Visual EM

Morel-Lavallée Lesion

Grant G Simpson* and Brandon R Allen, MD^*

DOI: https://doi.org/10.21980/J88G65Issue 1:2[mrp_rating_result]

On physical examination, the patient was noted to have a nearly “watermelon-sized” fluctuant mass to his right lateral superior quadriceps with multiple overlying abrasions (Image 1). Computed tomography (CT) scans of the area showed a large heterogeneous collection measuring roughly 37x9.5x16 centimeters in the subcutaneous adipose layer of the lateral right thigh (Image 2), while ultrasonography revealed a complex fluid collection containing some nodular solid components and debris (Image 3). Additionally, radiographs confirmed multiple fractures including most significantly a pelvic ring fracture. Surgical debridement, evacuation, and sclerodhesis were performed nine weeks post injury to allow overlying abrasions to heal prior to intervention.

Orthopedics Visual EM

Atrial Myxoma

Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J87P45Issue 1:1[mrp_rating_result]

Bedside ultrasound revealed the presence of a left atrial mass that appeared to be tethered to the mitral valve. The mass was best viewed on ultrasound in the apical four-chamber window with the phased array probe placed over the patients’ point of maximal impact (PMI), with the patient in left lateral decubitus position.

Ultrasound Cardiology/Vascular Visual EM

Hampton’s Hump in Pulmonary Embolism

Jonathan Patane, MD^* and Megan Boysen Osborn^*

DOI: https://doi.org/10.21980/J83W27Issue 1:1[mrp_rating_result]

In the lateral view chest x-ray, there is a Hampton’s Hump, a pleural based, wedge-shaped opacity at the base of the right lung, representing lung infarction (black arrow). These findings correlate with the sagittal view on CT angiography of the chest. The CT chest also shows a filling defect in the distal posterior basal segmental pulmonary artery (white arrow), as demonstrated by the absence of contrast enhancement in the distal portion of the vessel. This is associated with an opacification of the lung parenchyma distal to the occlusion (red arrow), representing lung infarction.

Respiratory Visual EM

Acute Pericarditis: Electrocardiogram

Jason Mefford, MD^* and Shannon L Toohey, MD^*

DOI: https://doi.org/10.21980/J8059QIssue 1:1[mrp_rating_result]

The ECG shows diffuse ST- elevation. The patient also has mild PR-depression, most notably in the inferior and lateral leads. The patient also has minimal PR elevation in lead aVR. The patient was diagnosed with acute pericarditis (ECG stage 1).

Cardiology/Vascular Visual EM

Thompson Test in Achilles Tendon Rupture

Spencer Albertson^* and Megan Boysen Osborn, MD, MHPE^*

DOI: https://doi.org/10.21980/J8VC7SIssue 1:1[mrp_rating_result]

The left Achilles tendon had a defect on palpation, while the right Achilles tendon was intact. When squeezing the right (unaffected) calf, the ankle spontaneously plantar flexed, indicating a negative (normal) Thompson test. Upon squeeze of the left (affected) calf, the ankle did not plantar flex, signifying a positive (abnormal) Thompson test. The diagnosis of left Achilles tendon rupture was confirmed intraoperatively one week later.

Orthopedics Trauma Visual EM