Visual EM

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Tick Removal

Belinda Lao, MD* and Xiao Chi Zhang, MD*

DOI: https://doi.org/10.21980/J8HK9H Issue 4:1[mrp_rating_result]
On physical exam, an engorged tick was found attached to the patient’s left upper back.  The underlying skin was nontender but mildly erythematous, without central clearing. The tick was gently removed with blunt angle forceps and sent for further analysis, which later revealed the specimen to be an American dog tick (Dermacentor variabilis).
WildernessVisual EM
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Lightning Ground Current Injury: A Subtle Shocker

Gregory S Podolej, MD* and Naomi Nardi, MD*

DOI: https://doi.org/10.21980/J8KD1C Issue 4:1[mrp_rating_result]
The first photograph demonstrates a dendritic blister (Lichtenburg figure) on the medial aspect of his right foot where the ground current injury entered the patient's foot. Although no data exists regarding the sensitivity or specificity of Lichtenberg figures as skin findings, they are considered pathognomonic for lightning injuries and are not produced by alternating current or industrial electrical injuries. The second photograph demonstrates a 4 x 3 cm area of petechiae where the ground current injury exited the patient.
WildernessDermatologyVisual EM
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Talonavicular Dislocation

Joseph Zakaria, BS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8PG91Issue 3:4[mrp_rating_result]
The X-rays were significant for a subtalar dislocation. The calcaneus (red) is laterally displaced with respect to the talar head (orange), and the white lines indicate the normal articular surface. Additionally, there was a talonavicular dislocation, as seen in the fourth image: the talus (green) and navicular bone (purple) overlapping suggests a dislocation. In a normally aligned foot, the boundaries of the two bones create a point of articulation.
OrthopedicsVisual EM
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Endocarditis

Sara Arastoo, BS* and Sari Lahham, MD, MBA*

DOI: https://doi.org/10.21980/J8JP73Issue 3:4[mrp_rating_result]
Upright frontal radiograph of the chest demonstrated large pleural effusion on the left and moderate pleural effusion on the right as shown by the visible menisci on both sides (red arrows) with diffuse bilateral nodular densities (yellow dotted lines), consistent with septic pulmonary emboli. Computed tomography (CT) of the chest demonstrated multiple scattered lung nodules bilaterally containing internal foci of air cavitation (green dotted lines).
Infectious DiseaseCardiology/VascularVisual EM
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Facial Fracture Induced Periorbital Emphysema

Hamid Ehsani-Nia, DO* and Robert Eisenstein, MD*

DOI: https://doi.org/10.21980/J8F05HIssue 3:4[mrp_rating_result]
Physical exam showed marked left palpebral subcutaneous crepitus, as well as bulbar and palpebral conjunctival bulging. Visual acuity was normal with intact extraocular movements, and normal pupillary exam. Computed tomography (CT) imaging of the face was obtained and revealed multiple displaced fractures involving the left orbital floor and zygomatic arch associated with moderate periorbital and postseptal extraconal gas, resulting in orbital proptosis.
TraumaENTVisual EM
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Fournier Gangrene

Joseph Zakaria, BS*, Steve Bunch, MD* and Victor Cisneros, MD, MPH*

DOI: https://doi.org/10.21980/J89626Issue 3:4[mrp_rating_result]
The computed tomography (CT) of the abdomen and pelvis revealed significant subcutaneous gas tracking along the perineum and right gluteal region (orange outline) into the scrotum with associated scrotal edema (yellow arrow) and subcutaneous inflammatory fat stranding of 0.92 cm (red arrow) consistent with Fournier’s gangrene.  There is early fluid loculation along the right medial gluteal cleft of 5.85 cm (green arrow) without a sizeable drainable abscess seen.
Infectious DiseaseVisual EM
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Foreign Body in Maxillary Sinus: A Rare Case of Chronic Rhinosinusitis

Richard Barnett, DO* and Meigra Chin, MD*

DOI: https://doi.org/10.21980/J85H09Issue 3:4[mrp_rating_result]
Computed tomography (CT) sinus with contrast demonstrated complete opacification of left paranasal sinuses and nasal cavity, and a linear radiopacity within the left maxillary sinus consistent with a foreign body.  There were additional left facial subcutaneous radiopaque opacities.
ENTVisual EM
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Brief Review of Intussusception Diagnosis and Management

Claire Thomas, MD*, Wirachin Hoonpongsimanont, MD*, Sara Paradise, MD* and Mohammad Helmy, MD^

DOI: https://doi.org/10.21980/J81P7FIssue 3:4[mrp_rating_result]
The patient’s abdominal ultrasound revealed intussusception in the right upper abdominal quadrant. The transverse ultrasound view showed a “doughnut sign” (dashed yellow line), telescoping bowel (yellow arrow), and invaginated hyperechoic mesenteric fat with crescent configuration (dashed orange line).  The sagittal ultrasound view demonstrated the intussusception formed by the outer recipient bowel loop (yellow arrows), invaginated hyperechoic mesenteric fat (orange asterisks), and telescoping bowel centrally (red arrow).
Abdominal/GastroenterologyPediatricsVisual EM