Visual EM

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Asymptomatic Wolff-Parkinson-White Syndrome: Incidental EKG

Samer Assaf, MD* and Christopher Libby, MD, MPH^

DOI: https://doi.org/10.21980/J8T05X Issue 2:3[mrp_rating_result]
The ECG shows slurred up-stroking of the QRS complexes characteristic of a delta wave. The PR interval is normal; however, the QT interval is greater than 110ms.
Cardiology/VascularVisual EM
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Renal Infarction from Type B Aortic Dissection

Marit Tweet, MD* and James Roy Waymack, MD*

DOI: https://doi.org/10.21980/J8HG9G Issue 2:3[mrp_rating_result]
Initial abdominal images demonstrated a dissection flap; therefore, a CTA of the chest was also obtained. These images revealed a Stanford type B aortic dissection beginning just distal to the left subclavian artery and extending to the origin of the inferior mesenteric artery. The right renal artery arose from the true lumen of the dissection while the left renal artery arose from the false lumen. This case is interesting as imaging shows the lack of perfusion to the left kidney, residing in the retroperitoneum, which correlates with her non-descript abdominal and left flank pain.
Cardiology/VascularRenal/ElectrolytesVisual EM
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Esophageal Perforation

Valentina Park, BS* and Jason Mefford, MD^

DOI: https://doi.org/10.21980/J8K91B Issue 2:3[mrp_rating_result]
History of present illness: A 51-year-old male with history of gastroesophageal reflux disease status post multiple endoscopies presented to the emergency department with severe abdominal pain. Paramedics reported the patient appeared diaphoretic on arrival and maintained stable vital signs during transit. The patient reported taking Prilosec that morning before eating breakfast, after which he felt like something was stuck in
Abdominal/GastroenterologyVisual EM
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Globe Rupture

Reid Honda, MD*

DOI: https://doi.org/10.21980/J8N91Z Issue 2:3[mrp_rating_result]
The patient’s computed tomography (CT) head demonstrated a deformed left globe, concerning for ruptured globe. The patient had hyperdense material in the posterior segment (see green arrow), consistent with vitreous hemorrhage. CT findings that are consistent with globe rupture may include a collapsed globe, intraocular air, or foreign bodies.
OphthalmologyVisual EM
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Steven-Johnson Syndrome

Pauline Joy F. Santos, MD* and Lauren Sylwanowicz, MD*

DOI: https://doi.org/10.21980/J8661W Issue 2:3[mrp_rating_result]
At presentation to the ED, a macular rash was notable on all four extremities, trunk and face, and involved mucous membranes of the oropharynx and vaginal introitus. The rash was painful, erythematous and purpuric with targetoid lesions. There were also multiple areas of sloughing and desquamation with a positive Nikolsky sign. Denudement totaled approximately 2% of total body surface area.
DermatologyVisual EM
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Ectopic Kidney

John Costumbrado, MD, MPH*, Reid Honda, MD^ and Eric McCoy, MD, MPH^

DOI: https://doi.org/10.21980/J89058 Issue 2:3[mrp_rating_result]
CT of the abdomen and pelvis revealed a normal left kidney and an ectopic, malrotated right kidney located in the pelvis (see white arrow).
Renal/ElectrolytesVisual EM
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Ruptured Abdominal Aortic Aneurysm

Jessica Andrusaitis, BS, MS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8FP6SIssue 2:3[mrp_rating_result]
CTA demonstrated a ruptured 7.4 cm infrarenal abdominal aortic aneurysm with a large left retroperitoneal hematoma.
Cardiology/VascularVisual EM
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Perforated Gastric Ulcer with Intra-abdominal Abscess

Leslie Palmerlee, MD, MPH*, Scott Mackey, DO* and Michael Petrauskis, MD, MEd*

DOI: https://doi.org/10.21980/J82H0C Issue 2:3[mrp_rating_result]
Bedside ultrasound revealed a large volume of free fluid in the right upper quadrant and in the pelvis. The fluid appeared complex with multiple septations. Its appearance was not consistent with ascites or acute intra-abdominal free fluid due to striations and pockets.
Abdominal/GastroenterologyVisual EM