Issue 3:3

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Bullous Emphysema

Valerie Lew, MD*, John Costumbrado, MD, MPH^ and Steven Kim, MD^

DOI: https://doi.org/10.21980/J8W62GIssue 3:3[mrp_rating_result]
The upright chest X-ray shows a large lucent area in the left lower lung field without lung markings, with associated curvilinear opacities (yellow arrows) consistent with a large air-filled bulla. The bulla is large enough to compress adjacent lung tissue as shown by the visible pleural line (blue line). The discontinuity of the pleural line and presence of lung markings superiorly makes these findings more consistent with bulla than pneumothorax. The chest computed tomography (CT) confirmed a large left hemithorax bulla.
RespiratoryVisual EM
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The Role of Chest X-Ray and Bedside Ultrasound in Diagnosing Pulmonary Bleb versus Pneumothorax

Mohamad Moussa, MD* and Venkat Reddy Vaddamani, BS*

DOI: https://doi.org/10.21980/J8MP7QIssue 3:3[mrp_rating_result]
The patient was evaluated with bedside ultrasound for concern of possible pneumothorax. Imaging of the left lung with M-mode demonstrated a “sea shore” sign showing a wavy pattern below the pleural line caused by lung sliding as well as “comet tail” artifact caused by from the deep pleura. However, there was no lung sliding on the right shown by a lack of “comet tail” artifact and a “bar code” sign where M-mode shows straight lines throughout the image, this is caused by lack of motion below the pleura. This lack of lung sliding is consistent with possible pneumothorax or bleb.  A two-view chest X-ray (CXR) revealed absent lung parenchyma in the right lung similar to a large pneumothorax (see red outline). Electronic medical record chart review revealed previous CXRs with similar findings. This patient was determined to have an acute COPD exacerbation with chronic blebs, but no pneumothorax.
RespiratoryVisual EM
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Fight Bite with Tendon Laceration

Michelle Chang, MD*, Grant Wei, MD*, Christopher J Bryczkowski, MD*, Sha Yan, DO* and Chirag N Shah, MD*

DOI: https://doi.org/10.21980/J8MP7QIssue 3:3[mrp_rating_result]
The video shows a water bath ultrasound of the right 4th digit, demonstrating soft tissue swelling with a hypoechoic region along the tendon consistent with edema and tendon disruption (see video and annotated still image).
OrthopedicsTraumaVisual EM
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Recurrent Sigmoid Volvulus in a Young Female

Ahmed Farhat, BS* and Robert Rowe, MD*

DOI: https://doi.org/10.21980/J8GW5SIssue 3:3[mrp_rating_result]
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/GastroenterologyVisual EM
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Bilateral Tibia/Fibula Fractures in Automobile versus Pedestrian Accident

Kevin Roy, BS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8C636 Issue 3:3[mrp_rating_result]
Plain film shows severely comminuted and displaced mid tibia/fibula fractures of bilateral lower extremities (red arrows) and comminuted right fibular head (blue arrow) and proximal shaft fracture (yellow arrow).
OrthopedicsVisual EM
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A Rare Cause of Pelvic Pain in a Teenage Girl

Amber Marie Hathcock, MD, MPH*, Manish I Shah, MD, MS*, Jennifer E Dietrich, MD, MSc^ and Esther M Sampayo, MD, MPH*

DOI: https://doi.org/10.21980/J87D0WIssue 3:3[mrp_rating_result]
Due to pain out of proportion to her exam, an ultrasound of her pelvis was obtained and showed a blood-filled distended uterus, or hematometrocolpos (white arrow), with a 4.9 cm right ovarian cyst (blue arrow). A pelvic magnetic resonance imaging (MRI) then revealed an obstructed right hemi-vagina, normal left uterus and vagina and ipsilateral renal agenesis (red arrow) with normal left kidney (double arrow) consistent with obstructed hemivagina, ipsilateral renal agenesis (OHVIRA) syndrome. The patient underwent surgical repair with complete resolution of symptoms.
Ob/GynVisual EM
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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[mrp_rating_result]
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/GastroenterologyVisual EM
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Dorsally-Displaced Metacarpal Dislocation-Fracture

Richard Barnett, DO* and Richard Brodsky, MD*

DOI: https://doi.org/10.21980/J8ZW54Issue 3:3[mrp_rating_result]
A two-view radiograph of the right hand was obtained which revealed a dorsal dislocation of the distal fourth and fifth metacarpals (see red and blue outline, respectively) with a concomitant fracture of the distal fifth metacarpal (see yellow line) and avulsion fracture of the lateral aspect of the hamate (see green line). After reduction the fourth and fifth metacarpal dislocations are resolved; however, the distal fifth metacarpal fracture (yellow line) and avulsion fracture of the lateral aspect of the hamate (green line) are still visible.
OrthopedicsVisual EM