X-Ray

Perilunate Dislocation

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

DOI: https://doi.org/10.21980/J8F59RIssue 1:2 No ratings yet.

In the left lateral wrist x-ray, the lunate is dislocated from the rest of the wrist bones but still articulates with the radius. The capitate does not sit within the distal articulation of the lunate and is displaced dorsally. Additionally, a line drawn through the radius and lunate fails to intersect with the capitate. This is consistent with a perilunate dislocation. This is compared to a lunate dislocation, where the lunate itself is displaced and turned ventrally (spilled teacup) and the proximal aspect does not articulate with the radius.

Orthopedics Visual EM

Femoral Neck Fracture

Jonathan Lee^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J89G6GIssue 1:2 No ratings yet.

In the anteroposterior view bilateral hip x-ray, there is an evident loss of Shenton’s line on the left when compared to the normal right, indicative of a fracture in the left femoral neck. This correlates with findings seen on pelvic CT, which reveals both a subcapital fracture and transcervical fracture. The neck of the femur is displaced superiorly relative to the head of the femur while the head of the femur remains in its anatomical position within the acetabulum.

Orthopedics Visual EM

Traumatic Aortic Injury

Brianna Miner^*, Megan Boysen Osborn, MD, MHPE^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J85P4JIssue 1:2 No ratings yet.

The initial chest x-ray showed an abnormal superior mediastinal contour (blue line), suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows) compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow). There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows).

Trauma Cardiology/Vascular Visual EM

Posterior Elbow Dislocation

Victoria Oppenheim^* and Megan Boysen Osborn, MD, MHPE^*

DOI: https://doi.org/10.21980/J8X593Issue 1:2 No ratings yet.

Elbow dislocations are classified by the position of the radio-ulnar joint relative to the humerus.1 Images 1, 2, and 3 show a left posterior elbow dislocation; the radius and ulna (red lines) are displaced posteriorly with respect to the distal humerus (blue line). The lateral view of the elbow most clearly shows this: trochlear notch of the ulna (red line) is empty and displaced posteriorly relative to the trochlea (blue line). There is no associated fracture. Images 4 and 5 show the elbow status-post reduction, demonstrating proper alignment of the distal humerus (blue line) with the radius and ulna (red lines).

Orthopedics Visual EM

5th Finger Dislocation Photograph JETem 2016

Open Dislocation of Fifth Digit

Robert Rowe, MD^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8J01XIssue 1:2 No ratings yet.

Physical exam revealed an open dislocation of the proximal interphalangeal joint (PIP) of the right fifth digit. X-ray confirmed dislocation and revealed no fractures. The patient received a tetanus booster, Cefazolin, and the dislocation was then washed out and reduced. Multiple reduction attempts were made and were only successful once the metacarpophalangeal joints were held in 90 degree flexion, which relaxed the lateral bands and enabled the finger to be reduced.

Orthopedics Visual EM

Pleural Effusion, AP Chest Xray JETem 2016

Large Right Pleural Effusion

Robert Rowe, MD^* and Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8D59FIssue 1:2 No ratings yet.

Chest x-ray and bedside ultrasound revealed a large right pleural effusion, estimated to be greater than two and a half liters in size.

Respiratory Visual EM

Hampton’s Hump in Pulmonary Embolism

Jonathan Patane, MD^* and Megan Boysen Osborn^*

DOI: https://doi.org/10.21980/J83W27Issue 1:1 No ratings yet.

In the lateral view chest x-ray, there is a Hampton’s Hump, a pleural based, wedge-shaped opacity at the base of the right lung, representing lung infarction (black arrow). These findings correlate with the sagittal view on CT angiography of the chest. The CT chest also shows a filling defect in the distal posterior basal segmental pulmonary artery (white arrow), as demonstrated by the absence of contrast enhancement in the distal portion of the vessel. This is associated with an opacification of the lung parenchyma distal to the occlusion (red arrow), representing lung infarction.

Respiratory Visual EM