Emergency #36

47-year-old female:

– Found EMV 3 after assault

What do you see?

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– Diagnosis: Diffuse subdural hematomas of multiple ages (convexities, parafalcine, tentorium) But more important:

Diffuse swelling of gyri and edema with effacement of the CSF-containing spaces
– Diffuse loss of normal grey-white differentiation
– Decreased bilateral basal ganglia attenuation

– = Sequelae of traumatic brain injury (TBI) indicating hypoxic-ischemic injury, with poor prognostic outcome. Patient died several hours later

– Note: We do not see here the reversal sign (reversal of the normal CT attenuation of grey and white matter) or white cerebellum sign (diffuse oedema and hypoattenuation of the cerebral hemispheres with sparing of the cerebellum and brainstem, resulting in apparent high attenuation of the cerebellum and brainstem relative to the cerebral hemispheres)

Emergency #34

A 73-year-old female:
– Pain LLQ
– CRP 68, leucocytes 19000.

What is the pathology?

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Diagnosis: Sigmoid diverticulitis, no signs of complications/perforation such as air bubbles outside bowel lumen or paracolic abscess. Reactive bowel wall thickening (always be aware of underlying carcinoma!)

Name the three coincidental findings:

1. Gall stones
2. Right adrenal mass, DD metastasis from 3. or adenoma
3. Right interpolar solid mass, suspect for renal cell carcinoma

Emergency #33

83-year-old female:
– Acute loss of function right arm and leg
– Bleeding? Ischemia?

What is the most likely diagnosis?

Dense left medial cerebral artery with subtle obscuring of grey-white matter interface temporal operculum of insula; early ischemia.

CTA: Occlusion M1 Patient received IV thrombolysis and her symptoms improved

Emergency #32

53-year-old male:
– Hemodialysis patient
– Presents with a very large scrotum, size of a football
– Patient is not sick, no fever
– Laboratory results are normal
– US: Incarcerated inguinal hernia? Hydrocele? Malignancy?

What is the most likely diagnosis?

Diagnosis: Extensive scrotal lymphoedema

– Extensive scrotal wall thickening associated with diffuse lymphoedema extending to the base of penis not involving the penile corpora
– No extension into the deep subcutaneous tissue planes, inguinal canal, or muscles
– No extension to the groin or lower abdomen
– No inguinal adenopathy
– Both testicles are morphologically normal with no associated hydroceles
– There is no associated soft-tissue mass

Emergency #27 – Flashcard

Elbow pain after a fall. What do you see?

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Findings

Large joint effusion with the displacement of the anterior fat pad. Mild posterior soft tissue swelling over the olecranon. Fracture line along the lateral aspect of the radial neck. Radial head and articular surface are normal

Diagnosis

Nondisplaced radial head fracture

Teaching points

– Check not only the bones and joints but also the soft tissues
– Search and interpret the findings in two different positions
– Pain always withholds a story behind

Emergency #26 – Flashcard

A 30-year-old female with right shoulder pain.

4 images of the right shoulder were obtained (axillar, Y-view, internal rotation, external rotation)

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Y-view

Internal rotation
External rotation
Findings:

Findings


Right shoulder: There is a nondisplaced fracture involving the inferior aspect of the glenoid, with involvement of the articular surface. Glenohumeral joint shows normal alignment. Acromioclavicular joint is normal. No soft-tissue calcification. No fracture or dislocation

What is the most likely diagnosis?

The most likely diagnosis is Hill-Sachs lesion

Hill-Sachs lesions are a posterolateral humeral head compression fracture. Typically occurs secondary to recurrent anterior shoulder dislocations. It is often associated with a Bankart lesion of the glenoid

Internal Rotation
External Rotation

These lesions are best seen following relocation of the joint. It appears as a sclerotic line running vertically from the top of the humeral head towards the shaft. A wedge defect may be evident in large lesions. The lesions are better appreciated on internal rotation views