36-year-old woman:
– With dyspnea and elevated D-dimers
What is the cause of the dyspnea?
Acute segmental pulmonary embolism
What is the cause of the consolidation?
Pulmonary infarction: typically wedge-shaped with a broad pleural base
Tag: emergency
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 #31
A 55-year-old male. Pain left flank and macroscopic hematuria.
What is your diagnosis?
Diagnosis: Left hydronephrosis and hydroureter with proximal obstructing ureter stone. Fat stranding surrounding left kidney, “blow out” of urine
Emergency #30
A 6-year-old child. Cough since months. DD, allergy, asthma
What do you see?
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Diagnosis: Pneumonia lingula (consolidation obscuring left heart border but not left hemidiaphragm)
What is the most probably causing organism at this age?
Mycoplasma (bacterial) pneumonia
Emergency #29
A 20-year-old male.
Fell off motor. Pain and swelling on the right wrist/hand.
What do you see?
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Diagnosis
Scaphoid fracture with perilunate dislocation. Also oblique non-displaced fracture of 3rd metacarpal
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)
Click here to see the images
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
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