Visual EM

Mushroom for Improvement Case Report: The Importance of Involving Mycologists

Gary Bhagat, MD*, Marit Tweet, MD^ and Steven Aks, MD^†

DOI: https://doi.org/10.21980/J8ZW7W Issue 7:4 No ratings yet.
The mushroom displayed here is large and lacks any gills. Small puffball mushrooms can resemble young immature button top Amanita type mushrooms. Opening the Amanita mushroom should reveal apparent gills and quickly differentiate the two- -the puffball mushroom should have a white interior without gills.
Abdominal/GastroenterologyCurrent IssueToxicologyVisual EM

A Case Report of a Man with Burning Arm and Leg Weakness

Carolina Ornelas-Dorian, MD* and Paul Jhun, MD*

DOI: https://doi.org/10.21980/J8V659 Issue 7:4 No ratings yet.
A non-contrast computed tomography (CT) of the head and neck was performed, followed by an MRI of the cervical spine. The CT demonstrated congenital narrowing of the cervical spinal canal, with posterior disc osteophyte complex and disc bulge at C3-4 and C4-5 (arrow). The T2-weighted MRI additionally demonstrated obliteration of the anterior and posterior subarachnoid space at the level of C3-C5, with associated patchy central cord signal abnormality (arrow).
Current IssueNeurologyVisual EM

Thigh Mass Case Report

Mary Rometti, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J8QD3C Issue 7:4 No ratings yet.
Point-of-care ultrasound (POCUS) demonstrates a large, subcutaneous mass with areas of mixed echogenicity. The mass contains fluid-filled, anechoic areas with internal septations and absent doppler flow. The majority of the mass appears isoechoic to the surrounding tissues with a hyperechoic border. Computed tomography (CT) of his right thigh shows a 16 x 8.1 x 9.5 cm heterogenous, complex mass within his hamstring muscles, inferior to the femur. His lab work was significant for a white blood cell (WBC) of 17.3 (103/µL).
Current IssueHematology/OncologyVisual EM

Inferior STEMI Electrocardiogram in a Young Postpartum Female with Sickle Cell Trait with Chest Pain – A Case Report

Jessica Truong*^, Ryan Perdomo, MD^, Daniel Ng, MD*^, Sassan Ghassemzadeh, MD*^ and John Costumbrado, MD, MPH*^

DOI: https://doi.org/10.21980/J8KP95 Issue 7:4 No ratings yet.
ECG shows evidence of ST segment elevation in the inferolateral leads with reciprocal change in a bigeminy pattern. The ECG pattern seen in this patient demonstrates ST elevations in the inferior leads (II, III, and avF) as well as the precordial leads V4-V6. Reciprocal changes can also be seen in leads I and avL. Though this STEMI pattern is typically associated with occlusion of the right coronary artery in 80% of cases, it may also be caused by occlusion of the left circumflex artery. This may explain this patient’s cardiac catheterization findings of vasospasm in the left circumflex coronary artery.
Cardiology/VascularCurrent IssueVisual EM

Transverse Myelitis in Naloxone Reversible Acute Respiratory Failure—A Case Report

Chance Dodson, MD* and Joshua Gentges, MD*

DOI: https://doi.org/10.21980/J8B659 Issue 7:4 No ratings yet.
Magnetic resonance imaging of the brain, cervical, thoracic and lumbar spine without contrast was obtained and revealed increased signal throughout the spinal cord from C-1 to the conus medullaris with mild expansion consistent with transverse myelitis.
Current IssueNeurologyVisual EM

‘Cath’ It Before It’s Too Late: A Case Report of ECG Abnormalities Indicative of Acute Pathology Requiring Immediate Catheterization

Diane Wei, BS*, Paul Truong, DO*^ and Patrick Bruss, MD*^

DOI: https://doi.org/10.21980/J8HW7V Issue 7:3 No ratings yet.
A 12 lead ECG performed at the time of emergency department (ED) admission revealed regular sinus rhythm with noted T-wave inversion (blue arrows on Figure 1) in Lead aVL new when compared to an ECG performed a few months prior (see Figure 3). Two days later a second ECG was done when the patient developed acute chest pain while in the ICU (Figure 2) that showed persistent inversion in Lead aVL (blue arrows) as well as new J point deviation (JPD) in Leads II, aVF, V5 and V6; and new JPD in Leads V1 and V2 (green arrows) from her previous ECG while in the emergency department. These focal repolarization abnormalities did not qualify as an ST-elevation myocardial infarction by current guidelines.
Cardiology/VascularVisual EM

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.
OrthopedicsVisual EM

Evaluation of ACE-inhibitor Induced Laryngeal Edema Using Fiberoptic Scope: A Case Report

Joya Singh, DO* and Colin Danko, MD *

DOI: https://doi.org/10.21980/J83P9T Issue 7:3 No ratings yet.
Physical exam was initially significant for swelling isolated to the right sided cheek and upper lip. There was no edema to lower lip, uvular swelling, or swelling to the submandibular space. She was speaking full sentences and did not endorse any voice changes. Initial vital signs were as follows: BP 125/77, HR 74, RR 16, and oxygen saturation of 100% on room air. Approximately 40 minutes later, after 125 mg solumedrol intravenous (IV) and 50mg diphenhydramine by mouth, swelling had spread to the entire upper lip and the patient reported spreading to her jaw (Photo 1). Although no jaw or submandibular edema was appreciated on physical exam, a flexible fiberoptic laryngoscope was used to evaluate the patient’s airways given worsening symptoms. Viscous lidocaine was applied intranasally five minutes prior to the procedure. The patient was positioned in a seated position on the stretcher. A flexible fiberoptic laryngoscope was then inserted through the nares and advanced slowly. Laryngoscopy showed diffuse edema of the epiglottis, arytenoids, and ventricular folds (see photos 2-4). Vital signs and respiratory status remained stable both during and after the procedure.
ENTProceduresVisual EM

A Case Report of May-Thurner Syndrome Identified on Abdominal Ultrasound

Michelle Brown, DO*, Edmund Hsu, MD*, Christopher McCoy, MD* and Matthew Whited, MD*

DOI: https://doi.org/10.21980/J8C64K Issue 7:3 No ratings yet.
The patient initially received a venous doppler ultrasound that showed no evidence of a right or left femoropopliteal venous thrombus. Due to the high suspicion of a DVT given the symmetric swelling to the entire limb and acute onset of pain, a CTV was ordered. The transverse view of the CTV showed chronic thrombotic occlusion of the proximal left common iliac vein associated with compression from the right common iliac artery (figure 1, transverse image of CTA), as well as thrombotic occlusion of the left internal iliac vein tributary and corresponding left ascending lumbar vein. Given the previously mentioned clinical context, these features suggested the diagnosis of May-Thurner syndrome.
Cardiology/VascularVisual 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).
OphthalmologyUltrasoundVisual EM