X-Ray

Spontaneous Pneumothorax

John Costumbrado, MD, MPH^* and Steven Kim, MD^*

DOI: https://doi.org/10.21980/J8M33BIssue 2:4 No ratings yet.

Initial chest radiograph showed a 50% right-sided pneumothorax with no mediastinal shift, which can be identified by the sharp line representing the pleural lung edge (see arrows) and lack of peripheral lung markings extending to the chest wall. While difficult to accurately estimate volume from a two-dimensional image, a 2 cm pneumothorax seen on chest radiograph correlates to approximately 50% volume.1 The patient underwent insertion of a pigtail pleural drain on the right and repeat chest radiograph showed resolution of previously seen pneumothorax. Ultimately the pigtail drain was removed and chest radiograph showed clear lung fields without evidence of residual pneumothorax or pleural effusion.

Respiratory Visual EM

Pediatric Esophageal Foreign Body

Samer Assaf, MD^* and Ryan Gibney, BS^*

DOI: https://doi.org/10.21980/J8GD1F Issue 2:4 No ratings yet.

A radiopaque foreign body was visualized in the proximal esophagus at the thoracic inlet on the chest and neck radiographs. The foreign body appeared to be metallic with visualized concentric rings consistent with a coin.

Abdominal/Gastroenterology Pediatrics Visual EM

Acetabular Fracture

Chad Correa^* and Sari Lahham, MD^{^}

DOI: https://doi.org/10.21980/J8BK8K Issue 2:4 No ratings yet.

The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows), with associated obturator muscle hematoma (blue oval).

Orthopedics Visual EM

Volvulus

Sari Lahham, MD, MBA^*, Kathryn Bennett, BS^* and Mohammad Helmy, MD^†

DOI: https://doi.org/10.21980/J8JH0Q Issue 2:3 No ratings yet.

Upright and supine frontal radiographs of the abdomen demonstrate gas dilation of the large bowel from the level of the cecum to the sigmoid colon with air fluid levels (yellow arrows). There is a swirled configuration of the distal descending to sigmoid colon indicating the level of the volvulus (dashed yellow line) and giving rise to the classic “coffee bean” sign (dotted white tracing). Note the elevated left hemidiaphragm on the upright view reflecting abdominal distention with increased intra-abdominal pressure (red arrow).

Abdominal/Gastroenterology Visual EM

Re-expansion Pulmonary Edema

Kathryn Bennett, BS, BA^* and Benjamin Feldman, MD^*

DOI: https://doi.org/10.21980/J8WS6V Issue 2:3 No ratings yet.

Initial chest X-ray (chest X-ray 1) showed a right-sided pleural effusion with compressive atelectasis of the mid to lower right lung. Repeat chest X-ray immediately after evacuation (chest X-ray 2) shows improvement of the pleural effusion and a new trace apical right pneumothorax measuring 6.7 mm. When the patient became tachypneic, a third X-ray (chest X-ray 3) showed persistent trace apical right pneumothorax measuring 6.7 mm.

Respiratory Visual EM

Open Pneumothorax

Bart Paull, MD^*, Zachary Jarou, MD^* and David Richards, MD^*

DOI: https://doi.org/10.21980/J88036 Issue 2:3 No ratings yet.

A large chest wound was clinically obvious. A chest radiograph performed after intubation showed subcutaneous emphysema, an anterior rib fracture, and a right-sided pneumothorax. He was then taken to the operating room for further management.

Trauma Respiratory Visual EM

Supracondylar Fracture

Jessica Andrusaitis, BS, MS^* and Ben Feldman, MD^*

DOI: https://doi.org/10.21980/J8492P Issue 2:3 No ratings yet.

History of present illness: A 15-year-old male presented to the emergency department with right elbow pain after falling off a skateboard. The patient denied a decrease in strength or sensation but did endorse paresthesias to his hand. On exam, the patient had an obvious deformity of his right elbow with tenderness to palpation and decreased range of motion at the

Orthopedics Visual EM

Bowel Perforation complicating an incarcerated inguinal hernia

Adam Sigal, MD* and Jamie Slotkin, DO^

DOI: https://doi.org/10.21980/J8D30BIssue 2:2 No ratings yet.

The AP and lateral pelvis x-rays revealed two sewing needles, 60 mm in length, within the soft tissue over the anterior right lower hemipelvis. In addition, the AP view showed emphysema involving the right hemiscrotum (arrow), concerning for perforated bowel.

Abdominal/Gastroenterology Visual EM

An Elderly Female with Dyspnea and Abdominal Pain

Jon Van Heukelom, MD^*

DOI: https://doi.org/10.21980/J83S3KIssue 2:1 No ratings yet.

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.

Respiratory Visual EM

Irreducible Traumatic Posterior Shoulder Dislocation

Blake Collier, DO^* and Christopher Trigger, MD^*

DOI: https://doi.org/10.21980/J8V884Issue 2:1 No ratings yet.

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).

Orthopedics Visual EM