Visual EM

Acute, massive pulmonary embolism with right heart strain and hypoxia requiring emergent tissue plasminogen activator (TPA) infusion

Jonathan Patane, MD^* and Wirachin Hoonpongsimanont, MD^*

DOI: https://doi.org/10.21980/J84K5K Issue 2:2 No ratings yet.

CT angiogram showed multiple large acute pulmonary emboli, most significantly in the distal right main pulmonary artery (image 1 and 2). Additional pulmonary emboli were noted in the bilateral lobar, segmental, and subsegmental levels of all lobes. There was a peripheral, wedge-shaped consolidation surrounded by groundglass changes in the posterolateral basal right lower lobe that was consistent with a small lung infarction (image 3).

Presentation of Significant Subarachnoid Hemorrhage without Loss of Consciousness

Nicholas Taylor, BA^* and Shannon Toohey, MD, MAEd^*

DOI: https://doi.org/10.21980/J80W29 Issue 2:2 No ratings yet.

A non-contrast head CT demonstrated extensive subarachnoid hemorrhage occupying both cerebral convexities, the anterior interhemispheric fissure, the sylvian fissures, and the basal cisterns. Later CTA would show an 8 mm by 7 mm by 8mm MCA aneurysm near the M1/M2 junction and two pericallosal artery aneurysms, 7 by 6 mm and 8 by 5 mm respectively.

Neurology Visual EM

Acute Subdural Hematoma

Ellen Lester, BS^*, Jonathan Peña, MD^* and Warren Wiechmann, MD, MBA^*

DOI: https://doi.org/10.21980/J87C76 Issue 2:2 No ratings yet.

Non-contrast Computed Tomography (CT) of the Head showed a dense extra-axial collection along the left frontal and parietal regions, extending superior to the vertex with mild mass effect, but no midline shift.

Neurology Visual EM

Wellens’ Sign (Wellens’ Syndrome)

Jonathan Patane, MD^* and Kim Sokol, MD^*

DOI: https://doi.org/10.21980/J8W30P Issue 2:2 No ratings yet.

This EKG shows deep, inverted T waves that are most pronounced in V2-V4, and are associated with continued T wave inversions in V5 and V6 and ST segment changes in V1-V3.

Cardiology/Vascular Visual EM

Herpes Zoster

Hamid Ehsani-Nia, BS, MS^* and Robert Rowe, MD^{^}

DOI: https://doi.org/10.21980/J8C301 Issue 2:2 No ratings yet.

The patient was in mild distress, afebrile, with stable vital signs. His physical exam revealed an erythematous, grouped vesicular rash in various stages of progression including erythematous papules, clear vesicles, and pustular vesicles. Few lesions were scabbed over. No signs of crusting or scarring were appreciated. The distribution encompassed the entire left T4 dermatome both posteriorly and anteriorly. No other rashes were appreciated elsewhere on the body.

Infectious Disease Dermatology Visual EM

Stingray Envenomation

Tanya Dall, MD^*

DOI: http://doi.org/10.21980/J86C7W Issue 2:2 No ratings yet.

Physical exam revealed a 3cm laceration to the ulnar side of the dorsum of the left hand with minimal hand swelling. There was no exposed tendon or bone, the hand was neurovascularly intact and had full strength. A small barb was visualized and removed from the injury site. Radiograph of the left hand confirmed that there was no remaining barb (see normal x-ray).

Wilderness Visual EM

The Lost Guidewire

Ankit Shah, MD^*, Adam Sigal, MD^* and Kristen Sandel, MD^*

DOI: https://doi.org/10.21980/J82P4M Issue 2:2 No ratings yet.

Initial chest radiograph shows a guidewire in the inferior vena cava (IVC), superior vena cava (SVC), and right IJ veins.

Procedures Administration Visual EM

A Toddler with Abdominal Pain and Emesis

Saema Said, BS^* and Kevin Koenig, MD^*

DOI: https://doi.org/10.21980/J8XW2P Issue 2:2 No ratings yet.

In the long axis video, the appendix appears as an enlarged, non-compressible, blind-ending tubular structure (white arrow) with distinct appendiceal wall layers and lack of peristalsis. In the short axis video, the appendix appears as a target sign (yellow arrow) between the abdominal and psoas muscles. The maximal outer diameter (MOD) measures 11.8mm and the appendix wall measures 0.17mm. There is trace adjacent free fluid and echogenic periappendiceal fat. Transverse axis video and image (red arrow) demonstrate that the appendix is not compressible. These findings are consistent with acute appendicitis.

Abdominal/Gastroenterology Infectious Disease Pediatrics Ultrasound Visual EM

An Elderly Female with Dyspnea and Abdominal Pain

Jon Van Heukelom, MD^*

DOI: https://doi.org/10.21980/J83S3KIssue 2:1 No ratings yet.

Radiography shows a dilated, gas-filled structure that fills nearly the entire left hemi-thorax. Lung markings are visible in the uppermost portion of the left hemi-thorax. There is mediastinal shift to the right. In the visualized portion of the abdomen, dilated loops of bowel are also visualized. This constellation of findings is consistent with a tension gastrothorax.

Respiratory Visual EM

Pulmonary Embolism: Diagnosis by Computerized Tomography without Intravenous Contrast

James Roy Waymack, MD^*

DOI: https://doi.org/10.21980/J8001ZIssue 2:1 No ratings yet.

Non-contrast CT of the chest demonstrates hyper-densities within both central and sub-segmental pulmonary arteries bilaterally (see yellow arrows). The right ventricle is dilated.

Respiratory Visual EM