CT

Acute Pyelonephritis with Perinephric Stranding on CT

Ronald Goubert^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8BH0VIssue 3:1 No ratings yet.

A CT abdomen and pelvis with IV contrast showed neither nephrolithiasis nor diverticulitis, and instead showed heterogeneous enhancement of the left kidney with mild edematous enlargement and striated left nephrogram. Significant perinephric stranding (red arrows) was also noted and was consistent with severe acute pyelonephritis.

Empyema

Jonathan Patane, MD^* and Daniel Ritter, BS^{^}

DOI: https://doi.org/10.21980/J86P9RIssue 3:1 No ratings yet.

The chest X-ray shows a large fluid collection in the right lung demonstrated by the opacification that blunts the costophrenic angle on the right side. There is also a meniscus present, which is generally indicative of fluid. Chest computed tomography (CT) demonstrated an infiltrate with a mixture of densities within the same collection, consistent with a loculated effusion and concerning for an empyema.

Respiratory Infectious Disease Visual EM

Oropharynx Ulceration

Lauren Sylwanowicz, MD^* and Andrew Wong, MD, MBA^*

DOI: https://doi.org/10.21980/J87W60 Issue 2:4 No ratings yet.

The photograph demonstrates an area of ulcerative tissue at the left palatine tonsil without surrounding erythema or purulent drainage. The computed tomography (CT) scan shows a large ulceration of the left soft palate and palatine tonsil (red arrow). There is no evidence of skull base osteomyelitis. There is suppurative lymphadenopathy with partial left jugular vein compression due to mass effect (yellow highlight). There is mild nasopharyngeal airway narrowing with architectural distortion (blue arrow), but no other evidence of airway obstruction.

ENT Visual EM

An Elderly Male with Amyand’s Hernia

Saema Said, MD^* and Roozbeh Houshyar, MD^{^}

DOI: https://doi.org/10.21980/J80D13 Issue 2:4 No ratings yet.

Ultrasound of the right scrotum shows a right inguinal hernia with an air-containing loop of bowel (white arrow) and a non-compressible appendix (yellow arrow). Coronal and axial views of abdomen-pelvis CT show a right inguinal hernia containing a loop of small bowel (white arrow) and appendix (yellow arrow).

Abdominal/Gastroenterology Visual EM

Acetabular Fracture

Chad Correa^* and Sari Lahham, MD^{^}

DOI: https://doi.org/10.21980/J8BK8K Issue 2:4 No ratings yet.

The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows), with associated obturator muscle hematoma (blue oval).

Orthopedics Visual EM

Choledocholithiasis

Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8Q62X Issue 2:3 No ratings yet.

Computed tomography (CT) was significant for two large gallstones measuring 1.1 centimeters impacted at the level of the pancreatic head with associated common bile duct (CBD) dilatation.

Abdominal/Gastroenterology Visual EM

Volvulus

Sari Lahham, MD, MBA^*, Kathryn Bennett, BS^* and Mohammad Helmy, MD^†

DOI: https://doi.org/10.21980/J8JH0Q Issue 2:3 No ratings yet.

Upright and supine frontal radiographs of the abdomen demonstrate gas dilation of the large bowel from the level of the cecum to the sigmoid colon with air fluid levels (yellow arrows). There is a swirled configuration of the distal descending to sigmoid colon indicating the level of the volvulus (dashed yellow line) and giving rise to the classic “coffee bean” sign (dotted white tracing). Note the elevated left hemidiaphragm on the upright view reflecting abdominal distention with increased intra-abdominal pressure (red arrow).

Abdominal/Gastroenterology Visual EM

Renal Infarction from Type B Aortic Dissection

Marit Tweet, MD^* and James Roy Waymack, MD^*

DOI: https://doi.org/10.21980/J8HG9G Issue 2:3 No ratings yet.

Initial abdominal images demonstrated a dissection flap; therefore, a CTA of the chest was also obtained. These images revealed a Stanford type B aortic dissection beginning just distal to the left subclavian artery and extending to the origin of the inferior mesenteric artery. The right renal artery arose from the true lumen of the dissection while the left renal artery arose from the false lumen. This case is interesting as imaging shows the lack of perfusion to the left kidney, residing in the retroperitoneum, which correlates with her non-descript abdominal and left flank pain.

Cardiology/Vascular Renal/Electrolytes Visual EM

Esophageal Perforation

Valentina Park, BS^* and Jason Mefford, MD^{^}

DOI: https://doi.org/10.21980/J8K91B Issue 2:3 No ratings yet.

History of present illness: A 51-year-old male with history of gastroesophageal reflux disease status post multiple endoscopies presented to the emergency department with severe abdominal pain. Paramedics reported the patient appeared diaphoretic on arrival and maintained stable vital signs during transit. The patient reported taking Prilosec that morning before eating breakfast, after which he felt like something was stuck in

Abdominal/Gastroenterology Visual EM

Globe Rupture

Reid Honda, MD^*

DOI: https://doi.org/10.21980/J8N91Z Issue 2:3 No ratings yet.

The patient’s computed tomography (CT) head demonstrated a deformed left globe, concerning for ruptured globe. The patient had hyperdense material in the posterior segment (see green arrow), consistent with vitreous hemorrhage. CT findings that are consistent with globe rupture may include a collapsed globe, intraocular air, or foreign bodies.

Ophthalmology Visual EM