X-Ray

Traumatic Diaphragmatic Rupture – A Case Report

Vincent Hussey, MS^* and Claire Thomas, MD^*

DOI: https://doi.org/10.21980/J8G64H Issue 4:4 No ratings yet.

Chest X-ray showed an elevated left hemi-diaphragm with superior displacement of a portion of intra-abdominal contents presumed to be the stomach (green arrowheads) with associated rightward mediastinal shift (yellow arrows). The diagnosis was confirmed by CT. Computed tomography imaging of the chest showed a large, left diaphragmatic defect measuring approximately 5.5 cm with herniation of the upper half of the stomach through the defect. The fundus of the stomach (blue arrow) herniated superiorly through the ruptured diaphragm (red arrow).

Classic Slipped Capital Femoral Epiphysis: A Case Report

James Webley, MD^*

DOI: https://doi.org/10.21980/J8BD16 Issue 4:4 No ratings yet.

The pelvis X-ray demonstrates a widened right capital femoral epiphysis (more than 2 mm) that is typical of a slipped capital femoral epiphysis (SCFE).1 The yellow highlight outlines this area of widening. The classic Klein’s line (orange lines) is often inaccurate and even difficult to draw with certainty.1 Nevertheless, in this X-ray, one has a sense that the right capital femoral epiphysis does not align with the femoral neck in the same way as it does on the left side, suggesting slippage.

Orthopedics Visual EM

Asymptomatic CT Iodinated Contrast Extravasation of the Upper Extremity

Eric Liao, MD^* and John Costumbrado, MD, MPH^*

DOI: https://doi.org/10.21980/J8VK87 Issue 4:3 No ratings yet.

The two radiographs demonstrate extravasation of radiopaque iodinated contrast in the lower left upper extremity with most seen in the left antecubital fossa and left proximal forearm. Extravasation is seen in the subcutaneous and subfascial tissue.

Visual EM Orthopedics

Open Fracture of the Patella

Zara Khan, BS^*, Devan Pandya, MD^{^} and John Costumbrado, MD, MPH^{^}

DOI: https://doi.org/10.21980/J8BK9Z Issue 4:3 No ratings yet.

X-ray of the right knee showed evidence of an acute comminuted fracture of the patella (red arrows) with a suprapatellar joint effusion with gas (blue arrow). There was no evidence of joint dislocation or other osseous lesions.

Orthopedics Visual EM

Gastric Volvulus

Julian Jakubowski, DO^*, Jared Lizzi, DO^* and Tyler Hill, DO^*

DOI: https://doi.org/10.21980/J8335F Issue 4:3 No ratings yet.

Point of care ultrasound of his abdomen showed a large fluid filled structure with well-defined borders containing gastric contents extending from the xiphoid process to the umbilical region. No free fluid was noted on focus assessment with sonography for trauma (FAST) examination. A computed tomography (CT) scan was performed emergently and it was noted that the patient had a significantly distended stomach and gastric volvulus (blue arrows) noted in the area of his paraesophageal/hiatal hernia.

Abdominal/Gastroenterology Visual EM

Diagnosis and Treatment of an Anterior Shoulder Dislocation with Bedside Ultrasound

Mary Rometti, MD^*, Michael Rohinton Mirza, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J8Z924Issue 4:3 No ratings yet.

Bedside ultrasound with the transducer placed on the posterior right shoulder revealed an anterior dislocation of the right humerus. This is evident by displacement of the humeral head further away from the posteriorly placed ultrasound transducer, and appears deep to the glenoid cavity. In a posterior shoulder dislocation, the humeral head would appear closer to the transducer (and the near field of the ultrasound image) than the glenoid. Note that a hypoechoic, heterogeneous fluid collection is within the joint space, compatible with a hematoma. A right shoulder X-ray confirmed the anterior dislocation with no evidence of fracture. Under direct ultrasound guidance the glenohumeral joint space was injected with 10 mL of 2% lidocaine as an intraarticular anesthetic block. The right shoulder was reduced using continual traction. Post-reduction ultrasound demonstrated a successful shoulder reduction, depicted by the humeral head being relocated to its anatomical location, adjacent to the glenoid cavity, as noted on the ultrasound image. A hematoma remains present within the joint space. Successful shoulder reduction was further confirmed by X-ray. The patient’s arm was placed in a sling and she was discharged home with orthopedics follow-up.

Orthopedics Visual EM

Pneumocystis jirovecii (carinii) Pneumonia

Brian Knight, BS^*, Jonathan Patane, MD^* and Robert Katzer, MD, MBA^*

DOI: https://doi.org/10.21980/J8RW6NIssue 4:2 No ratings yet.

Chest X-ray showed diffuse, patchy interstitial and alveolar infiltrates bilaterally concerning for Pneumocystis jirovecii(previously Pneumocystis carinii) pneumonia (PJP). The AP radiograph (top left figure) showed the classic “bat-wing” distribution on the left side. Repeat radiograph (bottom figure) one day after admission showed worsening of the infiltrates.

Infectious Disease Respiratory Visual EM

Bilateral Shoulder Dislocation after Ski Injury

Alaina Rajagopal, PhD, MD^*, Brian Knight, BS^* and Lance Orr, MD^{^}

DOI: https://doi.org/10.21980/J86929Issue 4:1 No ratings yet.

An anteroposterior chest X-ray demonstrates bilateral shoulder dislocations. Both the right and left humeral heads (blue lines) are displaced medially, anteriorly, and inferiorly from their normal positions in the glenoid fossae (red lines), thus signifying bilateral anterior dislocations. There is also a fracture of the left humeral head at the greater tubercle (green arrow).

Orthopedics Trauma Visual EM

Talonavicular Dislocation

Joseph Zakaria, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8PG91Issue 3:4 No ratings yet.

The X-rays were significant for a subtalar dislocation. The calcaneus (red) is laterally displaced with respect to the talar head (orange), and the white lines indicate the normal articular surface. Additionally, there was a talonavicular dislocation, as seen in the fourth image: the talus (green) and navicular bone (purple) overlapping suggests a dislocation. In a normally aligned foot, the boundaries of the two bones create a point of articulation.

Orthopedics Visual EM

Endocarditis

Sara Arastoo, BS^* and Sari Lahham, MD, MBA^*

DOI: https://doi.org/10.21980/J8JP73Issue 3:4 No ratings yet.

Upright frontal radiograph of the chest demonstrated large pleural effusion on the left and moderate pleural effusion on the right as shown by the visible menisci on both sides (red arrows) with diffuse bilateral nodular densities (yellow dotted lines), consistent with septic pulmonary emboli. Computed tomography (CT) of the chest demonstrated multiple scattered lung nodules bilaterally containing internal foci of air cavitation (green dotted lines).

Infectious Disease Cardiology/Vascular Visual EM