JETem - Journal of Education and Teaching Emergency Medicine

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Case Report: It’s a Small Whirl Afterall

Lisa M Schwartz, MD^*, Ryan M Perdomo, MD^* and Jason An, MD^*

DOI: https://doi.org/10.21980/J83S8G Issue 7:1 No ratings yet.

The CT imaging of the abdomen and pelvis demonstrated multiple loops of dilated small bowel with a whirl sign (red arrow) within the mid abdomen and a transition point (green arrow), suspicious for closed loop bowel obstruction and internal hernia.

Abdominal/Gastroenterology Visual EM

Ovarian Juvenile Granulosa Cell Tumor Case Report

Jasmine Lemmons, MD^*, Kim Little-Wienert, MD, MEd^* and Alia Hamad, MD^*

DOI: https://doi.org/10.21980/J8035H Issue 7:1 No ratings yet.

A focused assessment with sonography in trauma (FAST) exam was performed initially to evaluate for intra-abdominal injury given the clinical picture. A phased-array ultrasound transducer was placed in sagittal orientation along the patient’s right and left flank, demonstrating extensive heterogenous fluid collections in Morrison’s pouch (red arrow), subphrenic space (solid green arrow), and splenorenal recess (dashed green arrow). To further evaluate, a phased-array transducer was placed over her pelvic area in transverse orientation, demonstrating, a large, heterogeneous mass (outlined in yellow arrows). The surgical team was promptly consulted and blood products were ordered. Although there was concern for impending hemorrhagic shock due to patient’s presenting tachycardia, the patient was hemodynamically stable enough for a CT scan of her chest, abdomen, and pelvis. The CT scan showed large-volume ascites, which exerted mass effect on all abdominal organs with centralization of bowel loops. Additionally, there was a large, 6.4 x 6.8 x 10.9-centimeter, midline pelvic mass (outlined in blue arrows).

Ob/Gyn Visual EM

A Case Report of Aortic Dissection Involving the Aortic Root, Left Common Carotid Artery, and Iliac Arteries

Miguel Angel Martinez-Romo MD^* and Christopher Eric McCoy MD^*

DOI: https://doi.org/10.21980/J8V93K Issue 7:1 No ratings yet.

Computed tomography angiography (CTA) of the thoracic and abdominal aorta revealed an aortic dissection of the ascending aorta, with a dissection flap starting from the aortic root/aortic annulus (yellow arrows), extending into the aortic arch (light blue arrowhead) and involving the left common carotid artery (purple arrow), left subclavian artery (pink arrow), extending to the descending aorta (red arrows), and into the bilateral iliacs (green arrows). The true lumen (red star) and false lumen (blue star) created by the dissection flap can best be seen in the axial views.

Cardiology/Vascular Visual EM

A Case Report of Epiglottitis in an Adult Patient

Savannah Tan, BS^*, Kyle Dornhofer, MD^*, Allen Yang, MD^*, Shadi Lahham, MD, MS^* and Lindsey C Spiegelman, MD^*

DOI: https://doi.org/10.21980/J8QM09 Issue 7:1 No ratings yet.

At the time of presentation to the ED, laboratory results were significant for leukocytosis to 11.8 x 109 white blood cells/L and a partial pressure of carbon dioxide of 52 mmHg on venous blood gas. Computed tomography (CT) of the soft tissue of the neck with contrast showed edematous swelling of the epiglottis and aryepiglottic fold with internal foci of gas (blue arrow) and partial effacement of the laryngopharyngeal airway and scattered cervical lymph nodes bilaterally (Figure 1). Findings were consistent with epiglottitis containing nonspecific air. Additionally, the pathognomonic “thumbprint sign” (yellow arrow) was found on lateral x-ray of the neck (Figure 2). The CT findings as shown in figure 3 illustrate lateral view of the swelling of the epiglottis, gas, and blockage of the airway.

ENT Visual EM

An Unusual Case Report of a Toddler with Metastatic Neuroblastoma Mimicking Myasthenia Gravis

Raymen Rammy Assaf, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8G35V Issue 7:1 No ratings yet.

While still in the ED, MRI with and without gadolinium contrast of the brain, orbits, and cervical, thoracic and lumbar spine were obtained to evaluate for possible CNS lesions including encephalitis, myelitis, or demyelination. Imaging, however, demonstrated multiple unexpected findings: a T1 hypointense, T2 hyperintense and heterogeneously enhancing right adrenal mass measuring 2.7 x 2.1 x 3 cm (yellow asterisk) along with heterogenous enhancement at the clivus, C6, C7, T7, T8, T12, and L3 vertebral bodies (red asterisks). There were otherwise no significant intracranial signal or structural abnormalities and normal orbits.

Pediatrics Hematology/Oncology Neurology Visual EM

Not Another Presentation of Cellulitis: A Case Report of Erythromelalgia

Raymen Rammy Assaf, MD, MPH^{*^} and Kelly Winters, NP^{*^}

DOI: https://doi.org/10.21980/J8BD2K Issue 7:1 No ratings yet.

Episodic tender, warm, erythematous swelling of the extremity experienced by this patient is typical of erythromelalgia. Erythematous streaking on the volar surface of the left forearm (red arrow) and tender, warm, erythematous blanching swelling was present on the palmar hand (yellow arrow). Most patients with erythromelalgia also have lower extremity involvement including the dorsum or sole of the foot and toes.1

Pediatrics Dermatology Visual EM