Case- Abdominal pain

Patient with history of hypertension presents periumbilical abdominal pain radiating to the back. Minimal abdominal tenderness, no rebound or guarding, though  a pulsatile mass is felt.

The following ultrasound is obtained:

https://gmep.org/media/11742

As the title suggests, the patient was diagnosed with an abdominal aortic aneurysm and vascular surgery was consulted.

We’re experimenting a bit with the GMEP.org system. It’s a great educational collaborative run by the folks who brought you Life in the Fast Lane. Worth checking out.

As you may know, we have a Vimeo channel with a growing video archive as well. Our goal is to make this site and its content as helpful and accessible a possible, so please let us know how we can improve!

What The Heck 1

This patient presented with right upper quadrant abdominal pain. There was RUQ tenderness on exam, but no fever, rebound or Murphy sign. A point-of-care ultrasound was performed to assess for signs of cholecystitis and the following image was obtained. This prompted the operator to ask, “What the heck?”

Gallbladder
What structures are visible here? How could you differentiate them? More after the break!

Continue reading “What The Heck 1”

XRS- Rib pain

32 year old female with no past medical history presents with cough for two weeks, no fever, no sputum. Multiple sick contacts with same symptoms at work. She acutely presents with left rib pain for several days.  She reports no trauma, and noted the sharp, positional pain during a fit of coughing. Her vital signs are all within normal limits. She is breathing comfortably, with good air movement, no wheezes, rales, or ronchi. She displays point tenderness over her anterior left 8th rib at the anterior axillary line.  A chest x-ray was ordered; images are below.

 

Sonopalpation of the tender area revealed the following:

Untitled from Sinai EM Ultrasound on Vimeo.

 

Continue reading “XRS- Rib pain”

XRS – 1

X-Ray Stinks #1: Finger Injury

In this new series we will highlight cases where ultrasound proved more useful than x-ray.

A seven year old boy presented with distal phalanx pain, tenderness after a fall.

The following x-ray was performed:

What is your diagnosis? Can ultrasound help? How would you perform an ultrasound on such a superficial structure?

The following ultrasound of the distal finger was performed (probe marker towards fingertip):

What is your diagnosis now? Continue reading “XRS – 1”

Case of the Month: April 2010

Thanks to Tatiana for an expertly presented ultrasound case of the month.  She was kind enough to put together this summary.

43y.o. F with pmh of asthma, HTN, recently treated for PNA p/w worsening dyspnea, pleuritic chest  pain,  cough and fever. Found to be tachypnic and tachycardic in the ED. CXR suggesting perihilar PNA. While awaiting chest CTA to r/o PE you perform bedside echo and obtain the following image:

Is there anything abnormal? How does this change your management?

Continue reading “Case of the Month: April 2010”

Case 4

Thanks to Eduardo Lacalle for his presentation of the Ultrasound case of the month yesterday at Elmhurst conference.  Here’s a quick summary.

29M BIBEMS after assault.  Intoxicated but awake and cooperative.  Only complains of right eye and right flank pain. Vital Signs are stable.  The patient has some superficial right periorbital abrasions.  He is tender in the right upper quadrant and the eFAST exam reveals the following images.

RUQ Trauma

RUQ Trauma 2

Is there anything of interest noted here?  What are your next steps?

Continue reading “Case 4”

Case 3

54M with h/o HTN, DM, Tobacco and Focal Segmental Glomerulosclerosis presents with neck mass.  He looks dyspneic and uncomfortable at triage and has an obvious mass above his left clavicle to the degree that his head is tilted a bit to the right.  Concerned, the triage RN defers the EKG and A-Side attending consult and rolls the patient into your formerly mellow cardiac room shift.  Although overall he looks gaunt, his face is swollen and dark colored (“facial plethora”).  You go through your IV/O2/Monitor/ABCDEFGHIJKLMNOPQRST and then grab the ultrasound machine.

After turning on the machine,  you obtain the following images of the left neck.

nocompression
Without Compression
compression
With Compression

What do you think the patient has and whatcha  going to do about it?

Continue reading “Case 3”