Issue 4:4

Incarcerated Ventral Hernia of T-colon Resulting in Colon Perforation and Intraabdominal Abscess

Shu-Chen Han, MD^*

DOI: https://doi.org/10.21980/J83W74 Issue 4:4 No ratings yet.

History of present illness: A 75-year-old female with a remote history of rectal cancer presented to the emergency department with acute right upper abdominal pain. The pain had begun suddenly after lunch. On review of systems, the patient had mild nausea. Initial vital signs were within normal limit. She denied fever, chills, or vomiting. The physical examination revealed a distended,

Abdominal/Gastroenterology Visual EM

Ultrasonographic Findings of Acute Achilles Tendon Rupture

Charles Craig Rudy, MD^{*^}, John A Thompson, MD^* and Rachel R Bengtzen, MD^{*^}

DOI: https://doi.org/10.21980/J8063S Issue 4:4 No ratings yet.

The ultrasound video clip shows a longitudinal view of the AT during a dynamic exam. While the patient’s foot is gently passively dorsi/plantar flexed, the video demonstrates first a normal Achilles tendon (from the unaffected extremity) without disruption (highlighted by a yellow bracket on screen left). Then it shows an abnormal tendon (the patient’s affected side) with disruption of the typical linear tendon fibers (red arrow identifies area of rupture). Dynamic testing shows the movement of the distal stump of the AT is evident adjacent to hypoechoic fluid that is reactive edema or blood from the acute rupture.

Orthopedics Visual EM

Bezoars: An Interesting Case of Abdominal Pain

Eric Chronister, MD^*, Danielle Biggs, MD^*, David Feldman, MD^* and Yaser Daramna, MD^*

DOI: https://doi.org/10.21980/J8VD1V Issue 4:4 No ratings yet.

Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast was ordered to evaluate her symptoms. The CT showed three large collections of ingested material seen as hypodense material with circular rings surrounded by the hyperdense oral contrast (see red outlines). These findings are consistent with bezoars, the largest of which measured 11.5 x 7.8 cm. There was also thickening of the gastric wall (see blue outline), most notably at the pylorus, consistent with partial obstruction.

Abdominal/Gastroenterology Visual EM

Medial Subtalar Dislocation: A Case Report

Claire Thomas, MD^* and Annasha Vyas, BS^*

DOI: https://doi.org/10.21980/J8QP9D Issue 4:4 No ratings yet.

On examination, the patient had a significant deformity to his left foot and ankle. His left foot was pointed medially. His distal left tibia and fibula were visible and palpable upon inspection, with the overlying skin completely intact. There was no neurovascular compromise of the foot. X-ray demonstrated a subtalar dislocation of the left ankle (green arrow) and significant widening of the tibiotalar joint space (yellow arrow). There was associated soft tissue swelling but no acute displaced fractures were identified.

Orthopedics Visual EM

The Elusive Pheo: A Case Report of Pheochromocytoma in the Emergency Department

Jason Cody Pickett, MD^* and Jonah Gunalda, MD^*

DOI: https://doi.org/10.21980/J8KW63 Issue 4:4 No ratings yet.

ED work-up: BMP within normal limits (WNL), white blood cell (WBC) 27.4, ECG showed sinus tachycardia, nonspecific ST segment abnormalities, BNP and troponin were within normal limits, HR 146 beats/minute, CT abdomen/pelvis showed a 10-cm-heterogenous enhancing left adrenal mass (anterior-posterior view [shown in red], lateral view [shown in blue]).

Endocrine Visual EM

Traumatic Diaphragmatic Rupture – A Case Report

Vincent Hussey, MS^* and Claire Thomas, MD^*

DOI: https://doi.org/10.21980/J8G64H Issue 4:4 No ratings yet.

Chest X-ray showed an elevated left hemi-diaphragm with superior displacement of a portion of intra-abdominal contents presumed to be the stomach (green arrowheads) with associated rightward mediastinal shift (yellow arrows). The diagnosis was confirmed by CT. Computed tomography imaging of the chest showed a large, left diaphragmatic defect measuring approximately 5.5 cm with herniation of the upper half of the stomach through the defect. The fundus of the stomach (blue arrow) herniated superiorly through the ruptured diaphragm (red arrow).

Trauma Abdominal/Gastroenterology Visual EM

Classic Slipped Capital Femoral Epiphysis: A Case Report

James Webley, MD^*

DOI: https://doi.org/10.21980/J8BD16 Issue 4:4 No ratings yet.

The pelvis X-ray demonstrates a widened right capital femoral epiphysis (more than 2 mm) that is typical of a slipped capital femoral epiphysis (SCFE).1 The yellow highlight outlines this area of widening. The classic Klein’s line (orange lines) is often inaccurate and even difficult to draw with certainty.1 Nevertheless, in this X-ray, one has a sense that the right capital femoral epiphysis does not align with the femoral neck in the same way as it does on the left side, suggesting slippage.

Orthopedics Visual EM

FAST Exam to Diagnose Subcapsular Renal Hematoma

Michelle Sofia Bakardjiev, MD^* and Amanda Esposito, MD^{^}

DOI: https://doi.org/10.21980/J8NP8DIssue 4:4 No ratings yet.

A bedside point of care ultrasound FAST exam was performed revealing a left subcapsular renal hematoma. The hematoma was a non-compressing hematoma, evidenced by preserved renal contour with the hematoma labeled with a red H and the normal renal contour labeled with a green K. Additionally, cortical necrosis and ischemia can be characterized by a dark, hypoechogenic renal cortex on ultrasonography with a decrease in flow to the cortex on color doppler which was not seen on this patient, providing further evidence that the hematoma was non-compressing. The hematoma was concluded to be an acute process due to its hypoechoic appearance with some mixed ultrasonographic echoes caused by the early deposit of fibrin.

Renal/Electrolytes Visual EM

Right Upper Quadrant Pain in a World Explorer

Julia Hutchison, DO^* and Nur-Ain Nadir, MD, MHPE^*

DOI: https://doi.org/10.21980/J8QP9D Issue 4:4 No ratings yet.

The ultrasound images show the abscess, which is a large, circular, hypoechoic mass outlined in blue in the center of the image. The abscess is surrounded by the hyperechoic and heterogeneous liver tissue. For better delineation of the abscess, a CT was ordered. The axial CT scan image shows the liver abscess, which appears as a hypodense, ovoid, intrahepatic fluid collection within the liver parenchyma. The size of the abscess has been annotated with a dotted line measuring 194.9 mm x 166.2 mm.

Abdominal/Gastroenterology Visual EM