Plug the Hole

Isn't that a great picture? This patient presented with respiratory distress requiring intubation and placement of a gastric decompression tube.

Challenge: What's the diagnosis?

Image shown under Fair Use.

Bat Man

A 40 year old man presents with insidious gradual shortness of breath. He gets dyspneic on exertion and has a cough, fatigue, weight loss, and low-grade fever. His physical exam is pretty much normal. His labs show polycythemia, hypergammaglobulinemia, and increased LDH. Chest X-ray is below:

High resolution CT scan shows homogeneous ground glass opacities. Pulmonary function tests show a restrictive ventilatory defect. A bronchioalveolar lavage results in an opaque milky fluid which settles upon standing.

Challenge: Aha! Your diagnosis is...?

Image shown under Fair Use.

A Lie

Challenge: What do you think?

Image is shown under Fair Use.

_____

This patient comes in with this cervical spine X-ray:

Challenge: What's the arrow pointing to?

First image shown under Creative Commons Attribution Share-Alike License, second image is in the public domain.

Ouch

Oops - this case was scheduled to post last Thursday but didn't trigger.

A child is brought in by ambulance as a major trauma. He was hit by a slow moving car which pinned him against the wall. When EMS found him, his chest was pinned against the bumper. There was no injury at the neck. He is stable on your primary survey of airway, breathing, circulation, disability, and exposure. On your secondary trauma survey, you note bilateral conjunctival hemorrhage, facial edema, ecchymoses, and petechiae on the upper chest and face. Fortunately, the prognosis for this is generally favorable.

Challenge: What happened?

Leave It Up To

As I just certified in advanced trauma life support, this week will be trauma cases.

A woman is brought into your emergency department after a car crash. She was only wearing a lap belt, and it was positioned a little high, above her pelvic bones. She has a clear seat belt sign on her abdomen. Her neurologic exam is grossly normal. Lumbar spine films are shown above. By chance, you also order a CT abdomen which shows duodenal injury. She's taken immediately to the operating room.

Challenge: Your intern asks what the radiologist has arrowed on the X-ray. What fracture does she have?

Image shown under Fair Use.