X-Ray

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Lisfranc Injury

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

DOI: https://doi.org/10.21980/J8QD1MIssue 3:3[mrp_rating_result]
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.
OrthopedicsVisual EM
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Incidental Hiatal Hernia on Chest X-ray

Ahmed Farhat, BS* and Daryn Towle, MD*

DOI: https://doi.org/10.21980/J8KP8SIssue 3:3[mrp_rating_result]
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/GastroenterologyVisual EM
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Button Battery in Esophagus

Sha Yan, DO* and Ernest Leva, MD*

DOI: https://doi.org/10.21980/J8FW6VIssue 3:3[mrp_rating_result]
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/GastroenterologyVisual EM
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Pediatric Foreign Body Aspiration

Sha Yan, DO* and Uchechi Azubuine, MD^

DOI: https://doi.org/10.21980/J8B648Issue 3:3[mrp_rating_result]
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.
PediatricsRespiratoryVisual EM
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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[mrp_rating_result]
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/GastroenterologyVisual EM
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Lateral Epicondyle Fracture

Valerie Lew, BS*, John Costumbrado, MD, MPH* and Curtis Knight, MD*

DOI: https://doi.org/10.21980/J8J05F Issue 3:2[mrp_rating_result]
Radiographs of the right elbow revealed an acute fracture through the lateral epicondyle with dislocation of the radial head inferiorly. Radiographs of the left elbow revealed a slightly angulated fracture through the lateral epicondyle.
OrthopedicsVisual EM
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Glass Foreign Body Hand Radiograph

Hamid Ehsani-Nia, DO* and Joshua Bucher, MD*

DOI: https://doi.org/10.21980/J8W92HIssue 3:2[mrp_rating_result]
History of present illness: A 27-year-old female sustained an injury to her left hand after she tripped and fell on a vase. She presented to the emergency department (ED) complaining of pain over the laceration. Upon examination, patient presented with multiple small abrasions of the medial aspect of the left 5thdigit that are minimally tender. Additionally, she has one 0.5cm
TraumaUltrasoundVisual EM
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Acromioclavicular joint separation

Devan Pandya, BS* and John Costumbrado, MD, MPH^

DOI: https://doi.org/10.21980/J8C91G Issue 3:2[mrp_rating_result]
History of present illness: A 30-year-old male was brought in by ambulance to the emergency department as a trauma activation after a motorcycle accident. The patient was the helmeted rider of a motorcycle traveling at an unknown speed when he lost control and was thrown off his vehicle. He denied loss of consciousness, nausea, or vomiting. The patient’s vital signs
OrthopedicsVisual EM