CT

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Ovarian Teratoma

Laura Rubi Cuevas, BS* and Lauren Sylwanowicz, MD*

DOI: https://doi.org/10.21980/J8934XIssue 4:1[mrp_rating_result]
The CT scan with oral contrast in the emergency department revealed a large heterogeneous abdominopelvic mass measuring 13.2 x 18.8 x 23.1 cm (see white lines), suggestive of an ovarian teratoma from the right ovary. This mass included fat, fluid, calcifications (see yellow arrows), and enhancing soft tissue components. The teratoma resulted in mass effect upon large and small bowel loops (see blue highlighted areas), inferior vena cava (IVC), distal aorta (see red highlighted area) and right common iliac artery. A small volume of ascites was also observed. There was no evidence of bowel obstruction, vascular occlusion or other significant emergent finding. Additionally, transabdominal and transvaginal ultrasound images were obtained. The transabdominal image visualized the abdominopelvic mass (see four yellow stars). The transvaginal image visualized a cross section of the teratoma (see four red stars) in relation to the bladder (see four blue stars). 
Ob/GynVisual EM
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Intramural Hematoma with Type B Aortic Dissection

Ronald Goubert, BS*, Robert Rowe, MD* and Alisa Wray, MD, MAEd*

DOI: https://doi.org/10.21980/J81M03Issue 4:1[mrp_rating_result]
Computed tomography angiography of the chest and abdomen revealed a 9.5 cm thoracoabdominal aneurysm (red outline) with intramural hematoma (yellow shading) and large left pleural effusion versus hemothorax with old blood (blue shading).
Cardiology/VascularVisual EM
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Open Globe with Intraocular Foreign Body

Stephen Weiss, MD*, Dustin Williams, MD*, Yih Ying (Eva) Yuan, MD* and Jo-Ann Nesiama, MD, MS*

DOI: https://doi.org/10.21980/J8S348 Issue 4:1[mrp_rating_result]
On physical exam, his extraocular movements were intact. The right anterior chamber appeared cloudy, particularly nasal to the pupil. The conjunctiva of the right eye was injected. The right pupil was 3 mm and sluggishly reactive and appeared slightly irregular (see yellow arrow). Of note, the right eye also had a 1 mm hypopyon, indicating inflammation of the anterior chamber, which was visible on slit lamp examination (not pictured). There was no fluorescein uptake or Seidel sign. His visual acuity was 20/60 OD (right eye) and 20/20 OS (left eye).
OphthalmologyVisual EM
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Endocarditis

Sara Arastoo, BS* and Sari Lahham, MD, MBA*

DOI: https://doi.org/10.21980/J8JP73Issue 3:4[mrp_rating_result]
Upright frontal radiograph of the chest demonstrated large pleural effusion on the left and moderate pleural effusion on the right as shown by the visible menisci on both sides (red arrows) with diffuse bilateral nodular densities (yellow dotted lines), consistent with septic pulmonary emboli. Computed tomography (CT) of the chest demonstrated multiple scattered lung nodules bilaterally containing internal foci of air cavitation (green dotted lines).
Infectious DiseaseCardiology/VascularVisual EM
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Facial Fracture Induced Periorbital Emphysema

Hamid Ehsani-Nia, DO* and Robert Eisenstein, MD*

DOI: https://doi.org/10.21980/J8F05HIssue 3:4[mrp_rating_result]
Physical exam showed marked left palpebral subcutaneous crepitus, as well as bulbar and palpebral conjunctival bulging. Visual acuity was normal with intact extraocular movements, and normal pupillary exam. Computed tomography (CT) imaging of the face was obtained and revealed multiple displaced fractures involving the left orbital floor and zygomatic arch associated with moderate periorbital and postseptal extraconal gas, resulting in orbital proptosis.
TraumaENTVisual EM
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Fournier Gangrene

Joseph Zakaria, BS*, Steve Bunch, MD* and Victor Cisneros, MD, MPH*

DOI: https://doi.org/10.21980/J89626Issue 3:4[mrp_rating_result]
The computed tomography (CT) of the abdomen and pelvis revealed significant subcutaneous gas tracking along the perineum and right gluteal region (orange outline) into the scrotum with associated scrotal edema (yellow arrow) and subcutaneous inflammatory fat stranding of 0.92 cm (red arrow) consistent with Fournier’s gangrene.  There is early fluid loculation along the right medial gluteal cleft of 5.85 cm (green arrow) without a sizeable drainable abscess seen.
Infectious DiseaseVisual EM
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Foreign Body in Maxillary Sinus: A Rare Case of Chronic Rhinosinusitis

Richard Barnett, DO* and Meigra Chin, MD*

DOI: https://doi.org/10.21980/J85H09Issue 3:4[mrp_rating_result]
Computed tomography (CT) sinus with contrast demonstrated complete opacification of left paranasal sinuses and nasal cavity, and a linear radiopacity within the left maxillary sinus consistent with a foreign body.  There were additional left facial subcutaneous radiopaque opacities.
ENTVisual EM
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Sialadenitis

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

DOI: https://doi.org/10.21980/J8NH0NIssue 3:4[mrp_rating_result]
The computed tomography (CT) scan demonstrates prominent enlargement and heterogeneous enhancement of the right submandibular gland (single large arrow) compatible with sialadenitis. There is no evidence of a sialolith or obstruction on the CT. There is associated edema (two small arrows) of the right submandibular space, parapharyngeal space and anterior right neck with partial effacement of the right vallecula and right pyriform sinus.
ENTVisual EM