Visual EM

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Asymptomatic CT Iodinated Contrast Extravasation of the Upper Extremity

Eric Liao, MD* and John Costumbrado, MD, MPH*

DOI: https://doi.org/10.21980/J8VK87 Issue 4:3[mrp_rating_result]
The two radiographs demonstrate extravasation of radiopaque iodinated contrast in the lower left upper extremity with most seen in the left antecubital fossa and left proximal forearm. Extravasation is seen in the subcutaneous and subfascial tissue.
Visual EMOrthopedics
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Oral Herpes Zoster

Daniel Polvino, MD*, Grant Wei, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J8QS69Issue 4:3[mrp_rating_result]
Physical exam findings revealed vesicular lesions on the lip, hard and soft palates which did not cross the midline. The lesions appeared in the distribution of the maxillary branch (V2) of the trigeminal nerve, consistent with herpes zoster.
DermatologyInfectious DiseaseVisual EM
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Ruptured AAA Presenting with Unresponsiveness and Cardiac Arrest

Lana S Shaker, MD*, Michael W Ullo, MD* and Aislinn Black, DO, MPH*

DOI: https://doi.org/10.21980/J8M34QIssue 4:3[mrp_rating_result]
Axial CT images from the CT chest, abdomen and pelvis revealed a large infra-renal abdominal aortic aneurysm measuring 7.3 x 8.2 x 10 cm with extensive mural thrombus (single white arrow) that has ruptured, with active extravasation (black arrow) of contrast into the aneurysm sac and retroperitoneum with large right retroperitoneal hematoma (multiple white arrows).
Cardiology/VascularVisual EM
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Spontaneous Intracranial Hemorrhage in Severe Hemophilia A: A Rare Cause of Seizure in a Young Child

Sharon Kook Won, MD* and Andrea T Cruz, MD, MPH*

DOI: https://doi.org/10.21980/J8G91D Issue 4:3[mrp_rating_result]
A computed tomography (CT) scan of the head without contrast was obtained out of concern for intracranial pathology due to the patient’s young age and the witnessed focal seizure.  The CT showed a 4.2 x 1.2 x 1.5 cm acute extra-axial intracranial right frontoparietal hemorrhage favoring epidural over subdural hemorrhage given its lenticular shape. There was no underlying fracture, herniation or midline shift identified.
Hematology/OncologyNeurologyVisual EM
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Open Fracture of the Patella

Zara Khan, BS*, Devan Pandya, MD^ and John Costumbrado, MD, MPH^

DOI: https://doi.org/10.21980/J8BK9Z Issue 4:3[mrp_rating_result]
X-ray of the right knee showed evidence of an acute comminuted fracture of the patella (red arrows) with a suprapatellar joint effusion with gas (blue arrow). There was no evidence of joint dislocation or other osseous lesions.
OrthopedicsVisual EM
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Point-of-Care Ultrasound to Evaluate Intrahepatic Biliary Stent Function

Michael Louthan, BS* and Shadi Lahham, MD, MS*

DOI: https://doi.org/10.21980/J86S6N Issue 4:3[mrp_rating_result]
The ultrasound image demonstrates severe intrahepatic biliary ductal dilatation without an obvious intrahepatic obstructive lesion, as pointed out by the white arrows. The hepatic vasculature is well-distinguished from the biliary tree via color flow doppler, as seen by the white arrowheads.
Abdominal/GastroenterologyUltrasoundVisual EM
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Gastric Volvulus

Julian Jakubowski, DO*, Jared Lizzi, DO* and Tyler Hill, DO*

DOI: https://doi.org/10.21980/J8335F Issue 4:3[mrp_rating_result]
Point of care ultrasound of his abdomen showed a large fluid filled structure with well-defined borders containing gastric contents extending from the xiphoid process to the umbilical region. No free fluid was noted on focus assessment with sonography for trauma (FAST) examination. A computed tomography (CT) scan was performed emergently and it was noted that the patient had a significantly distended stomach and gastric volvulus (blue arrows) noted in the area of his paraesophageal/hiatal hernia.
Abdominal/GastroenterologyVisual EM
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Diagnosis and Treatment of an Anterior Shoulder Dislocation with Bedside Ultrasound

Mary Rometti, MD*, Michael Rohinton Mirza, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J8Z924Issue 4:3[mrp_rating_result]
Bedside ultrasound with the transducer placed on the posterior right shoulder revealed an anterior dislocation of the right humerus. This is evident by displacement of the humeral head further away from the posteriorly placed ultrasound transducer, and appears deep to the glenoid cavity.  In a posterior shoulder dislocation, the humeral head would appear closer to the transducer (and the near field of the ultrasound image) than the glenoid. Note that a hypoechoic, heterogeneous fluid collection is within the joint space, compatible with a hematoma. A right shoulder X-ray confirmed the anterior dislocation with no evidence of fracture.  Under direct ultrasound guidance the glenohumeral joint space was injected with 10 mL of 2% lidocaine as an intraarticular anesthetic block. The right shoulder was reduced using continual traction.  Post-reduction ultrasound demonstrated a successful shoulder reduction, depicted by the humeral head being relocated to its anatomical location, adjacent to the glenoid cavity, as noted on the ultrasound image.  A hematoma remains present within the joint space. Successful shoulder reduction was further confirmed by X-ray. The patient’s arm was placed in a sling and she was discharged home with orthopedics follow-up.
OrthopedicsVisual EM