Article Categories: Case File

POCUS Confirmation of Intraosseous Line Placement: Visualization of Agitated Saline within the Right Heart in a Critically Ill Infant

Inbar S.Y. Plaut, MD; Zachary W. Binder, MD – Intraosseous (IO) line placement can be a life-saving procedure in the management of critically ill patients.  Confirmation of correct IO line placement can be difficult. Prior studies have examined the use of point of care ultrasound (POCUS) to confirm IO line placement by using power Doppler over bone to detect flow within the intraosseous space. This case illustrates a novel use of POCUS in which agitated saline is visualized within the right heart as a means of confirming correct IO placement.

Thoracic Aortic Aneurysm Presenting as a Subacute Cough

Eduardo Diaz, DO; Hanan Atia, MD; Brian Kohen, MD; Seth Lotterman, MD – The suprasternal aortic notch cardiac point of care ultrasound (POCUS) window is a useful view for evaluating thoracic aortic pathologies. However, it is not routinely included in the standard cardiac POCUS exam despite its ability to capture emergent pathologies such as aortic dissection and thoracic aortic aneurysm (TAA). Ruptured aortic aneurysms can present with sudden, severe chest or back pain, as well as hemodynamic instability, resulting in a high mortality.

Acute Upper Extremity Arterial Occlusion Diagnosed on POCUS in the Emergency Department

Derrick Huang, MD; Jacob Ruzicka, MD; Leoh León, MD; Latha Ganti, MD, MS, MBA, FACEP – Upper extremity acute limb ischemia (ALI) is a limb-threatening and potentially lethal pathology that is most commonly caused by vascular embolization. Outcomes of limb ischemia are time-sensitive due to the correlation between a longer time from symptom onset to intervention with a vastly higher risk of amputation. In this report, point of care ultrasound (POCUS) was utilized to rapidly diagnose a patient with a proximal right brachial artery embolic occlusion, prompting expedited surgical consultation and successful embolectomy.

A Potential Pitfall in POCUS of the Gallbladder: Beware of the Duodenum

Fan J. Yang, MD; Brian Kohen, MD; Sowmya Sanapala, MD; Michael Halperin, MD MPH – It is estimated that 20 million people in the United States have gallbladder disease. Of the patients who present to the Emergency Department (ED) with abdominal pain, 3-10% have acute cholecystitis.

Point-of-Care Ultrasound for the Diagnosis of Colon Cancer

Weihao Chen, MBBS (Spore), MRCP (UK), MMed (Int Med); Readon Teh, MBBS (Spore), MRCP (UK); Absar Qurishi, MBBS (Chittagong), MRCP (UK) – We present a case of a 64-year-old gentleman for whom point of care ultrasound (POCUS) expedited the diagnosis and subsequent early treatment of colon adenocarcinoma.

Hickam’s Dictum Incarnate: A Case of Simultaneous Left-Sided Urolithiasis and Ruptured Iliac Artery Aneurysm  

Melissa Bouwsema, MD; Colin Bell, MD – A 51-year-old man with a history of nephrolithiasis presented to the Emergency Department after a sudden onset of left-sided groin pain and syncope. At presentation, he described his pain as similar to prior renal colic episodes. At his initial assessment, point of care ultrasound (POCUS) was used, which revealed findings consistent with obstructive renal stones, as well as a substantially enlarged left iliac artery.

Sonographic Crepitus, a Point-of-Care Ultrasound Finding  

Brian Kohen, MD; Michael Halperin, MD MPH; Gloria Felix, MD; Trevor Dixon, MD; Michelle Montenegro, MD; Fenil Patel, MD – Necrotizing fasciitis is a life-threatening polymicrobial skin and soft tissue infection that requires prompt diagnosis and treatment. Delays in diagnosis and treatment can result in an increase in morbidity and mortality [1]. Necrotizing fasciitis has historically been a clinical diagnosis. Patients with a high clinical suspicion for necrotizing fasciitis generally receive antibiotics and undergo emergent surgical debridement.

Diagnosing Paget-Schroetter Syndrome Using Point of Care Ultrasound (POCUS)  

Khaled Taha, MD, MSc, MRCP, MRCEM; Tomás Breslin, MD, MRCP, FRCEM; John M. Moriarty, MD, FSIR; Shammy Ali, MBBS, MD; Bernhard Louw, MBChB, DipPEC (SA) – Paget-Schroetter Syndrome, or effort thrombosis, is a relatively rare disorder. It refers to axillary-subclavian vein thrombosis (ASVT) that is associated with strenuous and repetitive activity of the upper extremities [1]. Anatomical abnormalities at the thoracic outlet and repetitive trauma to the endothelium of the subclavian vein are key factors in its initiation and progression. Doppler ultrasonography is the preferred initial test, but contrast venography is the gold standard for diagnosis [1,2].