Article Categories: Case File

Ultrasound-Guided Nerve Blocks for Flexor Tenosynovitis

John M. Bowling, Erick Zoumberakis – Performing an ultrasound-guided nerve block (UGNB) is now common practice in many emergency departments (EDs) and is considered a core skill according to the American College of Emergency Physicians (ACEP). Nerve blocks are mostly utilized for fractures and laceration repairs, however, these blocks have many other applications. We present a case of utilizing an ulnar UGNB in a patient with flexor tenosynovitis and a history of intravenous drug use (IVDU) when parental opiates proved to be ineffective.

A Young Man with Chest Pain

Anderson Wang, Aalap Shah – A calculous cholecystitis is a life-threatening diagnosis that is more commonly associated with ill patients in the ICU. We present a case of acute acalculous cholecystitis (ACC) in an otherwise healthy 18-year-old man who presented to the Emergency Department (ED) with right-sided chest pain that was ultimately diagnosed with point of care ultrasound (POCUS).

Diagnosis and Treatment of a Morel-Lavallee Lesion via Point of Care Ultrasound (POCUS)

Djoser Mack, Joselyn Miller, Frank Yuan, Edison Lee, Trent She – Morel-Lavallee Lesion (MLL) is a rare diagnosis of a closed internal degloving injury that can occur with high energy trauma. The pain, soft tissue swelling, and ecchymosis that patients describe mimic many other emergent diagnoses to include compartment syndrome and fractures.

Vaginal Bleeding in a Peri-Menopausal Woman

Ambika Shivarajpur, DO; Brian Kohen, MD – Point of care ultrasound (POCUS) is a useful modality to initially identify a molar pregnancy. In this case, we describe a 51-year-old perimenopausal woman who presented to the emergency department (ED) with vaginal bleeding. A transvaginal POCUS was performed, revealing findings concerning for a molar pregnancy. These findings led to prompt diagnosis and treatment.

Point of Care Ultrasound Identification and Aspiration of a Neck Lymph Node

Andrew Moore, DO; Ali Mrad, MD; Leonard Riley, MD; Sonia M. Castillo MD – The tissue diagnosis and staging of all types of lung cancer is foundational for prognosis and establishing the optimal treatment plan. In order to appropriately stage lung cancer, the highest stage should be established using the 8th edition TNM criteria, where tumor size (T), nodal involvement (N), and metastasis (M) are all taken into account. Establishing a tissue diagnosis may involve the use of CT guided biopsy, navigational bronchoscopy, endobronchial biopsy, endobronchial ultrasound, percutaneous lymph node biopsy and/or excisional biopsy of supraclavicular nodes.

Hematometra: A Rare Case of Pelvic Pain in Females Identified with Point of Care Ultrasound 

Andrew R. Helber, MD; Margaret Provencher, MD; Christy Moore, BS; Nova Panebianco, MD  – The differential diagnosis for abdominal or pelvic pain in women of child-bearing age that present to the emergency department is broad. A rare cause of abdominal and pelvic pain is hematometra, or a collection of blood products within the uterus. While blood is normally expelled through menses, this process is disrupted in some patients due to congenital or acquired abnormalities.