Visual EM
A Case Report of an Unstable C-spine Fracture in the Emergency Department
DOI: https://doi.org/10.21980/J8SK90The initial workup in the ED showed an acute displaced fracture of the left occipital condyle (CT-coronal, fracture of the left occipital condyle, red arrow; displacement, orange line), a shattered left lateral mass with involvement of the vertebral canal (CT-axial, red arrow), and malalignment of the craniocervical junction (CT-sagittal, red outline). The CT angiogram head and neck showed a possible irregularity in the left vertebral artery. The CT head without contrast had no significant findings.
Eye-Opener: A Case Report of Eyelid Taping as Presenting Symptom of Myasthenia Gravis
DOI: https://doi.org/10.21980/J8NW8GPhysical exam was significant for a very pleasant, well-appearing female in no acute distress, noted to have clear plastic tape attached to her bilateral eyelids and brows (Image 1). When the tape was removed, she had bilateral ptosis, more significantly in the left eye (Image 2). She had no conjunctival injection or pallor. Her airway was patent and protected. She had no neck masses or carotid bruits. Her heart and lung exams were normal, with no evident respiratory distress. Her neurologic exam was further significant for limited extra-ocular movement (EOM). Her most notable deficits were with lateral and upward gaze (Video 1) indicative of weakness at the muscles innervated by cranial nerves III and VI. Her pupillary response was symmetric and brisk bilaterally. She had no additional cranial nerve deficits, slurred speech, or asymmetry in her strength or sensation throughout.
A Case Report of Inferior Rectus Abscess
DOI: https://doi.org/10.21980/J8J35GNon-contrast computed tomography (CT) imaging of the head in coronal, sagittal, and axial planes revealed a distinct 1.7 x 2.2 x 1.4 cm peripherally enhancing fluid collection within the left inferior orbit, involving the inferior rectus (yellow circle). This lesion resulted in restricted extraocular motility due to structural compression of the left globe. Laboratory results showed a mildly elevated white blood cell count of 11.5/mm3 and otherwise normal results including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
A Case Report of Hydropic Gallbladder Presenting as Right Lower Quadrant Abdominal Pain
DOI: https://doi.org/10.21980/J8DD26Computed tomography (CT) of the abdomen and pelvis with contrast was ordered, and general surgery was consulted for the initial working diagnosis of acute appendicitis. However, the CT scan resulted with findings of a markedly distended gallbladder measuring approximately 14.5 x 4 centimeters (cm) with marked gallbladder wall thickening (magenta) and pericholecystic fat stranding (cyan). The appendix was not dilated and had no inflammatory changes or edema. Follow-up right upper quadrant ultrasound confirmed the diagnosis of acute cholecystitis.
A Case Report of Right Atrial Thrombosis Complicated by Multiple Pulmonary Emboli: POCUS For the Win!
DOI: https://doi.org/10.21980/J8TM07Pulmonary POCUS was performed by the ED physician (GE Venue, C1-5-RS 5MHz curvilinear transducer), and lung examination was unremarkable with no pleural effusion, pneumothorax, or infiltrate. Subxiphoid views (GE Venue, 3Sc-RS 4MHz phased-array transducer) were obtained because this patient’s COPD with severe pulmonary hyperexpansion made parasternal and apical 4-chamber views suboptimal. A large thrombus can be seen within the right atrium (movie 1, images 1, 2). This has a serpiginous, rounded appearance and is mobile, appearing to swirl within the right atrium with intermittent extrusion through the tricuspid valve. A pacemaker wire is also visible within the right ventricle as a non-moving, hyperechoic, linear structure with posterior enhancement artifact. Pericardial effusion is not present.
Retropharyngeal Abscess in an Adult Patient Presenting with Neck Fullness and Dysphagia: A Case Report
DOI: https://doi.org/10.21980/J8M36GContrast-enhanced CT soft tissue of the neck showed evidence of a prevertebral/retropharyngeal fluid collection, extending from the odontoid tip to the inferior C4 vertebral body margin, measuring 5.4 x 1.0 x 3.3 centimeters (cm) in size (yellow lines) without gross airway narrowing.
The Advantage of Using Video Laryngoscope in Puncture and Incisional Drainage of Peritonsillar Abscess: A Case Report
DOI: https://doi.org/10.21980/J8G935Incision of the peritonsillar abscess was performed with the assistance of the C-MAC video laryngoscope which provided a clear, illuminated, and unobstructed view of the incision site. Local anesthesia with 1% xylocaine was administered, and the abscess was incised with a scalpel and drained with a forceps.
A Case Report on an Elusive Incident of Erythema Multiforme
DOI: https://doi.org/10.21980/J8BM0WHer physical exam was notable for multiple scattered tense vesicles on an erythematous base along the left and right lower extremities and right upper extremity. The lesions were excoriated and in different stages of evolution. No oral, mucosal, or conjunctival lesions were found. Physical exam was otherwise unremarkable.
A Case Report on Dermatomyositis in a Female Patient with Facial Rash and Swelling
DOI: https://doi.org/10.21980/J8506DThe physical exam revealed significant periorbital swelling, facial edema, and a maculopapular rash across the upper chest, symmetrically across the extensor surfaces of the hands and the bilateral arms and thighs. The photograph of her face shows light-red to violaceous macules and patches, with inclusion of the nasolabial folds as well the forehead and upper eyelids with periorbital edema (heliotrope sign). The other rash images show “Shawl sign” (photograph of back showing erythema over the posterior aspect of the upper back), V sign (photograph of chest showing light-red violaceous plaque on mid-chest), Gottron's papules (photograph of hands showing light red scaly papules overlying the right proximal interphalangeal joint [R PIP] and the metacarpophalangeal joint [MCP], and holster sign (photograph of thigh showing light red patches on bilateral lateral thighs). This distribution of rashes is pathognomonic for DM.
Computed Tomography Findings in Non-Obstetric Vulvar Hematoma: A Case Report
DOI: https://doi.org/10.21980/J8194HBedside ultrasound was first used to evaluate for evidence of abscess or cyst formation. Ultrasound demonstrated a hypoechoic area within the right labia without evidence of a cyst or abscess wall. Based on these findings, an angiogram CT of the pelvis was obtained which revealed a vulvar hematoma with evidence of active arterial extravasation. In both the coronal and axial view, there is an asymmetric area of isodensity in the right labia representing a hematoma (blue circled area). Angiography may show areas of active extravasation, which appears as hyperdensity within the area of hematoma (see red arrow in coronal plane).