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Woman With Hip Pain After Car Accident
ANSWER
The radiograph demonstrates evidence of contrast material within the bladder. There is evidence of fixation of an old subcapital femoral neck fracture on the left.
There is an acute, mildly displaced right intertrochanteric fracture of the right hip. The orthopedic service was consulted, and plans were established to subsequently fix this fracture surgically.
ANSWER
The radiograph demonstrates evidence of contrast material within the bladder. There is evidence of fixation of an old subcapital femoral neck fracture on the left.
There is an acute, mildly displaced right intertrochanteric fracture of the right hip. The orthopedic service was consulted, and plans were established to subsequently fix this fracture surgically.
ANSWER
The radiograph demonstrates evidence of contrast material within the bladder. There is evidence of fixation of an old subcapital femoral neck fracture on the left.
There is an acute, mildly displaced right intertrochanteric fracture of the right hip. The orthopedic service was consulted, and plans were established to subsequently fix this fracture surgically.
A 55-year-old woman is transferred to your facility with injuries sustained in a motor vehicle collision. She was an unrestrained front-seat passenger in a vehicle that rear-ended another vehicle. There was no airbag deployment, and the patient believes she struck her face on the windshield. At the outside facility, it was determined that she had a cervical fracture and facial fractures. Upon arrival at your facility, she is complaining of bilateral hip pain as well. Her medical history is significant for coronary artery disease, several myocardial infarctions, hypertension, and stroke. She has a pacemaker. Six months ago, she had an open reduction internal fixation of her left hip for a fracture she sustained in a fall. Primary survey reveals a female who is uncomfortable but alert and oriented. Vital signs are normal. She has some facial swelling and bruising. Her heart and lungs are clear; abdomen is benign. She is able to move her upper extremities with-out any problems. She has limited movement of her lower extremities due to pain in her pelvis. She is able to move both feet and toes, and distal pulses and sensation are intact. No obvious leg shortening is noted. A portable radiograph of the pelvis is obtained. What is your impression?
Child hit by car
ANSWER
The chest radiograph demonstrates no acute abnormalities within the lungs, ribs, or chest. Of note, there are two radiodensities consistent with teeth, which are presumed to be in the patient’s stomach (most likely secondary to being swallowed following trauma to his face). Upon reexamination, it is noted that the child’s two front incisors are missing, with minimally bleeding sockets. Other than reassurance, no specific intervention was required.
ANSWER
The chest radiograph demonstrates no acute abnormalities within the lungs, ribs, or chest. Of note, there are two radiodensities consistent with teeth, which are presumed to be in the patient’s stomach (most likely secondary to being swallowed following trauma to his face). Upon reexamination, it is noted that the child’s two front incisors are missing, with minimally bleeding sockets. Other than reassurance, no specific intervention was required.
ANSWER
The chest radiograph demonstrates no acute abnormalities within the lungs, ribs, or chest. Of note, there are two radiodensities consistent with teeth, which are presumed to be in the patient’s stomach (most likely secondary to being swallowed following trauma to his face). Upon reexamination, it is noted that the child’s two front incisors are missing, with minimally bleeding sockets. Other than reassurance, no specific intervention was required.
A 6-year-old boy is brought to your facility by ambulance after being hit by a car. The child was apparently riding his bike when a slow-moving vehicle turned onto the street and accidentally bumped him, knocking him to the ground. He was not wearing a helmet. The child is crying but somewhat consolable. His medical history is unremarkable. On initial assessment, he is awake, crying, and moving all of his extremities spontaneously. His vital signs include a temperature of 36.3°C; blood pressure, 149/72 mm Hg; pulse, 110 beats/min; and respiratory rate, 22 breaths/min. Physical examination reveals several abrasions to his face, nose, and lips. Otherwise, he is normocephalic. His pupils are equal and react appropriately. Heart and lung sounds are clear, and the abdomen appears benign. You order some preliminary labwork and CT of the head. In addition, a portable chest radiograph is obtained (shown). What is your impression?
Foot Pain Following a Car Crash
The radiograph demonstrates an acute fracture of the second, third, and fourth distal metatarsals. The third and fourth are mildly impacted.
In addition, there is a deformity noted within the medial cuneiform, strongly suggestive of a fracture. This was later confirmed by CT. Orthopedic consultation was obtained.
The radiograph demonstrates an acute fracture of the second, third, and fourth distal metatarsals. The third and fourth are mildly impacted.
In addition, there is a deformity noted within the medial cuneiform, strongly suggestive of a fracture. This was later confirmed by CT. Orthopedic consultation was obtained.
The radiograph demonstrates an acute fracture of the second, third, and fourth distal metatarsals. The third and fourth are mildly impacted.
In addition, there is a deformity noted within the medial cuneiform, strongly suggestive of a fracture. This was later confirmed by CT. Orthopedic consultation was obtained.
Following a motor vehicle collision, a 60-year-old woman is brought in by emergency medical transport. She was a restrained driver in a vehicle that went out of control, hit a tree, and ended up in a ditch. There was a prolonged extrication time (> 30 minutes) due to extensive damage to the front of the vehicle. On arrival, the patient is awake and alert, complaining primarily of pain in her left hip and right foot. Her medical history is unremarkable. She has an initial Glasgow Coma Scale score of 15. Her vital signs are: blood pressure, 154/100 mm Hg; pulse, 108 beats/min; respiratory rate, 16 breaths/min; and O2 saturation, 100% on room air. Primary survey is otherwise unremarkable. A series of radiographs are ordered; that of the right foot is shown. What is your impression?
Cough and Back Pain in a Man With COPD
ANSWER
The radiograph shows some evidence of hyperinflated lungs, consistent with COPD. There is a small right effusion evident.
Of note is a superior mediastinal mass, which is causing right-sided and anterior displacement of the intrathoracic trachea. The differential includes possible adenopathy related to a carcinoma or a substernal goiter. Further diagnostic studies and surgical evaluation are warranted.
In this particular case, review of the patient’s imaging history showed he had a chest radiograph two years ago, at which time these findings were present. This favors substernal goiter as the diagnosis. Multinodular goiter was later confirmed with a thyroid ultrasound, and referral to general surgery was made.
ANSWER
The radiograph shows some evidence of hyperinflated lungs, consistent with COPD. There is a small right effusion evident.
Of note is a superior mediastinal mass, which is causing right-sided and anterior displacement of the intrathoracic trachea. The differential includes possible adenopathy related to a carcinoma or a substernal goiter. Further diagnostic studies and surgical evaluation are warranted.
In this particular case, review of the patient’s imaging history showed he had a chest radiograph two years ago, at which time these findings were present. This favors substernal goiter as the diagnosis. Multinodular goiter was later confirmed with a thyroid ultrasound, and referral to general surgery was made.
ANSWER
The radiograph shows some evidence of hyperinflated lungs, consistent with COPD. There is a small right effusion evident.
Of note is a superior mediastinal mass, which is causing right-sided and anterior displacement of the intrathoracic trachea. The differential includes possible adenopathy related to a carcinoma or a substernal goiter. Further diagnostic studies and surgical evaluation are warranted.
In this particular case, review of the patient’s imaging history showed he had a chest radiograph two years ago, at which time these findings were present. This favors substernal goiter as the diagnosis. Multinodular goiter was later confirmed with a thyroid ultrasound, and referral to general surgery was made.
A 60-year-old man presents for evaluation of fever, cough, and back pain. His symptoms have been intermittent but have worsened over the past month or so. He has had no treatment prior to today’s visit. His medical history is significant for hypertension, COPD, and chronic renal insufficiency. He denies any history of tobacco use. On physical exam, you see an older man in no obvious distress. His vital signs are stable. He is afe-brile, with a blood pressure of 150/90 mm Hg, a heart rate of 66 beats/min, and a respiratory rate of 18 breaths/min. His O2 saturation is 98% on room air. His neck is supple, with no evidence of ade-nopathy. Lung sounds are slightly decreased bilaterally, with a few crackles heard. The rest of his physical exam, overall, is normal. You order preliminary lab work as well as a chest radiograph (shown). What is your impression?
Hand Slammed in Door
ANSWER
The radiograph shows a comminuted fracture of the proximal fifth phalanx. Soft tissue swelling is noted as well. The patient’s hand was splinted, and arrangements for outpatient orthopedic follow-up were made.
ANSWER
The radiograph shows a comminuted fracture of the proximal fifth phalanx. Soft tissue swelling is noted as well. The patient’s hand was splinted, and arrangements for outpatient orthopedic follow-up were made.
ANSWER
The radiograph shows a comminuted fracture of the proximal fifth phalanx. Soft tissue swelling is noted as well. The patient’s hand was splinted, and arrangements for outpatient orthopedic follow-up were made.
A 48-year-old woman presents to the urgent care center with complaints of right hand pain second-ary to an injury she sustained earlier in the day. Her hand was accidentally caught in a metal door as it was being shut by someone else. The door struck her in the middorsal aspect of her hand. She is now complaining of pain and swelling. She is healthy except for mild but well-controlled hypertension. Her vital signs are normal. Examina-tion of her right hand shows mild to moderate soft tissue swelling and some early bruising. There is extreme tenderness over the fourth and fifth metacarpal bones. Good capillary refill time is noted, and sensation is intact. She is able to flex her fingers somewhat, although this is limited by the swelling. Radiograph of the right hand is obtained. What is your impression?
Chest Wall and Knee Pain Following Motor Vehicle Collision
ANSWER
The radiograph demonstrates lateral dislocation of the patella, with no evidence of an acute fracture of any surrounding bones. The patella was easily reduced in the emergency department, and the patient was placed in a knee immobilizer. Orthopedic consultation was obtained.
ANSWER
The radiograph demonstrates lateral dislocation of the patella, with no evidence of an acute fracture of any surrounding bones. The patella was easily reduced in the emergency department, and the patient was placed in a knee immobilizer. Orthopedic consultation was obtained.
ANSWER
The radiograph demonstrates lateral dislocation of the patella, with no evidence of an acute fracture of any surrounding bones. The patella was easily reduced in the emergency department, and the patient was placed in a knee immobilizer. Orthopedic consultation was obtained.
A 20-year-old man presents following a motor vehicle collision in which the car he was driving was broadsided by another vehicle. His air bag deployed, and the patient is now complaining of right-sided chest wall pain and right knee pain. His medical history is unremarkable. In a primary survey, the patient appears stable, with normal vital signs. Inspection of his right knee shows some deformity of the joint, with mild swelling and moderate tenderness. The patient is unable to perform flexion with his right knee. Good distal pulses are present, and sensation is intact. Radiograph of the right knee is obtained. What is your impression?
Severe Pain Following Car Crash
ANSWER
The radiograph shows malalignment at the L3-L4 level. There is a slight retrolisthesis, as well as widening of the interspinous disc space and the facets at this level. No compression fracture is seen.
Such findings are suggestive of a Chance fracture as a result of a hyperflexion injury. CT confirmed these findings. Such injuries are considered unstable and generally require surgical stabilization.
ANSWER
The radiograph shows malalignment at the L3-L4 level. There is a slight retrolisthesis, as well as widening of the interspinous disc space and the facets at this level. No compression fracture is seen.
Such findings are suggestive of a Chance fracture as a result of a hyperflexion injury. CT confirmed these findings. Such injuries are considered unstable and generally require surgical stabilization.
ANSWER
The radiograph shows malalignment at the L3-L4 level. There is a slight retrolisthesis, as well as widening of the interspinous disc space and the facets at this level. No compression fracture is seen.
Such findings are suggestive of a Chance fracture as a result of a hyperflexion injury. CT confirmed these findings. Such injuries are considered unstable and generally require surgical stabilization.
A 15-year-old girl is brought to your facility following a motor vehicle crash. She was a restrained back seat passenger in a vehicle that was struck from behind at a moderate rate of speed. Extensive damage to the vehicle was noted. The patient is complaining of severe abdominal and back pain. Medical history is unremarkable and vital signs are normal. Physical exam shows a female teen who is anxious but in no obvious distress. Her abdomen is firm, with diffuse tenderness and mild guarding. Palpation of her back reveals moderate tenderness in the lower lumbar spine. She is able to move all extremities well, with no other neurologic deficits noted. She is being sent for CT of the chest, abdomen, and pelvis; but first, a lateral radiograph of the lumbar spine is obtained (shown). What is your impression?
Woman With Back Pain Unable To Walk
ANSWER
The radiograph demonstrates a fairly large mass on the medial aspect of the left upper lobe. Such findings are usually associated with bronchogenic carcinomas.
Among the documentation from the transferring facility was a copy of a CT scan of the patient’s chest. On that study, the mass is seen; it appears to extend to the posterior chest wall, with extensive involvement and destruction of the ribs and posterior elements of T4 and T5. There is also evidence of some spinal cord compression, which would explain the patient’s presenting complaint.
Subsequent CT-guided biopsy demonstrated the lesion to be a non–small cell carcinoma. Due to the already extensive involvement, surgery was not an option, and the patient was referred for palliative radiation therapy.
ANSWER
The radiograph demonstrates a fairly large mass on the medial aspect of the left upper lobe. Such findings are usually associated with bronchogenic carcinomas.
Among the documentation from the transferring facility was a copy of a CT scan of the patient’s chest. On that study, the mass is seen; it appears to extend to the posterior chest wall, with extensive involvement and destruction of the ribs and posterior elements of T4 and T5. There is also evidence of some spinal cord compression, which would explain the patient’s presenting complaint.
Subsequent CT-guided biopsy demonstrated the lesion to be a non–small cell carcinoma. Due to the already extensive involvement, surgery was not an option, and the patient was referred for palliative radiation therapy.
ANSWER
The radiograph demonstrates a fairly large mass on the medial aspect of the left upper lobe. Such findings are usually associated with bronchogenic carcinomas.
Among the documentation from the transferring facility was a copy of a CT scan of the patient’s chest. On that study, the mass is seen; it appears to extend to the posterior chest wall, with extensive involvement and destruction of the ribs and posterior elements of T4 and T5. There is also evidence of some spinal cord compression, which would explain the patient’s presenting complaint.
Subsequent CT-guided biopsy demonstrated the lesion to be a non–small cell carcinoma. Due to the already extensive involvement, surgery was not an option, and the patient was referred for palliative radiation therapy.
A 63-year-old woman is transferred to your facility for evaluation of acute lower extremity paralysis. She has had ongoing back pain for the past several months. Yesterday, she noticed her legs were dragging; last night, she was unable to walk, which prompted her trip to the local emergency department. She says she had “some sort of scan” there and was told that she had a tumor on her spine. She denies any injury or trauma. Her medical history is significant for reflux, hypertension, and extensive tobacco use. She is in no obvious distress, and her vital signs are normal. Physical exam demonstrates extreme weakness in both lower extremities, from the hips down and worse on the left side. She has decreased sensation and reflexes as well. As you review the rest of her transfer paperwork and try to find any imaging studies or reports, the radiology technician collects the patient for a chest radiograph (the result of which is shown). What is your impression?
Woman with Malaise, Cough, and Shoulder Pain
ANSWER
The radiograph demonstrates a slightly elevated left hemidiaphragm, which is nonspecific, as well as normal to slightly increased lung markings. There is no definite infiltrate or consolidation noted.
Of note, there is a displaced fracture of the mid-distal left clavicle, which may be partially healed. There appears to be a focal lytic lesion within that area. The surrounding bone is extremely osteopenic as well.
These findings, especially in the absence of injury or trauma, raise the question of a pathologic fracture, and further workup is warranted. Subsequent workup on this patient demonstrated a large renal mass, which was felt to be, most likely, a metastatic lesion.
ANSWER
The radiograph demonstrates a slightly elevated left hemidiaphragm, which is nonspecific, as well as normal to slightly increased lung markings. There is no definite infiltrate or consolidation noted.
Of note, there is a displaced fracture of the mid-distal left clavicle, which may be partially healed. There appears to be a focal lytic lesion within that area. The surrounding bone is extremely osteopenic as well.
These findings, especially in the absence of injury or trauma, raise the question of a pathologic fracture, and further workup is warranted. Subsequent workup on this patient demonstrated a large renal mass, which was felt to be, most likely, a metastatic lesion.
ANSWER
The radiograph demonstrates a slightly elevated left hemidiaphragm, which is nonspecific, as well as normal to slightly increased lung markings. There is no definite infiltrate or consolidation noted.
Of note, there is a displaced fracture of the mid-distal left clavicle, which may be partially healed. There appears to be a focal lytic lesion within that area. The surrounding bone is extremely osteopenic as well.
These findings, especially in the absence of injury or trauma, raise the question of a pathologic fracture, and further workup is warranted. Subsequent workup on this patient demonstrated a large renal mass, which was felt to be, most likely, a metastatic lesion.
A 63-year-old woman presents to your clinic with complaints of general malaise, weakness, and occasional cough—symptoms that started a couple of days ago. Also, her left shoulder has been hurting her “more than usual.” She denies any fever, chills, nausea, or vomiting. She admits to smoking two packs of cigarettes per day and having hypertension. Otherwise, her medical history is unremarkable. During the physical exam, you observe that the patient is an older female in no obvious distress. She is afebrile, and the rest of her vital signs, including pulse oximetry, are normal. Her breath sounds demonstrate scattered rhonchi but overall are clear. She does have localized tenderness over her left shoulder, with decreased range of motion in that arm secondary to the pain and stiffness in it. You send a blood sample to the lab to check her complete blood count and obtain a chest radiograph, which is shown. What is your impression?
Man Fell Off Roof
ANSWER
The radiograph shows a comminuted fracture of the os calcis, as well as a comminuted fracture of the navicular bone. CT on this patient was pending to further assess for additional fractures, and the patient will likely undergo open reduction and internal fixation for definitive treatment.
ANSWER
The radiograph shows a comminuted fracture of the os calcis, as well as a comminuted fracture of the navicular bone. CT on this patient was pending to further assess for additional fractures, and the patient will likely undergo open reduction and internal fixation for definitive treatment.
ANSWER
The radiograph shows a comminuted fracture of the os calcis, as well as a comminuted fracture of the navicular bone. CT on this patient was pending to further assess for additional fractures, and the patient will likely undergo open reduction and internal fixation for definitive treatment.
A 51-year-old man is brought to your facility for evaluation of right foot pain after sustaining a fall. He was working on top of his house when he lost his balance and fell approximately 15 to 20 feet. He states he landed on his feet and has the above complaint. His medical history is significant for hypertension and heart disease. He regularly works as a truck driver and smokes one to two packs of cigarettes per day. His exam shows a middle-aged male who is uncomfortable but in no obvious distress. Primary survey is normal. His right foot shows no obvious deformity. There is some swelling and moderate tenderness over the dorsal aspect, as well as in the area of the heel. Pulses are present, sensation is intact, and good capillary refill time is noted. Portable radiograph of the right foot is obtained. What is your impression?
