Abhilash Koratala, MD; Mohamed Ibrahim, MD; Sirisha Gudlawar, MD – Venous Excess Ultrasound (VExUS) is a valuable bedside tool for nephrologists within a multi-organ point of care ultrasound (POCUS) framework. VExUS can address limitations of conventional physical examination in identifying hemodynamic congestion and monitoring treatment efficacy. A 53-year-old man with heart failure and end-stage kidney disease on hemodialysis presented with elevated liver function tests.
Eniola C. Gros; Lauren R. McCafferty – Ocular point of care ultrasound (POCUS) can help make timely recognition of multiple emergent ocular conditions and differentiate these from more benign conditions. While asteroid hyalosis (AH) is benign, it can easily mimic the more potentially serious vitreous hemorrhage on ocular POCUS, as both consist of numerous echogenic opacities within the vitreous with a classic “washing machine” appearance with eye movement.
Brian Kohen; Melanie Perez; Jheanelle McKay; Rolando Zamora; Curtis Xu – The use of point of care ultrasound (POCUS) for diagnosis and treatment of peritonsillar abscess (PTA) is increasing [1]. Proven advantages include improved diagnostic accuracy and treatment success rates as well as decreased otolaryngology consultation, computed tomography (CT) usage, return visits to the emergency department (ED), and length of stay [1]. We present a case of a patient with a PTA that was diagnosed and successfully treated utilizing POCUS, avoiding the need for otolaryngology consultation and CT.
Vladimir Cárdenas López; Pablo Blanco – Aortic dissection (AD) is a medical emergency with a poor prognosis if not recognized early and treated promptly. In this setting, clinical data may be equivocal, while electrocardiogram, laboratory tests, and chest radiography often show nonspecific findings. In contrast, cardiac point of care ultrasound (POCUS) has proven useful in the diagnosis and detection of complications of AD. We present the case of a 29-year-old man with marfanoid habitus presenting with chest pain and acute heart failure, in whom cardiac POCUS aided in the rapid diagnosis of type A AD and pulmonary edema.
William Noel; Brian B. Donahue – A 59-year-old man with past medical history including obesity status post gastric banding surgery and atrial fibrillation on rivaroxaban, presented to the emergency department with a complaint of focal pain to his right abdomen along with areas of visible bruising. He noted that since his diagnosis of COVID-19 a week prior, he had been having paroxysms of coughing. During one episode of coughing a few days prior to seeking medical care, the patient recalled a “ripping” sensation in his right abdomen followed by intermittent achiness and bruising to that area.
Rahul Nair; Jonathan Zuo; Ariel L. Shiloh – Serial point of care ultrasound (POCUS) exams are essential to assess acute pericardial effusions which can rapidly evolve into cardiac tamponade. A typical presentation includes dyspnea, tachycardia, and chest pain. Importantly, serial cardiac exams in such high-risk patients can detect other concurrent pathologies. We present an unusual case of a patient who initially presented with an acute circumferential pericardial effusion and upon serial POCUS exams developed an unexpected Takotsubo cardiomyopathy in the setting of cardiac tamponade.
Bernardo Vidal Pimentel; Christopher Tsoutsoulas; Kristin Lythgoe; Frank Myslik – Managing multiple pregnancies is challenging and requires careful evaluation. Point of care ultrasound (POCUS) has emerged as a potentially crucial tool in assessing suspected first-trimester pregnancies. However, its role in evaluating multiple pregnancies remains uncertain. We present the case of a 36-year-old Ghanaian female who presented with acute vaginal bleeding after undergoing in vitro fertilization. A bedside transabdominal POCUS identified four intrauterine gestations with fetal poles and cardiac activity, suggesting a quadruplet viable pregnancy. A subsequent transvaginal ultrasound confirmed the findings.
Zachary Boivin; Emily Mensel; Trent She – A 67-year-old female patient with a past medical history of hypertension presented to the emergency department (ED) with abdominal pain. She reported intermittent palpitations for the past three months, fevers for one week, and a recent admission three days prior for a pleural effusion and atrial fibrillation.
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.
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.