Visual EM

A Case Report of Glycogenic Hepatopathy

Dane Brown, MD* and Theresa Mead, DO, RDMS*

DOI: https://doi.org/10.21980/J8SQ0Z Issue 6:3 No ratings yet.
The ultrasound images reveal hepatomegaly and an increased echogenicity of the liver parenchyma that is diffuse. The increased echogenicity can be best appreciated by a comparison to surrounding structures. It is important to note that the increased echogenicity is non-focal and consistent throughout the entire liver in multiple views. These findings can be consistent with nonalcoholic steatohepatitis as well as glycogenic hepatopathy.
Current IssueEndocrineVisual EM

A Case Report of a Large Goiter Resulting in Tracheal Deviation

Thomas Powell, MD* and Geremiha Emerson, MD*

DOI: https://doi.org/10.21980/J80645 Issue 6:3 No ratings yet.
In the image, one can see significant tracheal deviation around the right side of the mass (black arrows). This degree of deviation would make ventilation in a paralyzed patient extremely difficult, if not impossible.
Current IssueEndocrineVisual EM

Case Report—Pediatric Brugada Phenotype from Accident Cocaine Ingestion

Patrick Bruss, MD*, Sarah Norris, DO*, Kaylene Pagan, MD*, Richard Cousino, DO*, Allison Grim*, and Gregory Reinhold, DO*

DOI: https://doi.org/10.21980/J8VH28 Issue 6:3 No ratings yet.
Initial EKG was concerning for type I Brugada pattern with an incomplete right bundle branch block in V1 & ST segment elevation terminating in an inverted T wave in V2. There are also signs of sodium channel toxicity with a widened QRS complex, tachycardia and a terminal R wave present in aVR where the R wave is bigger than the S wave or the R wave is over 3mm in aVR.
Cardiology/VascularCurrent IssueVisual EM

A Case Report of Neonatal Vomiting due to Adrenal Hemorrhage, Abscess and Pseudohypoaldosteronism

Raymen Rammy Assaf, MD, MPH* and Mary Jane Piroutek, MD^

DOI: https://doi.org/10.21980/J8QQ0B Issue 6:3 No ratings yet.
An ultrasound (US) of the abdomen was obtained to evaluate for possible pyloric stenosis (see US transverse/dopper imaging). While imaging showed a normal pyloric channel, it revealed an unexpected finding: a complex cystic mass arising from the right adrenal gland (yellow outline), measuring 5.8 by 4.0 by 6.4 cm with calcifications peripherally and mass effect on the kidney without evidence of vascular flow (blue arrow). Computed tomography (CT) of the abdomen/pelvis with IV contrast was subsequently obtained and measured the lesion as 2.8 by 4.6 by 4 cm without evidence of additional masses, lymphadenopathy or left adrenal gland abnormality (see CT axial, coronal, and sagittal imaging).
Current IssueEndocrineVisual EM

Case Report of Unusual Facial Swelling in an 8-Month-Old

Amanda E Mulcrone, MD*, Zobiya Z Momin, MD^ and Corrie E Chumpitazi, MD, MS*

DOI: https://doi.org/10.21980/J8M06F Issue 6:3 No ratings yet.
Facial ultrasound revealed local inflammatory changes such as increased echogenicity and heterogeneity in the soft tissues of the right cheek, suggestive of soft tissue edema. There was evidence of a prominent right parotid gland with increased heterogeneity suggestive of a traumatic injury. Additionally, facial ultrasound demonstrated a 6mm ill-defined anechoic collection within the right cheek without increased doppler flow (green arrow), thought to represent a focal area of edema instead of an abscess.
Current IssuePediatricsRenal/ElectrolytesVisual EM

Case Report: Altered with PRES

Fatima Dema, MD* and David C Feldman, MD*

DOI: https://doi.org/10.21980/J8NW73 Issue 6:2 No ratings yet.
On vitals, the patient was found to be consistently hypertensive to the 230s/160s. Point-of-care glucose was within normal limits. Noncontrast CT imaging of the head revealed no acute intracranial hemorrhage or evidence of ischemic stroke, but was remarkable for areas of biparietal subcortical low-attenuation (white arrows), concerning for PRES. Patient subsequently underwent CT angiogram imaging of the head with perfusion which revealed no large vessel occlusion.
Current IssueNeurologyVisual EM

A Case Report of Cardiac Tamponade

Derek JC Hunt, DO*, Kevin McLendon, DO* and Matthew Wiggins, MD*

DOI: https://doi.org/10.21980/J8J644 Issue 6:2 No ratings yet.
The patient was in noticeable respiratory distress and had oxygen saturation of 94% on room air. Bilateral jugular venous distention with severe right supraclavicular lymphadenopathy and diffuse bilateral wheezing was present. Although muffled heart sounds and hypotension are part of Beck’s Triad, these were not present in this case. Electrocardiogram obtained on arrival showed a sinus tachycardia with low-voltage QRS complexes and electrical alternans. Low voltage QRS can be seen on the ECG provided and is demonstrated by the low amplitude of the QRS complexes seen on all the leads. Electrical alternans may have an alternating axis or amplitudes of the QRS complex. Alternating axis is best visualized in V4-V6 on this ECG while alternating amplitudes are seen throughout the rest of the ECG. Computed tomography angiogram (CTA) of the chest revealed a large pericardial effusion with bilateral pulmonary emboli and a right upper lobe mass. A bedside transthoracic echocardiogram (TTE) was then performed and confirmed the large effusion, but also showed right ventricular collapse during diastole, indicative of cardiac tamponade.
Cardiology/VascularCurrent IssueVisual EM

A Different Type of Tension Headache: A Case Report of Traumatic Tension Pneumocephalus

Travis P Sharkey-Toppen, MD, PhD*, Dominique I Dabija, MD, MS* and Christopher San Miguel, MD*

DOI: https://doi.org/10.21980/J8DH0G Issue 6:2 No ratings yet.
CT head without contrast demonstrated a minimally displaced fracture of the frontal sinuses at the midline underlying his known laceration that involved the anterior and posterior tables of the calvarium. This is seen on the sagittal view and indicated by the blue arrow. There was a small volume of underlying subarachnoid hemorrhage along the falx. There was also extensive pneumocephalus most pronounced along the bilateral anterior frontal convexity associated with the frontal sinus fracture, seen on the axial image and indicated by the red arrow. This pattern of air is commonly referred to as the “Mount Fuji” sign.6 Other intracranial air can also be seen on the sagittal image and is indicated by the white arrow.
Current IssueNeurologyTraumaVisual EM

Jefferson Fracture and the Classification System for Atlas Fractures, A Case Report

Miguel Angel Martinez-Romo, MD* and Christopher Eric McCoy, MD, MPH*

DOI: https://doi.org/10.21980/J88P9C Issue 6:2 No ratings yet.
Computed tomography (CT) revealed a burst fracture (Jefferson) of the anterior arch (white arrows) and of the posterior arch (yellow arrows) of the first cervical vertebrae (C1). There was also a fracture of the right lateral mass (blue arrow) of C1 with mild lateral subluxation of the lateral masses (curved arrows).
Current IssueOrthopedicsTraumaVisual EM

Using Point-of-Care Ultrasound to Expedite Diagnosis of Necrotizing Fasciitis: A Case Report

Romero Kupai, MD*, Ashkan Morim, MD*, Lucas Friedman, MD*^ and Eva Tovar Hirashima, MD, MPH*^

DOI: https://doi.org/10.21980/J85051 Issue 6:2 No ratings yet.
A consultative scrotal ultrasound was performed, which was read as showing a small right hydrocele, small bilateral scrotal pearls, and normal-appearing testes. Although present, there was no mention of subcutaneous air suggestive of NF, seen in figure 1 as punctate hyperechoic foci (arrowhead) with ring-down artifact known as dirty shadowing (arrow). Also, subcutaneous thickening (asterisk) and free fluid (arrow) were seen as shown in figure 2, although their clinical relevance was not recognized in the radiologist's final report. Figure 3 shows an abdominal and pelvic CT that re-demonstrates subcutaneous air in the scrotum and lower abdomen (arrow) as well as fascial thickening of the perineum and free intra-abdominal air. After these images, the patient was transferred to our hospital for further management. Almost immediately after the patient's arrival, POCUS was employed. As seen in figures 4, we were able to identify in just a few minutes extensive subcutaneous air accompanied by dirty shadowing, as well as re-demonstration of subcutaneous thickening, fluid collections, and a right hydrocele. Even without the outside hospital's CT, the sonographic findings were highly suggestive for the diagnosis of NF of the perineum, also known as Fournier’s gangrene.
Current IssueInfectious DiseaseVisual EM