Photograph

Ascending Thoracic Aortic Dissection: A Case Report of Rapid Detection Via Emergency Echocardiography with Suprasternal Notch Views

Brandon Backlund, MD^*, Anastasia Kendrick-Adey, MD^*, Rachel Harper, MD^* and Martin Makela, MD^*

DOI: https://doi.org/10.21980/J8WW6WIssue 5:2 No ratings yet.

Video of parasternal long-axis bedside transthoracic echocardiogram: The initial images showed grossly normal left ventricular function, and no pericardial effusion or evidence of cardiac tamponade. However, the proximal aorta beyond the aortic valve was poorly-visualized in this window.

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

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

Oral Herpes Zoster

Daniel Polvino, MD^*, Grant Wei, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J8QS69Issue 4:3 No ratings yet.

Physical exam findings revealed vesicular lesions on the lip, hard and soft palates which did not cross the midline. The lesions appeared in the distribution of the maxillary branch (V2) of the trigeminal nerve, consistent with herpes zoster.

Dermatology Infectious Disease Visual EM

Brown Recluse Spider Bite

Laryssa A Patti, MD^*, Benajamin Landgraf, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J8TK99Issue 4:3 No ratings yet.

Examination of the skin revealed erythema and induration on the right lateral leg 12 cm in diameter with a 6 cm area of central necrosis and surrounding petechiae without fluctuance or crepitus. The patient was neurovascularly intact distal to the lesion. Laboratory values were within normal limits, except for an elevated C-reactive protein (5.31 mg/dL, normal range <0.70 mg/dL). The patient was diagnosed with ulceration secondary to envenomation from a brown recluse spider.

Wilderness Visual EM

Levamisole Induced, Cocaine Associated Vasculitis

Jaymin Patel, MD^*, Jason Mefford, MD^{^} and John Richards, MD^*

DOI: https://doi.org/10.21980/J8K35S Issue 4:3 No ratings yet.

An asymmetric pattern of palpable purpura with bullae was noted on bilateral lower extremities with smaller patches on bilateral upper extremities. There was no tenderness or crepitus.

Dermatology Cardiology/Vascular Visual EM

Pectoralis Muscle Tendon Rupture

Wyatt Verplaetse, MD^* and Gregory Podolej, MD^*

DOI: https://doi.org/10.21980/J81D01Issue 4:2 No ratings yet.

There is a noticeable difference in appearance and location of maximal prominence of the right pectoral muscle with arms outstretched (image 1). This is accentuated by having the patient perform an isometric arm press. (image 2).There is absence of the anterior axillary fold with adduction against resistance. The stump of the pectoralis muscle was palpated along his armpit. He otherwise has full range of motion in the shoulder with minimal pain.

Visual EM Orthopedics

Abdominal Pain with Black Tongue

David A Adler, MD^* and Isabel M Algaze Gonzalez, MD^{^}

DOI: https://doi.org/10.21980/J8XS7JIssue 4:1 No ratings yet.

Patient’s tongue had a black discoloration, without elongated filiform papillae. We could not appreciate lymphadenopathy. His abdomen was tender to palpation.

ENT Visual EM