Issue 6:2

Jefferson Fracture and the Classification System for Atlas Fractures, A Case Report

Miguel Angel Martinez-Romo, MD^* and Christopher Eric McCoy, MD, MPH^*

DOI: https://doi.org/10.21980/J88P9C Issue 6:2 No ratings yet.

Computed tomography (CT) revealed a burst fracture (Jefferson) of the anterior arch (white arrows) and of the posterior arch (yellow arrows) of the first cervical vertebrae (C1). There was also a fracture of the right lateral mass (blue arrow) of C1 with mild lateral subluxation of the lateral masses (curved arrows).

Using Point-of-Care Ultrasound to Expedite Diagnosis of Necrotizing Fasciitis: A Case Report

Romero Kupai, MD^*, Ashkan Morim, MD^*, Lucas Friedman, MD^{*^} and Eva Tovar Hirashima, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J85051 Issue 6:2 No ratings yet.

A consultative scrotal ultrasound was performed, which was read as showing a small right hydrocele, small bilateral scrotal pearls, and normal-appearing testes. Although present, there was no mention of subcutaneous air suggestive of NF, seen in figure 1 as punctate hyperechoic foci (arrowhead) with ring-down artifact known as dirty shadowing (arrow). Also, subcutaneous thickening (asterisk) and free fluid (arrow) were seen as shown in figure 2, although their clinical relevance was not recognized in the radiologist's final report. Figure 3 shows an abdominal and pelvic CT that re-demonstrates subcutaneous air in the scrotum and lower abdomen (arrow) as well as fascial thickening of the perineum and free intra-abdominal air. After these images, the patient was transferred to our hospital for further management. Almost immediately after the patient's arrival, POCUS was employed. As seen in figures 4, we were able to identify in just a few minutes extensive subcutaneous air accompanied by dirty shadowing, as well as re-demonstration of subcutaneous thickening, fluid collections, and a right hydrocele. Even without the outside hospital's CT, the sonographic findings were highly suggestive for the diagnosis of NF of the perineum, also known as Fournier’s gangrene.

Infectious Disease Visual EM

A Case Report on Detecting Porcelain Gallbladder form Wall-Echo-Shadow Sign on Point-of-Care Ultrasound

Fares Al-Khouja, MS^*, Proma Mazumder^{^}, John Moeller, MD^† and Shadi Lahham, MD, MS^†

DOI: https://doi.org/10.21980/J8164G Issue 6:2 No ratings yet.

Point-of-care ultrasound (POCUS) was performed by the emergency physician. Gallbladder ultrasound (US) should be performed using a curvilinear probe. If the patient’s body habitus does not allow for the use of a curvilinear probe, a phased array probe may be used. To find the gallbladder with ultrasonography, two approaches are commonly used. Many physicians prefer the “subcostal sweep” in which the probe is placed on the xiphoid process in a sagittal plane and swept along the inferior costal margin until the gallbladder is visualized. If this does not adequately locate the gallbladder, the “X minus 7” approach may be used. In this approach, the probe is placed on the xiphoid (X) process in a transverse view and moved 7 centimeters (minus 7) to the patient’s right. This technique is useful for patients with a larger body habitus. If the gallbladder is still not visualized, placing the patient in left lateral decubitus position or asking them to take a deep breath and hold may help the ultrasonographer locate the gallbladder. The US revealed mild hepatic biliary duct dilation with cholelithiasis and sludge, but no additional evidence to suggest cholecystitis. The US image showed a dilated common bile duct at 0.94 cm and calcifications. Visualization of the gallbladder wall is essential in differentiating between a positive wall-echo-shadow (WES) sign and a porcelain gallbladder. While a hypoechoic gallbladder wall is indicative of a WES sign, a hyperechoic wall layer will indicate a calcified gallbladder wall, suggesting a porcelain gallbladder. In image 1, the hyperechoic gallbladder wall can be visualized (white arrow), suggesting the presence of porcelain gallbladder and distinguishing it from a positive WES sign.

Abdominal/Gastroenterology Ultrasound Visual EM

Auricular Perichondritis after a “High Ear Piercing:” A Case Report

Diego Federico Craik Tobar, MD^* and Adeola Adekunbi Kosoko, MD^*

DOI: https://doi.org/10.21980/J8WH16 Issue 6:2 No ratings yet.

On physical examination, there was erythema, swelling, warmth, and general exquisite tenderness of the superior aspect of the left pinna (the outer ear) but excluding the ear canal, lobe, tragus, and crus. There was no facial involvement. There was no fluctuance about the ear and no drainage of fluid. The preauricular lymph nodes were enlarged and tender, but the anterior cervical lymph nodes were not tender. There was no mastoid tenderness, protrusion of the ear, or interruption of the postauricular crease.

ENT Infectious Disease Visual EM