UMEM Educational Pearls - Visual Diagnosis

Small Bowel Obstruction

  • Although it takes about 11 minutes to diagnose SBO on ultrasound, newer studies have shown a decrease in sensitivity and specificity of SBO with 11 false negatives and 57 fall positives. So PLEASE BE CAREFUL when looking for SBO with ultrasound.
  • Let’s give a shout out to one of our medical students, Alexa Van Besien, who recently took some great images of a patient with a known SBO.

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Aortic Dissection 

  • Ultrasound has a great specificity for aortic dissection. Remember to take a look at your aorta on all cardiac views.

  • Let’s give a shout out to Nikki Cali for diagnosing aortic dissection in a patient with a recent PE. Can you find the dissection flap in this image?

 

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Peritonsillar Abscess 

 

  • Ultrasound can differentiate abscess vs cellulitis and has been shown to increase EP success of drainage as well as lower CT use. If you are concerned about complicated PTA with extension, use your clinical judgment.
  • Let’s give a shout out to Kelsey Johnson and Karl Dachroeden who successfully identified and drained a PTA at bedside as well as Taylor Miller who had a difficult case of phlegmon vs early abscess.

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With the low supply of IV contrast for CT’s remember that you can use your friendly ultrasound to help you diagnose a wide range of pathology. Most often there is a HIGH SPECIFICITY (so if you see it, it is probably there but not a rule out test). Over the next week we will look at  5 cases where residents have diagnosed cool pathology using ultrasound. Just remember that with great power, comes great responsibility
 
 
 
 
 
 
 

 

Appendicitis

  • Ultrasound has a reported high specificity (97.9) for acute appendicitis in moderate to high pre-test probability of patients.

  • Let’s give a shout out to Reed Macy, who diagnosed appendicitis in a male with vomiting and abdominal pain! 

 


Question

23 y/o otherwise healthy Male presents for approx. 3 month history of Right  leg mass. It is painful with activity (deep and sharp) but not enlarging. Patient remembers a fall from a bicycle 6 months ago, with negative imaging for fracture.

 

What is the diagnosis?

 

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https://radsource.us/wp-content/uploads/2019/02/1E.jpg

 

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Question

A ~55 year-old female with a history of ESRD and diabetes who presented to the ED with progressively worsening foot odor. An x-ray was performed. The picture below shows the right foot.

What is the diagnosis?

 

 

 

 

 

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Question

75 y/o M is brought in by EMS after he fell off the light rail and hit his head. In the ED he is A&Ox3, and is asking for a urinal. Two minutes later the tech comes running to show you the following:

What is the cause of this patients Jolly Rancher Green Apple looking urine sample? 

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Question

A 50 years old male with a history of CHF, presenting to the ED with progressively worsening shortness of breath. POCUS was performed. The picture shows the left lower part of the chest. What is the diagnosis?

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Question

56 year-old male with history of hypertension presents with complaints of right scrotal swelling and pain. Denies any urinary symptoms, abdominal pain, nausea/vomiting or change in bowel habits or prior episodes. Temp was 99.0.

A scrotal ultrasound was done and an image of the right testis was seen (below). What's the diagnosis?

 

 

 

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Category: Visual Diagnosis

Title: What is the diagnosis ? (Case by Dr. Harry Achterberg)

Keywords: Herpes Zoster Ophthalmicus; Hutchinson's sign (PubMed Search)

Posted: 2/6/2017 by Hussain Alhashem, MBBS (Updated: 11/27/2022)
Click here to contact Hussain Alhashem, MBBS

Question

24-year-old male with a history of Wagner's Granulomatosis, currently on Cellcept (Mycophenolate Mofetil) and high dose prednisolone, presented with two days of sore throat, malaise and the lesions shown in the picture. What is the diagnosis?

 

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Question

25 year-old female with hx of cerebral palsy with significant developmental delay, s/p G-tube who presented with acute hypoxic respiratory failure, hypotension and a distended, tense abdomen. A CT was done with the scout film below. What's the diagnosis?

 

 
 

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Question

A 60 year-old man with history of atrial fibrillation, CAD presents with left lower leg/foot pain for a few days. His foot is seen below. What's the diagnosis?

 

 

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Question

A 36-year-old male, who recently immigrated from Africa, presented to the ED with fever, rash, cough and shortness of breath. He was noted to be febrile to 39.0 C. The rash is disseminated but present mainly in his trunk as shown in the picture. 

 

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Question

68 year-old male presents with 3-4 days of hedache, anorexia for 2 weeks and "balance trouble." His blood pressure was 226/140 and he states he has not been on his medications for 6 months.
Physical examination revealed a shuffled gait with his walker and the rest of his physical exam and neurologic exam was unremarkable. 
 
His CT is seen below. What's the diagnosis?
 
 
 
 

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Question

30 Year-old female presents to the ED for a rash. The rash started suddenly, mainly in her extremities and it is painful. The patient denied having fever or chills. Her past medical history is unremarkable. She admits to using cocaine frequently. The rash is shown in the picture.

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Question

27 year-old G2P1 presents with 3 days of abdominal pain that is mostly suprapubic. Denies any urinary symptoms and vaginal bleeding. Physical examination reveals slight rebound in the right lower quadrant.

An ultrasound revealed the following. What's the diagnosis?

 

 

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Question

A 15 months old male with no past medical history, presenting with two days of decreased oral intake and decreased urine output. The exam was notable for minimal tenderness of abdomen.  During an oral fluid challenge in the ED, the patient had a single episode of bilious vomiting.  The ED physician ordered an ultrasound study and the results are shown below. What is the diagnosis? 

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Question

8 year-old female with no PMH who presents with concerns for "purple patches" popping up on her arm for 2-3 days. Stated that one appeared and then, the other one appeared 12 hours later. She denied any trauma whatsoever, history of easy bleeding/bruising and did feel safe at home. The rest of the review of systems was negative.

Patient said there was mild pain when the area was touched. The rest of the physical examination was normal.

What's the diagnosis? (Image below)

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Question

30 year old female presents with a painful finger for 1 week. Finger exam showed the following. What is the diagnosis ?

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Category: Visual Diagnosis

Title: What's the Diagnosis?

Posted: 10/25/2016 by Tu Carol Nguyen, DO (Updated: 10/26/2016)
Click here to contact Tu Carol Nguyen, DO

Question

20 year-old female presents with sore throat, right throat fullness, difficulty speaking for 2-3 days. A bedside ultrasound and subsequent CT was obtained as seen below. What's the diagnosis?

 

 

 

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