Image Diagnoses

Gus M Garmel, MD, FACEP, FAAEM

Pulmonary Embolism

Figure 1. Axial view from a computed tomography (CT) angiogram which beautifully demonstrates a large saddle pulmonary embolus in a previously healthy female age 33 years who presented to the Emergency Department following a syncopal episode. She was not pregnant, and had mild chest pain, dyspnea, tachycardia, and tachypnea, which were not present before her episode.

Figure 2. (same patient) CT angiogram demonstrating a large branching clot consistent with a pulmonary embolism.

Figure 3. Compression ultrasound demonstrates a patent popliteal artery (A) in both images. A clot can be seen in the popliteal vein (V), which does not collapse during compression (right-sided image).

Acknowledgments

Dr Garmel would like to thank Bruce Wollman, MD; John Rego, MD; and Diane Craig, MD, for their assistance selecting the most illustrative images for this interesting case, as well as for their participation in the care of this challenging patient.

Radial Head Fracture

The patient presented to the urgent care clinic after trauma to the upper extremity.

Figure 1. Lateral view of an elbow, in which you can easily see a posterior fat pad (never normal) and an anterior “sail sign.” Together, these represent a relatively large hemarthrosis around the elbow joint, suggestive of a fracture. On close inspection, a cortical disruption and small depression of the radial head is apparent. There is also slight elevation of the supinator line due to the hemarthrosis present, although this finding is much more subtle and less specific.

Abdominal Aortic Aneurysm

Figure 1. Abdominal computed tomography (CT) scan with IV contrast demonstrates a leaking abdominal aortic aneurysm (AAA). The light arrow points to contrast within the lumen of the abdominal aorta. The dark arrow points to the outer walls of the abdominal aorta. At the level of the kidneys, the abdominal aorta is always found directly on top of the spine.

K = kidney, B = spine (vertebral body), L = liver

Figure 2. Normal abdominal CT scan.