X-Ray
Acute comminuted intertrochanteric hip fracture
DOI: https://doi.org/10.21980/J8QK9CHistory of present illness: A 69-year-old male presented to the emergency department (ED) with left hip pain after he was rear-ended on his bicycle by a vehicle traveling 10-15 miles per hour. He had normal vital signs. On exam, his left lower extremity was externally rotated and shortened with trochanteric point tenderness. His pelvis was stable. His lower extremity compartments
Pneumomediastinum After Cervical Stab Wound
DOI: https://doi.org/10.21980/J87P79Anteroposterior (AP) chest X-ray showed subcutaneous emphysema of the neck, surrounding the trachea (red arrows), right side greater than left, and a streak of gas adjacent to the aortic arch (white arrow). Computed tomography angiogram (CTA) of the neck showed air outside of the trachea, positive for pneumomediastinum (blue arrows).
Empyema
DOI: https://doi.org/10.21980/J86P9RThe chest X-ray shows a large fluid collection in the right lung demonstrated by the opacification that blunts the costophrenic angle on the right side. There is also a meniscus present, which is generally indicative of fluid. Chest computed tomography (CT) demonstrated an infiltrate with a mixture of densities within the same collection, consistent with a loculated effusion and concerning for an empyema.
Bilateral Hip Dislocation in Unrestrained Driver
DOI: https://doi.org/10.21980/J8HD0CThe initial radiograph of the pelvis revealed bilateral hip dislocations. Small bony fragments were noted in the right hip joint, suggestive of an underlying fracture. The sacroiliac joints and the pelvic ring were intact. In the emergency department, bilateral hip reductions were performed using the Captain Morgan technique.1 The post-reduction film showed reduction of the bilateral hip dislocations with extensive comminuted and displaced fractures of the right and left acetabula.
Open Book Pelvic Fracture
DOI: https://doi.org/10.21980/J8CK7HThe initial radiograph of the pelvis shows an open-book pelvic fracture deformity with pubic symphyseal dislocation, left greater than right sacroiliac diastases, and fractures of the left superior and inferior pubic rami, right inferior pubic ramus, and left acetabular anterior column. The additional inlet and outlet radiographs of the pelvis after application of a pelvic binder also show an open book fracture with significant improvement of the widened pubic symphysis.
Spontaneous Pneumothorax
DOI: https://doi.org/10.21980/J8M33BInitial 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.
Pediatric Esophageal Foreign Body
DOI: https://doi.org/10.21980/J8GD1FA 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.
Acetabular Fracture
DOI: https://doi.org/10.21980/J8BK8KThe 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).