Mount Sinai Emergency Medicine Ultrasound

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.

Read the rest of this entry »

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? Read the rest of this entry »

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.

Without Compression

With Compression

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

Read the rest of this entry »

This 16 year old patient presents to the Emergency Department you have just started at in Menominee Michigan.   All of today’s patients have been on their way home this last day of hunting season.  You suspect this patient will be more interesting, as she is wearing a PETA shirt and not a shred of orange or leather.  Although her chief complaint was nausea and vomiting, her urine pregnancy test was positive, prompting the ultrasound evaluation which revealed this image:

What is your diagnosis and what is the next step for this patient?

Read the rest of this entry »

7 year old child with abdominal pain presented with pain, nausea.  Noted to be febrile.  RLQ tender.  Linear transducer applied to point of maximal tenderness. 

Image attached was obtained.

Read the rest of this entry »