Diagnosing Early Cardiac Tamponade in Patient with JAK2+ Myeloproliferative Syndrome with Point of Care Ultrasound

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.

Hiding in Plain Sight: A Case of Perinephric Abscess Diagnosed by POCUS

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.

POCUS for Visualization and Facilitation of Urinary Catheter Placement

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.

Orbital Mass Detected with POCUS

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.

Shedding light on a hidden source of septic shock with POCUS

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.

Unexpected cyst within ascites

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.

A case of Fournier’s gangrene diagnosed with POCUS

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.

Case File: Point-of-care ultrasound should end the outdated practice of “marking for a tap”

by Anna Platovsky, MD and Benjamin T. Galen, MD

A 55 year old man with a history of alcoholic cirrhosis decompensated by esophageal varices status post banding presented to the emergency room with abdominal pain.  He also noted increased abdominal girth with associated poor oral intake and early satiety as well as a 10 lb. weight gain over 2 weeks.  On examination, the patient was afebrile with stable vital signs and no respiratory distress.  His abdominal examination revealed tense ascites with mild tenderness to palpation of the left upper quadrant.  There was no jaundice or asterixis. Laboratory testing was significant for mild thrombocytopenia but no leukocytosis or abnormal liver tests. Liver synthetic function was preserved.

Case File: Rapid Diagnosis of Pericardial Effusion

by Jeffrey Wilkinson, MD and Amer M. Johri, MD

Mr. DB was a 95 year old man who presented to the emergency department with dyspnea progressing over the last 3 months. Chest x-ray demonstrated an enlarged cardiac silhouette. He had a past medical history significant for coronary artery disease, hypertension and a lobectomy due to tuberculosis. A point of care cardiac ultrasound was conducted by an internal medicine resident as part of his physical examination in the emergency department. A large pericardial effusion was found. There were no clinical signs of tamponade.

Case Files: Use of hand held ultrasound to guide therapeutic and diagnostic thoracentesis in the pleural space clinic

by Michael Fitzpatrick, MD, FRCPC

Case 1: Mr. P was a 75 year old gentleman with a history of splenic marginal zone lymphoma. His cancer was complicated by development of a pleural effusion and ascites. He was admitted to hospital due to abdominal discomfort but following discharge developed dyspnea. He was referred to the Pleural Space Clinic by his oncologist for worsening dyspnea and consideration of thoracentesis.