84M with trauma, swollen upper lip, and epistaxis • Xray of the Week Figure 1. What is the important finding on this CT scan. Figure 2. Left: Axial CT showing fracture of the anterior and lateral maxillary sinus walls (yellow arrows) and pterygoid plates (red arrows). Right: 3D VR reconstruction showing bilateral Lefort 1 fractures traveling horizontally from the nasal septum to the lateral pyriform rims above the teeth (green arrows). Discussion: Lefort fractures were named for Rene Le Fort, a French army surgeon who conducted experiments on cadaver skulls by applying blunt force trauma (1 ..read more

84M with trauma, swollen upper lip, and epistaxis • Xray of the Week Figure 1. What is the important finding on this CT scan. Figure 2. Left: Axial CT showing fracture of the anterior and lateral maxillary sinus walls (yellow arrows) and pterygoid plates (red arrows)Right: 3D VR reconstruction showing bilateral Lefort 1 fractures traveling horizontally from the nasal septum to the lateral pyriform rims above the teeth (green arrows).. Discussion: Lefort fractures refer to complex fractures from blunt facial trauma that involve separation of the midface from the skull base, and include bilat ..read more

56M with new chest mass after recent cardiac surgery • Xray of the Week 56 yo M with complaints of new chest mass, cough and chest pain. Patient recently had a minimally invasive secundum ASD and PFO closure. Patient noticed a mass bulging on his right side at the surgical site when coughing. What is the diagnosis? Figure 1. Post op recent cardiac surgery. Right chest palpable mass. Diagnosis? Figure 2. . Figure 3. . Figure 4. Postop CT demonstrating repair of the lung herniation. Note the chest tube (orange arrow). Discussion: Lung herniation occurs uncommonly, with 20% due to a congenit ..read more

Orbital injury due to rubber bullet. Describe the injury. • Xray of the Week Figure 1. Describe the injury. Figure 2. A. Axial CT showing extensive vitreous hemorrhage of globe (yellow arrows) B. Coronal CT showing orbital blowout fracture affecting the right inferior orbital wall (red arrow) and right medial orbital wall (green arrow) Discussion: Rubber bullets are typically used to disperse demonstrations by inflicting nonlethal injuries (1). However, they can cause serious injuries as seen in this case. Ophthalmic injuries due to rubber bullets include ruptured globes, blunt force bruisi ..read more

18 year old male. Trauma due to punching a punching bag • Xray of the Week Figure 1. What is the important finding on this xray. Figure 2. Frontal, lateral, and oblique radiographs showing hamate body fracture (red arrows) due to the patient punching a punching bag. Introduction: Hamate fractures represent around 2-4% of all carpal fractures (1). Fractures involving the hamate bone can be divided into two broad categories. Type I is a hook of the hamate fracture and type II involves the body (Figs. 1,2). Type I can be specified under three subtypes depending if they involve the base, the wa ..read more

41 year old female. COVID-19 positive. SOB • Xray of the Week 41 yo female COVID-19 positive with LLE edema and Shortness of breath. Figure 1. Describe the abnormalities. Figure 2. A. B. C. D. E. Discussion: The SARS-CoV-2 novel virus was first isolated in Wuhan, China and quickly changed the landscape across the world during 2020 during the current COVID-19 pandemic. (1,2) In the United States, COVID-19 has been the cause of more than 220,000 deaths as of October 20, 2020 (3). Patients typically present with fever, tachypnea, cough, and sore throat. Severe complications like pulmonary embo ..read more

32 F with Vaginal Bleeding • Xray of the Week Patient at 25 weeks gestational age. Figure 1. Sagittal transvaginal ultrasound of the cervix. Figure 2. Sagittal transvaginal ultrasound of the cervix. A. Gray scale images show the fetal umbilical cord blood vessels (red arrow) across or near the internal os (orange arrow). B. Color doppler images show the fetal umbilical cord vessels across or near the internal os (yellow arrow). Discussion: Vasa previa is a rare and serious complication of pregnancy in which fetal umbilical cord blood vessels run across or near the internal opening of the ce ..read more

34 year old male with chest pain and shortness of breath • Xray of the Week Figure 1. 34 year old male with chest pain and shortness of breath. Figure 2. A and B: Axial and coronal CT with cardiomegaly due to markedly dilated heart. Right pleural effusion (blue arrow). Low EF with contrast only in RA (red arrows) and RV (orange arrow). Reflux of contrast into the IVC (green arrow) and hepatic veins (white arrow) indicates tricuspid valve regurgitation. C: Echocardiogram apical 4 chamber view. Mitral regurgitation as evidenced by a regurgitant jet extending into the RA (yellow arrow). Discus ..read more

History of arrhythmias • Xray of the Week What is the diagnosis? Figure 1. What is the important finding seen on these CT images? Figure 1A: Axial CT image of abdomen with hyperdense liver Figure 1B: Zoomed-in axial CT image of liver- note the ROI is 154 HU Figure 1C: Zoomed-in axial CT image of spleen- note the ROI is 63 HU Figure 1D: Coronal CT image of abdomen with hyperdense liver Discussion: Amiodarone is an antiarrhythmic agent used to treat ventricular arrhythmias and atrial fibrillation. It is a class III drug, based on the Vaughan Williams classification, and works by prolonging the ..read more

Lung mass. Diagnosis? • Xray of the Week Figure 1. What is the lung mass? Figure 2. Pulmonary hamartoma Figures 2A and 2B: Axial CT chest demonstrating well-demarcated, solitary peripheral, and inhomogeneous pulmonary mass arising from right lower lung lobe (yellow arrows). Note the low attenuation fat in the mass which is diagnostic of hamartoma. Small calcifications are also present. Figure 2C: Sagittal CT chest demonstrates posteriorly located well-demarcated solitary peripheral pulmonary mass. The mass is above the intact diaphragm (red arrow). Figure 2D: Coronal CT chest and abdomen de ..read more