Issue 2:3

Corneal Sparing Conjunctival Abrasion

Hamid Ehsani-Nia, MS^*, Tanya Dall, MD^{^} and Samantha Costantini, MD^{^}

DOI: https://doi.org/10.21980/J8KG93 Issue 2:3 No ratings yet.

Physical exam was significant for multiple broken teeth, multiple minor abrasions on the face, and fine shards of shattered glass on his face and hair. His right eye had conjunctival injection, with no signs of subconjunctival hemorrhage or ocular penetration. Vision, extraocular movement, and pupillary exam were grossly intact. Fluorescein staining with slit lamp exam with cobalt blue filter examination of the right eye revealed superficial bulbar conjunctival uptake of fluorescein dye staining an area of the conjunctiva inferior to the limbus 5 mm vertical by 2 mm horizontal (estimation by photo provided). No foreign bodies were visualized in the inferior fornix. These findings were consistent with superficial conjunctival abrasion. The exam noted sparing of the corneal epithelium.

Ophthalmology Visual EM

Volvulus

Sari Lahham, MD, MBA^*, Kathryn Bennett, BS^* and Mohammad Helmy, MD^†

DOI: https://doi.org/10.21980/J8JH0Q Issue 2:3 No ratings yet.

Upright and supine frontal radiographs of the abdomen demonstrate gas dilation of the large bowel from the level of the cecum to the sigmoid colon with air fluid levels (yellow arrows). There is a swirled configuration of the distal descending to sigmoid colon indicating the level of the volvulus (dashed yellow line) and giving rise to the classic “coffee bean” sign (dotted white tracing). Note the elevated left hemidiaphragm on the upright view reflecting abdominal distention with increased intra-abdominal pressure (red arrow).

Abdominal/Gastroenterology Visual EM

Pneumonia Diagnosed by Point-of-Care Ultrasound

Akash Patel, BA^*, Steven Bunch, MD^{^}, Maili Alvarado, MD^{^}, Shadi Lahham, MD^{^} and J. Christian Fox, MD^{^}

DOI: https://doi.org/10.21980/J8XP64 Issue 2:3 No ratings yet.

Point-of-care ultrasound of the left lower lobe demonstrates lung hepatization, a classic finding for pneumonia. In addition, a shred sign is present with both air bronchograms and focal B-lines—all suggestive of poorly aerated, consolidated lung. The patient was started on antibiotics and admitted to the hospital with a diagnosis of community-acquired pneumonia.

Ultrasound Respiratory Visual EM

Re-expansion Pulmonary Edema

Kathryn Bennett, BS, BA^* and Benjamin Feldman, MD^*

DOI: https://doi.org/10.21980/J8WS6V Issue 2:3 No ratings yet.

Initial chest X-ray (chest X-ray 1) showed a right-sided pleural effusion with compressive atelectasis of the mid to lower right lung. Repeat chest X-ray immediately after evacuation (chest X-ray 2) shows improvement of the pleural effusion and a new trace apical right pneumothorax measuring 6.7 mm. When the patient became tachypneic, a third X-ray (chest X-ray 3) showed persistent trace apical right pneumothorax measuring 6.7 mm.

Respiratory Visual EM

Asymptomatic Wolff-Parkinson-White Syndrome: Incidental EKG

Samer Assaf, MD^* and Christopher Libby, MD, MPH^{^}

DOI: https://doi.org/10.21980/J8T05X Issue 2:3 No ratings yet.

The ECG shows slurred up-stroking of the QRS complexes characteristic of a delta wave. The PR interval is normal; however, the QT interval is greater than 110ms.

Cardiology/Vascular Visual EM

Renal Infarction from Type B Aortic Dissection

Marit Tweet, MD^* and James Roy Waymack, MD^*

DOI: https://doi.org/10.21980/J8HG9G Issue 2:3 No ratings yet.

Initial abdominal images demonstrated a dissection flap; therefore, a CTA of the chest was also obtained. These images revealed a Stanford type B aortic dissection beginning just distal to the left subclavian artery and extending to the origin of the inferior mesenteric artery. The right renal artery arose from the true lumen of the dissection while the left renal artery arose from the false lumen. This case is interesting as imaging shows the lack of perfusion to the left kidney, residing in the retroperitoneum, which correlates with her non-descript abdominal and left flank pain.

Cardiology/Vascular Renal/Electrolytes Visual EM

Esophageal Perforation

Valentina Park, BS^* and Jason Mefford, MD^{^}

DOI: https://doi.org/10.21980/J8K91B Issue 2:3 No ratings yet.

History of present illness: A 51-year-old male with history of gastroesophageal reflux disease status post multiple endoscopies presented to the emergency department with severe abdominal pain. Paramedics reported the patient appeared diaphoretic on arrival and maintained stable vital signs during transit. The patient reported taking Prilosec that morning before eating breakfast, after which he felt like something was stuck in

Abdominal/Gastroenterology Visual EM

Globe Rupture

Reid Honda, MD^*

DOI: https://doi.org/10.21980/J8N91Z Issue 2:3 No ratings yet.

The patient’s computed tomography (CT) head demonstrated a deformed left globe, concerning for ruptured globe. The patient had hyperdense material in the posterior segment (see green arrow), consistent with vitreous hemorrhage. CT findings that are consistent with globe rupture may include a collapsed globe, intraocular air, or foreign bodies.

Ophthalmology Visual EM

Steven-Johnson Syndrome

Pauline Joy F. Santos, MD^* and Lauren Sylwanowicz, MD^*

DOI: https://doi.org/10.21980/J8661W Issue 2:3 No ratings yet.

At presentation to the ED, a macular rash was notable on all four extremities, trunk and face, and involved mucous membranes of the oropharynx and vaginal introitus. The rash was painful, erythematous and purpuric with targetoid lesions. There were also multiple areas of sloughing and desquamation with a positive Nikolsky sign. Denudement totaled approximately 2% of total body surface area.

Dermatology Visual EM