CT

Acute, massive pulmonary embolism with right heart strain and hypoxia requiring emergent tissue plasminogen activator (TPA) infusion

Jonathan Patane, MD^* and Wirachin Hoonpongsimanont, MD^*

DOI: https://doi.org/10.21980/J84K5K Issue 2:2 No ratings yet.

CT angiogram showed multiple large acute pulmonary emboli, most significantly in the distal right main pulmonary artery (image 1 and 2). Additional pulmonary emboli were noted in the bilateral lobar, segmental, and subsegmental levels of all lobes. There was a peripheral, wedge-shaped consolidation surrounded by groundglass changes in the posterolateral basal right lower lobe that was consistent with a small lung infarction (image 3).

Pulmonary Embolism: Diagnosis by Computerized Tomography without Intravenous Contrast

James Roy Waymack, MD^*

DOI: https://doi.org/10.21980/J8001ZIssue 2:1 No ratings yet.

Non-contrast CT of the chest demonstrates hyper-densities within both central and sub-segmental pulmonary arteries bilaterally (see yellow arrows). The right ventricle is dilated.

Respiratory Visual EM

Ventriculoperitoneal Shunt Migration

Justin P Puller, MD^* and Jonathan T Miller, MD^*

DOI: https://doi.org/10.21980/J8G019Issue 2:1 No ratings yet.

An immediate post-op abdominal x-ray performed after the patient’s VP shunt revision 30 days prior to this ED visit reveals the VP shunt tip in the mid abdomen. A CT of the abdomen performed on the day of the ED visit reveals the VP shunt tip interposed between the spleen and the diaphragm.

Abdominal/Gastroenterology Visual EM

Intraocular Foreign Body: Ultrasound and CT Findings

Maja Feldman, MPP^*, Kristi Shigyo, MD^{^} and Amy Kaji, MD^{^}

DOI: https://doi.org/10.21980/J8JS3MIssue 2:1 No ratings yet.

Point of care ultrasound revealed a mobile, radiolucent hyperechoic structure (see red arrow) with reverberation within the posterior chamber (see blue arrow), likely a metallic foreign body. Linear areas of mobile hyperechoic material revealed possible vitreous hemorrhage (see purple circular area). Orbital non-contrast CT confirmed a 3 mm metallic focus within the dependent portion of the left globe, lodged in the posterior sclera, with some vitreous hemorrhage but no evidence of globe rupture. Ophthalmology was consulted and the patient was taken to surgery later that night.

Ophthalmology Visual EM

Computed Tomography Diagnosis of Appendicitis

Christopher Libby, MPH^* and Shannon Toohey, MD, MAEd^{^}

DOI: https://doi.org/10.21980/J8F30NIssue 2:1 No ratings yet.

The CT abdomen/pelvis with IV contrast shows a dilated appendix (see red outline) with thickened, hyperenhancing wall (see blue outline) best visualized in the axial and coronal planes.

Abdominal/Gastroenterology Visual EM

Intracranial Hemorrhage Following a 3-week Headache

John Jiao, MHS^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J89885 Issue 2:1 No ratings yet.

The patient’s head CT showed a significant area of hyperdensity consistent with an intracranial hemorrhage located within the left frontal parietal lobe (red arrow). Additionally, there is rightward midline shift up to 1.1cm (green arrow) and entrapment of the right lateral ventricle (blue arrow).

Neurology Visual EM

Gastric Bezoar

Samer Assaf MD^*

DOI: https://doi.org/10.21980/J85K5WIssue 2:1 No ratings yet.

In the abdominal radiograph, a nonspecific and non-obstructive bowel gas pattern with no air-fluid level was noted, however the stomach was distended with soft tissue. The CT abdomen/pelvis revealed a distended stomach with undigested heterogeneous contents (presumed bezoar).

Abdominal/Gastroenterology Visual EM

Trimalleolar Fracture

Christopher Gilani^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J8PP46 Issue 1:2 No ratings yet.

Anteroposterior (AP), lateral, and oblique x-ray views were obtained. The AP view revealed a displaced spiral fracture of the lateral malleolus (red) and a vertical fracture of the medial malleolus (blue). The lateral view revealed a displaced fracture of the posterior malleolus, tibial plafond (yellow), and the oblique view showed widening of the distal tibiofibular syndesmosis (green). CT scans confirmed trimalleolar fracture, annotated with the same colored lines (red, lateral malleolus; blue, medial malleolus; yellow, posterior malleolus).

Orthopedics Visual EM

Femoral Neck Fracture

Jonathan Lee^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J89G6GIssue 1:2 No ratings yet.

In the anteroposterior view bilateral hip x-ray, there is an evident loss of Shenton’s line on the left when compared to the normal right, indicative of a fracture in the left femoral neck. This correlates with findings seen on pelvic CT, which reveals both a subcapital fracture and transcervical fracture. The neck of the femur is displaced superiorly relative to the head of the femur while the head of the femur remains in its anatomical position within the acetabulum.

Orthopedics Visual EM

Traumatic Aortic Injury

Brianna Miner^*, Megan Boysen Osborn, MD, MHPE^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J85P4JIssue 1:2 No ratings yet.

The initial chest x-ray showed an abnormal superior mediastinal contour (blue line), suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows) compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow). There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows).

Trauma Cardiology/Vascular Visual EM