CT

A Case Report on Miliary Tuberculosis in Acute Immune Reconstitution Inflammatory Syndrome

Erica Concors, MD^*, Hamid Ehsani-Nia, DO^* and Michael Mirza, MD^*

DOI: https://doi.org/10.21980/J81H02 Issue 5:3 No ratings yet.

A portable single-view radiograph of the chest was obtained upon the patient’s arrival to the ED resuscitation bay that showed diffuse reticulonodular airspace opacities (red arrows) seen throughout the bilateral lungs, concerning for disseminated pulmonary tuberculosis. Subsequently, a computed tomography (CT) angiography of the chest was obtained which again demonstrates this diffuse reticulonodular airspace opacity pattern (red arrows).

Rapid Airway Narrowing Associated with Hodgkin’s Lymphoma

Luke Hoffmann, BS^* and Toby Myatt, MD^*

DOI: https://doi.org/10.21980/J86D3Q Issue 5:2 No ratings yet.

Neck X-ray showed nonspecific significant prevertebral soft tissue swelling at the level of the cervical spine, with associated apparent thickening of the epiglottis (yellow arrow), diffuse soft tissue swelling of the neck (red arrows) and tracheal airway narrowing (light blue arrow). The computed tomography imaging of the neck was significant for multiple conglomerating pathological lymph nodes with a significant mass effect (orange arrows) compressing the right internal jugular vein (green arrow).

Hematology/Oncology Respiratory Visual EM

Fitz Hugh Curtis Case Report

Savannah Loehr, BS^* and Cindy Bitter, MD, MPH, MA^{^}

DOI: https://doi.org/10.21980/J82K9G Issue 5:2 No ratings yet.

A sagittal view from computed tomography (CT) of the abdomen and pelvis demonstrated fat stranding beneath the inferior margin of the liver (outlined in red). The axial view showed fat stranding adjacent to the ascending colon without significant colon wall thickening (arrow). Fat stranding can occur as a hazy increased attenuation (brightness) or a more distinct reticular pattern.

Ob/Gyn Infectious Disease Visual EM

Ascending Thoracic Aortic Dissection: A Case Report of Rapid Detection Via Emergency Echocardiography with Suprasternal Notch Views

Brandon Backlund, MD^*, Anastasia Kendrick-Adey, MD^*, Rachel Harper, MD^* and Martin Makela, MD^*

DOI: https://doi.org/10.21980/J8WW6WIssue 5:2 No ratings yet.

Video of parasternal long-axis bedside transthoracic echocardiogram: The initial images showed grossly normal left ventricular function, and no pericardial effusion or evidence of cardiac tamponade. However, the proximal aorta beyond the aortic valve was poorly-visualized in this window.

Cardiology/Vascular Ultrasound Visual EM

Hemorrhagic Renal Cyst

Mary Rometti, MD^*, Christopher Bryczkowski, MD^*and Michael Rohinton Mirza, MD^*

DOI: https://doi.org/10.21980/J8C92V Issue 5:1 No ratings yet.

Bedside renal ultrasound demonstrated a right renal cyst with echogenic debris consistent with a hemorrhagic cyst (red arrow). In addition, a computed tomography (CT) scan of the abdomen and pelvis revealed a 4mm non-obstructing right renal stone and bilateral renal cysts. The CT also confirmed the ultrasound finding of a right renal cyst with mild perinephric stranding possibly consistent with a hemorrhagic cyst.

Renal/Electrolytes Abdominal/Gastroenterology Visual EM

Meckel’s Diverticulum Causing Small Bowel Intussusception in Third Trimester Pregnancy

Reece Eric Wilson, DO^* and Diane Reali-Marini, MD^*

DOI: https://doi.org/10.21980/J87H19 Issue 5:1 No ratings yet.

A CT scan was obtained which demonstrated distal small bowel intussusception with focal dilation suggestive of a small bowel obstruction in a pregnant female in her third trimester of pregnancy. The fetus can be seen in the uterus. The yellow arrow identifies the area of small bowel intussusception shown by telescoping intestines with associated bowel wall edema.

Abdominal/Gastroenterology Visual EM

Bilateral Common Iliac Artery Aneurysm

Laura Kolster, DO^*, Danielle Biggs, MD^*, Amy Patwa, DO^* and Michael Gerardi, MD^*

DOI: https://doi.org/10.21980/J83S73 Issue 5:1 No ratings yet.

A bedside ultrasound of the aorta was performed. The proximal, middle, and distal aorta appeared normal in caliber, as demonstrated by the images; however there seemed to be some enlargement at the bifurcation. The bifurcation into the iliac arteries, as highlighted by the yellow arrow, demonstrates a slightly enlarged iliac artery on the left. The aorta was followed below the bifurcation as it divided into the iliac arteries, as shown in the video clip. The ultrasound demonstrated a left iliac artery aneurysm measuring 5.99 cm, as highlighted by the orange circle. There were aneurysms to the bilateral common and internal iliac arteries.

Cardiology/Vascular Abdominal/Gastroenterology Visual EM

Case Report: Acute Supraglottitis

Jamie Robin Chu, MD^* and Jonathan G Rogg, MD, MBA^{^}

DOI: https://doi.org/10.21980/J8006V Issue 5:1 No ratings yet.

On arrival, radiographs of the neck soft tissues were obtained, which showed a markedly enlarged epiglottic shadow (red arrow) concerning for epiglottitis. A computed tomography scan of the neck soft tissues with contrast was then obtained which revealed edematous mucosal thickening of the oropharynx (blue arrow) and supraglottic larynx (green arrow) including the epiglottis (purple arrow) concerning for acute infectious pharyngitis and supraglottic laryngitis with severe narrowing of the supraglottic laryngeal lumen, as well as associated extensive inflammation and edema of the superficial and deep left neck spaces. The patient’s white blood cell count was elevated to 25.7x109/L with 87% neutrophils. Her rapid strep test was positive. Otolaryngology was consulted and performed a bedside flexible laryngoscopy which showed significant edema of the epiglottis (orange arrow), vocal cords (white arrow), and arytenoids (black arrow), left greater than right. Based on the findings and concern for impending respiratory failure, the patient received an awake fiberoptic intubation by anesthesia at the bedside.

Infectious Disease ENT Visual EM

Case Report of the Unusual Presentation of Stridor in an Elderly Patient Following a Cervical Fracture

Benjamin Travers, BS^*, Rachel Dearden, MD^{^}, Shanna Jones, MD^{^}, and Michael Opsommer, MD^{^}

DOI: https://doi.org/10.21980/J8V926 Issue 5:1 No ratings yet.

The cervical CT was significant for a transverse fracture through the C4 vertebral body (see red arrow), lateral facet (green arrow), spinous process (blue arrow), and right lamina (purple arrow) as well as surrounding edema and retropharyngeal thickening (yellow line), best appreciated on sagittal view.

Visual EM Orthopedics Respiratory

Atypical Presentation of Abdominal Aortic Aneurysm

Michael Rohinton Mirza, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J82W6F Issue 4:4 No ratings yet.

Bedside ultrasound revealed an abdominal aortic aneurysm (AAA) with concern for dissection vs thrombus/hematoma due to an area of echogenicity within the lumen of the vessel, since normal blood vessels (including the aorta) have lumens that are uniformly anechoic. An intimal flap concerning for dissection appears as a hyperechoic stripe within the lumen of the vessel on ultrasound, often with a hypoechoic and/or anechoic area appreciated underneath the flap, indicating a separate area of blood flow. If this visualized area is of significant size, color doppler can be used to confirm blood flow on both sides of the flap. Given his bedside ultrasound findings, the patient underwent emergent computed tomography scan and was found to have an enlarged infrarenal abdominal aortic aneurysm, with acute intramural hematoma, extending into bilateral common iliac arteries.

Cardiology/Vascular Visual EM