UCONN Emergency Medicine Interest Group

Archive for the ‘IMAGES’ Category

EM Images #11

In IMAGES, RADIOLOGY on March 11, 2012 at 2:09 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

A 55 year old man came in with diffuse abdominal pain, mostly in RLQ, with tenderness and guarding there but no rebound. Questionable Rovsing’s.  Minimal RUQ findings. No Murphy´s sign. What are the diagnoses associated with this CT?

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EM Images #10

In IMAGES on February 25, 2012 at 11:11 AM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

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A simple question: what is the diagnosis for these patients?

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EM Images #9

In IMAGES on December 4, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Suozzi for images and text.

Just a short hint for this case: this is from a patient that Dr. Suozzi saw in Uganda.

What is the diagnosis?

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EM Images #8

In IMAGES on November 6, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

These three people all have the same condition, which can be diagnosed bedside. Note all three have extremities that are fixed in the position in which you see them. These arms can not be moved by active or passive range of motion.
The first, an older woman, and the third, a younger man, were pedestrian versus car with outstretched hands at the moment of impact. What do they have and how do you fix it and what special considerations accrue to such a diagnosis? (click below to see answers and explanation)

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EM Images #7

In IMAGES on September 12, 2011 at 3:46 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

Scenario: a 47-year-old gentleman came for a follow-up visit for positive blood cultures. He had been seen 2 days earlier with a past medical history of asthma and the history that approximately two weeks earlier he had been at a campfire where apparently someone nearby was burning poison ivy. Immediately he had broken out in a rash on his hands and neck and face and all areas that were exposed and not covered by clothes. He also noticed that his symptoms of cough and shortness of breath increased after that incident. He then came to HHED where he had had blood cultures, an x-ray that showed pneumonia and had been discharged on azithromycin. His blood cultures were positive for Staph and he had been requested to return to the ED. His physical exam showed some inspiratory râles in the LLL where the infiltrate had been and some expiratory wheezes throughout. After treatment had been initiated in the ED, prior to admission, he developed another skin eruption, seen in accompanying photograph.

What was the treatment and what is this reaction? (click below to see answers below the fold)

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EM Images #6

In IMAGES on August 13, 2011 at 7:22 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London, Dr. Bolton, Dr. Hitesh Shah for images and text.

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History:
A 25 year old male presented to HH ED in May 2009 complaining of 5 days of an itchy, scattered, worsening rash over his entire body. The rash began on his back and scalp, then spread to his arms, and is now everywhere. He was seen at a nearby clinic 5 days ago and sent home with Benadryl and Hydrocodone. He saw the PMD again 2 days ago and was also given Prednisone, Keflex, Permethrin, and Triamcinolone without relief. The rash was pruritic; he reported a sore throat and dysphagia from pain of oral lesions. He denied fever, cough, SOB, URI, conjunctivitis, congestion, runny nose, difficulty breathing, sick contacts, alleviating factors, exacerbating factors. Pt is an immigrant from Honduras and lives with his parents and his 1 year old child; he has been in the US for 4 years.

Physical Exam:
Vital Signs –T 98.2, P 111, R 16 –BP 146/89, O2 Sat 98%
Gen: Hispanic male, sitting, NAD
HEENT: NC/AT, MMM, PERRL, sclera anicteric, – JVD/LAD
Chest: Tachycardic, + S1/S2, CTAB
Back: No CVAT
Abdomen: + normoactive BS, soft, NTND, no r/g/HSM
Neurological: Awake, alert, oriented, cogent, nonfocal, MAE
Extremities: wwp, no c/c/e
Skin: see images

What is the diagnosis?

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EM Images #5

In IMAGES, RADIOLOGY on July 18, 2011 at 7:22 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London and Dr. Bolton for images and text.

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Patient is a 75 year old man c/o lower abdominal pain for 8 hours. Diaphoretic w/ chills and pain worsening for 2 hours; has never had this pain before; last BM 8 hours ago. no normal BM x 2 days.

PMH: CAD, CVA, Diabetes, High cholesterol/lipidemia, HTN

PE: VS: 97.8, 188/97, RR 18, 94% sat RA; HR 112
Pt had epigastric pain with some guarding and ? rebound. Rectal exam heme negative.

Labs: normal CBC, lytes, LFTs, lipase; only lab abnormality is glucose of 259.

Plain films from present admission and 2004 visit for bladder cancer, as well as CT from 2009 shown above in slideshow. What do they show? What are the radio-opacities in RUQ, and what is their relationship to the present illness? (click below to see answers below the fold)

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EM Images #4

In IMAGES, RADIOLOGY on July 2, 2011 at 11:38 AM

Syndicated from the UCONN EM Residency website; credit to Dr. London and Dr. Bolton for images and text.

AP (left) and lateral (right); click to enlarge

Click to enlarge

The patient is a 62-year-old female who yesterday suffered a fall from a standing height when she slipped on her kitchen floor feeling immediate pain in her left knee. She felt pain in no other area. She was able unable to get herself up, but her husband showed up shortly after she fell and helped her to the couch. She was brought by ambulance to the ER this morning for evaluation of her left knee. She was having no previous fevers, chills or sweats. There has been no back pain, chest pain or shortness of breath. She has had no previous injury to the left knee. She has joint-line tenderness laterally in the left knee. She has good range of motion from about 100 to 110 degrees from full extension. She does not tolerate the exam to varus or valgus stress secondary to pain. Similarly, she does not tolerate the anterior-posterior drawer, Lachman’s secondary to pain. She has no pain to palpation along her back or neck.

PMH: HIV, HTN, asthma, depression, anxiety.

PSH:
1. Left hip ORIF versus hip replacement (the patient is unsure which); she fell and broke her hip a few years ago and was treated at New Britain Hospital.
2. Right ankle ORIF for a fall similarly.

Medications: 1. Truvada. 2. Reyataz. 3. Norvir. All are for her HIV. She does have asthma but no longer takes medication for this.

Allergies: Percocet, which causes itching.

SH: 3 cigarettes a day x 30 years. ETOH occasionally. Denies IV drug abuse.

FH: noncontributory.

Plain films were ordered, which you can see at the top of the post; the reading is as follows:

Clinical Indication: Pain and swelling. Four views of the left knee show no evidence of joint effusion there is there is osteophytic spur arising from the lateral tibial plateau but no definite fracture is seen. Alignment is generally anatomic except for some minimal degenerative change. No other significant findings are seen.

What is the likely diagnosis? What would you do next? (click below to see answer below the fold)

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EM Images #3

In IMAGES on June 10, 2011 at 9:34 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

This is a case of a 13 year old otherwise healthy female who presents to the ED with a rapidly progressive rash over the past 2 days which initially started on her trunk and then spread to her extremities. There is no face, neck or mucosal involvement. The rash is pustular rather than vesicular and is follicular in distribution. This came on several days after going in a hot tub which was newly opened for the season. She is fully vaccinated for varicella.

What is the first-line treatment for this disease?

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EM Images #2

In IMAGES on May 12, 2011 at 7:54 PM

Syndicated from the UCONN EM Residency website; credit to Dr. Ratzan for images and text.

The following patient presented with swelling of the tongue for several hours duration without any dyspnea. She had never had this before. She had a past medical history of hypertension, CHF, hypothyroidism, rheumatoid arthritis, diabetes mellitus, dementia and was on synthroid, lisinopril and glucophage. Physical examination was negative except for the massively edematous tongue. No stridor and normal breath sounds. EKG and O2 sats were normal.

What does this patient have? What would you do and why? (click below to see the answer below the fold)

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