Photograph

Pemphigoid Gestationis

Michael Niechayev, BS^* and Lauren Sylwanowicz, MD^*

DOI: https://doi.org/10.21980/J8MG9DIssue 3:4 No ratings yet.

Physical exam findings were significant for 1-3 cm diameter well-demarcated superficial ulcers on the patient’s abdomen and extremities, with mucosal sparing. Several small tense bullae were present on the bilateral inner thighs and numerous small reddish plaques were scattered over the patient’s back. Nikolsky’s sign was negative. No lymphadenopathy was noted.

Dermatology Visual EM

Fight Bite with Tendon Laceration

Michelle Chang, MD^*, Grant Wei, MD^*, Christopher J Bryczkowski, MD^*, Sha Yan, DO^* and Chirag N Shah, MD^*

DOI: https://doi.org/10.21980/J8MP7QIssue 3:3 No ratings yet.

The video shows a water bath ultrasound of the right 4th digit, demonstrating soft tissue swelling with a hypoechoic region along the tendon consistent with edema and tendon disruption (see video and annotated still image).

Orthopedics Trauma Visual EM

Dorsally-Displaced Metacarpal Dislocation-Fracture

Richard Barnett, DO^* and Richard Brodsky, MD^*

DOI: https://doi.org/10.21980/J8ZW54Issue 3:3 No ratings yet.

A two-view radiograph of the right hand was obtained which revealed a dorsal dislocation of the distal fourth and fifth metacarpals (see red and blue outline, respectively) with a concomitant fracture of the distal fifth metacarpal (see yellow line) and avulsion fracture of the lateral aspect of the hamate (see green line). After reduction the fourth and fifth metacarpal dislocations are resolved; however, the distal fifth metacarpal fracture (yellow line) and avulsion fracture of the lateral aspect of the hamate (green line) are still visible.

Orthopedics Visual EM

Woman Swallows a “Handful of Pills”

Sarah E Mott, MD^*, Michael Paddock, DO, MS^{*^} and Jessie Nelson, MD^{*^}

DOI: https://doi.org/10.21980/J8V64XIssue 3:3 No ratings yet.

Soft tissue lateral X-ray of neck was performed. The lateral soft tissue X-ray of the neck showed a metallic foreign body at the level cricoid.

Abdominal/Gastroenterology Visual EM

Traumatic Hyphema

James Roy Waymack, MD^* and Mark Baker, MD^*

DOI: https://doi.org/10.21980/J8Z04SIssue 3:3 No ratings yet.

Upon initial evaluation, the patient had an obvious hyphema in the right eye with associated conjunctival injection. Initially, the bleeding in the anterior chamber was cloudy just above the level of the pupil (yellow arrow), appearing to possibly be a grade II hyphema. There were no other signs of trauma to the eye under Wood’s lamp examination with fluorescein staining. The globe was intact. Intraocular pressure in the affected eye was 19 mmHg and 15 mmHg in the unaffected eye. Extraocular movements were full and intact. The pupil was 4 mm round and reactive to direct and consensual light. Visual acuity was greater than 20/200 in the affected eye compared to 20/25 in the unaffected eye. After an observation period of two hours, with the patient remaining upright, the hyphema had settled down to a rim in the lower anterior chamber (green arrow), a grade I hyphema.

Ophthalmology Visual EM

An Unusual Case of Pharyngitis: Herpes Zoster of Cranial Nerves 9, 10, C2, C3 Mimicking a Tumor

Jason Cheng, DO^*, Gregory Reinhold, DO^* and Rahmon Zuckerman, DO^*

DOI: https://doi.org/10.21980/J8B05K Issue 3:2 No ratings yet.

On exam, the patient was sitting upright while holding an emesis basin filled with saliva. His voice was noticeably hoarse. Examination of the head and neck revealed vesicular eruptions on the left scalp in the V1 dermatome and on the left mastoid process (Images 1 and 2). Physical exam also shows vesicular eruptions on the left posterior oropharynx that did not cross midline (Image 3).

ENT Visual EM

Ramsay Hunt Syndrome

John Costumbrado, MD, MPH^* and Ryan Brenchley, MD^*

DOI: https://doi.org/10.21980/J85S7QIssue 3:2 No ratings yet.

Left-sided cranial nerve VII palsy with flattened forehead creases, inability to keep the left eye open, and drooping of the corner of mouth. Vesicular lesions were found in and posterior to the left ear in a unilateral, dermatomal distribution.

ENT Visual EM

Herpes Zoster Ophthalmicus

Shayna Adams, BS^* and Darren Knight, MD^{^}

DOI: https://doi.org/10.21980/J88H07 Issue 3:2 No ratings yet.

Physical exam was significant for an erythematous maculopapular rash in the right ophthalmic nerve (V1) region, a crusted vesicle at the right upper eyelid, and surrounding eyelid edema. Visual acuity remained at baseline and intraocular pressure was within normal limits. External slit lamp exam with fluorescein staining was remarkable for pseudodendrites in the inferior-temporal cornea approximately 1.5 mm from the limbus. Ophthalmology was consulted and completed an in-depth evaluation of the corneal lesions. They found no evidence of anterior chamber reaction and performed a complete dilated fundus examination which demonstrated no retinal involvement. The patient was then discharged on acyclovir and erythromycin ointment with close follow-up.

Ophthalmology Visual EM

Radial Nerve Palsy

Richard Barnett, DO^* and Amy Church, MD^*

DOI: https://doi.org/10.21980/J8KS7F Issue 3:2 No ratings yet.

On physical exam, the patient was unable to extend his right wrist, thumb, and fingers, and had no sensation of his 1stdorsal interosseous muscles up to the proximal dorsal radial aspect of his forearm. The patient also had slight weakness in thumb abduction. Triceps strength was preserved.

Neurology Visual EM

Rare Rapidly Growing Thumb Lesion in a 12-Year-Old Male

Alana J Arnold, MD, MBA^*

DOI: https://doi.org/10.21980/J8B92J Issue 3:2 No ratings yet.

History of present illness: A 12-year-old male presented to the emergency department with right thumb pain and a mass for four months (see images). He denied fevers, chills, change in appetite, or fatigue. He noted that the lesion was growing and “bleeds easily if bumped.” He denied any trauma to the thumb, except “hitting it” months ago while in football

Hematology/Oncology Orthopedics Visual EM