Issue 3:3

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 No ratings yet.

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).

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

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 No ratings yet.

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).

Orthopedics Visual EM

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 No ratings yet.

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/Gyn 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

Dorsally-Displaced Metacarpal Dislocation-Fracture

Richard Barnett, DO^* and Richard Brodsky, MD^*

DOI: https://doi.org/10.21980/J8ZW54Issue 3:3 No ratings yet.

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.

Orthopedics Visual EM

Woman Swallows a “Handful of Pills”

Sarah E Mott, MD^*, Michael Paddock, DO, MS^{*^} and Jessie Nelson, MD^{*^}

DOI: https://doi.org/10.21980/J8V64XIssue 3:3 No ratings yet.

Soft tissue lateral X-ray of neck was performed. The lateral soft tissue X-ray of the neck showed a metallic foreign body at the level cricoid.

Abdominal/Gastroenterology Visual EM

Lisfranc Injury

Lisa Schwartz, BS^*, Nelly Tan, MD^{^} and John Costumbrado, MD, MPH^*

DOI: https://doi.org/10.21980/J8QD1MIssue 3:3 No ratings yet.

The frontal view of the right foot showed divergent dislocation of the second through fifth metatarsal bones (red outlines) consistent with Lisfranc injury. Though the Lisfranc ligament is not visualized by radiograph, the yellow markings represent the location of the Lisfranc ligament between the medial cuneiform (blue dot) and the base of the second metatarsal bone. The first metatarsal and the medial cuneiform remain congruent. The lateral view shows dorsal dislocation of the midfoot (pink circle) consistent with instability. There is associated extensive midfoot soft tissue swelling.

Orthopedics Visual EM

Incidental Hiatal Hernia on Chest X-ray

Ahmed Farhat, BS^* and Daryn Towle, MD^*

DOI: https://doi.org/10.21980/J8KP8SIssue 3:3 No ratings yet.

The two-view chest X-ray shows mild opacification of the bilateral lower lobes concerning for pneumonia (red arrows). Incidental retrocardiac opacity with air-fluid level consistent with large hiatal hernia is also observed (green arrow).

Abdominal/Gastroenterology Visual EM

Button Battery in Esophagus

Sha Yan, DO^* and Ernest Leva, MD^*

DOI: https://doi.org/10.21980/J8FW6VIssue 3:3 No ratings yet.

Chest radiograph showed the presence of a round radiopaque foreign body in the mid-chest. It was suspected to be in the esophagus rather than in the trachea due to the en-face positioning of the foreign body. The foreign body demonstrated two concentric ring circles concerning for a “double ring” or “halo" sign, which was suggestive of the presence of a button battery rather than a coin.

Abdominal/Gastroenterology Visual EM