User login
A Different Source of Elbow Pain
ANSWER
The radiograph shows no obvious fracture or dislocation. However, there are two small, radiopaque densities noted within the soft tissue. These are most likely consistent with broken glass pieces.
When the laceration was irrigated and the wound probed, the glass bits were found and removed prior to wound closure.
ANSWER
The radiograph shows no obvious fracture or dislocation. However, there are two small, radiopaque densities noted within the soft tissue. These are most likely consistent with broken glass pieces.
When the laceration was irrigated and the wound probed, the glass bits were found and removed prior to wound closure.
ANSWER
The radiograph shows no obvious fracture or dislocation. However, there are two small, radiopaque densities noted within the soft tissue. These are most likely consistent with broken glass pieces.
When the laceration was irrigated and the wound probed, the glass bits were found and removed prior to wound closure.
A 30-year-old man is brought to your facility after being in a motor vehicle collision. He was an unrestrained driver who lost control of his vehicle, went off the road, and hit a tree. Emergency personnel on the scene indicated there was moderate damage to his vehicle, including a broken windshield, and no air bag deployment. The patient is complaining of right shoulder, chest, hip, and left elbow pain. His medical history is unremarkable. His vital signs are normal. On physical examination, he has superficial lacerations on his forehead, face, and both forearms. Bleeding from all wounds is controlled. Palpation reveals some bruising of the right shoulder, chest, right hip, and left elbow; no obvious deformity or neurovascular compromise is noted. Multiple radiographs are ordered; the left elbow is shown. What is your impression?
Woman with Severe Ankle Pain After Fall
ANSWER
There is an obvious oblique fracture of the distal fibula. In addition, there is widening of the mortise medially—usually suggestive of a ligament injury. Also, there may be a small avulsion at the inferior aspect of the medial malleolus.
The patient was admitted with a plan for her to undergo an open reduction and internal fixation procedure.
ANSWER
There is an obvious oblique fracture of the distal fibula. In addition, there is widening of the mortise medially—usually suggestive of a ligament injury. Also, there may be a small avulsion at the inferior aspect of the medial malleolus.
The patient was admitted with a plan for her to undergo an open reduction and internal fixation procedure.
ANSWER
There is an obvious oblique fracture of the distal fibula. In addition, there is widening of the mortise medially—usually suggestive of a ligament injury. Also, there may be a small avulsion at the inferior aspect of the medial malleolus.
The patient was admitted with a plan for her to undergo an open reduction and internal fixation procedure.
A 39-year-old woman presents to your emergency department complaining of right ankle pain following an injury last night. She states that she got out of bed during the night, somehow misstepped, and fell to the floor. She is unable to bear weight on the ankle and is experiencing severe pain. Her medical history is significant for being one month status post Chiari decompression. She also has a history of bipolar disorder. Examination of the patient’s right ankle shows it to be moderately swollen with some bruising laterally. The patient has limited flexion and extension, and her ankle is extremely tender to palpation. Her distal pulses and her sensation are intact. Radiographs of the right ankle are shown. What is your impression?
Shoulder Pain in Man Hospitalized for Brain Mass
ANSWER
There is no evidence of an acute fracture or dislocation. However, there is a focal lytic lesion within the scapula. Given a presumed history of renal cell carcinoma, this finding is strongly suspicious for metastasis and must be worked up.
ANSWER
There is no evidence of an acute fracture or dislocation. However, there is a focal lytic lesion within the scapula. Given a presumed history of renal cell carcinoma, this finding is strongly suspicious for metastasis and must be worked up.
ANSWER
There is no evidence of an acute fracture or dislocation. However, there is a focal lytic lesion within the scapula. Given a presumed history of renal cell carcinoma, this finding is strongly suspicious for metastasis and must be worked up.
A 53-year-old man is admitted with a possible brain mass. He gives a two-week history of headaches and intermittent left-sided weakness. Outpatient CT of the head showed a possible right frontal mass. His medical history is significant for mild hypertension and for the removal of one kidney seven years ago, due to cancer. He states he received no adjuvant therapy. When you check on the patient today, he mentions that his left shoulder has been bothering him for some time. He denies any injury to it. He states he has decreased range of motion and pain with range of motion. You order a radiograph of the shoulder (shown). What is your impression?
Man with Decreasing Consciousness and Increasing Confusion
ANSWER
The radiograph demonstrates a lucency at the base of the odontoid (C2). In addition, there is a slight posterior subluxation of C1 on C2.
Although these findings were deemed likely to be chronic and old in nature, for completeness, an MRI of the cervical spine was obtained. It did, in fact, confirm the findings to be old.
ANSWER
The radiograph demonstrates a lucency at the base of the odontoid (C2). In addition, there is a slight posterior subluxation of C1 on C2.
Although these findings were deemed likely to be chronic and old in nature, for completeness, an MRI of the cervical spine was obtained. It did, in fact, confirm the findings to be old.
ANSWER
The radiograph demonstrates a lucency at the base of the odontoid (C2). In addition, there is a slight posterior subluxation of C1 on C2.
Although these findings were deemed likely to be chronic and old in nature, for completeness, an MRI of the cervical spine was obtained. It did, in fact, confirm the findings to be old.
A 72-year-old nursing home resident is sent for evaluation of decreased level of consciousness, nausea, vomiting, and increasing confusion. He denies any recent injury or trauma. His medical history is significant for diabetes, stroke, dementia, atrial fibrillation, and hypertension. The patient denies any head or neck pain. His vital signs are stable. Overall, aside from reports of occasional confusion, his physical examination is benign. He moves all of his extremities well and appears to have no deficits, including no neck or back tenderness. In reviewing his lab work, you see his sodium concentration is 126 mEq/L. CT of the head shows only chronic changes. Cervical spine radiographs are also obtained; the lateral view is shown. What is your impression?
