CT

Fournier Gangrene

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

DOI: https://doi.org/10.21980/J89626Issue 3:4 No ratings yet.

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 Disease Visual EM

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 No ratings yet.

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.

ENT Visual EM

Sialadenitis

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

DOI: https://doi.org/10.21980/J8NH0NIssue 3:4 No ratings yet.

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.

ENT Visual EM

Subcutaneous Emphysema After Chest Trauma

Ronald Goubert, BS^* and Alisa Wray, MD, MAEd^*

DOI: https://doi.org/10.21980/J8864NIssue 3:4 No ratings yet.

Plain film anteroposterior (AP) radiography of the chest shows left-sided subcutaneous emphysema (red arrow) with overlapping muscle striations of the pectoralis major (green arrow). After chest tube placement (blue arrow), AP chest radiography shows persistent left-sided subcutaneous emphysema (red arrow). CT of the chest shows pneumomediastinum (blue arrow), left apical pneumothorax (pink arrow), and subcutaneous emphysema (red arrow) at the level of T2. At the level of T6, rib fractures can be visualized on the CT (yellow arrow). At the level of T8, left sided pneumothorax is also seen (pink arrow) as the absence of lung tissue on CT.

Trauma Respiratory Visual EM

An Unusual Case of Hematemesis

Amanda Amen, BA^*, Jane Xiao, MD^{^}, Julie Parks-Bortel, MD^† and Shanna Jones, MD^†

DOI: https://doi.org/10.21980/J84H00Issue 3:4 No ratings yet.

The patient’schest X-ray revealed a prominent mediastinum and opacification in the left middle and lower lung fields. The CT showed an aortic aneurysm extending from the thorax to the abdomen with rupture near T7 (blue arrow). It also showed periaortic hemorrhage with active extravasation (green arrow) likely secondary to a penetrating ulcer and bilateral pulmonary opacities concerning for hemothorax (pink arrow).

Cardiology/Vascular Visual EM

Extensive Aortic Dissection with Normal Vital Signs

Meryl Abrams, MD^*, Nicole Pagliuso, EMT^* and Xiao Chi Zhang, MD, MS^*

DOI: https://doi.org/10.21980/J80S6SIssue 3:4 No ratings yet.

The patient was found to have a Stanford type A dissection (see yellow arrow) with visible false lumen starting at aortic arch (see green circle). The dissection extended into the descending aorta (see blue circle) as shown by the false lumen (red highlighted area) visible on CT. The radiologist performed a reconstruction of the aorta, which showed that the left kidney was not being perfused, making the kidney not visible on the reconstruction.

Cardiology/Vascular Visual EM

Recurrent Sigmoid Volvulus in a Young Female

Ahmed Farhat, BS^* and Robert Rowe, MD^*

DOI: https://doi.org/10.21980/J8GW5SIssue 3:3 No ratings yet.

Computed tomography (CT) of the abdomen and pelvis was obtained revealing a colonic volvulus in the left mid to upper abdomen (blue arrow) involving the distal transverse colon and descending colon, with gaseous colonic distention to 8.5 cm (red arrow). The characteristic “whirl pattern” is also present (yellow arrow). These findings are suggestive of a high-grade colonic obstruction. It was without evidence of pneumoperitoneum, pneumatosis, or drainable collection. Of note, a 3.6 cm dermoid tumor is also observable in the left adnexa (green arrow).

Abdominal/Gastroenterology Visual EM

Acute Dysphagia in a 25-Year-Old Male

Michael Ullo, MD^*, Robert Joshua Dym, MD^{^} and Jill Ripper, MD^*

DOI: https://doi.org/10.21980/J83P8FIssue 3:3 No ratings yet.

After an unremarkable chest radiograph was obtained, a computed tomography (CT) scan of the chest was obtained due to possible co-ingestion of bones to rule out perforation. The CT scan demonstrated focal distention of the mid-esophagus due to an impacted food bolus (white arrow). An aberrant right subclavian artery (yellow arrow) was located just distal to the impaction site with partial compression of the esophagus (red arrow).

Abdominal/Gastroenterology Visual EM

Achalasia: An Uncommon Presentation with Classic Imaging

Joseph Adamson, BS^*, Mina Altwail, MD^{^} and Shanna Jones, MD^{^}

DOI: https://doi.org/10.21980/J86D2BIssue 3:3 No ratings yet.

The chest X-ray demonstrated a markedly widened mediastinum (red brackets), raising concern for thoracic aortic aneurysm/aortic dissection, which prompted labs and contrast-enhanced computed tomography (CT) of the chest. The CT revealed a dilated proximal esophagus that narrowed distally (yellow tracing and red arrow), with particulate material, mass-effect on the trachea (purple outline), and bilateral patchy opacities suggesting aspiration. Barium esophagram showed a drastically dilated esophagus filled with contrast (yellow arrow), terminating into the classic “bird’s beak sign” (red arrow) at the lower esophageal sphincter (LES). Esophageal manometry later confirmed achalasia, proving that widened mediastina can have unexpected etiologies.

Abdominal/Gastroenterology Visual EM

An Unusual Case of Pharyngitis: Herpes Zoster of Cranial Nerves 9, 10, C2, C3 Mimicking a Tumor

Jason Cheng, DO^*, Gregory Reinhold, DO^* and Rahmon Zuckerman, DO^*

DOI: https://doi.org/10.21980/J8B05K Issue 3:2 No ratings yet.

On exam, the patient was sitting upright while holding an emesis basin filled with saliva. His voice was noticeably hoarse. Examination of the head and neck revealed vesicular eruptions on the left scalp in the V1 dermatome and on the left mastoid process (Images 1 and 2). Physical exam also shows vesicular eruptions on the left posterior oropharynx that did not cross midline (Image 3).

ENT Visual EM