Clinical Image Challenges

A 28-year-old woman presents to urgent care after an indoor rock-climbing event. She fell 10 feet from the wall without any safety gear to break the fall. She describes deep pain in her left foot, and she is limping. An exam reveals dorsal and plantar midfoot tenderness and bruising across the dorsal foot. A 3-view x-ray series is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page. Figure 1. The X-ray …
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A 65-year-old female with a history of hypertension presents with chest pain and dyspnea for 1 day. She denies fever, cough, nausea, vomiting, or abdominal pain. Upon arrival to urgent care, her respiratory rate was 28 breaths per minute, blood pressure 179/102, and oxygen saturation 92% on room air. An ECG is obtained. View the ECG captured above and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1: Initial ECG Case presented by Catherine Reynolds, MD, McGovern Medical …
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A 36-year-old man presents to urgent care with asymptomatic hair loss that developed on multiple sites of his scalp over the previous 2 months. The hair loss developed in round patches that expanded to involve most of the back of his scalp. His past medical history is notable for hyperthyroidism. View the image above and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page. Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/jucm) …
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A 7-year-old boy presents to urgent care with his worried mother after he fell off a swing at daycare. He is complaining of right foot pain and can’t walk on the injured foot. Anterior posterior and oblique foot x-rays are ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page …
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A 57-year-old man presents to the urgent care with a 3-day history of left foot pain and swelling after walking barefoot on a wooden deck under construction. He recalls feeling a sharp pain in the affected foot at the time but could not see any foreign object. On examination, he has mild erythema, tenderness, and induration over the plantar surface of the midfoot. There is no visible puncture wound or foreign body present. Plain radiographs (XR) of the foot reveal no radiopaque foreign body or bony abnormalities. A point-of-care ultrasound …
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