September 28, 2018
Physical exam showed marked left palpebral subcutaneous crepitus, as well as bulbar and palpebral conjunctival bulging. Visual acuity was normal with intact extraocular movements, and normal pupillary exam. Computed tomography (CT) imaging of the face was obtained and revealed multiple displaced fractures involving the left orbital floor and zygomatic arch associated with moderate periorbital and postseptal extraconal gas, resulting in orbital proptosis.
September 28, 2018
The computed tomography (CT) of the abdomen and pelvis revealed significant subcutaneous gas tracking along the perineum and right gluteal region (orange outline) into the scrotum with associated scrotal edema (yellow arrow) and subcutaneous inflammatory fat stranding of 0.92 cm (red arrow) consistent with Fournier’s gangrene. There is early fluid loculation along the right medial gluteal cleft of 5.85 cm (green arrow) without a sizeable drainable abscess seen.
September 28, 2018
Computed tomography (CT) sinus with contrast demonstrated complete opacification of left paranasal sinuses and nasal cavity, and a linear radiopacity within the left maxillary sinus consistent with a foreign body. There were additional left facial subcutaneous radiopaque opacities.
September 28, 2018
The patient’s abdominal ultrasound revealed intussusception in the right upper abdominal quadrant. The transverse ultrasound view showed a “doughnut sign” (dashed yellow line), telescoping bowel (yellow arrow), and invaginated hyperechoic mesenteric fat with crescent configuration (dashed orange line). The sagittal ultrasound view demonstrated the intussusception formed by the outer recipient bowel loop (yellow arrows), invaginated hyperechoic mesenteric fat (orange asterisks), and telescoping bowel centrally (red arrow).
September 28, 2018
The photograph reveals a limbic metallic foreign body with a surrounding corneal rust ring (arrow) in the three o’clock position of the left cornea.
September 28, 2018
On exam, the patient has a gross deformity to the left pinna that was not painful to touch or fluctuant. Findings and history are consistent with cauliflower ear, secondary to a chronic auricular hematoma.
September 28, 2018
The computed tomography (CT) scan demonstrates prominent enlargement and heterogeneous enhancement of the right submandibular gland (single large arrow) compatible with sialadenitis. There is no evidence of a sialolith or obstruction on the CT. There is associated edema (two small arrows) of the right submandibular space, parapharyngeal space and anterior right neck with partial effacement of the right vallecula and right pyriform sinus.
September 28, 2018
An electrocardiogram (ECG) was concerning for ST segment elevation in leads II, III, aVF, and V4, with subtle ST elevations in V5 and V6 (see black arrows). There is also ST segment depression in aVL (see blue arrows).
