infectious Disease Visual EM

Perianal Abscess

Luke Walls-Smith, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8QP81Issue 3:1 No ratings yet.

Computed Tomography (CT) of the Pelvis with intravenous (IV) contrast revealed a 5.7 cm x 2.4 cm air-fluid collection in the right perianal soft tissue along the right gluteal cleft, with surrounding fat stranding, consistent with a perianal abscess with cellulitis.

Abdominal/Gastroenterology Infectious Disease Visual EM