Visual EM

Wolff-Parkinson-White Syndrome: Electrocardiogram

Brianna Miner^*, Jonathan Patane, MD^*, and Carrie Chandwani, MD^*

DOI: https://doi.org/10.21980/J8201KIssue 1:2 No ratings yet.

The initial EKG showed wide complex, irregular tachycardia > 200 bpm (EKG 1). Given the possibility of Wolff-Parkinson-White (WPW), procainamide was given to the patient. The patient’s heart rate responded and decreased to 120-140 bpm with narrowing of the QRS complex. A repeat EKG showed narrow complex tachycardia without P waves approximately 120 bpm (EKG 2). Once the procainamide infusion was complete, the patient had converted to sinus rhythm with a delta wave now apparent, consistent with WPW (EKG 3).

Cardiology/Vascular Visual EM

Posterior Elbow Dislocation

Victoria Oppenheim^* and Megan Boysen Osborn, MD, MHPE^*

DOI: https://doi.org/10.21980/J8X593Issue 1:2 No ratings yet.

Elbow dislocations are classified by the position of the radio-ulnar joint relative to the humerus.1 Images 1, 2, and 3 show a left posterior elbow dislocation; the radius and ulna (red lines) are displaced posteriorly with respect to the distal humerus (blue line). The lateral view of the elbow most clearly shows this: trochlear notch of the ulna (red line) is empty and displaced posteriorly relative to the trochlea (blue line). There is no associated fracture. Images 4 and 5 show the elbow status-post reduction, demonstrating proper alignment of the distal humerus (blue line) with the radius and ulna (red lines).

Orthopedics Visual EM

Ruptured Ectopic Pregnancy

Valentina Park, BS^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J8SG6TIssue 1:2 No ratings yet.

The patient’s serum beta-hCG was 5,637 mIU/mL. The transvaginal ultrasound showed an empty uterus with free fluid posteriorly in the pelvis and Pouch of Douglas (00:00). A 4.5 cm heterogeneous mass was visible in the left adnexa concerning for an ectopic pregnancy (00:10).

Ob/Gyn Visual EM

Odontoid Fracture, CT Coronal. JETem 2016

Odontoid Fracture: Computed Tomography

Jonathan Peña, MD^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8NP4WIssue 1:2 No ratings yet.

Computed Tomography (CT) of the cervical spine showed a stable, acute, non-displaced fracture of the odontoid process extending into the body of C2, consistent with a Type III Odontoid Fracture. He was evaluated by orthopedic spine service who recommended conservative, non-operative management.

Orthopedics Visual EM

5th Finger Dislocation Photograph JETem 2016

Open Dislocation of Fifth Digit

Robert Rowe, MD^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8J01XIssue 1:2 No ratings yet.

Physical exam revealed an open dislocation of the proximal interphalangeal joint (PIP) of the right fifth digit. X-ray confirmed dislocation and revealed no fractures. The patient received a tetanus booster, Cefazolin, and the dislocation was then washed out and reduced. Multiple reduction attempts were made and were only successful once the metacarpophalangeal joints were held in 90 degree flexion, which relaxed the lateral bands and enabled the finger to be reduced.

Orthopedics Visual EM

Pleural Effusion, AP Chest Xray JETem 2016

Large Right Pleural Effusion

Robert Rowe, MD^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8D59FIssue 1:2 No ratings yet.

Chest x-ray and bedside ultrasound revealed a large right pleural effusion, estimated to be greater than two and a half liters in size.

Respiratory Visual EM

Morel-Lavallée Lesion

Grant G Simpson* and Brandon R Allen, MD^*

DOI: https://doi.org/10.21980/J88G65Issue 1:2 No ratings yet.

On physical examination, the patient was noted to have a nearly “watermelon-sized” fluctuant mass to his right lateral superior quadriceps with multiple overlying abrasions (Image 1). Computed tomography (CT) scans of the area showed a large heterogeneous collection measuring roughly 37x9.5x16 centimeters in the subcutaneous adipose layer of the lateral right thigh (Image 2), while ultrasonography revealed a complex fluid collection containing some nodular solid components and debris (Image 3). Additionally, radiographs confirmed multiple fractures including most significantly a pelvic ring fracture. Surgical debridement, evacuation, and sclerodhesis were performed nine weeks post injury to allow overlying abrasions to heal prior to intervention.

Orthopedics Visual EM

Atrial Myxoma

Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J87P45Issue 1:1 No ratings yet.

Bedside ultrasound revealed the presence of a left atrial mass that appeared to be tethered to the mitral valve. The mass was best viewed on ultrasound in the apical four-chamber window with the phased array probe placed over the patients’ point of maximal impact (PMI), with the patient in left lateral decubitus position.

Ultrasound Cardiology/Vascular Visual EM

Hampton’s Hump in Pulmonary Embolism

Jonathan Patane, MD^* and Megan Boysen Osborn^*

DOI: https://doi.org/10.21980/J83W27Issue 1:1 No ratings yet.

In the lateral view chest x-ray, there is a Hampton’s Hump, a pleural based, wedge-shaped opacity at the base of the right lung, representing lung infarction (black arrow). These findings correlate with the sagittal view on CT angiography of the chest. The CT chest also shows a filling defect in the distal posterior basal segmental pulmonary artery (white arrow), as demonstrated by the absence of contrast enhancement in the distal portion of the vessel. This is associated with an opacification of the lung parenchyma distal to the occlusion (red arrow), representing lung infarction.

Respiratory Visual EM

Acute Pericarditis: Electrocardiogram

Jason Mefford, MD^* and Shannon L Toohey, MD^*

DOI: https://doi.org/10.21980/J8059QIssue 1:1 No ratings yet.

The ECG shows diffuse ST- elevation. The patient also has mild PR-depression, most notably in the inferior and lateral leads. The patient also has minimal PR elevation in lead aVR. The patient was diagnosed with acute pericarditis (ECG stage 1).

Cardiology/Vascular Visual EM