X-Ray

Don’t Forget the Pacemaker – A Rare Complication

Amanda Esposito, MD^*, Kenneth Rapp, MD^* and Albert Ritter, MD^*

DOI: https://doi.org/10.21980/J8GS7HIssue 3:4 No ratings yet.

The ECG demonstrated the presence of pacemaker spikes without appropriate capture (green arrows) and a ventricular escape rhythm which can be identified by an absence of P waves prior to the QRS complex (purple arrows). The portable chest X- demonstrated displaced pacemaker leads (red arrows) that were coiled around the pulse generator (blue arrow).

Cardiology/Vascular Visual EM

The Role of Chest X-Ray and Bedside Ultrasound in Diagnosing Pulmonary Bleb versus Pneumothorax

Mohamad Moussa, MD^* and Venkat Reddy Vaddamani, BS^*

DOI: https://doi.org/10.21980/J8MP7QIssue 3:3 No ratings yet.

The patient was evaluated with bedside ultrasound for concern of possible pneumothorax. Imaging of the left lung with M-mode demonstrated a “sea shore” sign showing a wavy pattern below the pleural line caused by lung sliding as well as “comet tail” artifact caused by from the deep pleura. However, there was no lung sliding on the right shown by a lack of “comet tail” artifact and a “bar code” sign where M-mode shows straight lines throughout the image, this is caused by lack of motion below the pleura. This lack of lung sliding is consistent with possible pneumothorax or bleb. A two-view chest X-ray (CXR) revealed absent lung parenchyma in the right lung similar to a large pneumothorax (see red outline). Electronic medical record chart review revealed previous CXRs with similar findings. This patient was determined to have an acute COPD exacerbation with chronic blebs, but no pneumothorax.

Respiratory Visual EM

Bilateral Tibia/Fibula Fractures in Automobile versus Pedestrian Accident

Kevin Roy, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8C636 Issue 3:3 No ratings yet.

Plain film shows severely comminuted and displaced mid tibia/fibula fractures of bilateral lower extremities (red arrows) and comminuted right fibular head (blue arrow) and proximal shaft fracture (yellow arrow).

Orthopedics Visual EM

Dorsally-Displaced Metacarpal Dislocation-Fracture

Richard Barnett, DO^* and Richard Brodsky, MD^*

DOI: https://doi.org/10.21980/J8ZW54Issue 3:3 No ratings yet.

A two-view radiograph of the right hand was obtained which revealed a dorsal dislocation of the distal fourth and fifth metacarpals (see red and blue outline, respectively) with a concomitant fracture of the distal fifth metacarpal (see yellow line) and avulsion fracture of the lateral aspect of the hamate (see green line). After reduction the fourth and fifth metacarpal dislocations are resolved; however, the distal fifth metacarpal fracture (yellow line) and avulsion fracture of the lateral aspect of the hamate (green line) are still visible.

Orthopedics Visual EM

Woman Swallows a “Handful of Pills”

Sarah E Mott, MD^*, Michael Paddock, DO, MS^{*^} and Jessie Nelson, MD^{*^}

DOI: https://doi.org/10.21980/J8V64XIssue 3:3 No ratings yet.

Soft tissue lateral X-ray of neck was performed. The lateral soft tissue X-ray of the neck showed a metallic foreign body at the level cricoid.

Abdominal/Gastroenterology Visual EM

Lisfranc Injury

Lisa Schwartz, BS^*, Nelly Tan, MD^{^} and John Costumbrado, MD, MPH^*

DOI: https://doi.org/10.21980/J8QD1MIssue 3:3 No ratings yet.

The frontal view of the right foot showed divergent dislocation of the second through fifth metatarsal bones (red outlines) consistent with Lisfranc injury. Though the Lisfranc ligament is not visualized by radiograph, the yellow markings represent the location of the Lisfranc ligament between the medial cuneiform (blue dot) and the base of the second metatarsal bone. The first metatarsal and the medial cuneiform remain congruent. The lateral view shows dorsal dislocation of the midfoot (pink circle) consistent with instability. There is associated extensive midfoot soft tissue swelling.

Orthopedics Visual EM

Incidental Hiatal Hernia on Chest X-ray

Ahmed Farhat, BS^* and Daryn Towle, MD^*

DOI: https://doi.org/10.21980/J8KP8SIssue 3:3 No ratings yet.

The two-view chest X-ray shows mild opacification of the bilateral lower lobes concerning for pneumonia (red arrows). Incidental retrocardiac opacity with air-fluid level consistent with large hiatal hernia is also observed (green arrow).

Abdominal/Gastroenterology Visual EM

Button Battery in Esophagus

Sha Yan, DO^* and Ernest Leva, MD^*

DOI: https://doi.org/10.21980/J8FW6VIssue 3:3 No ratings yet.

Chest radiograph showed the presence of a round radiopaque foreign body in the mid-chest. It was suspected to be in the esophagus rather than in the trachea due to the en-face positioning of the foreign body. The foreign body demonstrated two concentric ring circles concerning for a “double ring” or “halo" sign, which was suggestive of the presence of a button battery rather than a coin.

Abdominal/Gastroenterology Visual EM

Pediatric Foreign Body Aspiration

Sha Yan, DO^* and Uchechi Azubuine, MD^{^}

DOI: https://doi.org/10.21980/J8B648Issue 3:3 No ratings yet.

Chest radiograph showed increased radiolucency (red arrow) and flattening of the diaphragm on the right side (blue arrow) consistent with hyperinflation of the right lung, as well as left mediastinal shift (green arrow), indicating obstruction.

Pediatrics Respiratory Visual EM

Achalasia: An Uncommon Presentation with Classic Imaging

Joseph Adamson, BS^*, Mina Altwail, MD^{^} and Shanna Jones, MD^{^}

DOI: https://doi.org/10.21980/J86D2BIssue 3:3 No ratings yet.

The chest X-ray demonstrated a markedly widened mediastinum (red brackets), raising concern for thoracic aortic aneurysm/aortic dissection, which prompted labs and contrast-enhanced computed tomography (CT) of the chest. The CT revealed a dilated proximal esophagus that narrowed distally (yellow tracing and red arrow), with particulate material, mass-effect on the trachea (purple outline), and bilateral patchy opacities suggesting aspiration. Barium esophagram showed a drastically dilated esophagus filled with contrast (yellow arrow), terminating into the classic “bird’s beak sign” (red arrow) at the lower esophageal sphincter (LES). Esophageal manometry later confirmed achalasia, proving that widened mediastina can have unexpected etiologies.

Abdominal/Gastroenterology Visual EM