X-Ray

Subcutaneous Emphysema After Chest Trauma

Ronald Goubert, BS^* and Alisa Wray, MD, MAEd^*

DOI: https://doi.org/10.21980/J8864NIssue 3:4 No ratings yet.

Plain film anteroposterior (AP) radiography of the chest shows left-sided subcutaneous emphysema (red arrow) with overlapping muscle striations of the pectoralis major (green arrow). After chest tube placement (blue arrow), AP chest radiography shows persistent left-sided subcutaneous emphysema (red arrow). CT of the chest shows pneumomediastinum (blue arrow), left apical pneumothorax (pink arrow), and subcutaneous emphysema (red arrow) at the level of T2. At the level of T6, rib fractures can be visualized on the CT (yellow arrow). At the level of T8, left sided pneumothorax is also seen (pink arrow) as the absence of lung tissue on CT.

An Unusual Case of Hematemesis

Amanda Amen, BA^*, Jane Xiao, MD^{^}, Julie Parks-Bortel, MD^† and Shanna Jones, MD^†

DOI: https://doi.org/10.21980/J84H00Issue 3:4 No ratings yet.

The patient’schest X-ray revealed a prominent mediastinum and opacification in the left middle and lower lung fields. The CT showed an aortic aneurysm extending from the thorax to the abdomen with rupture near T7 (blue arrow). It also showed periaortic hemorrhage with active extravasation (green arrow) likely secondary to a penetrating ulcer and bilateral pulmonary opacities concerning for hemothorax (pink arrow).

Cardiology/Vascular Visual EM

Croup

Victor Cisneros, MD, MPH^*, Joseph Zakaria, BS^* and Wirachin Hoonpongsimanont, MD^*

DOI: https://doi.org/10.21980/J8W05JIssue 3:4 No ratings yet.

The anteroposterior X-ray reveals the classic steeple sign (blue outline) indicative of subglottic edema leading to tracheal narrowing, consistent with croup. The lateral x-ray shows narrowing of the subglottic region (green outline and arrows).

Pediatrics Respiratory Visual EM

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