Article Categories: Case Report

Case Report: A cardiac mass diagnosed using Point-of-care ultrasound in a dyspneic patient. An integrated ultrasound examination of lung-heart-Inferior Vena Cava

by Maria Viviana Carlino MD; Costantino Mancusi MD; Alfonso Sforza MD; Giorgio Bosso MD; Valentina Di Fronzo MD; Gaetana Ferro MD; Giovanni de Simone Prof.; Fiorella Paladino MD –

A 74-year-old woman with history of hypertension presented to the Emergency Department (ED) with severe resting dyspnea and swelling in the feet, ankles and legs. She was on treatment with furosemide and a beta blocker. At the time of admission blood pressure was 145/88 mmHg, heart rate (HR) 99 bpm, regular, oxygen saturation was 89% (FiO2 21%) and respiratory rate was 17 breaths/min.

Case Report: Type 1 aortic dissection presenting as acute pericarditis: the roles of POCUS and transthoracic echocardiography

by Bill Ayach MD PhD; Aadil Dhansay MD1, Andrew Morris MD; James W. Tam MD; Davinder S. Jassal MD –

A 59 year old male presented with a 1 day history of non-exertional chest pain that was pleuritic in nature and aggravated by lying flat. His chest pain symptoms were preceded by a one week history of “flu-like” symptoms. Physical exam demonstrated a blood pressure of 114/55 mmHg, heart rate of 75 bpm, and a normal oxygen saturation on room air. Cardiac examination revealed a biphasic pericardial rub vs. to-and-fro murmur.

Case Report: Early signs of tamponade may be detected by cardiac point-of-care ultrasound

by Michael Cenkowski, MD; Amer M. Johri, MD; Raveen Pal, MD; Jennifer Hutchison, RDCS –

A 35-year-old male with a past medical history of end stage renal disease on hemodialysis and a chronic pericardial effusion secondary to dialysis presented to the Emergency Room (ER) with a 2-week history of a flu-like illness and pleuritic chest pain. He was compliant with dialysis three times per week. His blood pressure was 150/85 mmHg with a heart rate of 85 beats per minute and the remainder of his vital signs were stable. Pulsus paradoxus was not present.

Case Report: Pediatric POCUS: 4 month old infant with a timely diagnosis

by Victor Istasy MD, FRCPC; Tim Lynch MD, FRCPC; Rodrick Lim, MD, FRCPC –

A healthy, four month-old female infant presented to a local emergency department with a 12-hour history of decreased activity, non-bilious vomiting and one episode of dark red blood in the stools. There was no history of fever. Telephone consultation was completed and the patient was transferred to a tertiary, pediatric centre for further evaluation. On arrival, the infant appeared pale and was lethargic during the exam.

Case Report: Point of care ultrasound of a broken heart

by Winnie Chan, MD, FRCPC and Joseph Newbigging, CCFP(EM), FCFP –

Mrs. K, a 70 year old lady, presented to the urgent care with severe retrosternal chest pain that started at rest. She described the pain as a constant heaviness and rated it as 9/10 in severity. The pain did not radiate to the neck, arms, or back. The pain had started one hour after she was informed that her son had passed away unexpectedly.

Case Report: A wolf in another wolf’s clothing: point-of-care ultrasound in a patient with an acute exacerbation of chronic obstructive pulmonary disease

by Jordan K. Leitch MD and Nicole A. Rocca MD FRCPC –

Patients often present to hospital, and to the Intensive Care Unit (ICU) in particular, in situations that render them unable to provide an accurate (or any) clinical history to facilitate diagnosis. These patients also typically have multiple, serious medical co-morbidities, which further makes diagnosing and initiating an appropriate treatment difficult. Furthermore, the investigations performed to optimally diagnose acute critical medical conditions are often only possible in remote locations in the hospital or only available during regular daytime work hours, both of which are a concern with critically ill patients.

Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

by Stuart Douglas, MD; Joseph Newbigging, MD; David Robertson, MD –

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

Case Report: Incarcerated femoral hernia containing ovary, unusual presentation of uncommon groin hernia

by Priyank Gupta, MD, FRCR; Hadiel Kaiyasah, MRCS Glasgow; Mahra AlSuwaidi, MRCS Glasgow –

Of all groin hernias, femoral hernias account for around 2–8%. They occur four to five times more commonly in females than males and have a peak incidence in those between 30 and 60 years old [1,2]. In adult population, femoral hernias are more commonly found in patients with previous inguinal hernia repair [3].

Case Report: Hemoptysis localization – hearing with your eyes

by Barry Chan, MD –

Clinical Vignette: 45 year old was transferred from a peripheral facility for acute massive hemoptysis though maintained sufficient airway patency with no evidence of hemodynamic instability or respiratory failure. Thoracic auscultation revealed vesicular breathing with no adventitious sound. CXR from the peripheral site was normal.

Case Report: The use of gastric ultrasound to assess risk of pulmonary aspiration

by James Cheng, PGY-4 –

Pulmonary aspiration of gastric contents is a dreaded complication of general anesthesia, as it carries significant patient morbidity and mortality. Subsequent aspiration pneumonia can lead to prolonged mechanical ventilation, and a mortality rate of up to 5%. To minimize the risk of pulmonary aspiration, patients are required – as per the American Society of Anesthesiology’s “Practice Guidelines for Preoperative Fasting” – to fast prior to elective surgery in order to ensure that the stomach is empty prior to induction of general anesthesia.