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].

Point of Care Ultrasound Diagnosis of Pseudoaneurysm of an Upper Extremity Arteriovenous Dialysis Graft

Forrest Lindsay-McGinn, MD; Nathaniel C. Reisinger, MD – We describe the rapid diagnosis with point of care ultrasound (POCUS) of two acute pseudoaneurysms of a bovine arteriovenous dialysis graft with superimposed cellulitis in a 44-year old male patient who presented with pain over his upper arm graft site. POCUS evaluation decreased the time to diagnosis and vascular surgery consultation.

Utility of Nephrologist-Performed Point of Care Ultrasonography in the Evaluation of Hyponatremia

Mahmud Saqib, MD; Gregory Capelli, DO; Abhilash Koratala, MD – Point of care ultrasonography can be a valuable adjunct to conventional physical examination in patients with hyponatremia that aids in clinical decision making. It can address the shortcomings of traditional volume status assessment such as the inherent low sensitivity of ‘classic’ signs such as lower extremity edema.

Point of Care Ultrasonography to Monitor Decongestive Therapy in Heart Failure: Seeing is Believing

Abhilash Koratala, MD – Point of care ultrasonography (POCUS) is a non-invasive bedside diagnostic tool that aids in clinical decision-making process. In addition, it allows to monitor the efficacy of therapeutic interventions in real time. As such, nephrologists can enhance patient care by adopting this skill, especially in those with simultaneous cardiac dysfunction and difficult to manage fluid status.

Evaluation of Venous Congestion Using Beside Ultrasonography by the Nephrology Consultant: The VExUS Nexus

Abhilash Koratala, MD – In patients with heart failure and cardiorenal syndrome, lingering congestion is associated with worse outcomes. As such, titrating diuretic or ultrafiltration therapy based on objective assessment of volume status plays a crucial role in the management of these patients. Conventional physical examination findings and parameters such as daily weight measurement are not always reliable in this setting. Recently, point of care ultrasonography (POCUS) has emerged as an attractive enhancement to bedside clinical examination in assessing fluid volume status.