X-Ray

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An Elderly Female with Dyspnea and Abdominal Pain

Jon Van Heukelom, MD*

DOI: https://doi.org/10.21980/J83S3KIssue 2:1[mrp_rating_result]
Radiography shows a dilated, gas-filled structure that fills nearly the entire left hemi-thorax. Lung markings are visible in the uppermost portion of the left hemi-thorax. There is mediastinal shift to the right. In the visualized portion of the abdomen, dilated loops of bowel are also visualized. This constellation of findings is consistent with a tension gastrothorax.
RespiratoryVisual EM
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Irreducible Traumatic Posterior Shoulder Dislocation

Blake Collier, DO* and Christopher Trigger, MD*

DOI: https://doi.org/10.21980/J8V884Issue 2:1[mrp_rating_result]
Radiographs demonstrated posterior displacement of the humeral head on the “Y” view (see white arrow) and widening of the glenohumeral joint space on anterior-posterior view (see red arrow). The findings were consistent with posterior dislocation and a Hill-Sachs type deformity. Sedation was performed and reduction was attempted using external rotation, traction counter-traction. An immediate “pop” was felt during the procedure. Post-procedure radiographs revealed a persistent posterior subluxation with interlocking at posterior glenoid. CT revealed posterior dislocation with acute depressed impaction deformity medial to the biceps groove with the humeral head perched on the posterior glenoid, interlocked at reverse Hill-Sachs deformity (see blue arrow).
OrthopedicsVisual EM
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Pseudogout and Calcium Pyrophosphate Disease

Andrew Williamson, MD*

DOI: https://doi.org/10.21980/J8QG66Issue 2:1[mrp_rating_result]
Radiographs of the knee showed multiple radio-dense lines paralleling the articular surface (see red arrows) consistent with calcium pyrophosphate crystal deposition within the joint often seen in calcium pyrophosphate disease (CPPD) also known as pseudogout.
OrthopedicsVisual EM
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Ventriculoperitoneal Shunt Migration

Justin P Puller, MD* and Jonathan T Miller, MD*

DOI: https://doi.org/10.21980/J8G019Issue 2:1[mrp_rating_result]
An immediate post-op abdominal x-ray performed after the patient’s VP shunt revision 30 days prior to this ED visit reveals the VP shunt tip in the mid abdomen. A CT of the abdomen performed on the day of the ED visit reveals the VP shunt tip interposed between the spleen and the diaphragm.
Abdominal/GastroenterologyVisual EM
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Lunate Dislocation

Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J86K56Issue 2:1[mrp_rating_result]
Plain film of the right wrist showed the classic “spilled teacup” consistent with a lunate dislocation. There is a loss of the normal articulation between the distal radius and lunate.
OrthopedicsTraumaVisual EM
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Pediatric Supracondylar Fracture

Jonathan Peña, MD* and John R. Marshall, MD*

DOI: https://doi.org/10.21980/J8T88TIssue 2:1[mrp_rating_result]
Plain film radiography showed a displaced supracondylar fracture with disrupted anterior and posterior periostea, consistent with a type 3 supracondylar fracture.
OrthopedicsVisual EM
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Calcaneal Fractures and Böhler’s Angle

Lindsey Spiegelman, MD* and Mohammed Helmy, MD^

Issue 2:1[mrp_rating_result]
The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow) in addition to fracture fragments along the heel pad margin (blue arrow). The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow). There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow) in addition to a joint effusion. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle).
OrthopedicsVisual EM
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Gastric Bezoar

Samer Assaf MD*

DOI: https://doi.org/10.21980/J85K5WIssue 2:1[mrp_rating_result]
In the abdominal radiograph, a nonspecific and non-obstructive bowel gas pattern with no air-fluid level was noted, however the stomach was distended with soft tissue. The CT abdomen/pelvis revealed a distended stomach with undigested heterogeneous contents (presumed bezoar).
Abdominal/GastroenterologyVisual EM