Nathan A. Friedman, MD; Caleb P. Canders, MD; Alan T. Chiem, MD, MPH – A 46-year-old man presented with a painless mass on his dorsal right foot one week after striking it on a door. A traumatic hematoma was suspected, and needle aspiration of the mass is considered. However, point-of-care ultrasound performed by the emergency physician identified a pseudoaneurysm of the dorsalis pedis artery, a rare condition that can occur after minor trauma or iatrogenic intervention.
Jeffrey Lam, MD; Steven Montague, MSc, MD – A 78-year-old male with chronic kidney disease on peritoneal dialysis developed unprovoked bilateral pulmonary embolisms. He was started on IV unfractionated heparin, but shortly thereafter developed severe pain and a small firm abdominal nodule near his dialysis catheter site.
Omar Damji, BHSc, MSc, MD; Russ A. Lam, BSc, MD; Mark Bromley BSc, MD; Melanie Willimann BSc, MD – Pediatric endocarditis, a rare entity in developed countries, remains a challenging diagnosis to make in children. We present an uncommon etiology of shortness of breath on exertion (SOBOE) in a 7-year-old male presenting with two weeks of nocturnal fever, malaise and fatigue following a viral prodrome.
Evan Cameron, MD; Lawrence Istrail, MD – Herein is a case of POCUS diagnosing life threatening cardiac tamponade in a patient with a new diagnosis of JAK2+ myeloproliferative syndrome prompting urgent intervention with pericardiocentesis. This case illustrates the utility of POCUS through its ability to serve as a quick diagnostic tool that can hasten intervention for potentially life-threatening conditions.
David Haughey, MD; Tai Truong, MD – An 87 year old male with obstructive uropathy was initially diagnosed with acute kidney injury (AKI), a new renal mass and hydronephrosis. When transferred to a facility with a hospital medicine POCUS program, the renal mass was correctly identified as a perinephric abscess, which was percutaneously drained leading to resolution of AKI and the underlying infection. Renal POCUS is readily taught via brief educational interventions and empowers providers to identify common (hydronephrosis) and uncommon (perinephric abscess) renal pathology at the bedside.
Joseph Garagliano, MD; Jai Madhok, MD – The use of point-of-care genitourinary ultrasound allows dynamic visualization of urinary catheter placement within the bladder and serves to minimize the potential for traumatic injury to the prostate and urethra during difficult insertion.
by Daniel Rusiecki, HBSc; Andrew Helt, MD; Kathryn McCabe, MD FACEP; Colin Bell, MD FRCPC – A previously healthy 46-year-old female patient presented to the Emergency Department (ED) with a primary complaint of binocular diplopia worsening over the past 48 hours. Physical exam revealed minor left inferior lid ecchymosis and was significant for proptosis.
by Miguel Lourenço Varela; Rita Martins Fernandes; Maria Luísa Melão; Javier Moreno; Cristina Granja –
A 77-year old male was admitted in the emergency department for septic shock, yet no clear source of infection was noted upon physical examination and a portable chest x-ray. Due to his unstable condition, bedside ultrasound was performed. A heterogeneous mass in the liver was noted, hence a tentative diagnosis of liver abscess was made. This was latter confirmed by abdominal computed tomography. This case highlights that point-of-care ultrasound, when performed by expert physicians, can significantly decrease time to diagnosis for septic patients.
by Jeff Ames, MD; Steven Montague, MD –
A 59-year-old man, with known alcohol-induced liver cirrhosis and diuretic refractory ascites, was seen in General Internal Medicine clinic for a therapeutic paracentesis. The tense large volume ascites caused abdominal pain, which had been previously relieved with paracentesis on several occasions. In preparation for paracentesis, routine POCUS was performed to landmark for the procedure.
by Marco Badinella Martini, MD; Antonello Iacobucci, MD –
An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.