Issue 3:4

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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/VascularVisual EM
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Croup

Victor Cisneros, MD, MPH*, Joseph Zakaria, BS* and Wirachin Hoonpongsimanont, MD*

DOI: https://doi.org/10.21980/J8W05JIssue 3:4 No ratings yet.
The anteroposterior X-ray reveals the classic steeple sign (blue outline) indicative of subglottic edema leading to tracheal narrowing, consistent with croup. The lateral x-ray shows narrowing of the subglottic region (green outline and arrows).
PediatricsRespiratoryVisual EM
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Various Degrees of Thermal Burns

Hamid Ehsani-Nia, DO*, Mohammad I Ehsani-Nia, BS* and John Collins, MD*

DOI: https://doi.org/10.21980/J8R91WIssue 3:4 No ratings yet.
On exam,there is a large swath of skin with evidence of thermal injury involving the neck, shoulder, chest, and face, including damage to the ear, external nostril, and lips. Burns exhibit varying degrees of severity and total approximately 4.5% of the body surface area. Several areas are charred and insensate to pinprick. The left earlobe is partially burned off. Patient's airway is patent with no evidence of thermal injury or obstruction to the oropharynx or nasal vestibule.
TraumaVisual EM
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Pemphigoid Gestationis

Michael Niechayev, BS* and Lauren Sylwanowicz, MD*

DOI: https://doi.org/10.21980/J8MG9DIssue 3:4 No ratings yet.
Physical exam findings were significant for 1-3 cm diameter well-demarcated superficial ulcers on the patient’s abdomen and extremities, with mucosal sparing. Several small tense bullae were present on the bilateral inner thighs and numerous small reddish plaques were scattered over the patient’s back. Nikolsky’s sign was negative. No lymphadenopathy was noted.
DermatologyVisual EM
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Don’t Forget the Pacemaker – A Rare Complication

Amanda Esposito, MD*, Kenneth Rapp, MD* and Albert Ritter, MD*

DOI: https://doi.org/10.21980/J8GS7HIssue 3:4 No ratings yet.
The ECG demonstrated the presence of pacemaker spikes without appropriate capture (green arrows) and a ventricular escape rhythm which can be identified by an absence of P waves prior to the QRS complex (purple arrows). The portable chest X- demonstrated displaced pacemaker leads (red arrows) that were coiled around the pulse generator (blue arrow).   
Cardiology/VascularVisual EM