Visual EM

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Radial Nerve Palsy

Richard Barnett, DO* and Amy Church, MD*

DOI: https://doi.org/10.21980/J8KS7F Issue 3:2[mrp_rating_result]
On physical exam, the patient was unable to extend his right wrist, thumb, and fingers, and had no sensation of his 1stdorsal interosseous muscles up to the proximal dorsal radial aspect of his forearm. The patient also had slight weakness in thumb abduction. Triceps strength was preserved.
NeurologyVisual EM
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Osborn Waves

James Elliot Karz, DO*, Grant Wei, MD* and Chirag Shah, MD*

DOI: https://doi.org/10.21980/J8G34G Issue 3:2[mrp_rating_result]
The initial ECG shows a junctional rhythm with Osborn waves (or J point elevations/J waves) in the lateral precordial leads, as well as the limb leads (Image 1). The second ECG, 49 minutes later, shows an improving ventricular rate and Osborn wave height decrease of approximately 50% (Image 2). 
Cardiology/VascularVisual EM
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Rare Rapidly Growing Thumb Lesion in a 12-Year-Old Male

Alana J Arnold, MD, MBA*

DOI: https://doi.org/10.21980/J8B92J Issue 3:2[mrp_rating_result]
History of present illness: A 12-year-old male presented to the emergency department with right thumb pain and a mass for four months (see images). He denied fevers, chills, change in appetite, or fatigue. He noted that the lesion was growing and “bleeds easily if bumped.” He denied any trauma to the thumb, except “hitting it” months ago while in football
Hematology/OncologyOrthopedicsVisual EM
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Large Ventral Hernia

Meryl Abrams, MD*, Raymond Feuga, MD*, Nicholas Governatori, MD* and Jennifer White, MD*

DOI: https://doi.org/10.21980/J86K9QIssue 3:2[mrp_rating_result]
Computed tomography (CT) scan with intravenous (IV) contrast of the abdomen and pelvis demonstrated a large pannus containing a ventral hernia with abdominal contents extending below the knees (white circle), elongation of mesenteric vessels to accommodate abdominal contents outside of the abdomen (white arrow) and air fluid levels (white arrow) indicating a small bowel obstruction.
Abdominal/GastroenterologyVisual EM
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Elderly female with acute abdominal pain presenting with Superior Mesenteric Artery Thrombus

Sassan Ghassemzadeh, MD*

DOI: https://doi.org/10.21980/J82W52 Issue 3:2[mrp_rating_result]
Computed tomography (CT) angiogram of the abdomen and pelvis revealed a superior mesenteric artery (SMA) thrombosis 5 cm from the origin off of the abdominal aorta. As seen in the sagittal view, there does not appear to be any contrast 5 cm past the origin of the SMA. On the axial views, you can trace the SMA until the point that there is no longer any contrast visible which indicates the start of the thrombus.  The SMA does not appear to be reconstituted. There was normal flow to the celiac artery. (See annotated images).
Abdominal/GastroenterologyCardiology/VascularVisual EM
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Biceps Tendon Rupture

Daniel M Polvino, MD* and Grant Wei, MD*

DOI: https://doi.org/10.21980/J8RP8B Issue 3:1[mrp_rating_result]
Physical exam was significant for ecchymosis and mild swelling of the right bicep. When the right arm was flexed at the elbow, a prominent mass was visible and palpable over the right bicep. Right upper extremity strength was 4/5 with flexion at the elbow.
OrthopedicsVisual EM
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Hutchinson’s Sign

Lawrence Lau, MD*, Hannah Mirzakhani, BA^ and Nicholas Governatori, MD*

DOI: https://doi.org/10.21980/J8N040 Issue 3:1[mrp_rating_result]
The unilateral distribution of vesicular lesions over the patient's left naris, cheek, and upper lip are consistent with Herpes zoster reactivation with Hutchinson's sign.  Hutchinson's sign is a herpes zoster vesicle present on the tip or side of the nose.1 It reflects zoster involvement of the 1st branch of the trigeminal nerve, and is concerning for herpes zoster ophthalmicus.1 Herpes zoster vesicles may present as papular lesions or macular vesicles on an erythematous base.2,3 Emergent diagnosis must be made to prevent long-term visual sequelae.4
Infectious DiseaseDermatologyVisual EM
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Viridans streptococci Intracranial Abscess Masquerading as Metastatic Disease

Brandon Ruderman, MD*, Traci Thoureen, MD* and Joshua Broder, MD*

DOI: https://doi.org/10.21980/J8CH05 Issue 3:1[mrp_rating_result]
A non-contrast CT (Figure 1) revealed a large hypoattenuating left parietal lesion. When the CT was enhanced with intravenous contrast (Figure 2), the same lesion showed peripheral rim enhancement, suggestive of a brain abscess.
Infectious DiseaseNeurologyVisual EM