CT

Bezoars: An Interesting Case of Abdominal Pain

Eric Chronister, MD^*, Danielle Biggs, MD^*, David Feldman, MD^* and Yaser Daramna, MD^*

DOI: https://doi.org/10.21980/J8VD1V Issue 4:4 No ratings yet.

Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast was ordered to evaluate her symptoms. The CT showed three large collections of ingested material seen as hypodense material with circular rings surrounded by the hyperdense oral contrast (see red outlines). These findings are consistent with bezoars, the largest of which measured 11.5 x 7.8 cm. There was also thickening of the gastric wall (see blue outline), most notably at the pylorus, consistent with partial obstruction.

Abdominal/Gastroenterology Visual EM

The Elusive Pheo: A Case Report of Pheochromocytoma in the Emergency Department

Jason Cody Pickett, MD^* and Jonah Gunalda, MD^*

DOI: https://doi.org/10.21980/J8KW63 Issue 4:4 No ratings yet.

ED work-up: BMP within normal limits (WNL), white blood cell (WBC) 27.4, ECG showed sinus tachycardia, nonspecific ST segment abnormalities, BNP and troponin were within normal limits, HR 146 beats/minute, CT abdomen/pelvis showed a 10-cm-heterogenous enhancing left adrenal mass (anterior-posterior view [shown in red], lateral view [shown in blue]).

Endocrine Visual EM

Traumatic Diaphragmatic Rupture – A Case Report

Vincent Hussey, MS^* and Claire Thomas, MD^*

DOI: https://doi.org/10.21980/J8G64H Issue 4:4 No ratings yet.

Chest X-ray showed an elevated left hemi-diaphragm with superior displacement of a portion of intra-abdominal contents presumed to be the stomach (green arrowheads) with associated rightward mediastinal shift (yellow arrows). The diagnosis was confirmed by CT. Computed tomography imaging of the chest showed a large, left diaphragmatic defect measuring approximately 5.5 cm with herniation of the upper half of the stomach through the defect. The fundus of the stomach (blue arrow) herniated superiorly through the ruptured diaphragm (red arrow).

Trauma Abdominal/Gastroenterology Visual EM

FAST Exam to Diagnose Subcapsular Renal Hematoma

Michelle Sofia Bakardjiev, MD^* and Amanda Esposito, MD^{^}

DOI: https://doi.org/10.21980/J8NP8DIssue 4:4 No ratings yet.

A bedside point of care ultrasound FAST exam was performed revealing a left subcapsular renal hematoma. The hematoma was a non-compressing hematoma, evidenced by preserved renal contour with the hematoma labeled with a red H and the normal renal contour labeled with a green K. Additionally, cortical necrosis and ischemia can be characterized by a dark, hypoechogenic renal cortex on ultrasonography with a decrease in flow to the cortex on color doppler which was not seen on this patient, providing further evidence that the hematoma was non-compressing. The hematoma was concluded to be an acute process due to its hypoechoic appearance with some mixed ultrasonographic echoes caused by the early deposit of fibrin.

Renal/Electrolytes Visual EM

Right Upper Quadrant Pain in a World Explorer

Julia Hutchison, DO^* and Nur-Ain Nadir, MD, MHPE^*

DOI: https://doi.org/10.21980/J8QP9D Issue 4:4 No ratings yet.

The ultrasound images show the abscess, which is a large, circular, hypoechoic mass outlined in blue in the center of the image. The abscess is surrounded by the hyperechoic and heterogeneous liver tissue. For better delineation of the abscess, a CT was ordered. The axial CT scan image shows the liver abscess, which appears as a hypodense, ovoid, intrahepatic fluid collection within the liver parenchyma. The size of the abscess has been annotated with a dotted line measuring 194.9 mm x 166.2 mm.

Abdominal/Gastroenterology Visual EM

Spontaneous Intracranial Hemorrhage in Severe Hemophilia A: A Rare Cause of Seizure in a Young Child

Sharon Kook Won, MD^* and Andrea T Cruz, MD, MPH^*

DOI: https://doi.org/10.21980/J8G91D Issue 4:3 No ratings yet.

A computed tomography (CT) scan of the head without contrast was obtained out of concern for intracranial pathology due to the patient’s young age and the witnessed focal seizure. The CT showed a 4.2 x 1.2 x 1.5 cm acute extra-axial intracranial right frontoparietal hemorrhage favoring epidural over subdural hemorrhage given its lenticular shape. There was no underlying fracture, herniation or midline shift identified.

Hematology/Oncology Neurology Visual EM

Gastric Volvulus

Julian Jakubowski, DO^*, Jared Lizzi, DO^* and Tyler Hill, DO^*

DOI: https://doi.org/10.21980/J8335F Issue 4:3 No ratings yet.

Point of care ultrasound of his abdomen showed a large fluid filled structure with well-defined borders containing gastric contents extending from the xiphoid process to the umbilical region. No free fluid was noted on focus assessment with sonography for trauma (FAST) examination. A computed tomography (CT) scan was performed emergently and it was noted that the patient had a significantly distended stomach and gastric volvulus (blue arrows) noted in the area of his paraesophageal/hiatal hernia.

Abdominal/Gastroenterology Visual EM

Wandering Spleen

Jeffrey Nafash, MD, MPH^* and Uchechi Azubuine, MD^*

DOI: https://doi.org/10.21980/J8PS7C Issue 4:3 No ratings yet.

History of present illness: A 7-month-old boy presented for evaluation of an abdominal mass. Two weeks prior, the patient had a fever followed by 24 hours of vomiting and abdominal pain, which self-resolved. His pediatrician noted the mass on exam and referred child to the emergency department (ED). His abdominal exam was significant for a hard mass palpated to the

Abdominal/Gastroenterology Visual EM

Acute Pancreatitis

Ronald Goubert, BS^*, Jonathan Peña, MD^*, Alisa Wray, MD, MAEd^* and Eleanor Chu, MD^{^}

DOI: https://doi.org/10.21980/J88W5XIssue 4:2 No ratings yet.

Computed tomography of the abdomen and pelvis with contrast show edema of the pancreas (red outline) and duodenum (yellow arrow) with peripancreatic inflammation, fluid and fat stranding (blue highlight). The distal pancreatic tail was noted to appear normal (green arrow). There was no organized drainable fluid collection, and no parenchymal hypo-enhancement. These findings are consistent with moderate severity acute interstitial pancreatitis.

Abdominal/Gastroenterology Visual EM

Renal and Splenic Infarcts

Niketu Patel, MPH^* and Loice Swisher, MD^*

DOI: https://doi.org/10.21980/J8804KIssue 4:2 No ratings yet.

On the coronal sections of computed tomography (CT), bilateral renal infarctions (blue arrows) and several splenic infarctions (green arrows) are noted. Of particular interest, part of the clot totally occluding the left renal artery visibly extends into the aorta (red arrow). The vascular reconstruction image is remarkable for the absent left kidney, the unusual contour of the right kidney and the abnormal splenic blush.

Visual EM Abdominal/Gastroenterology