Visual EM

Monteggia Fracture in an Assault Patient

John Jiao, MHS^* and Shannon Toohey, MD, MAEd^*

DOI: https://doi.org/10.21980/J81S3ZIssue 2:1 No ratings yet.

On the axial elbow x-ray, the radial head (red arrow) is dislocated anteriorly from the humerus; the humeroulnar articulation is intact. On the AP forearm x-ray, there is a closed, displaced, comminuted fracture of the ulna (blue arrow).

Orthopedics Visual EM

Cholelithiasis: WES Sign

Hamid Ehsani-Nia, MS^* and Shannon Toohey, MD, MAEd^{^}

DOI: https://doi.org/10.21980/J8X300Issue 2:1 No ratings yet.

Abdominal ultrasound showed the classic presentation of the Wall-Echo-Shadow (WES) sign. The superficial aspect of the gallbladder wall is represented by a hyperechogenic curve. Below this, bile fluid is represented by hypoechogenicity. Underneath the bile fluid is the echo of the dense border created by the collection of gallstones, represented by a hyperechogenic curve. Due to the high density of the gallstones, nothing deeper can be visualized (including other gallstones or the far end of the gallbladder); this is the shadow.

Abdominal/Gastroenterology Ultrasound Visual EM

Hill-Sachs Deformity

Jessa Baker^* and Shannon Toohey, MD^*

DOI: https://doi.org/10.21980/J8Z59DIssue 1:2 No ratings yet.

In the post-reduction film, there is a lateral depression in the humeral head (arrow, a Hill-Sachs deformity). A Hill-Sachs deformity is a cortical depression (fracture) in the humeral head that forms as the humeral head hits the glenoid rim during the dislocation.

Orthopedics Visual EM

Perforated Duodenal Ulcer

Jessa Baker^*, Jonathan Patane, MD^* and Carrie Chandwani, MD^*

DOI: https://doi.org/10.21980/J8TG64Issue 1:2 No ratings yet.

In the chest radiograph, there was obvious free air under the both the right diaphragm (above the liver) and the left diaphragm, consistent with pneumoperitoneum.

Abdominal/Gastroenterology Visual EM

Trimalleolar Fracture

Christopher Gilani^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J8PP46 Issue 1:2 No ratings yet.

Anteroposterior (AP), lateral, and oblique x-ray views were obtained. The AP view revealed a displaced spiral fracture of the lateral malleolus (red) and a vertical fracture of the medial malleolus (blue). The lateral view revealed a displaced fracture of the posterior malleolus, tibial plafond (yellow), and the oblique view showed widening of the distal tibiofibular syndesmosis (green). CT scans confirmed trimalleolar fracture, annotated with the same colored lines (red, lateral malleolus; blue, medial malleolus; yellow, posterior malleolus).

Orthopedics Visual EM

Hyperkalemia on ECG

Bryson Hicks, MD^*

DOI: https://doi.org/10.21980/J8K017Issue 1:2 No ratings yet.

Initial ECG shows tall, peaked T waves, most prominently in V3 and V4, as well as QRS widening. These findings are consistent with hyperkalemia, which was promptly treated. Follow-up ECG post-treatment shows narrowing of the QRS complexes and normalization of peaked T waves.

Cardiology/Vascular Visual EM

Perilunate Dislocation

John Jiao, MHS^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J8F59RIssue 1:2 No ratings yet.

In the left lateral wrist x-ray, the lunate is dislocated from the rest of the wrist bones but still articulates with the radius. The capitate does not sit within the distal articulation of the lunate and is displaced dorsally. Additionally, a line drawn through the radius and lunate fails to intersect with the capitate. This is consistent with a perilunate dislocation. This is compared to a lunate dislocation, where the lunate itself is displaced and turned ventrally (spilled teacup) and the proximal aspect does not articulate with the radius.

Orthopedics Visual EM

Femoral Neck Fracture

Jonathan Lee^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J89G6GIssue 1:2 No ratings yet.

In the anteroposterior view bilateral hip x-ray, there is an evident loss of Shenton’s line on the left when compared to the normal right, indicative of a fracture in the left femoral neck. This correlates with findings seen on pelvic CT, which reveals both a subcapital fracture and transcervical fracture. The neck of the femur is displaced superiorly relative to the head of the femur while the head of the femur remains in its anatomical position within the acetabulum.

Orthopedics Visual EM

Traumatic Aortic Injury

Brianna Miner^*, Megan Boysen Osborn, MD, MHPE^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J85P4JIssue 1:2 No ratings yet.

The initial chest x-ray showed an abnormal superior mediastinal contour (blue line), suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows) compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow). There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows).

Trauma Cardiology/Vascular Visual EM

Wolff-Parkinson-White Syndrome: Electrocardiogram

Brianna Miner^*, Jonathan Patane, MD^*, and Carrie Chandwani, MD^*

DOI: https://doi.org/10.21980/J8201KIssue 1:2 No ratings yet.

The initial EKG showed wide complex, irregular tachycardia > 200 bpm (EKG 1). Given the possibility of Wolff-Parkinson-White (WPW), procainamide was given to the patient. The patient’s heart rate responded and decreased to 120-140 bpm with narrowing of the QRS complex. A repeat EKG showed narrow complex tachycardia without P waves approximately 120 bpm (EKG 2). Once the procainamide infusion was complete, the patient had converted to sinus rhythm with a delta wave now apparent, consistent with WPW (EKG 3).

Cardiology/Vascular Visual EM