Photograph

Suspicious Skin Lesion in an 11-Year-Old Male

Rachel E Bonczek, MSN^*, Kimberley M Farr, MD^{^} and Corrie E Chumpitazi, MD, MS^‡

DOI: https://doi.org/10.21980/J8JK9TIssue 4:1 No ratings yet.

The patient had a 5 cm ulcerative lesion with raised borders and a yellow, “fatty” center. There was no active drainage, site tenderness, or lymphadenopathy.

Visual EM Dermatology Infectious Disease

Warm & Blue: A Case of Methemoglobinemia

Danielle Biggs, MD^* and David C Castillo, DO^*

DOI: https://doi.org/10.21980/J8591M Issue 4:1 No ratings yet.

The patient hadperioral cyanosis, blue coloration around her mouth, but the rest of the skin on her face appeared normal. She also had acrocyanosis to bilateral hands that can be seen in the image. The patient has a tan complexion up to the level of her wrists, but the palms of her hands are pale and cyanotic.

Hematology/Oncology Visual EM

Open Globe with Intraocular Foreign Body

Stephen Weiss, MD^*, Dustin Williams, MD^*, Yih Ying (Eva) Yuan, MD^* and Jo-Ann Nesiama, MD, MS^*

DOI: https://doi.org/10.21980/J8S348 Issue 4:1 No ratings yet.

On physical exam, his extraocular movements were intact. The right anterior chamber appeared cloudy, particularly nasal to the pupil. The conjunctiva of the right eye was injected. The right pupil was 3 mm and sluggishly reactive and appeared slightly irregular (see yellow arrow). Of note, the right eye also had a 1 mm hypopyon, indicating inflammation of the anterior chamber, which was visible on slit lamp examination (not pictured). There was no fluorescein uptake or Seidel sign. His visual acuity was 20/60 OD (right eye) and 20/20 OS (left eye).

Ophthalmology Visual EM

Hypopyon

Chandni Ravi, MD^* and Tiffany Murano, MD^*

DOI: https://doi.org/10.21980/J8N92BIssue 4:1 No ratings yet.

Physical examination of the left eye revealed a hypopyon (green arrow) – which is a layered white to yellow sediment in front of the inferior aspect of the iris associated with scleral injection and chemosis. Extraocular movements were intact bilaterally and pain did not worsen with extraocular movement. The pupil was poorly reactive to direct light and only hand movement could be perceived. The intraocular pressure was 14 mmHg. Slit lamp exam demonstrated a dense cataract. Bedside ocular ultrasound demonstrated vitreous opacities concerning for possible intraocular foreign bodies.

Ophthalmology Visual EM

Tick Removal

Belinda Lao, MD^* and Xiao Chi Zhang, MD^*

DOI: https://doi.org/10.21980/J8HK9H Issue 4:1 No ratings yet.

On physical exam, an engorged tick was found attached to the patient’s left upper back. The underlying skin was nontender but mildly erythematous, without central clearing. The tick was gently removed with blunt angle forceps and sent for further analysis, which later revealed the specimen to be an American dog tick (Dermacentor variabilis).

Wilderness Visual EM

Lightning Ground Current Injury: A Subtle Shocker

Gregory S Podolej, MD^* and Naomi Nardi, MD^*

DOI: https://doi.org/10.21980/J8KD1C Issue 4:1 No ratings yet.

The first photograph demonstrates a dendritic blister (Lichtenburg figure) on the medial aspect of his right foot where the ground current injury entered the patient's foot. Although no data exists regarding the sensitivity or specificity of Lichtenberg figures as skin findings, they are considered pathognomonic for lightning injuries and are not produced by alternating current or industrial electrical injuries. The second photograph demonstrates a 4 x 3 cm area of petechiae where the ground current injury exited the patient.

Wilderness Dermatology Visual EM

Facial Fracture Induced Periorbital Emphysema

Hamid Ehsani-Nia, DO^* and Robert Eisenstein, MD^*

DOI: https://doi.org/10.21980/J8F05HIssue 3:4 No ratings yet.

Physical exam showed marked left palpebral subcutaneous crepitus, as well as bulbar and palpebral conjunctival bulging. Visual acuity was normal with intact extraocular movements, and normal pupillary exam. Computed tomography (CT) imaging of the face was obtained and revealed multiple displaced fractures involving the left orbital floor and zygomatic arch associated with moderate periorbital and postseptal extraconal gas, resulting in orbital proptosis.

Trauma ENT Visual EM

Corneal Rust Ring

Joseph Zakaria, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8X067Issue 3:4 No ratings yet.

The photograph reveals a limbic metallic foreign body with a surrounding corneal rust ring (arrow) in the three o’clock position of the left cornea.

Ophthalmology Visual EM

Cauliflower Ear Secondary to a Chronic Auricular Hematoma

Nichole Niknafs, DO^*

DOI: https://doi.org/10.21980/J8S63XIssue 3:4 No ratings yet.

On exam, the patient has a gross deformity to the left pinna that was not painful to touch or fluctuant. Findings and history are consistent with cauliflower ear, secondary to a chronic auricular hematoma.

ENT Visual EM

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.

Trauma Visual EM