Images In Emergency Medicine

Cecal Diverticulitis: A Diagnostic Conundrum

Volume 16, Issue 2, March 2015
Kristof Nemeth, MD et al.

We report an unusual presentation of a 63-year-old female who presented with a five-day history of right-sided loin to groin pain. On assessment she was afebrile and her observations were stable. She had right iliac fossa pain and tenderness in the right renal angle.

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Silent Killer: Case Report of Acute Gastrostomy Tube Erosion

Volume 16, Issue 2, March 2015
Allen D. Chang, MD et al.

An 87-year-old male with multiple medical problems and percutaneous endoscopic gastrostomy (PEG) tube placement presented to the emergency department for recurrent dysphagia, constipation, and concern for stool appearing in his PEG tube.

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Penile Foreskin Avulsion from Parrot Fish Bite

Volume 16, Issue 2, March 2015
Sow A. Kobayashi, MD et al.

A healthy, uncircumcised 34-year-old male presented to an emergency department (ED) in Tinian (Commonwealth of the Northern Mariana Islands) after a parrot fish bite. The patient was spearfishing in the Philippine Sea and impaled a 15-pound parrot fish. As the patient was attempting to grasp the speared fish it bit him in the groin exterior to his swimming trunks.

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13-Year-Old with Cryptic Abdominal Pain

Volume 16, Issue 1, January 2015
Stephanie Spring, DO et al.

A 13-year old female patient presented to the emergency department (ED) with four days of intermittent non-radiating, left upper quadrant pain, associated with non-bloody, non-bilious emesis and decreased appetite. The patient had been evaluated by a gastroenterologist three months prior for abdominal pain.

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Bilateral Inferior Shoulder Dislocation

Volume 16, Issue 1, January 2015
Erica Cacioppo, MD et al.

A 42-year-old male with a history of multiple shoulder dislocations presented to the emergency department via emergency medical services with both arms locked above his head, stating that he had been jumped at a bar and had since been unable to move his arms.

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Achilles Tendon Rupture

Volume 16, Issue 1, January 2015
Sean P. Stickles, MD et al.

A 60-year-old man presented to the emergency department complaining of acute onset posterior ankle pain. He reported playing tennis earlier in the afternoon when he suddenly stopped and pivoted, noting a “pop” sensation and pain to the right posterior ankle.

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Herpes Zoster Ophthalmicus Extending to the Palate

Volume 16, Issue 1, January 2015
Todd Schneberk, MD, MA et al.

A 57-year-old female presented to the emergency department with left sided facial rash with associated pain, blurred vision and oral discomfort. Past medical history included hypertension, and remote scleroderma (untreated).

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Persistent Pain After Lithotripsy

Volume 16, Issue 1, January 2015
Ellen Jones, MD et al.

A 36-year old man presents to the emergency room five days after undergoing extracorporeal shock wave lithotripsy (ESWL) for a symptomatic 11mm left renal pelvis stone. The patient has persistent symptoms of severe left flank pain at presentation.

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Ultrasound Evaluation of an Inguinal Mass

Volume 15, Issue 7, November 2014
Jeffrey L. Wiswell, MD et al.

A 33 year-old female presented to the emergency department (ED) with of two weeks of diffuse abdominal pain, right flank pain, and a slowly enlarging right inguinal mass.

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Ultrasound Distinguishes Ascites from a Large Ovarian Fluid-Filled Cyst

Volume 15, Issue 7, November 2014
Marissa Camilon, MD et al.

A 51-year-old woman with Hepatitis C was referred to the emergency department (ED) for “massive ascites.” She reported increasing abdominal girth for six months with intermittent abdominal pain. An outpatient ultrasound performed two weeks prior to ED presentation was interpreted by a radiologist as “massive ascites, no masses within the abdomen” on the paper report the patient brought with her. In the ED, the patient was afebrile with normal vital signs. Her abdomen was distended with mild right upper quadrant tenderness.

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Old Man with Groin Bruising

Volume 15, Issue 7, November 2015
Basak Bayram, MD et al.

A 67-year-old man presented to the emergency department with abdominal pain and groin bruising. He had no history of any disease or drug use.

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Hip Pain Secondary to Small Bowel Fistula to Pelvis

Volume 15, Issue 7, November 2014
Chris Cruz, MD, et al.

A 26-year old man presented to the emergency department for two months of worsening right hip and thigh pain. He complained of radicular pain from his buttocks to his calf and has difficulty bearing weight on his right leg. He denies a history of trauma, fever, prior surgery, or arthritis. In addition, he was being evaluated by a gastroenterologist for recurrent diarrhea. In the middle of his encounter, the radiologist called to discuss a result of his computed tomography (CT) performed three days prior. CT images showed inflamed loops of bowel involving the distal ileum and rectum. A fistula is seen from the rectum, extending into the distal ileal loop and the posterior pelvis (Figures 1 and 2). An abscess was found between the piriformis and gluteus medius. He was admitted for intravenous antibiotic therapy, including a consultation with general surgery for Chrohn’s Disease (CD). He responded well to antibiotics and was discharged six days later.

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Intragastic Balloon Rupture

Volume 15, Issue 7, November 2014
George Lim, MD et al.

A 38 year old obese female presented to the emergency department with 1 hour of nausea and blue colored urine.

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Patellar Sleeve Fracture

Volume 15, Issue 7, November 2014
Scott Sullivan, MD et al.

A 10 year-old male presented to the ED with knee pain after falling off his bicycle. He landed on his flexed knee with an audible “pop.” He could not extend his knee or walk. Physical examination revealed an effusion and high riding patella with a palpable inferior pole defect. He was neurovascularly intact, and the remaining examination of his lower extremity was unremarkable.

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Egg Shell Sign: Rare Finding in Acute Aortic Dissection

Volume 15, Issue 7, November 2014
John Ashurst, DO et al.

A 77 year-old woman presented with a one day history of central chest pressure that radiated to the neck and right upper extremity. She had a history of hypertension and chronic obstruction pulmonary disease.

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Post Transapical Aortic Valve Replacement (TAVR) Pseudoaneurysm

Volume 15, Issue 7, November 2014
Michael W. Manning, MS et al.

A 63-year-old female presented to the emergency department with complaints of her “heart beating out of my chest,” palpitations, and shortness of breath. She was three months postoperative a #23 Edwards Sapien Transapical Aortic Valve Replacement (TAVR).

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Middle Cerebral Artery Arrow Sign

Volume 15, Issue 7, November 2014
Zachary D. Levy, MD et al.

A 54-year-old woman presented to the emergency department with sudden onset severe headache, nausea and vomiting upon waking that morning.

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Complex Thoracic Aortic Dissection

Volume 15, Issue 6, September 2014
Mihir Patel, MD et al.

A 50-year-old man presented with sudden onset abdominal pain and non-productive cough. Past medical history was significant for hypertension, treated with hydrochlorothiazide, azilsartan and a beta-blocker. Cardiovascular exam was notable for soft diastolic murmur in right second intercostal space and an abdominal bruit in umbilical region.

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From the Heart: Interatrial Septal Aneurysm Identified on Bedside Ultrasound

Volume 15, Issue 6, September 2014
Michael Butterfield, MD, MS, MPH et al.

A 61 year-old man presented to the Emergency Department for one day of nonspecific chest pain. Bedside echocardiogram performed by the emergency physician revealed normal systolic cardiac function but also showed a large ( > 10mm) bicornuate interatrial septal aneurysm (IASA) projecting into the right atrium (Figure 1, Video 1). There was no evidence of intraatrial thrombus. A formal echocardiogram performed later that day confirmed the diagnosis and also detected a patent foramen ovale (PFO) with a left-to-right shunt that reversed with Valsalva maneuver.

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Orange, CA 92868, USA
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Email: editor@westjem.org

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

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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.