Images In Emergency Medicine

Point-of-care Ultrasound in the Diagnosis of Calciphylaxis

Natasha Tobarran, DO

A 63-year-old male with a past medical history of end stage renal disease presented to the emergency department with painful, lower-extremity necrotic ulcerations. Ultrasound and computed tomography imaging showed concerns for calcium deposits. Biopsy confirmed the diagnosis of calciphylaxis, a rare lethal disease.

Read More

Point-of-care Ultrasound for Long Head of the Biceps Tendon Rupture

Browning S. Wayman, MD, DTM&H

We present a case of a 59-year-old male who presented to the emergency department with left upper arm pain that started suddenly after lifting some plywood a few days prior. Point-of-care ultrasound (POCUS) was performed, which revealed a rupture of the long head of the biceps tendon.

Read More

Bilateral Foot Skin Eruption in a Hepatitis C Patient

Shane Davis, MD

A 58-year-old female with history of hepatitis C virus presented to the emergency department with a bilateral skin eruption to her feet for one year. Following skin biopsy, the patient was diagnosed with Necrolytic acral erythema (NAE). She was treated with clobetasol ointment, zinc supplementation, and mupirocin, which resulted in improvement in her symptoms.

Read More

A Case of a Missing Proximal Humerus

Jessica Lynn Williams, MD

In this case, we demonstrate how a small radiolucency in the proximal humerus can progress to an even larger problem within a few months in a patient without follow-up. Our patient’s ultimate diagnosis was renal cell carcinoma with metastasis to the right proximal humerus, completely obliterating the affected bone.

Read More

Tubelight Adrenals in Diabetic Ketoacidosis

Prakrati Yadav, MBBS

We report a patient with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis associated with computed tomography hypoperfusion complex and adrenal hyperdensity on abdominal imaging – an association not previously reported in diabetic ketoacidosis.

Read More

Hirschsprung’s Disease: A Rare Adult Diagnosis

Kaitlyn Schmutz, PA-C

Approximately 94% of patients with Hirschsprung’s disease (HD) are diagnosed before the age of five. In our case, a young adult with years of constipation presented to the emergency department with significant abdominal distention. He was ultimately diagnosed with HD, which was identified using computed tomography (CT).

Read More

Rare Cause of Syncope in a Gravid Female

Andrew Bellino, MD

A 33-year-old gravid female was brought to the emergency department after she collapsed in the street. Point-of-care ultrasound showed free fluid in the abdomen and confirmed an intrauterine pregnancy. Surgical teams were consulted, and cross-sectional imaging revealed a spontaneously ruptured splenic artery aneurysm (SAA). The patient was taken expeditiously to the operating room for splenic artery ligation and subsequent splenectomy.

Read More

Symptomatic Aortic Endograft Occlusion in a 70-year-old Male

Jose Cardenas, MD

A 70-year-old male with prior aorta endovascular aneurysm repair presented with progressive lower extremity weakness over the course of several hours. There was noted loss of palpable bilateral femoral pulses in the emergency department. Computed tomography angiography revealed a kinked and occluded aortic endograft. He subsequently underwent successful axillobifemoral bypass revascularization.

Read More

Abdominal Computed Tomography with a Twist: The ‘Whirl Sign’ for Mesenteric Volvulus

Jodi Spangler, BA

A 55-year-old woman with a history of end-stage renal disease, peripheral vascular disease, and multiple prior abdominal surgeries presented to the emergency department with three days of diffuse, severe, abdominal pain with accompanying nausea, emesis, and food intolerance. A computed tomography (CT) of her abdomen demonstrated a “whirl” of small bowel and mesenteric vessels, raising suspicion for mesenteric volvulus and resultant small bowel obstruction.

Read More

Chest Wall Pain after Minor Trauma

Deepak Chandwani, MD

A 30-year-old healthy male presented with a complaint of chest pain after mild thoracic trauma sustained while rescuing stranded flood victims during Hurricane Harvey. Careful physical examination revealed a tender palpable cord along the lateral aspect of his chest consistent with a superficial thrombophlebitis.

Read More

Pulmonary Artery Dissection Post-blunt Thoracoabdominal Trauma

Daniel Quesada, MD

Pulmonary artery dissection is a rare condition that is usually diagnosed in patients exhibiting chronic pulmonary arterial hypertension, congenital heart abnormalities or secondary to iatrogenic injury. Diagnosis is often made at autopsy as many patients experience sudden death when the pulmonary artery dissection progresses rapidly and ruptures into the pericardium, resulting in acute cardiac tamponade.

Read More

48-year-old with Coronavirus Disease 2019

Holly Gil, MD

A 48-year-old male who presented with signs and symptoms suggestive of an upper respiratory infection was seen at an urgent care, he had a negative chest radiograph and was discharged. With no other cases of coronavirus disease 2019 (COVID-19) in the state, the patient presented to the emergency department two days later with worsening shortness of breath.

Read More

COVID-19 with Hypoxic Respiratory Failure

Miguel A. Martinez-Romo, MD

We describe an elderly male presenting to the emergency department with shortness of breath that progressed to hypoxic respiratory failure. Radiography and computed tomography findings were suggestive of coronavirus disease 2019 (COVID-19).

Read More

New Onset Nystagmus in a Patient with Multiple Sclerosis

Daugherty, MS, et al.

A 50-year-old White male with a history of multiple sclerosis presented to the emergency department with fatigue, lightheadedness, and dizziness, exacerbated with sitting upright and worsening over the prior one to two days. He stated his last flare was approximately two years prior, and presented with aphasia as his primary symptom.

Read More

A Young Boy with Fever and Grunting

Shapiro, MD, et al.

A 16-month-old healthy boy presented to the emergency department with a temperature of 99°Fahrenheit (F) (down from 102°F at home after antipyretics), tachypnea, and grunting.

Read More

A Piercing Diagnosis – Occult Foreign Body as the Cause of Acute Inguinal Pain

Bays-Muchmore, BS, et al.

A 35-year-old woman presented to the emergency department with severe right inguinal pain. Her medical history was non-contributory and there was no known trauma or injury to the region. Amid concern for an incarcerated inguinal hernia, a computed tomography was obtained revealing a linear foreign body (FB) lateral to the femoral vessels.

Read More

Male with Altered Mental Status

Kondrat, DO, et al.

A 62-year-old male presented to the emergency department with altered mental status and fever. Computed tomography of the head showed enlargement of the left lateral ventricle. Magnetic resonance imaging demonstrated debris and purulence in the ventricle along with edema and transependymal flow of cerebrospinal fluid surrounding both ventricles.

Read More

Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

3800 W Chapman Ave Ste 3200
Orange, CA 92868, USA
Phone: 1-714-456-6389


ISSN: 1936-900X
e-ISSN: 1936-9018

ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.