Archives

VExUS to Guide Ultrafiltration in Hemodialysis: Exploring a Novel Dimension of Point of Care Ultrasound 

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.

Point of Care Ultrasound Diagnosis of Maxillary Artery Pseudoaneurysm in the Emergency Department

Marwa L. Ali, MD; Sean Beckman, DO; Stephen Alerhand, MD  – A pseudoaneurysm results from a tear in a vessel wall. This leads to extravasation of blood into adjacent tissue and eventual formation of a fibrous sac that maintains continuity with the lumen. These vascular injuries very rarely occur in deeper vessels of the face (e.g. maxillary artery) due to protection from structures like the bony mandible and parotid gland. If left untreated, these pseudoaneurysms can lead to infection, thromboembolism, hemorrhage, and compression of surrounding structures such as facial nerve branches

Hemodialysis Catheter-Associated Right Atrial Thrombus Diagnosed via Point of Care Transesophageal Echocardiogram

Heather Andrade, MD; Julie Carroll, MD; Evan Tomkiewicz, MD; Edwin Jackson, DO MBA RDCS – Catheter-associated right atrial thrombus (CRAT) is a potential complication of central venous catheter placement and is associated with an increase in morbidity and mortality. The precise incidence of CRAT is unknown, and there is a lack of clear screening and management guidelines for this condition. Additionally, the diagnosis is often missed when using transthoracic echocardiography (TTE) alone. Here, we present a case of a 64-year-old female admitted to the medical intensive care unit with multiorgan dysfunction who was diagnosed with hemodialysis catheter-associated right atrial thrombus (HDCRAT) via intensivist-performed point of care transesophageal echocardiography (TEE) after an initial TTE was negative.

Point of Care Ultrasound Used to Diagnose Nontyphoidal Endocarditis 

Zahraa Y. Alqallaf, Ossama S. Maadarani, FRCP; Mohamed E. Elhabibi, MD; Mohamad Abdelfatah, MD; Zouheir I. Bitar, FRCP EDIC EDEC – Point of care ultrasound (POCUS) can make an expedited diagnosis, which might lead to early correct management. POCUS should be used in a systemic and integrated approach to evaluate multiple organs in patients with sepsis and septic shock. We present a rare case of sepsis due to nontyphoidal Salmonella endocarditis with splenic abscess in which a multiorgan POCUS examination led to expedited treatment. 

Diagnosis of Cutaneous Larva Migrans using Point of Care Ultrasound 

Daniella Lamour, DO; Robert A. Farrow, DO; Jean Pierre; Daniel Puebla, MD; Paul Khalil, MD – Larva migrans is a cutaneous parasitic infection that occurs when an immature hookworm larva inadvertently penetrates the dermis of a human, typically on the extremities. Traditionally, a clinical diagnosis is made when a tortuous/serpiginous eruption is seen superficially in the skin with complaints of intense pruritus. Point of care ultrasound (POCUS) is a useful diagnostic tool for soft tissue complaints in the emergency department (ED). We describe a case of an 18-year-old woman who presented to the ED with foot pruritis four days after walking on the beach barefoot.

Terson Syndrome Diagnosed by Ocular Point of Care Ultrasound on the Medical Floor 

Mark Johnson, MRCP MBBCh BSc – In acute care environments, accurately assessing complications of intracranial pathology can be challenging. Ocular complications in acute intracranial disease are not consistently evaluated despite their high morbidity. We report on a case of monocular diplopia in a 63-year-old man with subacute traumatic brain injury with localized subarachnoid hemorrhage.

Gas Forming Pyogenic Liver Abscess Diagnosed by Point of Care Ultrasound 

Wei Ven Chin, MD MRCP; Mae Jane Khaw, MD MRCP – Gas-forming pyogenic liver abscess (GFLPA) carries a high mortality rate. Early identification of the source of infection in sepsis results in better survival. Bedside point of care ultrasound (POCUS) can be used to help localize a source of infection. A 59-year-old man presented with systemic inflammatory response syndrome (SIRS) and was diagnosed with GFLPA on the initial encounter via clinical assessment and POCUS examination.

Resolution of Sonographic Appendicitis in Pediatrics: a Point of Care Ultrasound Case-Series 

Eric Scheier, MD; Benjamin Taragin, MD – Studies of pediatric appendicitis treated conservatively show a considerable rate of recurrence. Point of care ultrasound (POCUS) imaging at our facility is routinely performed for abdominal pain and may be more likely than radiology-performed ultrasound to encounter cases that then self-resolve. We present a case series collected from a POCUS quality assurance review from 2019 through 2022.

Return of the Living Dead Gut – A Case Report of Ischemic Colitis Identified on Point of Care Ultrasound 

Kandria Ledesma, MD; Joseph Kim, MD; Allison Cohen, MD; Nicholas Bielawa, PA-C; Mathew Nelson, DO – Ischemic colitis is the most common form of gastrointestinal ischemia [1]. The diagnosis of ischemic colitis is made by clinical data and computed tomography (CT) imaging of the abdomen and pelvis [1]. While colonoscopy is considered the gold standard for diagnosis, this is not performed in the emergency department (ED) [2]. Few studies have been performed to describe the sonographic findings of ischemic colitis using point of care ultrasound (POCUS). We report a case that highlights the sonographic findings of ischemic colitis in a patient who had two separate visits to the ED, showcasing the utility of POCUS in making this diagnosis.

Testicular Torsion with Intact Blood Flow: A Point of Care Ultrasound Case-Series 

Eric Scheier, MD – Studies have demonstrated the high sensitivity and specificity of pediatric emergency department (PED) point of care ultrasound (POCUS) in the evaluation of testicular torsion. Rarely, testicular torsion may present with intact blood flow. Here, we present a case series of four children with testicular torsion confirmed intraoperatively, who had intact blood flow on POCUS.