Visual EM

Point-of-care Ultrasound for the Diagnosis of Ectopic Pregnancy

Ahmed Farhat, BS^*, Jessica Hoffmann, MD^* and Maili Alvarado, MD^{^}

DOI: https://doi.org/10.21980/J8VK7VIssue 2:4 No ratings yet.

The transabdominal pelvic ultrasound shows an empty uterus (annotated) with free fluid and a right sided extrauterine gestational sac representing an ectopic pregnancy (red arrow).

Erythema Migrans

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

DOI: https://doi.org/10.21980/J8QW7QIssue 2:4 No ratings yet.

History of present illness: A 28-year-old male presented to the emergency department with a chief complaint of two weeks of headache, chills, and numbness in his hands. He reported removing a tick from his upper back approximately two weeks ago, but did not know how long the tick had been embedded. His review of symptoms was otherwise unremarkable. Significant findings:

Dermatology Infectious Disease Visual EM

Spontaneous Pneumothorax

John Costumbrado, MD, MPH^* and Steven Kim, MD^*

DOI: https://doi.org/10.21980/J8M33BIssue 2:4 No ratings yet.

Initial chest radiograph showed a 50% right-sided pneumothorax with no mediastinal shift, which can be identified by the sharp line representing the pleural lung edge (see arrows) and lack of peripheral lung markings extending to the chest wall. While difficult to accurately estimate volume from a two-dimensional image, a 2 cm pneumothorax seen on chest radiograph correlates to approximately 50% volume.1 The patient underwent insertion of a pigtail pleural drain on the right and repeat chest radiograph showed resolution of previously seen pneumothorax. Ultimately the pigtail drain was removed and chest radiograph showed clear lung fields without evidence of residual pneumothorax or pleural effusion.

Respiratory Visual EM

Pediatric Esophageal Foreign Body

Samer Assaf, MD^* and Ryan Gibney, BS^*

DOI: https://doi.org/10.21980/J8GD1F Issue 2:4 No ratings yet.

A radiopaque foreign body was visualized in the proximal esophagus at the thoracic inlet on the chest and neck radiographs. The foreign body appeared to be metallic with visualized concentric rings consistent with a coin.

Abdominal/Gastroenterology Pediatrics Visual EM

Acetabular Fracture

Chad Correa^* and Sari Lahham, MD^{^}

DOI: https://doi.org/10.21980/J8BK8K Issue 2:4 No ratings yet.

The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows), with associated obturator muscle hematoma (blue oval).

Orthopedics Visual EM

Bedside Ultrasound for the Diagnosis of Small Bowel Obstruction

Alexander Anshus, BS^* and Maili Alvarado, MD^{^}

DOI: https://doi.org/10.21980/J86W6PIssue 2:4 No ratings yet.

The POCUS utilizing the low frequency curvilinear probe demonstrates fluid-filled, dilated bowel loops greater than 2.5cm with to-and-fro peristalsis, and thickened bowel walls greater than 3mm, concerning for SBO.

Abdominal/Gastroenterology Visual EM

Chancre of Primary Syphilis

Adnan Riaz MD^* and Grant Wei MD^*

DOI: https://doi.org/10.21980/J83342 Issue 2:4 No ratings yet.

Physical examination revealed a non-tender, erythematous lesion on the glans penis, two similar adjacent satellite lesions, as well as tender inguinal lymphadenopathy. No penile discharge was noted.

Infectious Disease Dermatology Genitourinary Visual EM

Choledocholithiasis

Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8Q62X Issue 2:3 No ratings yet.

Computed tomography (CT) was significant for two large gallstones measuring 1.1 centimeters impacted at the level of the pancreatic head with associated common bile duct (CBD) dilatation.

Abdominal/Gastroenterology Visual EM

Using Bedside Ultrasound to Rapidly Differentiate Shock

Mohamad Moussa, MD^*, Jacob Willen, BS^* and Sudipa Biswas, BS, MS^*

DOI: https://doi.org/10.21980/J8S047 Issue 2:3 No ratings yet.

A RUSH exam demonstrated hyperdynamic cardiac contractility and collapse of the inferior vena cava (IVC) with probe compression more than 50% suggesting hypovolemia likely secondary to sepsis. Incidentally, Morrison’s pouch revealed a large right renal cyst but no signs of free fluid. A computed tomography of abdomen/pelvis showed a 10.8 x 9.5 cm right renal cyst and left lower lobe pneumonia.

Ultrasound Infectious Disease Visual EM

Corneal Sparing Conjunctival Abrasion

Hamid Ehsani-Nia, MS^*, Tanya Dall, MD^{^} and Samantha Costantini, MD^{^}

DOI: https://doi.org/10.21980/J8KG93 Issue 2:3 No ratings yet.

Physical exam was significant for multiple broken teeth, multiple minor abrasions on the face, and fine shards of shattered glass on his face and hair. His right eye had conjunctival injection, with no signs of subconjunctival hemorrhage or ocular penetration. Vision, extraocular movement, and pupillary exam were grossly intact. Fluorescein staining with slit lamp exam with cobalt blue filter examination of the right eye revealed superficial bulbar conjunctival uptake of fluorescein dye staining an area of the conjunctiva inferior to the limbus 5 mm vertical by 2 mm horizontal (estimation by photo provided). No foreign bodies were visualized in the inferior fornix. These findings were consistent with superficial conjunctival abrasion. The exam noted sparing of the corneal epithelium.

Ophthalmology Visual EM