Issue 5:1

Bilateral Common Iliac Artery Aneurysm

Laura Kolster, DO^*, Danielle Biggs, MD^*, Amy Patwa, DO^* and Michael Gerardi, MD^*

DOI: https://doi.org/10.21980/J83S73 Issue 5:1 No ratings yet.

A bedside ultrasound of the aorta was performed. The proximal, middle, and distal aorta appeared normal in caliber, as demonstrated by the images; however there seemed to be some enlargement at the bifurcation. The bifurcation into the iliac arteries, as highlighted by the yellow arrow, demonstrates a slightly enlarged iliac artery on the left. The aorta was followed below the bifurcation as it divided into the iliac arteries, as shown in the video clip. The ultrasound demonstrated a left iliac artery aneurysm measuring 5.99 cm, as highlighted by the orange circle. There were aneurysms to the bilateral common and internal iliac arteries.

Case Report: Acute Supraglottitis

Jamie Robin Chu, MD^* and Jonathan G Rogg, MD, MBA^{^}

DOI: https://doi.org/10.21980/J8006V Issue 5:1 No ratings yet.

On arrival, radiographs of the neck soft tissues were obtained, which showed a markedly enlarged epiglottic shadow (red arrow) concerning for epiglottitis. A computed tomography scan of the neck soft tissues with contrast was then obtained which revealed edematous mucosal thickening of the oropharynx (blue arrow) and supraglottic larynx (green arrow) including the epiglottis (purple arrow) concerning for acute infectious pharyngitis and supraglottic laryngitis with severe narrowing of the supraglottic laryngeal lumen, as well as associated extensive inflammation and edema of the superficial and deep left neck spaces. The patient’s white blood cell count was elevated to 25.7x109/L with 87% neutrophils. Her rapid strep test was positive. Otolaryngology was consulted and performed a bedside flexible laryngoscopy which showed significant edema of the epiglottis (orange arrow), vocal cords (white arrow), and arytenoids (black arrow), left greater than right. Based on the findings and concern for impending respiratory failure, the patient received an awake fiberoptic intubation by anesthesia at the bedside.

Infectious Disease ENT Visual EM

Case Report of the Unusual Presentation of Stridor in an Elderly Patient Following a Cervical Fracture

Benjamin Travers, BS^*, Rachel Dearden, MD^{^}, Shanna Jones, MD^{^}, and Michael Opsommer, MD^{^}

DOI: https://doi.org/10.21980/J8V926 Issue 5:1 No ratings yet.

The cervical CT was significant for a transverse fracture through the C4 vertebral body (see red arrow), lateral facet (green arrow), spinous process (blue arrow), and right lamina (purple arrow) as well as surrounding edema and retropharyngeal thickening (yellow line), best appreciated on sagittal view.

Visual EM Orthopedics Respiratory

Henoch-Schönlein Purpura in the Adult

Ivan Virovets, DO^* and Danielle Biggs, MD^*

DOI: https://doi.org/10.21980/J8QH08 Issue 5:1 No ratings yet.

The images show a raised, palpable, purpuric rash on the lower extremities, surrounded by a mild, 1+ non-pitting edema. Several of the lesions are exfoliated with serous discharge. There is no surrounding erythema, fluctuance, or lymphangitis to suggest cellulitis. There was no tenderness to palpation; however, pruritus was exacerbated on palpation.

Dermatology Cardiology/Vascular Visual EM

Digital Nerve Block for the Reduction of a Proximal Phalanx Fracture of the Foot – a Case Report

Emerald Raney, MD^*, John Costumbrado, MD, MPH^*, Barbara Blasko, MD^*and Dev Dhillon, BS^{^}

DOI: https://doi.org/10.21980/J8KS8T Issue 5:1 No ratings yet.

Plain film of the right foot showed evidence of an oblique fracture of the body of the proximal 4th phalanx (image 2). No other acute traumatic injuries noted in the rest of the bones and joints of the right foot. After performing a digital block of the toe and reduction, repeat imaging showed evidence of successful reduction with anatomic alignment and redemonstration of the fracture line (image 3).

Visual EM Orthopedics

Case Report: Antifreeze Ingestion and Urine Fluorescence

Taras Varshavsky, MD^* and Meigra Myers Chin, MD^*

DOI: https://doi.org/10.21980/J8G05T Issue 5:1 No ratings yet.

The patient’s urine sample (right) was compared to a control (left) using a Wood’s lamp. It revealed light green fluorescence under ultraviolet light, which increased suspicion for ethylene glycol poisoning from antifreeze ingestion.

Toxicology Visual EM