Visual EM

Asymptomatic Wolff-Parkinson-White Syndrome: Incidental EKG

Samer Assaf, MD^* and Christopher Libby, MD, MPH^{^}

DOI: https://doi.org/10.21980/J8T05X Issue 2:3 No ratings yet.

The ECG shows slurred up-stroking of the QRS complexes characteristic of a delta wave. The PR interval is normal; however, the QT interval is greater than 110ms.

Cardiology/Vascular Visual EM

Renal Infarction from Type B Aortic Dissection

Marit Tweet, MD^* and James Roy Waymack, MD^*

DOI: https://doi.org/10.21980/J8HG9G Issue 2:3 No ratings yet.

Initial abdominal images demonstrated a dissection flap; therefore, a CTA of the chest was also obtained. These images revealed a Stanford type B aortic dissection beginning just distal to the left subclavian artery and extending to the origin of the inferior mesenteric artery. The right renal artery arose from the true lumen of the dissection while the left renal artery arose from the false lumen. This case is interesting as imaging shows the lack of perfusion to the left kidney, residing in the retroperitoneum, which correlates with her non-descript abdominal and left flank pain.

Cardiology/Vascular Renal/Electrolytes Visual EM

Esophageal Perforation

Valentina Park, BS^* and Jason Mefford, MD^{^}

DOI: https://doi.org/10.21980/J8K91B Issue 2:3 No ratings yet.

History of present illness: A 51-year-old male with history of gastroesophageal reflux disease status post multiple endoscopies presented to the emergency department with severe abdominal pain. Paramedics reported the patient appeared diaphoretic on arrival and maintained stable vital signs during transit. The patient reported taking Prilosec that morning before eating breakfast, after which he felt like something was stuck in

Abdominal/Gastroenterology Visual EM

Globe Rupture

Reid Honda, MD^*

DOI: https://doi.org/10.21980/J8N91Z Issue 2:3 No ratings yet.

The patient’s computed tomography (CT) head demonstrated a deformed left globe, concerning for ruptured globe. The patient had hyperdense material in the posterior segment (see green arrow), consistent with vitreous hemorrhage. CT findings that are consistent with globe rupture may include a collapsed globe, intraocular air, or foreign bodies.

Ophthalmology Visual EM

Steven-Johnson Syndrome

Pauline Joy F. Santos, MD^* and Lauren Sylwanowicz, MD^*

DOI: https://doi.org/10.21980/J8661W Issue 2:3 No ratings yet.

At presentation to the ED, a macular rash was notable on all four extremities, trunk and face, and involved mucous membranes of the oropharynx and vaginal introitus. The rash was painful, erythematous and purpuric with targetoid lesions. There were also multiple areas of sloughing and desquamation with a positive Nikolsky sign. Denudement totaled approximately 2% of total body surface area.

Dermatology Visual EM

Ectopic Kidney

John Costumbrado, MD, MPH^*, Reid Honda, MD^{^} and Eric McCoy, MD, MPH^{^}

DOI: https://doi.org/10.21980/J89058 Issue 2:3 No ratings yet.

CT of the abdomen and pelvis revealed a normal left kidney and an ectopic, malrotated right kidney located in the pelvis (see white arrow).

Renal/Electrolytes Visual EM

Ruptured Abdominal Aortic Aneurysm

Jessica Andrusaitis, BS, MS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8FP6SIssue 2:3 No ratings yet.

CTA demonstrated a ruptured 7.4 cm infrarenal abdominal aortic aneurysm with a large left retroperitoneal hematoma.

Cardiology/Vascular Visual EM

Perforated Gastric Ulcer with Intra-abdominal Abscess

Leslie Palmerlee, MD, MPH^*, Scott Mackey, DO^*and Michael Petrauskis, MD, MEd^*

DOI: https://doi.org/10.21980/J82H0C Issue 2:3 No ratings yet.

Bedside ultrasound revealed a large volume of free fluid in the right upper quadrant and in the pelvis. The fluid appeared complex with multiple septations. Its appearance was not consistent with ascites or acute intra-abdominal free fluid due to striations and pockets.

Abdominal/Gastroenterology Visual EM

Use of Bedside Compression Ultrasonography for Diagnosis of Deep Venous Thrombosis

Mohamad Moussa, MD^* and Maher Abdo, BS^*

DOI: https://doi.org/10.21980/J81G94 Issue 2:3 No ratings yet.

As shown in the still image of the performed ultrasound, a transverse view of the proximal-thigh revealed a visible thrombus (green shading) occluding the lumen of the left common femoral vein (blue ring), which was non-compressible when direct pressure was applied to the probe. Also visible is a patent and compressible branch of the common femoral vein (purple ring) and the femoral artery (red ring), highlighted by its thick vessel wall and pulsatile motion.

Ultrasound Cardiology/Vascular Visual EM

Open Pneumothorax

Bart Paull, MD^*, Zachary Jarou, MD^* and David Richards, MD^*

DOI: https://doi.org/10.21980/J88036 Issue 2:3 No ratings yet.

A large chest wound was clinically obvious. A chest radiograph performed after intubation showed subcutaneous emphysema, an anterior rib fracture, and a right-sided pneumothorax. He was then taken to the operating room for further management.

Trauma Respiratory Visual EM