Issue 3:3

Pediatric Foreign Body Aspiration

Sha Yan, DO^* and Uchechi Azubuine, MD^{^}

DOI: https://doi.org/10.21980/J8B648Issue 3:3 No ratings yet.

Chest radiograph showed increased radiolucency (red arrow) and flattening of the diaphragm on the right side (blue arrow) consistent with hyperinflation of the right lung, as well as left mediastinal shift (green arrow), indicating obstruction.

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

Right Ventricular Dilation in Patient With Submassive Pulmonary Embolism

Adrian Diez, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J82P84Issue 3:3 No ratings yet.

Bedside echocardiography four chamber view revealed enlarged right ventricular (RV) to left ventricular (LV) ratio (greater than 1) on apical four-chamber view (see red and blue outlines respectively). The right atrium is not clearly delineated in this image and therefore is not outlined. One can also rule out a large pericardial effusion as the cause of her dyspnea, since there is no large hypoechoic collection surrounding the heart on either four- chamber view or parasternal long view.

Cardiology/Vascular Visual EM

Traumatic Hyphema

James Roy Waymack, MD^* and Mark Baker, MD^*

DOI: https://doi.org/10.21980/J8Z04SIssue 3:3 No ratings yet.

Upon initial evaluation, the patient had an obvious hyphema in the right eye with associated conjunctival injection. Initially, the bleeding in the anterior chamber was cloudy just above the level of the pupil (yellow arrow), appearing to possibly be a grade II hyphema. There were no other signs of trauma to the eye under Wood’s lamp examination with fluorescein staining. The globe was intact. Intraocular pressure in the affected eye was 19 mmHg and 15 mmHg in the unaffected eye. Extraocular movements were full and intact. The pupil was 4 mm round and reactive to direct and consensual light. Visual acuity was greater than 20/200 in the affected eye compared to 20/25 in the unaffected eye. After an observation period of two hours, with the patient remaining upright, the hyphema had settled down to a rim in the lower anterior chamber (green arrow), a grade I hyphema.

Ophthalmology Visual EM

Point of Care Ultrasound Illustrating Small Bowel Obstruction

Badriah Alruwaili, MBBS^* and Shadi Lahham, MD^*

DOI: https://doi.org/10.21980/J8T637Issue 3:3 No ratings yet.

POCUS of the small bowel illustrated significantly dilated loops of bowel (white line), thickened bowel wall (white arrow) and to-and-fro peristalsis, consistent with small bowel obstruction.

Abdominal/Gastroenterology Ultrasound Visual EM