Visual EM

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Right Atrial Thrombus

Michael Berkenbush, MD, NRP*, Mei-Yung Chan, MD* and Amanda Esposito, MD*

DOI: https://doi.org/10.21980/J8F93V Issue 4:3[mrp_rating_result]
  History of present illness: A 77-year-old male presented to the emergency department with shortness of breath. Symptoms progressively worsened over the last 4-5 days, and on arrival was associated with chest tightness. He denied any medical conditions, smoking, or pertinent family history. He has not seen a primary care physician in “many years.” Upon arrival he was in mild
Cardiology/VascularVisual EM
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Posterior Vitreous Detachment

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

DOI: https://doi.org/10.21980/J89K9N Issue 4:3[mrp_rating_result]
Ocular ultrasound was performed and demonstrated a thin, slightly echogenic strand (blue arrow) extending from the posterior eye into the vitreous humor (yellow arrow) which was hyperkinetic with extraocular motion. These findings are consistent with a posterior vitreous detachment (PVD).
OphthalmologyVisual EM
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Macula-Off Retinal Detachment Identified on Bedside Ultrasound

Colin Prather, MD* and Bryson Hicks, MD*

DOI: https://doi.org/10.21980/J8WP8KIssue 4:2[mrp_rating_result]
Point-of-care ultrasound was performed, demonstratinga free-floating, serpiginous, hyperechoic membrane (R) tethered at the optic nerve (ON) and ora serrata (OS), but detached at the macula (M) lateral to the optic nerve. This is diagnostic for macula-off retinal detachment. It can be differentiated from macula-on retinal detachment, in which the hyperechoic retina would appear attached posteriorly at the location of the macula just lateral to the optic nerve. Ophthalmology was consulted, agreed with the diagnosis of macula-off retinal detachment, and took the patient to the OR for laser photocoagulation.
OphthalmologyVisual EM
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Point-of-Care Ultrasound for the Diagnosis of Systolic Heart Failure

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

DOI: https://doi.org/10.21980/J8HD1R Issue 4:2[mrp_rating_result]
Bedside ultrasound with the phased array probe was used to obtain a parasternal long axis view which demonstrated poor contractility and a severely decreased ejection fraction (EF). M-mode was placed over the anterior leaflet of the mitral valve to create a tracing depicting both the E-wave of early diastole (green arrow) and the A-wave from the atrial kick (blue arrow). The shortest distance between the septum and the mitral valve on the M-mode tracing gives the patient’s E-Point Septal Separation (EPSS) (pink arrow). EF can be estimated using the formula EF=75.5-2.5 x EPSS (in mm). This patient’s EPSS was measured to be 20mm which estimates that she had an EF of 25.5%.
Visual EMCardiology/Vascular
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Bedside Ultrasound for the Rapid Diagnosis of Fournier’s Gangrene

Patrick Penalosa, BS*, Maili Alexandria Drachman, MD^ and Vy Han, MD*

DOI: https://doi.org/10.21980/J8CP99Issue 4:2[mrp_rating_result]
Point of care ultrasound (POCUS) utilizing a high-frequency linear probe revealed heterogeneous debris with subcutaneous air within the scrotal wall extending into the perineum consistent with necrotizing fasciitis of the perineum or Fournier’s gangrene (FG). The video shows multiple foci of gas that appear as echogenic dots with “dirty shadows” posteriorly from reverberation artifact arising from gas within the soft tissue.
Infectious DiseaseGenitourinaryVisual EM
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Pneumocystis jirovecii (carinii) Pneumonia

Brian Knight, BS*, Jonathan Patane, MD* and Robert Katzer, MD, MBA*

DOI: https://doi.org/10.21980/J8RW6NIssue 4:2[mrp_rating_result]
Chest X-ray showed diffuse, patchy interstitial and alveolar infiltrates bilaterally concerning for Pneumocystis jirovecii(previously Pneumocystis carinii) pneumonia (PJP). The AP radiograph (top left figure) showed the classic “bat-wing” distribution on the left side. Repeat radiograph (bottom figure) one day after admission showed worsening of the infiltrates.
Infectious DiseaseRespiratoryVisual EM
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Acute Pancreatitis

Ronald Goubert, BS*, Jonathan Peña, MD*, Alisa Wray, MD, MAEd* and Eleanor Chu, MD^

DOI: https://doi.org/10.21980/J88W5XIssue 4:2[mrp_rating_result]
Computed tomography of the abdomen and pelvis with contrast show edema of the pancreas (red outline) and duodenum (yellow arrow) with peripancreatic inflammation, fluid and fat stranding (blue highlight). The distal pancreatic tail was noted to appear normal (green arrow). There was no organized drainable fluid collection, and no parenchymal hypo-enhancement. These findings are consistent with moderate severity acute interstitial pancreatitis.
Abdominal/GastroenterologyVisual EM
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Renal and Splenic Infarcts

Niketu Patel, MPH* and Loice Swisher, MD*

DOI: https://doi.org/10.21980/J8804KIssue 4:2[mrp_rating_result]
On the coronal sections of computed tomography (CT), bilateral renal infarctions (blue arrows) and several splenic infarctions (green arrows) are noted. Of particular interest, part of the clot totally occluding the left renal artery visibly extends into the aorta (red arrow). The vascular reconstruction image is remarkable for the absent left kidney, the unusual contour of the right kidney and the abnormal splenic blush.
Visual EMAbdominal/Gastroenterology