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Construction Worker Falls From Scaffolding
ANSWER
The radiograph shows an acute, comminuted fracture of the scaphoid bone. The patient was placed in a thumb spica splint and sling. He was instructed to follow up in one to two days with the hand surgeon who was on call, with anticipation of subsequent open reduction and internal fixation.
ANSWER
The radiograph shows an acute, comminuted fracture of the scaphoid bone. The patient was placed in a thumb spica splint and sling. He was instructed to follow up in one to two days with the hand surgeon who was on call, with anticipation of subsequent open reduction and internal fixation.
ANSWER
The radiograph shows an acute, comminuted fracture of the scaphoid bone. The patient was placed in a thumb spica splint and sling. He was instructed to follow up in one to two days with the hand surgeon who was on call, with anticipation of subsequent open reduction and internal fixation.
A 45-year-old construction worker is brought to your facility for evaluation following a fall. He was at a job site, standing on scaffolding approximately 20 feet above the ground, when he accidentally fell. He does not remember for sure, but he thinks he landed on his face. He did briefly lose consciousness. He is complaining of right-side facial pain and right wrist pain. His medical history is unremarkable. The physical exam reveals stable vital signs. The patient appears somewhat uncomfortable but is in no obvious distress. There is a moderate amount of periorbital soft-tissue swelling around his right eye, with moderate associated tenderness. Pupils are equal and react well bilaterally. Examination of the right wrist shows a moderate amount of soft-tissue swelling. The patient is unable to flex or extend his wrist due to pain. Good pulses and capillary refill of the nail beds are noted. There is also moderate tenderness along the base of the first metacarpal. Radiograph of the right wrist is shown. What is your impression?
Woman Assaulted on Street
The chest radiograph demonstrates a massive amount of soft tissue and subcutaneous emphysema extending from the neck down through the chest and into the lower chest/upper abdomen. In addition, there are several fractured posterior ribs bilaterally. No large pneumothorax or pneumomediastinum is noted.
Because of the extent and mechanism of injury, CT of the chest, abdomen, and pelvis had already been ordered. Arrangements were also made for the patient to be admitted to the ICU for closer observation.
The chest radiograph demonstrates a massive amount of soft tissue and subcutaneous emphysema extending from the neck down through the chest and into the lower chest/upper abdomen. In addition, there are several fractured posterior ribs bilaterally. No large pneumothorax or pneumomediastinum is noted.
Because of the extent and mechanism of injury, CT of the chest, abdomen, and pelvis had already been ordered. Arrangements were also made for the patient to be admitted to the ICU for closer observation.
The chest radiograph demonstrates a massive amount of soft tissue and subcutaneous emphysema extending from the neck down through the chest and into the lower chest/upper abdomen. In addition, there are several fractured posterior ribs bilaterally. No large pneumothorax or pneumomediastinum is noted.
Because of the extent and mechanism of injury, CT of the chest, abdomen, and pelvis had already been ordered. Arrangements were also made for the patient to be admitted to the ICU for closer observation.
A 40-year-old woman is brought in by EMS for evaluation of injuries secondary to being assaulted. She was out walking late last night when she was approached by two men who pushed her to the ground and began punching and kicking her repeatedly on her face, chest, and back. She is primarily complaining of chest wall and back pain. Her medical history is significant for hypertension, diet-controlled diabetes, and “some sort of heart problem” for which she takes medication. Surgical history is significant for hysterectomy, cholecystectomy, and appendectomy. She smokes more than a pack of cigarettes per day and consumes at least a six-pack of beer daily. Initial exam shows an anxious female who appears somewhat uncomfortable but is in no obvious distress. Her vital signs are as follows: blood pressure, 130/88 mm Hg; pulse, 120 beats/min; respiratory rate, 22 breaths/min; and O2 saturation, 100% on room air. Physical exam reveals extensive facial/periorbital swelling, as well as swelling in the neck. Some splinting is noted. There is extensive crepitus noted within the soft tissue of the face, neck, and chest wall. Also, there is moderate tenderness bilaterally over the ribs. Chest radiograph is obtained (shown). What is your impression?
Competitive Swimmer With Hip Pain
ANSWER
The radiograph demonstrates no evidence of an acute fracture or dislocation. Normal gas/stool pattern is present. Essentially, this radiograph is normal.
The patient most likely has an acute strain of her hip quadriceps or flexor. On occasion, severe enough strain injuries can cause a slight avulsion fracture within the hip at the muscle origination point. These can sometimes be evident on plain films.
ANSWER
The radiograph demonstrates no evidence of an acute fracture or dislocation. Normal gas/stool pattern is present. Essentially, this radiograph is normal.
The patient most likely has an acute strain of her hip quadriceps or flexor. On occasion, severe enough strain injuries can cause a slight avulsion fracture within the hip at the muscle origination point. These can sometimes be evident on plain films.
ANSWER
The radiograph demonstrates no evidence of an acute fracture or dislocation. Normal gas/stool pattern is present. Essentially, this radiograph is normal.
The patient most likely has an acute strain of her hip quadriceps or flexor. On occasion, severe enough strain injuries can cause a slight avulsion fracture within the hip at the muscle origination point. These can sometimes be evident on plain films.
A 17-year-old girl presents for evaluation of severe pain in her left hip. She is a competitive swimmer; earlier in the day, she was at practice doing dry land (out of the water) activities/exercises. Having completed a series of stretches and warm-up exercises, she and her teammates proceeded to do sprints. During one of these sprints, she immediately felt a “pop” in her left hip followed by severe, debilitating pain in that hip and thigh. Medical history is otherwise unremarkable. Physical exam reveals that it is extremely painful for the patient to bear weight on the affected leg. There is moderate-to-severe tenderness over the lateral hip. Some swelling is noted; no bruising is present. Distal pulses are good, and motor and sensation are intact. Radiograph of the pelvis is obtained (shown). What is your impression?
Unresponsive Woman Extricated From Car
ANSWER
The radiograph shows a right acetabular fracture that is mildly displaced. In addition, the right hip and femoral head are dislocated. Orthopedic consultation was made to reduce the hip and evaluate the fracture.
ANSWER
The radiograph shows a right acetabular fracture that is mildly displaced. In addition, the right hip and femoral head are dislocated. Orthopedic consultation was made to reduce the hip and evaluate the fracture.
ANSWER
The radiograph shows a right acetabular fracture that is mildly displaced. In addition, the right hip and femoral head are dislocated. Orthopedic consultation was made to reduce the hip and evaluate the fracture.
An unidentified female is brought in as a trauma code. She was apparently in a motor vehicle crash, the specific details of which are unclear. Emergency medical personnel describe extensive damage to her vehicle, which resulted in a pro-longed extrication time. Due to unresponsiveness at the scene, she was intubated in the field. The patient is probably in her late 30s to early 40s. She has two large-bore IV lines with normal saline infusing at a wide-open rate. Blood pressure is 90/60 mm Hg and heart rate, 140 beats/min. She has several superficial lacerations on her head, her pupils are fixed and dilated, and there is minimal withdrawal to pain in her extremities. No other trauma is im-mediately evident. Portable radiographs of her chest and pelvis are obtained prior to sending her for CT. Pelvis radiograph is shown. What is your impression?
Knee Pain After Falling Off Ladder
ANSWER
The radiograph shows a lucency within the lateral tibial plateau and tibial metaphysis, consistent with a fracture. It is mildly depressed and slightly comminuted.
Fluid collection is also evident on the lateral view, likely reflecting a lipohemarthrosis. The patient was placed in a knee immobilizer and made non–weight-bearing. She was instructed to follow up with an orthopedist when she returned home (as she was visiting from out of town).
ANSWER
The radiograph shows a lucency within the lateral tibial plateau and tibial metaphysis, consistent with a fracture. It is mildly depressed and slightly comminuted.
Fluid collection is also evident on the lateral view, likely reflecting a lipohemarthrosis. The patient was placed in a knee immobilizer and made non–weight-bearing. She was instructed to follow up with an orthopedist when she returned home (as she was visiting from out of town).
ANSWER
The radiograph shows a lucency within the lateral tibial plateau and tibial metaphysis, consistent with a fracture. It is mildly depressed and slightly comminuted.
Fluid collection is also evident on the lateral view, likely reflecting a lipohemarthrosis. The patient was placed in a knee immobilizer and made non–weight-bearing. She was instructed to follow up with an orthopedist when she returned home (as she was visiting from out of town).
A 25-year-old woman presents for evaluation of left knee pain secondary to a fall. She states she was descending a ladder when she missed a step while still several feet above the ground. She landed on her left foot, awkwardly twisting her leg. She now has swelling and pain in her knee and difficulty bearing weight on that leg. Her medical history is unremarkable. Examination reveals a moderate amount of swelling that limits her ability to flex her left knee. She has diffuse tenderness throughout the knee. Because of the swelling and the patient’s severe discomfort, instability tests are not performed. She has good distal pulses and sensation. Radiographs of the knee are obtained. What is your impression?
Is Chest Pain Related to Prior Fracture?
ANSWER
The radiograph demonstrates evidence of previous surgery on the sternum. There also is evidence of scarring or discoid atelectasis along the left mid lung.
Of note, though, is a soft tissue mass (about 5 to 6 cm) within the left pulmonary apex. This lesion could represent a rounded infiltrate, an atypical infection such as a mycetoma, or possibly a pulmonary neoplasm.
Since the patient was stable, he was placed on antibiotics with instructions to follow up with his primary care provider for further work-up on the mass. The patient did follow up; the lesion persisted and subsequent biopsy confirmed carcinoma.
ANSWER
The radiograph demonstrates evidence of previous surgery on the sternum. There also is evidence of scarring or discoid atelectasis along the left mid lung.
Of note, though, is a soft tissue mass (about 5 to 6 cm) within the left pulmonary apex. This lesion could represent a rounded infiltrate, an atypical infection such as a mycetoma, or possibly a pulmonary neoplasm.
Since the patient was stable, he was placed on antibiotics with instructions to follow up with his primary care provider for further work-up on the mass. The patient did follow up; the lesion persisted and subsequent biopsy confirmed carcinoma.
ANSWER
The radiograph demonstrates evidence of previous surgery on the sternum. There also is evidence of scarring or discoid atelectasis along the left mid lung.
Of note, though, is a soft tissue mass (about 5 to 6 cm) within the left pulmonary apex. This lesion could represent a rounded infiltrate, an atypical infection such as a mycetoma, or possibly a pulmonary neoplasm.
Since the patient was stable, he was placed on antibiotics with instructions to follow up with his primary care provider for further work-up on the mass. The patient did follow up; the lesion persisted and subsequent biopsy confirmed carcinoma.
A 61-year-old man presents to your urgent care center for evaluation of “chest pain” he has been experiencing for almost four weeks. He denies any injury or trauma. He describes the pain as “sharp” and “stabbing” and says occasionally it is associated with breathing, localized primarily to the left side. There is no radiation of the pain. He denies fever, nausea, weight loss, night sweats, and hemoptysis. He has smoked a half-pack of cigarettes daily for more than 40 years. His medical history is otherwise unremarkable, except that he was told he had “high blood pressure” and he had his sternum repaired several years ago, following fracture in an accident. Vital signs are as follows: temperature, 36.4°C; blood pressure, 174/100 mm Hg; ventricular rate, 88 beats/min; respiratory rate, 20 breaths/min; and O2 saturation, 100% on room air. He appears to be in no obvious distress. Lung sounds are normal, as is the rest of the physical examination. You obtain a chest radiograph. What is your impression?
Man with Consistent Headaches
ANSWER
The image shows obvious mass effect throughout the left hemisphere. On close examination, there is evidence of an isodense subdural collection within the left frontoparietal region. This is causing a left-to-right shift of almost 11 mm.
This finding is most likely a subacute subdural hematoma, probably seven to 14 days old. Further questioning reveals that the patient had fallen in the shower approximately two weeks prior and hit his head. The patient was admitted for observation and subsequently underwent a craniotomy for evacuation of the subdural hematoma.
ANSWER
The image shows obvious mass effect throughout the left hemisphere. On close examination, there is evidence of an isodense subdural collection within the left frontoparietal region. This is causing a left-to-right shift of almost 11 mm.
This finding is most likely a subacute subdural hematoma, probably seven to 14 days old. Further questioning reveals that the patient had fallen in the shower approximately two weeks prior and hit his head. The patient was admitted for observation and subsequently underwent a craniotomy for evacuation of the subdural hematoma.
ANSWER
The image shows obvious mass effect throughout the left hemisphere. On close examination, there is evidence of an isodense subdural collection within the left frontoparietal region. This is causing a left-to-right shift of almost 11 mm.
This finding is most likely a subacute subdural hematoma, probably seven to 14 days old. Further questioning reveals that the patient had fallen in the shower approximately two weeks prior and hit his head. The patient was admitted for observation and subsequently underwent a craniotomy for evacuation of the subdural hematoma.
You are called to the emergency department (ED) in reference to a patient who was sent there by radiology with a reported “brain mass” noted on imaging. During further investigation in the ED, the patient, who is in his 50s, stated that he has had headaches for the past several weeks; he consulted his primary care provider, who ordered outpatient MRI of the brain—the test that ultimately led to his arrival in the ED. Since the MRI results were not immediately available for review, the ED staff obtained noncontrast CT of the head. The ED provider notes that it “looks like there is something there causing significant mass effect and shift.” When you arrive to see the patient, you note that he is awake, alert, and oriented times three. His Glasgow Coma Scale score is 15, and his vitals signs are normal. He states he has a mild headache, rating it a 3 out of 10 on a pain scale. His only other complaint is mild right-sided weakness, which he has noticed in the past week or so. Clinically, the strength in his right upper and lower extremities is good. His medical history is significant for prostate cancer and hypertension. A single cut from the CT of his head is shown. What is your impression?
Wrist Pain After a Fall
ANSWER
The radiograph shows some osteopenia and significant vascular calcifications. Of note, there is a fracture of the styloid process of the radius, extending slightly to the joint space. The patient was placed in a splint and orthopedic referral was obtained.
ANSWER
The radiograph shows some osteopenia and significant vascular calcifications. Of note, there is a fracture of the styloid process of the radius, extending slightly to the joint space. The patient was placed in a splint and orthopedic referral was obtained.
ANSWER
The radiograph shows some osteopenia and significant vascular calcifications. Of note, there is a fracture of the styloid process of the radius, extending slightly to the joint space. The patient was placed in a splint and orthopedic referral was obtained.
A 90-year-old man is brought to your facility for evaluation after a fall. The patient states he was out in his yard, near his garden, when he “just passed out.” He landed in an ant bed and was eventually found by a neighbor, who brought him for evaluation. The patient says he has felt weak for the past several days. He has no other constitutional complaints. He is also experiencing bilateral wrist pain, he presumes as a result of receiving multiple ant bites. His medical history is significant for diabetes. His vital signs are normal. Inspection of both wrists demonstrates mild to moderate circumferential swelling with several raised, reddened bumps. Both wrists are tender; range of motion does cause some tenderness. Sensation is intact, and good capillary refill time is noted. While waiting for lab results, you obtain a radiograph of the left wrist (shown). What is your impression?
Elderly Woman with Shoulder Pain
ANSWER
The radiograph demonstrates significant osteopenia. In addition, there is a slightly impacted subcapital fracture of the humeral neck.
Orthopedics was consulted, and the patient was to be treated with nonoperative management. She was given a swathe for immobilization and comfort.
ANSWER
The radiograph demonstrates significant osteopenia. In addition, there is a slightly impacted subcapital fracture of the humeral neck.
Orthopedics was consulted, and the patient was to be treated with nonoperative management. She was given a swathe for immobilization and comfort.
ANSWER
The radiograph demonstrates significant osteopenia. In addition, there is a slightly impacted subcapital fracture of the humeral neck.
Orthopedics was consulted, and the patient was to be treated with nonoperative management. She was given a swathe for immobilization and comfort.
A 90-year-old woman is transferred to your facility from an outside hospital for evaluation of an intracranial hemorrhage secondary to a fall. The patient normally resides in a nursing home and has dementia. She was reportedly ambulating with her walker when she tripped and fell forward. In addition to dementia, her medical history is significant for sick sinus syndrome, for which she has a pacemaker. She also has hypertension and degenerative joint disease. Examination reveals an elderly female who is alert but very confused. Her vital signs are normal. She has moderate swelling and bruising on the left side of her forehead and left orbit. Her pupils react well. As you examine her, you note her unwillingness to use or move her left arm. When you inquire, she states, “It hurts.” Close examination of the left upper extremity shows no obvious deformity or swelling. She does have some tenderness over the left shoulder. You order a radiograph of the left shoulder (shown). What is your impression?
Elderly Man Failed To Mention Hip Pain After Fall
ANSWER
The radiograph demonstrates diffuse bony demineralization, as well as generalized degenerative changes. No obvious fracture or dislocation of the hip joint is seen.
Of note, though, are air lucencies within the area of the scrotum. This most likely represents a bowel finding and is strongly suggestive of an inguinal hernia. No acute intervention is warranted for this incidental finding; outpatient follow-up with general surgery was arranged.
ANSWER
The radiograph demonstrates diffuse bony demineralization, as well as generalized degenerative changes. No obvious fracture or dislocation of the hip joint is seen.
Of note, though, are air lucencies within the area of the scrotum. This most likely represents a bowel finding and is strongly suggestive of an inguinal hernia. No acute intervention is warranted for this incidental finding; outpatient follow-up with general surgery was arranged.
ANSWER
The radiograph demonstrates diffuse bony demineralization, as well as generalized degenerative changes. No obvious fracture or dislocation of the hip joint is seen.
Of note, though, are air lucencies within the area of the scrotum. This most likely represents a bowel finding and is strongly suggestive of an inguinal hernia. No acute intervention is warranted for this incidental finding; outpatient follow-up with general surgery was arranged.
An 87-year-old man is admitted to the hospital with a traumatic subarachnoid hemorrhage secondary to a fall down some steps. He is taking warfarin for atrial fibrillation; because his INR is elevated, he is placed in the ICU for close observation and warfarin reversal. His medical history is otherwise unremarkable, except for mild hypertension. During rounds, he complains of severe hip pain, possibly related to the fall. He admits that he “probably didn’t mention this” while he was in the emergency department. Physical examination demonstrates moderate tenderness and bruising in the left hip. No obvious leg shortening is noted. There is pain in the left hip with abduction and adduction, as well as with internal and external rotation. Good distal pulses are noted, as well as good color and sensation. His vital signs are normal. You order a portable pelvis radiograph (shown). What is your impression?
