X-Ray
Metastatic Calcinosis Cutis in the Emergency Department: A Case Report
DOI: https://doi.org/10.21980/J87Q00X-ray imaging was obtained of the left elbow and showed soft tissue calcium deposits. Radiology stated, “massive periarticular calcinosis of renal failure obscures fine osseous detail. Several of the largest calcifications have decompressed since the prior exam and may contribute to the drainage observed clinically. Superimposed infection is not excluded.” X-rays with an asterisk are the comparison images from two months previous to the visit. Areas of decompression are highlighted in blue demonstrating that some of the larger calcified nodules are no longer present.
A Case Report of Facial Swelling and Crepitus Following a Dental Procedure
DOI: https://doi.org/10.21980/J83W8HGiven the physical exam findings of crepitus on the right neck up to the right lower eyelid, a maxillofacial CT scan without contrast was performed. It revealed diffuse subcutaneous air within the soft tissues of the face and neck and free air within the pre-septal soft tissue of the right eye, appearing as hyperlucent (dark) areas on CT within the soft tissue planes (blue outline). It showed no evidence of post-septal free air. A single-view chest X-ray was also performed and was unremarkable except for incompletely imaged soft tissue gas in the right lower neck (blue outline). On flexible fiberoptic laryngoscopy performed by ENT, the oropharynx appeared diffusely edematous and narrowed.
Case Report of Incarcerated Gastric Volvulus and Splenic Herniation in Undiagnosed Congenital Diaphragmatic Hernia in an Infant
DOI: https://doi.org/10.21980/J8VD27An upper gastrointestinal series (UGI) showed an enteric tube with its tip in the stomach and side-port in the esophagus. There was a large amount of air in the stomach and a small volume of scattered distal bowel gas. The tip of an enteric tube was seen in the stomach (red arrow). Contrast partially filled the stomach, and the greater curvature was visualized superior to the lesser curvature in the left upper quadrant (blue arrow). The body of the stomach was herniated into the right chest through a Bochdalek hernia (blue star). There was a large amount of air in the stomach and a small volume of scattered distal bowel gas. These findings were consistent with mesenteroaxial gastric volvulus.
A Case Report of Lateral Subtalar Dislocation: Emergency Medicine Assessment, Management and Disposition
DOI: https://doi.org/10.21980/J8SS8PIn a lateral subtalar dislocation, the navicular bone (red bone in 3D anatomy image) and the calcaneus (yellow bone in 3D anatomy image) dislocate laterally in relation to the talus (lavender bone in 3D anatomy image). Plain film oblique and lateral X-rays demonstrate the initial dislocation (talus in red, navicular in blue). It is clear in the initial lateral view that there is loss of the talar/navicular articulation (noted by red arrow). The anterior-posterior x-ray is more challenging to discern the anatomy; however, the talus (red dot) is laterally displaced in comparison to the navicular (blue dot).
A Case Report of Acute Compartment Syndrome
DOI: https://doi.org/10.21980/J87061Inspection of the extremity revealed significant swelling with dark discoloration and multiple bullae (pre-operative photograph). Furthermore, notable swelling of the right foot was noted, which felt cold to palpation. Radiographs of pelvis, bilateral knees, tibia, fibula, and feet demonstrated no fractures or dislocations. The bilateral tibia and fibula X-ray revealed soft tissue swelling in the proximal legs, particularly evident in the right leg's AP view, which also showed numerous ovoid radiodensities in the anterior compartment, likely related to soft tissue injury. Post operative images are also provided demonstrating the patients’ four compartment fasciotomies which were loosely closed using staples.
Case Report of a Child with Colocolic Intussusception with a Primary Lead Point
DOI: https://doi.org/10.21980/J8564QOn the initial ED visit, an abdominal ultrasound (US) was ordered which showed the classic intussusception finding of a target sign (yellow arrow), or concentric rings of telescoped bowel, on the transverse view of the left lower quadrant (LLQ).
A Case of Community-Acquired Tuberculosis in an Infant Presenting with Pneumonia Refractory to Antibiotic Therapy
DOI: https://doi.org/10.21980/J8X07MChest radiographs during the initial presentation at seven weeks of life demonstrated right lower lobe (RLL) air space opacity on both PA and lateral views, compatible with pneumonia (referenced by yellow and green arrows, respectively). Repeat chest radiograph performed 12 days after the initial imaging revealed persistent right lower lobe opacity and right hilar fullness, seen as an opacified projection off of the mediastinal border as compared with the prior image, concerning for lymphadenopathy (designated by the aqua arrow). On the third presentation, computed tomography (CT) of the chest with intravenous contrast found persistent right lower lobe consolidation, innumerable 2-3 mm nodules, and surrounding ground glass opacities. This is best visualized as scattered areas of hyperdensity in the lung parenchyma. Axial images confirmed the presence of right hilar as well as subcarinal lymphadenopathy (indicated by white and pink arrows, respectively). Magnetic resonance imaging (MRI) of the brain with IV contrast was performed which showed a punctate focus of enhancement in the left precentral sulcus compatible with a tuberculoma (denoted with red arrow).
Electronic Cigarette or Vaping-Associated Lung Injury Case Report
DOI: https://doi.org/10.21980/J8S65PThe CT of the chest with contrast showed subcutaneous emphysema (green star), pneumomediastinum (yellow arrow), and pneumopericardium (purple asterix) without an identifiable tracheal tear. Extensive air was visualized as hypodense areas within the chest wall within the soft tissue. The image also detailed a hypodense area surrounding the heart consistent with pneumopericardium. No disruption of the trachea was present. Additionally, the CT of the chest also showed bilateral ground glass airspace opacities (red stars) with subpleural sparing that is consistent with EVALI findings.2,5 These specific findings have been seen in many of the EVALI cases.5 This image is interesting because there is extensive pneumomediastinum with no clearly identifiable cause. The imaging shows no esophageal or tracheal or lung injury, so it is important to note relevant information collected during interview regarding patient’s recent history of vaping THC, especially when establishing a differential diagnosis.
Case Report of a Tongue-Type Calcaneal Fracture
DOI: https://doi.org/10.21980/J8NH11Examination of the right ankle demonstrated a large deformity of the superior talus with bruising and blanching of the overlying skin in the area of the Achilles tendon (see images 2,3). The remaining bones of the foot were not tender to palpation and the foot was neurovascularly intact throughout with only mild numbness in the area of the tented skin. Completing the trauma exam, the patient had no signs of head injury and no midline spinal tenderness to palpation. Inspection of the remaining long bones and joints showed no other injuries. There were mild skin scrapes on the right flank from the fall. X-rays of the right foot and ankle showed a longitudinal fracture of the calcaneal tuberosity from the articular surface to the posterior surface (see red outline) with extension into the subtalar joint (blue lines) and roughly 1.8 cm displacement between the fracture segments (yellow double arrow). These findings represented a tongue-type calcaneal bone fracture.
High-Pressure Injection Injury to the Hand – A Case Report
DOI: https://doi.org/10.21980/J8D64WPlain radiographs of the left hand and forearm demonstrated extensive subcutaneous emphysema. The air can be seen as lucent striations tracking along the second and third fingers as well as along the dorsum of the hand and wrist. There is also diffuse soft tissue emphysema surrounding the metacarpophalangeal joints. Lab analysis did not show any significant acute abnormalities.