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

Irreducible Traumatic Posterior Shoulder Dislocation

Blake Collier, DO^* and Christopher Trigger, MD^*

DOI: https://doi.org/10.21980/J8V884Issue 2:1 No ratings yet.

Radiographs demonstrated posterior displacement of the humeral head on the “Y” view (see white arrow) and widening of the glenohumeral joint space on anterior-posterior view (see red arrow). The findings were consistent with posterior dislocation and a Hill-Sachs type deformity. Sedation was performed and reduction was attempted using external rotation, traction counter-traction. An immediate “pop” was felt during the procedure. Post-procedure radiographs revealed a persistent posterior subluxation with interlocking at posterior glenoid. CT revealed posterior dislocation with acute depressed impaction deformity medial to the biceps groove with the humeral head perched on the posterior glenoid, interlocked at reverse Hill-Sachs deformity (see blue arrow).

Orthopedics Visual EM

Pseudogout and Calcium Pyrophosphate Disease

Andrew Williamson, MD*

DOI: https://doi.org/10.21980/J8QG66Issue 2:1 No ratings yet.

Radiographs of the knee showed multiple radio-dense lines paralleling the articular surface (see red arrows) consistent with calcium pyrophosphate crystal deposition within the joint often seen in calcium pyrophosphate disease (CPPD) also known as pseudogout.

Orthopedics Visual EM

ST Elevation in aVR with Coexistent Multilead ST Depression

Benjamin Cooper, MD^*

DOI: https://doi.org/10.21980/J8KS3XIssue 2:1 No ratings yet.

The ECG shows ST-segment depressions in precordial leads V3 through V6, and limb leads I, II, and aVL, and 1 mm of ST-segment elevation in aVR. The initial troponin I was elevated at 1.37 ng/mL (upper limit of normal 0.40). Cardiology decided to delay catheterization until the next day when diffuse coronary disease was discovered (including 90% of the left circumflex stenosis, 60% proximal and 75% mid-left anterior descending stenosis, 75% third diagonal branch stenosis, and 90% posterior descending artery stenosis). The following day, the patient went to the operating room for coronary artery bypass grafting (CABG).

Cardiology/Vascular Visual EM