X-Ray

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

Pseudogout and Calcium Pyrophosphate Disease

Andrew Williamson, MD*

DOI: https://doi.org/10.21980/J8QG66Issue 2:1 No ratings yet.

Radiographs of the knee showed multiple radio-dense lines paralleling the articular surface (see red arrows) consistent with calcium pyrophosphate crystal deposition within the joint often seen in calcium pyrophosphate disease (CPPD) also known as pseudogout.

Orthopedics Visual EM

Ventriculoperitoneal Shunt Migration

Justin P Puller, MD^* and Jonathan T Miller, MD^*

DOI: https://doi.org/10.21980/J8G019Issue 2:1 No ratings yet.

An immediate post-op abdominal x-ray performed after the patient’s VP shunt revision 30 days prior to this ED visit reveals the VP shunt tip in the mid abdomen. A CT of the abdomen performed on the day of the ED visit reveals the VP shunt tip interposed between the spleen and the diaphragm.

Abdominal/Gastroenterology Visual EM

Lunate Dislocation

Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J86K56Issue 2:1 No ratings yet.

Plain film of the right wrist showed the classic “spilled teacup” consistent with a lunate dislocation. There is a loss of the normal articulation between the distal radius and lunate.

Orthopedics Trauma Visual EM

Pediatric Supracondylar Fracture

Jonathan Peña, MD^* and John R. Marshall, MD^*

DOI: https://doi.org/10.21980/J8T88TIssue 2:1 No ratings yet.

Plain film radiography showed a displaced supracondylar fracture with disrupted anterior and posterior periostea, consistent with a type 3 supracondylar fracture.

Orthopedics Visual EM

Calcaneal Fractures and Böhler’s Angle

Lindsey Spiegelman, MD^* and Mohammed Helmy, MD^{^}

Issue 2:1 No ratings yet.

The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow) in addition to fracture fragments along the heel pad margin (blue arrow). The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow). There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow) in addition to a joint effusion. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle).

Orthopedics Visual EM

Gastric Bezoar

Samer Assaf MD^*

DOI: https://doi.org/10.21980/J85K5WIssue 2:1 No ratings yet.

In the abdominal radiograph, a nonspecific and non-obstructive bowel gas pattern with no air-fluid level was noted, however the stomach was distended with soft tissue. The CT abdomen/pelvis revealed a distended stomach with undigested heterogeneous contents (presumed bezoar).

Abdominal/Gastroenterology Visual EM

Monteggia Fracture in an Assault Patient

John Jiao, MHS^* and Shannon Toohey, MD, MAEd^*

DOI: https://doi.org/10.21980/J81S3ZIssue 2:1 No ratings yet.

On the axial elbow x-ray, the radial head (red arrow) is dislocated anteriorly from the humerus; the humeroulnar articulation is intact. On the AP forearm x-ray, there is a closed, displaced, comminuted fracture of the ulna (blue arrow).

Orthopedics Visual EM