Visual EM

Vitreous Hemorrhage Case Report

Mary Rometti, MD^*, Laryssa Patti, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J88D3B Issue 7:3 No ratings yet.

Point of care ultrasound (POCUS) revealed hyperechoic material in the vitreous consistent with a vitreous hemorrhage. On the ultrasound images, there is visible hyperechoic debris seen floating in the vitreous as the patient moves his eye. Since the vitreous is typically anechoic (black) in color on ultrasound, turning up the gain on the ultrasound machine makes these findings easier to see and often highlights abnormalities, such as this hemorrhage (see annotated still).

High-Pressure Injection Injury to the Hand – A Case Report

Cesar Fortuna, MD^{*^}, Derek Prince, MD^†, Daniel Ng, MD^{^†} and John Costumbrado, MD, MPH^{^†}

DOI: https://doi.org/10.21980/J8D64W Issue 7:3 No ratings yet.

Plain radiographs of the left hand and forearm demonstrated extensive subcutaneous emphysema. The air can be seen as lucent striations tracking along the second and third fingers as well as along the dorsum of the hand and wrist. There is also diffuse soft tissue emphysema surrounding the metacarpophalangeal joints. Lab analysis did not show any significant acute abnormalities.

Orthopedics Visual EM

Point-of-Care Ultrasound to Diagnose Molar Pregnancy: A Case Report

Katherine Wietecha, MD^*, Caitlin A Williams, MS^{^}and Valori Slane, MD^*

DOI: https://doi.org/10.21980/J82W7T Issue 7:2 No ratings yet.

A transabdominal point-of-care ultrasound (POCUS) was initiated to determine whether an abnormality to the pregnancy could be identified. Curvilinear probe was used. Our transabdominal POCUS, in the transverse plane, showed a heterogenous mass with multiple anechoic areas in the uterus. The white arrow on the ultrasound identifies these findings. The classic “snowstorm” appearance was concerning for molar pregnancy.

Ob/Gyn Visual EM

A Case Report of Fournier’s Gangrene

Huy Alex Duong, BS^*, Mark Slader, BS^*, Jana Florian, MD^* and Jonathan Smart, MD^*

DOI: https://doi.org/10.21980/J8Z356 Issue 7:2 No ratings yet.

Physical exam revealed a comfortable-appearing male patient with tachycardia and a regular cardiac rhythm. The genitourinary exam indicated significant erythema and fluctuance of the bilateral lower buttocks with extension to the perineum. Black eschar and ecchymosis were also noted at the perineum. There was significant tenderness to palpation that extended beyond the borders of erythema. There was no palpable crepitus on initial examination. Physical exam was otherwise unremarkable.

Infectious Disease Urology Visual EM

A Case Report of the Rapid Evaluation of a High-Pressure Injection Injury of a Finger Leading to Positive Outcomes

Nathaniel Hansen, MD^*and Colin Danko, MD^*

DOI: https://doi.org/10.21980/J8TD2X Issue 7:2 No ratings yet.

On exam the patient was noted to have a punctate wound to the ulnar aspect of his right index finger, just proximal to the distal interphalangeal joint. The finger appeared pale and taut, with absent capillary refill. The patient displayed diminished range of motion with both extension and flexion of the joints of the finger. Sensation was absent and no doppler flow was appreciated to the distal aspects of the finger. X-ray of the hand was obtained and showed many small foreign bodies in the soft tissue and extensive radiolucent material consistent with gas or oil-based material to the palmar aspect of the index finger tracking up to the level of the metacarpal heads.

Orthopedics Visual EM

Unravelling the Mystery of a Continuous Coil: A Case Report

Ryan Brown, MD^*, Sharon Kim, PhD^{^}and Robert Tennill, MD^*

DOI: https://doi.org/10.21980/J8PM00 Issue 7:2 No ratings yet.

A CT scan of the abdomen and pelvis with intravenous contrast for evaluation of new onset abdominal pain and distension was obtained in the emergency department. The axial view (CT Image A) shows the coil pack from the prior coil-assisted retrograde transvenous obliteration procedure, seen in the left renal vein and gastric varix (red arrow). The path of the coil (yellow arrow) is continuous into the inferior vena cava (CT Image B). It is then seen (CT Image C) situated in the right ventricle (green arrow). Finally, the coil pack is seen in a coronal section, demonstrating its upward path (blue arrow) in the inferior vena cava. (CT Image D). Additional findings included ascites with advanced cirrhosis. As noted in the CT images, a vascular embolization coil was seen within a varix near the junction of the left renal vein. This appeared to have unraveled and extended superiorly into the inferior vena cava and ultimately into the right atrium and right ventricle.

Cardiology/Vascular Visual EM

Clinical and Radiologic Features of Fulminant Pediatric Autoimmune Encephalitis: A Case Report

Raymen Rammy Assaf, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8JW75 Issue 7:2 No ratings yet.

The neurology service was consulted in the ED and multisequence MRI and MR angiography (MRA) of the brain were obtained without and with IV contrast. Diffusion-weighted imaging (DWI) and T2-weighted-Fluid-Attentuated Inversion Recovery (FLAIR) sequences showed multifocal small areas of diffusion signal abnormality in the brainstem and basal ganglia (red asterisks) suggestive of ischemia. Additional multifocal bilateral supra- and infratentorial foci of signal abnormality including subcortical white matter and deep grey matter were highly concerning for encephalitis or demyelinating disease. MRI was repeated on day 3 and day 7 during evolution of disease.

Pediatrics Infectious Disease Visual EM

Case Report of a Pelvic Kidney with Ureteral Obstruction from Inguinal Hernia Entrapment and Concurrent Cryptorchid Testis

Nathan Feil, BS^*, Daniel Kwan, BA^*, Cameron Fateri, BS^*, Lindsey Spiegelman, MD^{^} and Roozbeh Houshyar, MD^*

DOI: https://doi.org/10.21980/J8F345 Issue 7:2 No ratings yet.

The patient was afebrile with normal lactate and white blood cell count. Initial CT imaging showed an ectopic right pelvic kidney with entrapment of his right ureter within an indirect right inguinal hernia causing severe hydronephrosis (coronal: white arrow). Also discovered was an ovoid hypodensity in the right anterior pelvis consistent with right undescended testis (axial: orange arrow; coronal: green arrow) that was previously unknown to the patient, with a normal left scrotal testis (axial: red arrowhead; coronal: blue arrowhead). Other potential etiologies of the patient’s symptoms could include appendicitis or incarcerated inguinal hernia, though the imaging results and absence of systemic inflammatory response syndrome made these causes less likely.

Renal/Electrolytes Visual EM

Initial Management and Recognition of Aortoiliac Occlusive Disease, A Case Report

Ashley Hope, BA^*, Alisa Wray, MD, MAEd^* and Graham Stephenson, MD^*

DOI: https://doi.org/10.21980/J87M0Z Issue 7:1 No ratings yet.

Computerized tomography with angiography (CTA) of the entire aorta demonstrated an occluded distal infrarenal aorta with extension into the bilateral common femoral arteries (red outline), lack of flow through femoral arteries (yellow outline) and trickle flow reconstituted distally consistent with aortoiliac occlusive disease (blue outline). Some small segments of the proximal celiac axis showed signs of occlusion (purple outline). A short segment of non-specific bowel wall thickening, which may have been related to ischemic changes, was also seen (not seen on images). The included coronal slice shows the extent of the bilateral occlusive burden, with three-dimensional reconstruction emphasizing the same findings.

Cardiology/Vascular Visual EM

Case Report: It’s a Small Whirl Afterall

Lisa M Schwartz, MD^*, Ryan M Perdomo, MD^* and Jason An, MD^*

DOI: https://doi.org/10.21980/J83S8G Issue 7:1 No ratings yet.

The CT imaging of the abdomen and pelvis demonstrated multiple loops of dilated small bowel with a whirl sign (red arrow) within the mid abdomen and a transition point (green arrow), suspicious for closed loop bowel obstruction and internal hernia.

Abdominal/Gastroenterology Visual EM