Emergency #17 – Flashcard

40-year-old male:
* Fell off bike at 40 km/h
* Pain left shoulder

> What views of the shoulder in trauma setting should be done?
> Is this in endo- or exorotation?
> Do you need right shoulder to compare with?

Click here to see the images

Right shoulder for comparison

Additional trauma chest X-ray was done.

Differential diagnosis includes:

* AC-luxation
* CC-luxation
* Left pneumothorax
* No rib #

Emergency #16 – Long case

21-year-old male:

* Collapse twice
* Loss of strength of right arm
* Trouble finding words
* Headache

What findings do you see on the CT?

CT Findings

* No abnormalities were seen
* No bleeding
* No signs of recent ischemia

Patient develops fever. Cannot bend his neck properly. When asked, he has been traveling recently to Thailand.

What further imaging could help us?

An MRI is performed.

What findings do you see on the MRI?

MRI Findings

* Two areas left frontal and left parietal with T2/FLAIR hyperintense swelling/edema of cortex and subcortical white matter, with diffusion restriction and patchy, gyriform cortical enhancement

* Diffusely leptomeningeal enhancement

* No ring-enhancing lesions. No white matter vasogenic or cytotoxic edema

What is the most likely diagnosis?

Cerebritis (precursor of abscess) and meningitis. Not yet an abscess

Note: Encephalitis means inflammation of PARENCHYMA

Differential diagnosis of meningitis:
> Leptomeningeal carcinomatosis
> Sarcoidosis and other granulomatous diseases
> Vasculitis
> Connective tissue diseases

Viral inflammatory cause for symptoms was confirmed with lumbar puncture and patient was treated with IV anti-viral treatment

Emergency #15 – Flashcard

62-year-old female.

* Sudden collapse
* Headache
* Paresis of mouth left-sided
* Pupil difference L>R

What is the most likely diagnosis? What should be the next diagnostic step?

Diagnosis: PCOM aneurysm subarachnoid bleed (with subdural hematoma, intraventricular bleed, midline shift, hydrocephalus)
Next step:CTA (you already see aneurysm on NECT)

Emergency #14 – Flashcard

18-years-old male:
* Rigid abdomen and generalised tenderness
* Pain lower abdomen
* CRP 250

What do you see? Perforated appendicitis? What is your diagnosis?

Diagnosis Perforated sigmoid diverticulitis (Hinchey 3 or 4, peritonitis)

> Mesenterial fatty infiltration, free air bubbled outside bowel lumen.
> Also subdiaphragmal free air and free fluid.
> Notice enlarged reactive lymph nodes and peritoneal thickening and enhancement, indicative of peritonitis.
> Patient was operated, free faeces was found in the abdomen.

Hinchey classification of acute diverticulitis:
* Stage 1a: phlegmon
* Stage 1b: diverticulitis with pericolic or mesenteric abscess
* Stage 2: diverticulitis with walled off pelvic abscess
* Stage 3: diverticulitis with generalised purulent peritonitis
* Stage 4: diverticulitis with generalised faecal peritonitis

Emergency #12 – Flashcard

31-year-old male:
* With flank pain
* Increased inflammatory parameters
* Decreased kidney function

Why is the right kidney less dense than the left?

Click here to see the answer

Obstructive kidney stone in the right proximal ureter (arrow) with secondary hydronephrosis

The increased pressure in the collecting system slows the ultrafiltration of urine and causes a slower enhancement of the right kidney in comparison with the left kidney, reflecting the impaired kidney function