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Woman Swallows a “Handful of Pills”

Sarah E Mott, MD*, Michael Paddock, DO, MS*^ and Jessie Nelson, MD*^

DOI: https://doi.org/10.21980/J8V64XIssue 3:3 No ratings yet.
Soft tissue lateral X-ray of neck was performed. The lateral soft tissue X-ray of the neck showed a metallic foreign body at the level cricoid.
Abdominal/GastroenterologyVisual EM
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Lisfranc Injury

Lisa Schwartz, BS*, Nelly Tan, MD^ and John Costumbrado, MD, MPH*

DOI: https://doi.org/10.21980/J8QD1MIssue 3:3 No ratings yet.
The frontal view of the right foot showed divergent dislocation of the second through fifth metatarsal bones (red outlines) consistent with Lisfranc injury. Though the Lisfranc ligament is not visualized by radiograph, the yellow markings represent the location of the Lisfranc ligament between the medial cuneiform (blue dot) and the base of the second metatarsal bone.  The first metatarsal and the medial cuneiform remain congruent. The lateral view shows dorsal dislocation of the midfoot (pink circle) consistent with instability. There is associated extensive midfoot soft tissue swelling.
OrthopedicsVisual EM
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Incidental Hiatal Hernia on Chest X-ray

Ahmed Farhat, BS* and Daryn Towle, MD*

DOI: https://doi.org/10.21980/J8KP8SIssue 3:3 No ratings yet.
The two-view chest X-ray shows mild opacification of the bilateral lower lobes concerning for pneumonia (red arrows). Incidental retrocardiac opacity with air-fluid level consistent with large hiatal hernia is also observed (green arrow).
Abdominal/GastroenterologyVisual EM
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Button Battery in Esophagus

Sha Yan, DO* and Ernest Leva, MD*

DOI: https://doi.org/10.21980/J8FW6VIssue 3:3 No ratings yet.
Chest radiograph showed the presence of a round radiopaque foreign body in the mid-chest. It was suspected to be in the esophagus rather than in the trachea due to the en-face positioning of the foreign body. The foreign body demonstrated two concentric ring circles concerning for a “double ring” or “halo" sign, which was suggestive of the presence of a button battery rather than a coin.
Abdominal/GastroenterologyVisual EM
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Pediatric Foreign Body Aspiration

Sha Yan, DO* and Uchechi Azubuine, MD^

DOI: https://doi.org/10.21980/J8B648Issue 3:3 No ratings yet.
Chest radiograph showed increased radiolucency (red arrow) and flattening of the diaphragm on the right side (blue arrow) consistent with hyperinflation of the right lung, as well as left mediastinal shift (green arrow), indicating obstruction.
PediatricsRespiratoryVisual EM
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Achalasia: An Uncommon Presentation with Classic Imaging

Joseph Adamson, BS*, Mina Altwail, MD^ and Shanna Jones, MD^

DOI: https://doi.org/10.21980/J86D2BIssue 3:3 No ratings yet.
The chest X-ray demonstrated a markedly widened mediastinum (red brackets), raising concern for thoracic aortic aneurysm/aortic dissection, which prompted labs and contrast-enhanced computed tomography (CT) of the chest. The CT revealed a dilated proximal esophagus that narrowed distally (yellow tracing and red arrow), with particulate material, mass-effect on the trachea (purple outline), and bilateral patchy opacities suggesting aspiration. Barium esophagram showed a drastically dilated esophagus filled with contrast (yellow arrow), terminating into the classic “bird’s beak sign” (red arrow) at the lower esophageal sphincter (LES). Esophageal manometry later confirmed achalasia, proving that widened mediastina can have unexpected etiologies.
Abdominal/GastroenterologyVisual EM