UCONN Emergency Medicine Interest Group

Archive for the ‘RADIOLOGY’ 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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Ultrasound Case #7

In RADIOLOGY on January 28, 2012 at 2:27 PM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

Case

CC: Right flank pain

HPI: 54 yo male with PMH HTN and high cholesterol presents to the ED with acute onset of right sided flank pain beginning 18 hours prior to arrival.  Associated with nausea, vomiting and chills.  Pain is  intermittent, 10/10 and colicky.  He denies any diarrhea, constipation or urinary symptoms.

SH: Smokes 1.5 pack year history, denies other drugs or alcohol use.

FH: DM2, HTN, Hyperlipidemia

PE: Afebrile, VSS
Abdomen is obese, soft, non-distended, tender in RUQ, + Murphy’s sign, + bowel sounds

Labs: WBC’s16.2 with left shift.  Otherwise rest of CBC and chem7 within normal limits.

UA: 10 RBC’s, >25 WBC’s, no nitrites.

Urine culture: polymicrobial.

Bedside U/S:

What do you see?

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Ultrasound Case #6

In RADIOLOGY on November 29, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

CC: left leg swelling

HPI: 81 yo male with PMH HTN, DM2, h/o colon cancer with recent colon resection one month prior presents to ED with left leg swelling, beginning 2-3 days ago.  Denies any chest pain, fevers, chills, h/o recent travel or urinary complaints.

SH: history of 20 pack years but quit 10 years ago.  No other drugs.

FH: denies.

PE: afebrile, VSS
Left lower extremity: calf edema, remarkably larger than the right. No tenderness to palpation, no erythema.  Distal pulses intact.

Labs: WBC slightly elevated at 11.8, otherwise rest of CBC and Chem7 grossly wnl.

Bedside U/S: see above images.

Where are the 2 points that should be compressed to look for a lower extremity DVT? What was the finding in this case?

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Ultrasound Case #5

In RADIOLOGY on October 23, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

Gallbladder wall

Common bile duct

CC: Abdominal pain – RUQ

HPI: 25 yo female with no PMH presents to the ED with nausea, vomiting and abdominal pain beginning the previous evening ½ hour after eating dinner.  Pain located in RUQ, 10/10 intermittent colicky pain.  Denies any fevers, chills, diarrhea, constipation, urinary symptoms or anorexia.

SH: Smokes 1.5 pack year history, denies other drugs or alcohol.

FH: DM2, HTN, Hyperlipidemia, Colon Cancer

PE: Afebrile, VSS
Abdomen is obese, soft, non-distended, tender in RUQ, + murphy’s sign, + bowel sounds

Labs: WBC’s14.9 with left shift.  H/H, Platelets and Chem7, AST, ALT, lipase and bilirubin within normal limits.  Alk Phos 141.

Bedside U/S: see above images.

How would you describe the ultrasonographic findings?

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Ultrasound Case #4

In RADIOLOGY on September 25, 2011 at 11:19 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

CC: shortness of breath

HPI: 62 yo female with no significant pmh presents with shortness of breath worsening over the last 3 days with associated lest sided chest pain, low grade fever and non productive cough.

SH: 40 pack year smoking history, occasional alcohol.  Denies drug use.

FH: Lung cancer

PE: T 100.8 BP 110/90 HR 99 RR 24 SAT 90% ra. GEN: Uncomfortable, speaking in fragmented sentences.  CV: Regular rate and rhythm, no MRG.  PULM: Moderate respiratory distress.  Absent breath sounds in the base and midway up the back on the left.  Dullness to percussion on the left compared to the right.

EKG: Normal sinus rhythm with occasional PVCs.

Labs: WBC 12.5 with left shift, remainder of CBC, Chem7, PT/INR and cardiac enzymes grossly within normal limits.

Bedside U/S: see beginning of post for 1st still image; click for video.

What is the cause of the patient’s dyspnea? (click below to see the answer below the fold)

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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.

This slideshow requires JavaScript.

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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Ultrasound Case #3

In RADIOLOGY on June 16, 2011 at 8:43 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

CC: RLQ abdominal pain.

HPI: 25 yo female presents to ED with severe right lower quadrant abdominal pain beginning yesterday.  LMP about 7 weeks ago.  Denies vaginal discharge or bleeding.  No history of abnormal pap smears, STI’s or previous pregnancies.  Sexually active without protection.

FH: denies alcohol, smoking or drug use.

PE: Afebrile. VSS.  Abdomen tender to palpation suprapubic, right and left lower quadrants.  Pelvic exam with bilateral adnexal tenderness.  Cervical os closed.

Labs: Urinalysis negative for infection.  Urine pregnancy positive. H/H stable.  Quantitative B-hCG: 83,000.

Bedside U/S: (see beginning of post for 1st still image): click for video.

What is the next step in management? (click below to see answer below the fold)

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Ultrasound Case #2

In RADIOLOGY on May 29, 2011 at 9:21 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

CC: Vision loss in right eye

HPI: 59 yo male with PMH poorly controlled diabetes presents with painless vision loss in the right eye.  Patient initially noticed blurry vision in the periphery of his right eye for the past week and an increase in the number of floaters in the eye.  Today it was almost like a black curtain was coming down in the eye so he came to the ED for an evaluation.  He denies any history of trauma, redness or foreign body sensation.

SH: Smokes 1ppd for the past 40 years, no IVDU or alcohol use.

FH: Diabetes.

PE: Afebrile, VSS.  Eyes: EOMI, PERRLA, no evidence of globe trauma.  Fundoscopic exam: no obvious abnormality.  Visual acuity: patient not able to see light or moving objects in right eye, left 20/50.  Intraocular pressure, 15 bilaterally.  Visual fields: not able to see out of right eye, normal in left eye. SLE: anterior chamber appears normal, no foreign bodies or corneal ulcerations appreciated.

Bedside U/S (see beginning of post for 1st still image): click for video.

What is the diagnosis? (click below to see the answer below the fold)

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Ultrasound Case #1

In RADIOLOGY on May 1, 2011 at 5:51 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

CC: Back pain

HPI: 68 yo male with PMH hyperlipidemia and HTN presents to the ED with sudden onset of back pain beginning about 3 hours ago.  Pain is severe and sharp.  Associated lightheadedness, nausea and vomiting.  Denies chest pain, urinary symptoms, constipation, diarrhea, fever, chills or problems breathing.

SH: + smoking 50 pack year history, denies alcohol or other drug use

FH: HTN

PE: afebrile.  BP 100/80 HR 105 remainder of vital signs within normal limits. ABD: soft, diffusely tender, pulsatile mass,  +bruit.  No evidence of scrotal hematoma or Cullen sign.  Back: No CVA tenderness.  No ecchymosis.  Rectal: heme negative.

Labs: CBC, Chem7, LFTs, PT/INR/PTT and lactate within normal limits.  Urinalysis > 25 RBC’s, no evidence of infection.

Bedside U/S (see beginning of post for 1st still image):

 

Click for doppler video.

What is the diagnosis? (click below to see the answer below the fold)

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