Visual EM
A Case Report Evaluating Gastric Emphysema versus Emphysematous Gastritis
DOI: https://doi.org/10.21980/J8ZH26A CT scan of the abdomen and pelvis was obtained and revealed gas within the gastric wall at the fundus (blue arrows), concerning for gastric emphysema versus emphysematous gastritis. There was no gastric wall thickening, free air, bowel obstruction, drainable fluid collection, or evidence of portal venous gas. Incidentally, hepatomegaly and likely hepatic steatosis were also noted.
Telescoping into Adulthood: A Case Report of Intussusception in an Adult Patient
DOI: https://doi.org/10.21980/J8Q06CComputed tomography imaging of the abdomen and pelvis with intravenous and oral contrasts was obtained. In the axial view, one will see a concentric ring formed by layers of bowel, mesenteric vessels, and fat (red arrow and circle); this is the equivalent of the ultrasonographic “target sign.” The inner ring (blue arrow) represents the lead point causing telescoping of the bowel. One can see that the proximal bowel is dilated (yellow arrow). In the coronal view, one can see an obstructive mass, also known as the lead point (red arrow), located in the lumen of the descending colon. Located proximal to the lead point are dilated loops of bowel with edematous changes and fat stranding (pink circle). The proximal portion of the bowel will take on a concentric appearance with the telescoping loop of bowel.
The Clue is in the Eyes. A Case Report of Internuclear Ophthalmoplegia
DOI: https://doi.org/10.21980/J8DP9MThere was no appreciable esotropia or exotropia noted on straight gaze (yellow arrows). On extraocular muscle examination, patient was noted to have a complete left medial rectus palsy consistent with a left internuclear ophthalmoplegia (red arrow). This was evidence by both eyes easily gazing left (green arrows); however, with rightward gaze, her left eye failed to gaze past midline (red arrow).
Septic Arthritis of the Acromioclavicular Joint: A Case Report
DOI: https://doi.org/10.21980/J8VP9NMagnetic resonance imaging (MRI) with contrast was obtained of the shoulder and ankle, and results from both scans showed findings consistent with septic arthritis complicated by intraarticular abscesses. The MRI of the patient’s left acromioclavicular joint is shown as both a T1-weighted sequence in sagittal view and T2-weighted sequence in coronal view. The images show effusion (the dark fluid denoted by the red arrow) with an adjacent fluid collection (blue arrow). A T2-weighted MRI in coronal view of the patient’s right ankle showing multiple effusions (green arrows) and a fluid collection along the medial tibial cortex and subcutaneous tissues (yellow arrow).
Case Report of a Child with Colocolic Intussusception with a Primary Lead Point
DOI: https://doi.org/10.21980/J8564QOn the initial ED visit, an abdominal ultrasound (US) was ordered which showed the classic intussusception finding of a target sign (yellow arrow), or concentric rings of telescoped bowel, on the transverse view of the left lower quadrant (LLQ).
Point-Of-Care Ultrasound Use for Detection of Multiple Metallic Foreign Body Ingestion in the Pediatric Emergency Department: A Case Report
DOI: https://doi.org/10.21980/J83D2DBedside POCUS was performed on the patient’s abdomen using the curvilinear probe. The left upper quadrant POCUS image demonstrates multiple hyperechoic spherical objects with shadowing and reverberation artifacts concerning multiple foreign body ingestions. Though the patient and mother initially denied knowledge of foreign body ingestion, on repeated questioning after POCUS findings, the patient admitted to his mother that he ate the spherical magnets he received for his birthday about one week ago. The patient swallowed these over the course of two days. The presence of multiple radiopaque foreign bodies was confirmed with an abdominal X-ray.
Sonographic Retrobulbar Spot Sign in Diagnosis of Central Retinal Artery Occlusion: A Case Report
DOI: https://doi.org/10.21980/J8735PThe bedside ocular ultrasound (B-scan) was significant for small, hyperechoic signal (white arrow) in the distal aspect of the optic nerve, concerning for embolus in the central retinal artery. Subsequent direct fundoscopic exam was significant for a pale macula with cherry red spot (black arrow), consistent with central retinal artery occlusion (CRAO).
Trauma by Couch: A Case Report of a Massive Traumatic Retroperitoneal Hematoma
DOI: https://doi.org/10.21980/J84D2QUpon arrival at the trauma center, a FAST revealed a large, well-circumscribed abnormality (red outline) deep to the liver (blue outline and star) and gallbladder (green outline and star). The right kidney and hepatorenal space were not clearly visualized. The remainder of the FAST showed no free fluid in the splenorenal space, pelvis, and no pericardial effusion. He had lung sliding bilaterally.