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.

Point of Care Ultrasound (POCUS) in Bedside Diagnosis of Pyomyositis  

Olusegun Oduyoye, MBBS, MSc, FHEA, FRCPE; Euan Thomas, BSc, MSc
– Pyomyositis is an acute bacterial infection of skeletal muscle that results in localised abscess formation presenting with symptoms, including pain, swelling, erythema, and fever. It is usually associated with tropical climates; however, there has been an increasing number of cases presenting with pyomyositis in patients with a history of intravenous drug use [1-3].

The Takotsubo Syndrome: Clinical Diagnosis Using POCUS  

Josu López Libano, MD; Lorenzo Alomar Lladó, MD; Leire Zarraga López – Takotsubo syndrome is a cardiomyopathy that can mimic an acute heart attack, in terms of clinical presentation, electrocardiographic changes, and findings on echocardiogram. Point-of-care-ultrasound (POCUS) can be used to detect this condition, even though the definitive diagnosis is made angiographically.

Impact of Point-of-Care Ultrasound in Medical Decision Making: Informing the Development of an Internal Medicine Global Health POCUS Curriculum  

Michelle Fleshner, MD MPH; Steve Fox, MD; Thomas Robertson, MD; Ayako Wendy Fujita, MD; Divya Bhamidipati, MD; Thuy Bui MD – Point-of-care Ultrasound (POCUS) is particularly useful in low-middle income countries (LMICs) where advanced imaging modalities and diagnostics are often unavailable. However, its use among Internal Medicine (IM) practitioners is limited and without standard curricula. This study describes POCUS scans performed by U.S. IM residents rotating in LMICs to provide recommendations for curriculum development.

About the Special Kidney Issue

Nathaniel Reisinger, MD; Abhilash Koratala, MD – We know what you’re thinking. we’ve heard it a thousand times: “Oh, you’re a kidney doctor who dinks around with ultrasound? What do you look for? Hydronephrosis?” You may be asking, “Is this issue just going to be a bunch of pictures of hydronephrosis and distended bladders?” And yes, for the thousandth time, in acute kidney injury it’s almost never wrong to get a kidney and bladder ultrasound as part of the initial workup.

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.