Visual Diagnosis Part 8
Ludwig's angina is a rapidly progressive bacterial infection of the submandibular, sublingual, and submental spaces beneath the tongue, resulting in severe cellulitis of the neck and floor of the mouth. Early recognition is critical due to the high risk of airway obstruction. Symptoms of Ludwig's angina include tongue elevation, dysphagia, drooling, trismus (jaw locking), and muffled speech. Immediate hospitalization and aggressive antibiotic therapy with airway management are essential to prevent life-threatening complications. The main pathogens are Streptococcus viridans, Staphylococcus aureus, and anaerobes.
Rectus sheath hematoma
Rectus sheath hematoma is a collection of blood within the rectus abdominis muscle sheath. Rectus sheath hematoma can arise from diverse causes, including traumatic injury, spontaneous tears in blood vessels, or complications of anticoagulation therapy. Rectus sheath hematoma is often unilateral and exacerbated by straining or coughing.
Management of Rectus sheath hematoma range from observation for small cases to surgical intervention for larger or actively bleeding hematomas.
Pulmonary and right atrial thrombus
Risk factors of pulmonary embolism include: recent surgery, prolonged immobilization, and deep vein thrombosis (DVT). The diagnostic test of choice for pulmonary embolism is CT pulmonary angiography. Prompt treatment with anticoagulants is crucial to prevent further complications.
Slipped capital femoral epiphysis (SCFE)
Salter-Harris fracture type I. The risk factors of slipped capital femoral epiphysis include: obesity, teenager, male, and Legg-Calvé-Perthes disease. Slipped capital femoral epiphysis can occur bilaterally in 20-40% of cases. Severe slips (greater than 50 degrees) need urgent surgery within 6 to 12 hours to prevent further damage and complications.
Chvostek's sign and Trousseau's sign
Chvostek's sign is a clinical finding associated with hypocalcemia, elicited by tapping the facial nerve in front of the ear, just below the cheekbone. A positive Chvostek's sign is indicated by a twitch of the facial muscles on the same side of the face as the tap. Trousseau's sign is another clinical finding associated with hypocalcemia, elicited by inflating a blood pressure cuff above systolic pressure on the arm, a positive test is confirmed if the hand involuntarily contorts into a "main d'accoucheur" pose (wrist bent, thumb drawn in, fingers arched). Additional symptoms of hypocalcemia include tingling in the lips, tongue, fingers, and feet, muscle aches, laryngospasm, tetany, seizures, and arrhythmias.
Keep in mind that, knee dislocation is about the vessels, not the bones. Popliteal artery can be injured in up to 40% of knee dislocations leading to distal ischemia and/or compartment syndrome. Delayed neurovascular compromise is common, so admission for observation is the standard of care. Persistent ischemia for greater than 8 hours can result in an above-the-knee amputation. Many knee dislocations will spontaneously reduce and can have falsely reassuring exams. A palpable distal pulse is not adequate to rule out vascular injury; the ankle-brachial index (ABI) and a CT angiogram should be obtained if knee dislocation is suspected.
Omental cake refers to CT images showing abnormally thickened "greater omentum" due to infiltration by other types of soft-tissue, ascites, or chronic inflammation resulting in a cake-like appearance. The most common etiology of omental cake is ovarian cancer. Other causes include gastric cancer, colon cancer, pancreatitis, peritonitis, Crohn's disease, ascites, and tuberculosis.