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X-Ray

A Case of Community-Acquired Tuberculosis in an Infant Presenting with Pneumonia Refractory to Antibiotic Therapy

Audra N Iness, MD*, Andrea T Cruz, MD, MPH^†, Scott R Dorfman, MD^^ and Esther M Sampayo, MD, MPH^

DOI: https://doi.org/10.21980/J8X07M Issue 8:1 No ratings yet.
Chest 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).
Infectious DiseasePediatricsVisual EM

Electronic Cigarette or Vaping-Associated Lung Injury Case Report

Amy Chuang, DO*, Lauren Bacon, MD* and Anthony Lucero, MD*

DOI: https://doi.org/10.21980/J8S65P Issue 8:1 No ratings yet.
The 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.
RespiratoryVisual EM

Case Report of a Tongue-Type Calcaneal Fracture

Kylie T Callan, BS *, Michael Head, BA*, Gregg Pickett, EMT^ and Ronald Rivera, MD*

DOI: https://doi.org/10.21980/J8NH11 Issue 8:1 No ratings yet.
Examination 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.
OrthopedicsTraumaVisual EM

A Case Report of the Rapid Evaluation of a High-Pressure Injection Injury of a Finger Leading to Positive Outcomes

Nathaniel Hansen, MD* and Colin Danko, MD*

DOI: https://doi.org/10.21980/J8TD2X Issue 7:2 No ratings yet.
On exam the patient was noted to have a punctate wound to the ulnar aspect of his right index finger, just proximal to the distal interphalangeal joint. The finger appeared pale and taut, with absent capillary refill. The patient displayed diminished range of motion with both extension and flexion of the joints of the finger. Sensation was absent and no doppler flow was appreciated to the distal aspects of the finger. X-ray of the hand was obtained and showed many small foreign bodies in the soft tissue and extensive radiolucent material consistent with gas or oil-based material to the palmar aspect of the index finger tracking up to the level of the metacarpal heads.
OrthopedicsVisual EM

A Case Report of Epiglottitis in an Adult Patient

Savannah Tan, BS*, Kyle Dornhofer, MD*, Allen Yang, MD*, Shadi Lahham, MD, MS*  and Lindsey C Spiegelman, MD*

DOI: https://doi.org/10.21980/J8QM09 Issue 7:1 No ratings yet.
At the time of presentation to the ED, laboratory results were significant for leukocytosis to 11.8 x 109 white blood cells/L and a partial pressure of carbon dioxide of 52 mmHg on venous blood gas. Computed tomography (CT) of the soft tissue of the neck with contrast showed edematous swelling of the epiglottis and aryepiglottic fold with internal foci of gas (blue arrow) and partial effacement of the laryngopharyngeal airway and scattered cervical lymph nodes bilaterally (Figure 1). Findings were consistent with epiglottitis containing nonspecific air. Additionally, the pathognomonic “thumbprint sign” (yellow arrow) was found on lateral x-ray of the neck (Figure 2). The CT findings as shown in figure 3 illustrate lateral view of the swelling of the epiglottis, gas, and blockage of the airway.
ENTVisual EM

A Case Report of a Large Goiter Resulting in Tracheal Deviation

Thomas Powell, MD* and Geremiha Emerson, MD*

DOI: https://doi.org/10.21980/J80645 Issue 6:3 No ratings yet.
In the image, one can see significant tracheal deviation around the right side of the mass (black arrows). This degree of deviation would make ventilation in a paralyzed patient extremely difficult, if not impossible.
EndocrineVisual EM

Adult Clavicular Fracture Case Report

Jessica L Sea, PhD*, Nadia Zuabi, MD* and Alisa Wray, MD, MAEd*

DOI: https://doi.org/10.21980/J8FM0TIssue 5:4 No ratings yet.
The patient's chest and clavicular radiographs showed a comminuted displaced acute fracture of the right mid-clavicle (green, blue, yellow). The clavicular fracture was also visible on the chest computed tomography (CT). The remainder of his trauma workup was negative for acute findings.
Current IssueOrthopedicsTraumaVisual EM

Case Report of Distal Radioulnar Joint and Posterior Elbow Dislocation

Danielle Matonis, MD*, Katelyn Wittel, BS* and Alisa Wray, MD, MAEd*

DOI: https://doi.org/10.21980/J89S6K Issue 5:4 No ratings yet.
Radiographs of the left elbow and wrist were obtained. Left elbow radiographs showed simple posterolateral dislocation of the olecranon (red) without fracture of the olecranon (red) or trochlea (blue). Left wrist lateral radiographs demonstrated DRUJ dislocation with dorsal displacement of the distal ulna (green) without fracture or widening of the radioulnar joint (purple). Post-reduction radiographs demonstrated appropriate alignment of the elbow with the trochlea seated in the olecranon and improved alignment of the DRUJ.
Current IssueOrthopedicsTraumaVisual EM

A Case Report of Ogilvie’s Syndrome in a 58-year-old Quadriplegic

Rosie Kumar, BS*, Brett Cowan, MD*, Daniel Quesada, MD* and Sage Wexner, MD*

DOI: https://doi.org/10.21980/J82922 Issue 5:4 No ratings yet.
Plain radiograph of the patient's abdomen revealed a gaseous distention of the colon. This is demonstrated as noted in the abdominal x-ray as gaseous distention, most notably in the large bowel (arrows) including the rectal region (large circle). Follow up computed tomography (CT) scan affirmed severe pancolonic gaseous distention measuring up to 11.2 cm, compatible with colonic pseudo-obstruction as noted by the large red arrows. No anatomical lesion or mechanical obstruction was observed, as well as no evidence of malignancy or other acute process.
Abdominal/GastroenterologyCurrent IssueVisual EM

Is an X-ray a Useful Test for Esophageal Food Boluses? A Case Report

Meryl M Abrams, MD*, Jennifer L White, MD* and Jeffrey Gardecki, MD*

DOI: https://doi.org/10.21980/J8Q639 Issue 5:3 No ratings yet.
The plain film radiograph of the chest demonstrated a fluid level (yellow arrow) in the distal esophagus with dilation of the esophagus proximal to that point (blue line). Neither of these findings were present on the previous visit.
Abdominal/GastroenterologyVisual EM
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