Photograph

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

Biceps Tendon Rupture

Daniel M Polvino, MD^*and Grant Wei, MD^*

DOI: https://doi.org/10.21980/J8RP8B Issue 3:1 No ratings yet.

Physical exam was significant for ecchymosis and mild swelling of the right bicep. When the right arm was flexed at the elbow, a prominent mass was visible and palpable over the right bicep. Right upper extremity strength was 4/5 with flexion at the elbow.

Orthopedics Visual EM

Hutchinson’s Sign

Lawrence Lau, MD^*, Hannah Mirzakhani, BA^{^} and Nicholas Governatori, MD^*

DOI: https://doi.org/10.21980/J8N040 Issue 3:1 No ratings yet.

The unilateral distribution of vesicular lesions over the patient's left naris, cheek, and upper lip are consistent with Herpes zoster reactivation with Hutchinson's sign. Hutchinson's sign is a herpes zoster vesicle present on the tip or side of the nose.1 It reflects zoster involvement of the 1st branch of the trigeminal nerve, and is concerning for herpes zoster ophthalmicus.1 Herpes zoster vesicles may present as papular lesions or macular vesicles on an erythematous base.2,3 Emergent diagnosis must be made to prevent long-term visual sequelae.4

Infectious Disease Dermatology Visual EM

A Sublingual Mass in a 5-Year-Old Male

Chris A Rees MD, MPH^*, Andrea T Cruz, MD, MPH^{^} and Corrie E Chumpitazi, MD, MS^{^}

DOI: https://doi.org/10.21980/J8H622Issue 3:1 No ratings yet.

Oral ranula. On oral inspection he had a 3 x 1.5 cm, soft, non-tender, mobile, cystic, sublingual mass on the right aspect of the floor of his mouth that did not move with swallowing (Image 1). There was mild associated submandibular swelling on the right side of his face.

ENT Visual EM

Oropharynx Ulceration

Lauren Sylwanowicz, MD^* and Andrew Wong, MD, MBA^*

DOI: https://doi.org/10.21980/J87W60 Issue 2:4 No ratings yet.

The photograph demonstrates an area of ulcerative tissue at the left palatine tonsil without surrounding erythema or purulent drainage. The computed tomography (CT) scan shows a large ulceration of the left soft palate and palatine tonsil (red arrow). There is no evidence of skull base osteomyelitis. There is suppurative lymphadenopathy with partial left jugular vein compression due to mass effect (yellow highlight). There is mild nasopharyngeal airway narrowing with architectural distortion (blue arrow), but no other evidence of airway obstruction.

ENT Visual EM

Erythema Migrans

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

DOI: https://doi.org/10.21980/J8QW7QIssue 2:4 No ratings yet.

History of present illness: A 28-year-old male presented to the emergency department with a chief complaint of two weeks of headache, chills, and numbness in his hands. He reported removing a tick from his upper back approximately two weeks ago, but did not know how long the tick had been embedded. His review of symptoms was otherwise unremarkable. Significant findings:

Dermatology Infectious Disease Visual EM

Chancre of Primary Syphilis

Adnan Riaz MD^* and Grant Wei MD^*

DOI: https://doi.org/10.21980/J83342 Issue 2:4 No ratings yet.

Physical examination revealed a non-tender, erythematous lesion on the glans penis, two similar adjacent satellite lesions, as well as tender inguinal lymphadenopathy. No penile discharge was noted.

Infectious Disease Dermatology Genitourinary Visual EM

Corneal Sparing Conjunctival Abrasion

Hamid Ehsani-Nia, MS^*, Tanya Dall, MD^{^} and Samantha Costantini, MD^{^}

DOI: https://doi.org/10.21980/J8KG93 Issue 2:3 No ratings yet.

Physical exam was significant for multiple broken teeth, multiple minor abrasions on the face, and fine shards of shattered glass on his face and hair. His right eye had conjunctival injection, with no signs of subconjunctival hemorrhage or ocular penetration. Vision, extraocular movement, and pupillary exam were grossly intact. Fluorescein staining with slit lamp exam with cobalt blue filter examination of the right eye revealed superficial bulbar conjunctival uptake of fluorescein dye staining an area of the conjunctiva inferior to the limbus 5 mm vertical by 2 mm horizontal (estimation by photo provided). No foreign bodies were visualized in the inferior fornix. These findings were consistent with superficial conjunctival abrasion. The exam noted sparing of the corneal epithelium.

Ophthalmology Visual EM

Steven-Johnson Syndrome

Pauline Joy F. Santos, MD^* and Lauren Sylwanowicz, MD^*

DOI: https://doi.org/10.21980/J8661W Issue 2:3 No ratings yet.

At presentation to the ED, a macular rash was notable on all four extremities, trunk and face, and involved mucous membranes of the oropharynx and vaginal introitus. The rash was painful, erythematous and purpuric with targetoid lesions. There were also multiple areas of sloughing and desquamation with a positive Nikolsky sign. Denudement totaled approximately 2% of total body surface area.

Dermatology Visual EM