Visual EM

Pediatric Esophageal Foreign Body

Samer Assaf, MD^* and Ryan Gibney, BS^*

DOI: https://doi.org/10.21980/J8GD1F Issue 2:4 No ratings yet.

A radiopaque foreign body was visualized in the proximal esophagus at the thoracic inlet on the chest and neck radiographs. The foreign body appeared to be metallic with visualized concentric rings consistent with a coin.

Acetabular Fracture

Chad Correa^* and Sari Lahham, MD^{^}

DOI: https://doi.org/10.21980/J8BK8K Issue 2:4 No ratings yet.

The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows), with associated obturator muscle hematoma (blue oval).

Orthopedics Visual EM

Bedside Ultrasound for the Diagnosis of Small Bowel Obstruction

Alexander Anshus, BS^* and Maili Alvarado, MD^{^}

DOI: https://doi.org/10.21980/J86W6PIssue 2:4 No ratings yet.

The POCUS utilizing the low frequency curvilinear probe demonstrates fluid-filled, dilated bowel loops greater than 2.5cm with to-and-fro peristalsis, and thickened bowel walls greater than 3mm, concerning for SBO.

Abdominal/Gastroenterology Visual EM

Chancre of Primary Syphilis

Adnan Riaz MD^* and Grant Wei MD^*

DOI: https://doi.org/10.21980/J83342 Issue 2:4 No ratings yet.

Physical examination revealed a non-tender, erythematous lesion on the glans penis, two similar adjacent satellite lesions, as well as tender inguinal lymphadenopathy. No penile discharge was noted.

Infectious Disease Dermatology Genitourinary Visual EM

Choledocholithiasis

Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8Q62X Issue 2:3 No ratings yet.

Computed tomography (CT) was significant for two large gallstones measuring 1.1 centimeters impacted at the level of the pancreatic head with associated common bile duct (CBD) dilatation.

Abdominal/Gastroenterology Visual EM

Using Bedside Ultrasound to Rapidly Differentiate Shock

Mohamad Moussa, MD^*, Jacob Willen, BS^* and Sudipa Biswas, BS, MS^*

DOI: https://doi.org/10.21980/J8S047 Issue 2:3 No ratings yet.

A RUSH exam demonstrated hyperdynamic cardiac contractility and collapse of the inferior vena cava (IVC) with probe compression more than 50% suggesting hypovolemia likely secondary to sepsis. Incidentally, Morrison’s pouch revealed a large right renal cyst but no signs of free fluid. A computed tomography of abdomen/pelvis showed a 10.8 x 9.5 cm right renal cyst and left lower lobe pneumonia.

Ultrasound Infectious Disease Visual EM

Corneal Sparing Conjunctival Abrasion

Hamid Ehsani-Nia, MS^*, Tanya Dall, MD^{^} and Samantha Costantini, MD^{^}

DOI: https://doi.org/10.21980/J8KG93 Issue 2:3 No ratings yet.

Physical exam was significant for multiple broken teeth, multiple minor abrasions on the face, and fine shards of shattered glass on his face and hair. His right eye had conjunctival injection, with no signs of subconjunctival hemorrhage or ocular penetration. Vision, extraocular movement, and pupillary exam were grossly intact. Fluorescein staining with slit lamp exam with cobalt blue filter examination of the right eye revealed superficial bulbar conjunctival uptake of fluorescein dye staining an area of the conjunctiva inferior to the limbus 5 mm vertical by 2 mm horizontal (estimation by photo provided). No foreign bodies were visualized in the inferior fornix. These findings were consistent with superficial conjunctival abrasion. The exam noted sparing of the corneal epithelium.

Ophthalmology Visual EM

Volvulus

Sari Lahham, MD, MBA^*, Kathryn Bennett, BS^* and Mohammad Helmy, MD^†

DOI: https://doi.org/10.21980/J8JH0Q Issue 2:3 No ratings yet.

Upright and supine frontal radiographs of the abdomen demonstrate gas dilation of the large bowel from the level of the cecum to the sigmoid colon with air fluid levels (yellow arrows). There is a swirled configuration of the distal descending to sigmoid colon indicating the level of the volvulus (dashed yellow line) and giving rise to the classic “coffee bean” sign (dotted white tracing). Note the elevated left hemidiaphragm on the upright view reflecting abdominal distention with increased intra-abdominal pressure (red arrow).

Abdominal/Gastroenterology Visual EM

Pneumonia Diagnosed by Point-of-Care Ultrasound

Akash Patel, BA^*, Steven Bunch, MD^{^}, Maili Alvarado, MD^{^}, Shadi Lahham, MD^{^} and J. Christian Fox, MD^{^}

DOI: https://doi.org/10.21980/J8XP64 Issue 2:3 No ratings yet.

Point-of-care ultrasound of the left lower lobe demonstrates lung hepatization, a classic finding for pneumonia. In addition, a shred sign is present with both air bronchograms and focal B-lines—all suggestive of poorly aerated, consolidated lung. The patient was started on antibiotics and admitted to the hospital with a diagnosis of community-acquired pneumonia.

Ultrasound Respiratory Visual EM

Re-expansion Pulmonary Edema

Kathryn Bennett, BS, BA^* and Benjamin Feldman, MD^*

DOI: https://doi.org/10.21980/J8WS6V Issue 2:3 No ratings yet.

Initial chest X-ray (chest X-ray 1) showed a right-sided pleural effusion with compressive atelectasis of the mid to lower right lung. Repeat chest X-ray immediately after evacuation (chest X-ray 2) shows improvement of the pleural effusion and a new trace apical right pneumothorax measuring 6.7 mm. When the patient became tachypneic, a third X-ray (chest X-ray 3) showed persistent trace apical right pneumothorax measuring 6.7 mm.

Respiratory Visual EM