CT

Necrotizing Soft Tissue Infection

Sahil Aggarwal, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8X92TIssue 3:2 No ratings yet.

Computed tomography (CT) of the abdominal and pelvis with intravenous (IV) contrast revealed inflammatory changes, including gas and fluid collections within the ventral abdominal wall extending to the vulva, consistent with a necrotizing soft tissue infection.

Infectious Disease Visual EM

Spontaneous Pneumomediastinum: Hamman Syndrome

Tushank Chadha, BS^* and Ethan Kunstadt, MD^*

DOI: https://doi.org/10.21980/J8NS72 Issue 3:2 No ratings yet.

The initial CT scans showed extraluminal gas surrounding the distal esophagus as it traversed the posterior mediastinum, concerning for possible distal esophageal perforation that prompted surgery and GI consultations. There was no evidence of a drainable collection or significant fat stranding. The image also showed an intraluminal stent traversing the gastric antrum and gastric pylorus with no indication of obstruction. Circumferential mural thickening of the gastric antrum and body were consistent with the patient’s history of gastric adenocarcinoma. The shotty perigastric lymph nodes with associated fat stranding, along the greater curvature of the distal gastric body suggested local regional nodal metastases and possible peritoneal carcinomatosis. The thoracic CT scans showed extensive pneumomediastinum that tracked into the soft tissues of the neck, which given the history of vomiting also raised concern for esophageal perforation. There was still no evidence of mediastinal abscess or fat stranding. Additionally, a left subclavian vein port catheter, which terminates with tip at the cavoatrial junction of the superior vena cava can also be seen on the image.

Respiratory Visual EM

Procedural Sedation for the removal of a rectal foreign body

John Costumbrado, MD, MPH^*, Valerie Lew, BS^* and David Wagner, MD^*

DOI: https://doi.org/10.21980/J81332Issue 3:2 No ratings yet.

Axial and coronal views on CT showed evidence of a large, tube-shaped foreign body in the rectum (see arrows) without evidence of acute gastrointestinal tract disease.

Abdominal/Gastroenterology Procedures Visual EM

A Case of Otomastoiditis

Chad Correa, BS^* and Claire Thomas, MD^{^}

DOI: https://doi.org/10.21980/J8RK89Issue 3:2 No ratings yet.

The patient underwent computed tomography (CT) of the head which revealed opacification of the left middle ear (red arrow) and mastoid air cells (red circles). Additionally, there was thickening of the soft tissues of the external auditory canal (blue arrowhead), likely reflecting concurrent otitis externa. Based on the imaging, he was admitted for findings consistent with acute otomastoiditis.

ENT Infectious Disease Visual EM

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 No ratings yet.

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/Gastroenterology Visual EM

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 No ratings yet.

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/Gastroenterology Cardiology/Vascular Visual EM

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 No ratings yet.

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 Disease Neurology Visual EM

Pneumomediastinum After Cervical Stab Wound

Chad Correa, BS^* and Emily Ma, MD^{^}

DOI: https://doi.org/10.21980/J87P79 Issue 3:1 No ratings yet.

Anteroposterior (AP) chest X-ray showed subcutaneous emphysema of the neck, surrounding the trachea (red arrows), right side greater than left, and a streak of gas adjacent to the aortic arch (white arrow). Computed tomography angiogram (CTA) of the neck showed air outside of the trachea, positive for pneumomediastinum (blue arrows).

Trauma Respiratory Visual EM

Computed Tomography and Ultrasound Diagnosis of Spontaneous Subcapsular Renal Hematoma

Samer Assaf, MD^*, Thalia Nguyen^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8062DIssue 3:1 No ratings yet.

Bedside ultrasound was performed and demonstrated a hypoechoic area within the left kidney (images not shown). The non-contrast computed tomography (CT) of the abdomen and pelvis shows a significantly enlarged left kidney and a region of high-attenuation encapsulating the left kidney, concerning for acute hemorrhage.

Renal/Electrolytes Visual EM

Perianal Abscess

Luke Walls-Smith, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8QP81Issue 3:1 No ratings yet.

Computed Tomography (CT) of the Pelvis with intravenous (IV) contrast revealed a 5.7 cm x 2.4 cm air-fluid collection in the right perianal soft tissue along the right gluteal cleft, with surrounding fat stranding, consistent with a perianal abscess with cellulitis.

Abdominal/Gastroenterology Infectious Disease Visual EM