Visual EM

Ventriculoperitoneal Shunt Migration

Justin P Puller, MD^* and Jonathan T Miller, MD^*

DOI: https://doi.org/10.21980/J8G019Issue 2:1 No ratings yet.

An immediate post-op abdominal x-ray performed after the patient’s VP shunt revision 30 days prior to this ED visit reveals the VP shunt tip in the mid abdomen. A CT of the abdomen performed on the day of the ED visit reveals the VP shunt tip interposed between the spleen and the diaphragm.

Abdominal/Gastroenterology Visual EM

K-9 Police Dog Bite

Vy Han, MD^* and John R. Marshall, MD^*

DOI: https://doi.org/10.21980/J8B88GIssue 2:1 No ratings yet.

The photograph is of the anterior compartment of the right lower leg demonstrating multiple deep lacerations with exposed and torn muscle. X-ray showed no foreign body.

Trauma Visual EM

Lunate Dislocation

Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J86K56Issue 2:1 No ratings yet.

Plain film of the right wrist showed the classic “spilled teacup” consistent with a lunate dislocation. There is a loss of the normal articulation between the distal radius and lunate.

Orthopedics Trauma Visual EM

Bedside Echocardiography for Rapid Diagnosis of Malignant Cardiac Tamponade

Alaina Brinley, MD, PhD*, Maili Alvarado, MD* and J Christian Fox, MD*

DOI: https://doi.org/10.21980/J82S38Issue 2:1 No ratings yet.

The video shows a subxiphoid view of the heart with evidence of a large pericardial effusion with tamponade – note the anechoic stripe in the pericardial sac (see red arrow). This video demonstrates paradoxical right ventricular collapse during diastole and right atrial collapse during systole which is indicative of tamponade.1,2 Figure 1 is from the same patient and shows sonographic pulsus paradoxus. This is an apical 4 chamber view of the heart with the sampling gate of the pulsed wave doppler placed over the mitral valve. The Vpeak max and Vpeak min are indicated. If there is more than a 25% difference with inspiration between these 2 values, this is highly suggestive of tamponade.1 In this case, there is a 32.4% difference between the Vpeak max 69.55 cm/s and Vpeak min 46.99 cm/s.

Cardiology/Vascular Hematology/Oncology Ultrasound Visual EM

Takotsubo (Stress) Cardiomyopathy

Justin J Hourmozdi, MD^*, Julian P Suszanski, MD^*and Jacqueline M Pflaum, MD^{*^}

DOI: https://doi.org/10.21980/J8Z309Issue 2:1 No ratings yet.

Bedside echocardiography showed the findings consistent with Takotsubo cardiomyopathy. Echocardiographic images are shown in subxiphoid (A) and apical four chamber (B) views. Note the apical ballooning appearance (asterisk) of the left ventricle (LV).

Cardiology/Vascular Visual EM

Pediatric Supracondylar Fracture

Jonathan Peña, MD^* and John R. Marshall, MD^*

DOI: https://doi.org/10.21980/J8T88TIssue 2:1 No ratings yet.

Plain film radiography showed a displaced supracondylar fracture with disrupted anterior and posterior periostea, consistent with a type 3 supracondylar fracture.

Orthopedics Visual EM

Calcaneal Fractures and Böhler’s Angle

Lindsey Spiegelman, MD^* and Mohammed Helmy, MD^{^}

Issue 2:1 No ratings yet.

The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow) in addition to fracture fragments along the heel pad margin (blue arrow). The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow). There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow) in addition to a joint effusion. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle).

Orthopedics Visual EM

Intraocular Foreign Body: Ultrasound and CT Findings

Maja Feldman, MPP^*, Kristi Shigyo, MD^{^} and Amy Kaji, MD^{^}

DOI: https://doi.org/10.21980/J8JS3MIssue 2:1 No ratings yet.

Point of care ultrasound revealed a mobile, radiolucent hyperechoic structure (see red arrow) with reverberation within the posterior chamber (see blue arrow), likely a metallic foreign body. Linear areas of mobile hyperechoic material revealed possible vitreous hemorrhage (see purple circular area). Orbital non-contrast CT confirmed a 3 mm metallic focus within the dependent portion of the left globe, lodged in the posterior sclera, with some vitreous hemorrhage but no evidence of globe rupture. Ophthalmology was consulted and the patient was taken to surgery later that night.

Ophthalmology Visual EM

Computed Tomography Diagnosis of Appendicitis

Christopher Libby, MPH^* and Shannon Toohey, MD, MAEd^{^}

DOI: https://doi.org/10.21980/J8F30NIssue 2:1 No ratings yet.

The CT abdomen/pelvis with IV contrast shows a dilated appendix (see red outline) with thickened, hyperenhancing wall (see blue outline) best visualized in the axial and coronal planes.

Abdominal/Gastroenterology Visual EM

Intracranial Hemorrhage Following a 3-week Headache

John Jiao, MHS^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J89885 Issue 2:1 No ratings yet.

The patient’s head CT showed a significant area of hyperdensity consistent with an intracranial hemorrhage located within the left frontal parietal lobe (red arrow). Additionally, there is rightward midline shift up to 1.1cm (green arrow) and entrapment of the right lateral ventricle (blue arrow).

Neurology Visual EM