Ovarian Teratoma
Ovarian Teratoma
Fournier Gangrene -
Fournier Gangrene -
Uterine Rupture (Positive FAST)
Uterine Rupture (Positive FAST)
Perinephric Hematoma
Perinephric Hematoma
In-Vivo Shoulder Reduction
In-Vivo Shoulder Reduction
The Piano Sign
The Piano Sign
The Twinkle Artifact
The Twinkle Artifact
Ultrasound for Abscess Identification -
Ultrasound for Abscess Identification -
Now I see you….Ocular ultrasound
Now I see you….Ocular ultrasound
Reducing Aspiration Risk
Reducing Aspiration Risk
Resolving Pneumothorax
Resolving Pneumothorax
A New Horizon In A Gallbladder
A New Horizon In A Gallbladder
Ureterovesical Junction Nephrolithiasis
Ureterovesical Junction Nephrolithiasis
Biliary Colic That Wasnt
Biliary Colic That Wasnt
Thoracic Cavity Mass
Thoracic Cavity Mass
A Case Of Colicky Abdominal Pain
A Case Of Colicky Abdominal Pain
Polycystic Kidney Disease
Polycystic Kidney Disease
Acute Chest Syndrome
Acute Chest Syndrome
Appendicitis with free fluid and appendicocolith, axial view (1/2)
Appendicitis with free fluid and appendicocolith, axial view (1/2)
Appendicits with appendicocolith, long view (2/2)
Appendicits with appendicocolith, long view (2/2)
Normal Appendix (longitudinal)
Normal Appendix (longitudinal)
Normal appendix, transverse (2/2)
Normal appendix, transverse (2/2)
Miliary TB
Miliary TB
IVC Thrombus
IVC Thrombus
Distal Radius Fracture
Distal Radius Fracture
Lung Hepatization (Pneumonia)
Lung Hepatization (Pneumonia)
Hip Effusion
Hip Effusion
Hydrocarbon Ingestion
Hydrocarbon Ingestion
Hydronephrosis (severe) in Prune Belly Syndrome
Hydronephrosis (severe) in Prune Belly Syndrome
Hydronephrosis (mild)
Hydronephrosis (mild)
Infant Pneumonia
Infant Pneumonia
Intussuception
Intussuception
Target Sign - Intussuception
Target Sign - Intussuception
Pneumothorax with Lung Point
Pneumothorax with Lung Point
Pyloric Stenosis
Pyloric Stenosis
Pylorus (normal)
Pylorus (normal)
Infant Skull Fracture
Infant Skull Fracture
Ovarian Teratoma
Ovarian TeratomaThis is a transverse view of a RLQ in a young female who presented with dysuria and a history of constipation. On physical exam, a visible mass was noted to the right of her umbilicus. Urinalysis and urine pregnancy test were negative. Bedside transabdominal ultrasound revealed a septated mass containing heterogeneous material with scattered hyperechoic foci most consistent with an ovarian teratoma.  Allison Perkins MD, PGY-1CMU Emergency Medicine ResidencyJared Toupin MD, PGY-2CMU Emergency Medicine Residency
Fournier Gangrene -
Fournier Gangrene -Fournier Gangrene.  A patient presented for worsening, severe scrotal pain.  Point-of-care ultrasound demonstrated a normal appearing testicle with an associated hydrocele.  Significant ring down artifact is visualized posterior producing a “dirty shadow”.  The patient was taken to the operating room where the ring down artifact was confirmed as significant subcutaneous air associated with a necrotizing infection.  By: Michael Schick DO, Emergency Physician 
Uterine Rupture (Positive FAST)
Uterine Rupture (Positive FAST)21 year old female that was having prolonged labour and pain, presented in shock and delivered a non viable fetus with minimal amount of blood loss from vagina. Continued to be hypotensive and became altered requiring intubation and crash central line. RUSH (including FAST) exam performed to determined etiology of undifferentiated shock.  FAST revealed free fluid in abdomen and was taken to the OR with GYN and Trauma Surgery. Found to have uterine rupture in OR. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Perinephric Hematoma
Perinephric HematomaThis is a longitudinal view of the right kidney in a patient who presented with sudden, severe right flank pain. There was no history of trauma. No gross hematuria. The patient’s pain was difficult to control with analgesics and bedside ultrasound revealed apparently spontaneous perinephric hematoma. Therese Mead, DOEmergency Physician 
In-Vivo Shoulder Reduction
In-Vivo Shoulder ReductionThis is a posterior approach looking at the left shoulder showing an anterior dislocation.  The dislocation was found before X-ray was shot. While the resident was performing the Cunningham technique to reduce the shoulder, the attending was able to in real time watch it go back in place. In between the humeral head and the glenoid rim is a large hematoma where I would am my needle if I were to do an intra-articular block. Helpful technique in those recurrent dislocators. Saves the initial X-ray, but probably should get the post-reduction film at this point.Matt Rutz, MDOn Behalf of IU School of Medicine Department of Emergency Medicine, Ultrasound Division 
The Piano Sign
The Piano Sign The Case:A 55 year old male came to ED c/o abdomen pain for 3 days associated with abdominal distention and vomiting. He was noted to be tachycardic and his abdominal exam demonstrated tenderness and bulging in the right inguinal area.  POCUS:  A curvilinear probe was used to evaluate for bowel obstruction. The clip demonstrates a dilated loop of bowel, "to and fro" movements of bowel content suggesting dysfunctional peristalsis, and the piano sign. The piano sign (or keyboard sign) is essentially visualization of the plicae circularis which is associated with the diagnosis of small bowel obstruction.  Dr. Mahmoud S Alsomali EM Resident R4; Saudi Board Of Emergency Medicine; King Saud Medical City; Riyadh KSA 
The Twinkle Artifact
The Twinkle Artifact Ultrasonographic color doppler twinkling artifact is a phenomenon that may aid in the detection of nephrolithiasis. Seen here is a left ureterovesicular junction stone with a positive twinkle artifact. Maria Perez; Emergency Registrar; St Vincent’s Hospital; Melbourne - Australia
Ultrasound for Abscess Identification -
Ultrasound for Abscess Identification -A patient with cerebral palsy and quadriplegia presented with her mother for evaluation of a fluctuant mass in her right axilla.  Ultrasound imaging of the mass showed an abscess with multiple septations.  The abscess was incised and drained, and the patient was discharged on antibiotics.Katy Van Donselaar, Emergency Medicine ResidentChristopher Heberer, Emergency Medicine ResidentSimhadri Botta, 4th year Medical Student 
Now I see you….Ocular ultrasound
Now I see you….Ocular ultrasoundA 44 year old man attended ED with a shimmering effect in his left eye and unilateral temporary painless visual disturbance. He had previously been treated for a retinal tear.Ocular PoCUS shows a frond-like linear structure lifting away from the posterior surface of the globePosterior vitreous detachment (PVD) was suspected while retinal detachment (RD) was also considered. PVD was confirmed by the specialist team and the patient was treated conservativelyRD and PVD are 2 causes of acute painless loss of vision that I find difficult to detect on clinical examination. The diagnosis may be made using bedside ocular USVive PoCUS!Dr Cian McDermottEmergency Physician, University Hospital Geelong, AustraliaReferencesThe diagnostic accuracy of bedside ocular ultrasonography for the diagnosis of retinal detachment: a systematic review and meta-analysis PMID: 24680547Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 2: The use of bedside ultrasound in diagnosing retinal detachment in emergency department PMID 24623730
Reducing Aspiration Risk
Reducing Aspiration Risk This clip demonstrates a distended stomach with swirling particles within.Clinical background:A 76 year old female ward patient was vomiting and in respiratory distress possibly due to aspiration. The patient is impending respiratory failure and the plan was to intubate and admit to ICU. A POCUS was done to evaluate her distended abdomen prior to intubation and the image demonstrated a grossly distended stomach with swirling hyperechoic particles. NG tube was placed and approximately 1 liter of bilious fluid was removed. Patient was safely intubated thereafter with aspiration risk minimized. Learning point:For peri-intubation patient with distended abdomen or with high aspiration risk, a quick POCUS can help determine the amount of gastric content and potentially alter management to include maneuvers to minimize aspiration risk. This has been studied in anesthesia literature and is routinely performed by Dr. Paul Mayo’s critical care team at Northwell LIJ. References:Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume.  Br J Anaesth. 2014 Jul;113(1):12-22. doi: 10.1093/bja/aeu151.Leon Chen, NP – Critical Care Medicine Service; Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Adjunct Clinical Faculty, NYU Rory Meyer College of Nursing, New York, NY 
Resolving Pneumothorax
Resolving PneumothoraxThis is an image of a patient's chest wall using a high frequency transducer, with the transducer oriented in a transverse plane between rib spaces. The patient had a pneumothorax and a chest tube was placed. This clip illustrates what happens when the suction is turned 'on'.  You will see the pleura slide from right to left as the pneumothorax resolves.- Jason Tanguay, DO; Ultrasound Leadership Academy Graduate
A New Horizon In A Gallbladder
A New Horizon In A Gallbladder The image above is from a patient presenting to the emergency department with recurrent abdominal pain. The image demonstrates a large amount of biliary sludge within a normal sized gallbladder. Biliary colic from intermittent obstruction was suspected. While the gallbladder wall is noted to be mildly thick here, cholecystitis was ruled out based on other clinical factors.Marco Garrone, MDTorino, Italy 
Ureterovesical Junction Nephrolithiasis
Ureterovesical Junction NephrolithiasisThis is a 58 year old man that presented with first episode of severe LLQ pain and vomiting. The differentials were diverticulitis vs nephro/urolithiasis. POCUS was performed obtaining images of left and right kidneys, bladder and aorta. The image shows a 7 mm stone seen with shadowing at the L UVJ.Maria Perez; Emergency Registrar; St Vincent’s Hospital; Melbourne - Australia
Biliary Colic That Wasnt
Biliary Colic That WasntThis is an image from a 55 years gentleman with suspected biliary colic. A gallstone was confirmed however the patient's symptoms during exam did not match classic biliary colic. A more in depth evaluation of the right upper quadrant confirmed the presence of right colonic mass. Color flow was appreciated on a separate clip. Although bowel pathologies are an uncommon finding at emergency ultrasound, they can be easily found with further investigation in atypical presentations. Stefanie Tamburrini, MDEmergency Radiologist  
Thoracic Cavity Mass
Thoracic Cavity Mass PLEURAL EFFUSION, THE SPINE SIGN AND SOMETHING ELSE…This is a clip of a 46 year old woman that presented to ED with gradual onset of severe right sided chest pain, pleuritic, associated with tachycardia but normal blood pressure. She was mildly tachypneic but not hypoxic, unable to lie down as that exacerbated her pain. The clip shown here is of the patients right upper quadrant and right lung base. The spine sign is seen along with a right pleural effusion and a circumscribed mass 8 x 6 cm with likely compressive atelectasis and mass effect of the right hemidiaphragm. The effusion was drained obtaining almost 1L of blood, and the CT scan reported very close findings to the ones seen with POCUS few seconds after patient arrival. Put the probe on your chest pain patients!Maria Perez; Emergency Registrar; St Vincent’s Hospital; Melbourne - Australia  
A Case Of Colicky Abdominal Pain
A Case Of Colicky Abdominal Pain Caption: This is a transverse view of the right upper quadrant of an infant who presented with several days of worsening colicky pain. He had decreased appetite, activity and vomiting. Bedside ultrasound revealed evidence of intussusception with extensive surrounding bowel edema likely secondary to delayed presentation.Chris Heberer, DO EM PGY-3CMU-Saginaw
Polycystic Kidney Disease
Polycystic Kidney Disease This middle-aged adult female presented to the emergency department with abdominal pain. The patient reported history of polycystic kidney disease. Bedside renal ultrasound revealed multiple renal cysts in both the cortex and medullary areas of the kidney, consistent with her history. Stones and hydronephrosis would be difficult to detect in the setting of polycystic kidney disease.Ahmad Jaber, MBBS PGY-3 Resident Physician, Central Michigan University Emergency Medicine ResidencyLinks for teaching points for ED physiciansParapelvic cyst misdiagnosed as Hydro Radiopaedia ADPKD Radiopaedia Hydro staging 
Acute Chest Syndrome
Acute Chest Syndrome6 y/o sickle cell (HbSS) coughing with left sided chest pain and 1 day of fever. On exam febrile without hypoxia. Lung without crackles, good air entry bilaterally.A consolidative process is seen with a hypoechoic region with posterior enhancement greater than 1cm in an area where normal A lines should be present. This is highly suggestive of acute chest syndrome given clinical features.Dr. Sathya Subramaniam - Kings County/SUNY Downstate Pediatrics EM
Appendicitis with free fluid and appendicocolith, axial view (1/2)
Appendicitis with free fluid and appendicocolith, axial view (1/2)18 y/o with severe acute onset RLQ abdominal pain, associated with vomiting. temp 100.8 with guarding over RLQ. POCUS performed and revealed appendicitis. An 8mm dilated, non compressible, aperistaltic, appendix with an appendocolith present (hyperechoic structure in blind end of appendix). The patient it tender directly over the appendix. The surrounding tissue is more hyperechoic indicating fatty inflammation around the appendix with adjacent free fluid. The psoas muscle can be seen on the right side of the screen and bowel to the left of the screen. Free fluid can be seen around the bowel and posterolateral portion of the appendix. Dr. Bryan Jarret - Kings County/SUNY Downstate - Emergency Medicine ResidentDr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Appendicits with appendicocolith, long view (2/2)
Appendicits with appendicocolith, long view (2/2)18 y/o with severe acute onset RLQ abdominal pain, associated with vomiting. temp 100.8 with guarding over RLQ. POCUS performed and revealed appendicitis. An 8mm dilated, non compressible, aperistaltic, appendix with an appendocolith present (hyperechoic structure in blind end of appendix). The patient it tender directly over the appendix. The surrounding tissue is more hyperechoic indicating fatty inflammation around the appendix with adjacent free fluid. The psoas muscle can be seen on the right side of the screen and bowel to the left of the screen. Free fluid can be seen around the bowel and posterolateral portion of the appendix. Dr. Bryan Jarret - Kings County/SUNY Downstate - Emergency Medicine ResidentDr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Normal Appendix (longitudinal)
Normal Appendix (longitudinal)13 y/o F with several days of suprapubic pain, dysuria, nausea, vomiting, tender to palpation in the suprapubic and RLQ area. This study was eventually repeated and confirmed as normal. The appendix was visualized on both longitudinal and transverse views as a blind ended structure overlying the iliac vessels, a typical location for the appendix. In this view the slightly dilated blind end can be seen to the right of the screen as it tapers off to the left side of the screen. The pulsating iliac vessels can be seen below. This study was eventually repeated and confirmed as normal.  Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Normal appendix, transverse (2/2)
Normal appendix, transverse (2/2)13 y/o F with several days of suprapubic pain, dysuria, nausea, vomiting, tender to palpation in the suprapubic and RLQ area.  The appendix was visualized on both longitudinal and transverse views as a blind ended structure overlying the iliac vessels, a typical location for the appendix. In this view the iliac vessels and psoas muscle can clearly be visualized to the right of the appendix viewed in cross section. This study was eventually repeated and confirmed as normal.  Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Miliary TB
Miliary TBThe clip was captured in rural Uganda on a patient who presented for weight loss, night sweats, and cough.  Utilizing the high-frequency, linear transducer the patient’s thoracic pleura and superficial lung was evaluated. The ultrasound demonstrated multiple focal sub-pleural lesions with tripartite B-lines consistent with miliary tuberculosis.   Michael Schick DO, MAEmergency Medicine Physician 
IVC Thrombus
IVC ThrombusA 30-year-old man presented with shortness of breath. Normally fit and well with no past medical history apart from a lump in right axilla. Observations were stable apart from a high respiratory rate. Physical examination revealed more lymph nodes in the groin. Working diagnosis of Lymphoma and sent for a CT chest, abdomen and pelvis. In the interim, point of care ultrasound showed clot in the IVC. Confirmed on CT scan. Patient was ultimately diagnosed with metastatic testicular cancer and tumour thrombus in the IVC, which was managed conservatively with anticoagulation.Dr Parmy Deol, Emergency Physician, Chelsea and Westminster hospital, London
Distal Radius Fracture
Distal Radius Fracture7 year old fallen off monkey bars. Tender over right distal radius with mild swelling.POCUS reveals a discontinuity in the hyperechoic cortex of the child's distal radius with minimal displacement. This is suggestive of a buckle fracture or minimally displaced distal radius fracture.Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Lung Hepatization (Pneumonia)
Lung Hepatization (Pneumonia)5 year old child with sickle cell disease. Coughing and fever for 3 days. On exam not ill appearing but decreased breath sounds over right lung. POCUS completed to evaluate for pneumonia.Hepatization of the lung clearly demonstrates consolidative process concerning for pneumonia especially while accounting for this patient's clinical features. The beginning of the image demonstrates hepatization in the lung field. The ultrasonographer then slides the probe inferiorly over normal lung past the diaphragm to the liver, demonstrating how similar lung hepatization can be appear compared to the actual liver. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Hip Effusion
Hip Effusion8 year old female with fever and upper left thigh pain starting last night. Refusing to bear weight and will not flex hip, discomfort with rotating hip. POCUS performed revealed effusion. Still image comparing sides confirms effusion. Etiology of effusion remained uncertain. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow 
Hydrocarbon Ingestion
Hydrocarbon Ingestion5 year old male that drank out of container with gasoline and started coughing and was breathing fast. On exam appeared tachypneic, with air entry bilaterally and subcostal retractions. POCUS revealed bilateral infiltrates, confirmed with CXR. Infiltrate, similar to C lines seen in other consolidative processes, present in patient post hydrocarbon ingestion. This suggests an aspiration pneumonia.Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Hydronephrosis (severe) in Prune Belly Syndrome
Hydronephrosis (severe) in Prune Belly Syndrome10 y/o with Prune Belly Syndrome and bilateral hydronephrosis presenting with suprapubic pain.Bilateral severe grade IV hydronephrosis. Bear claw appearance of left kidney. Prune Belly Syndrome is a rare disorder known for lack of abdominal muscles, cryptorchidism, and urinary tract malformations. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Hydronephrosis (mild)
Hydronephrosis (mild)21 y/o female post op emergency hysterectomy post uterine rupture with rising creatine in surgical ICU. POCUS revealed right sided mild Grade I hydronephrosis with appreciable dilated major calyces and renal pelvis. Initial concern is for obstructive process or ureter injury. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Infant Pneumonia
Infant Pneumonia11 month old recent immigrant infant not up to date with vaccinations presenting with cough, fever and tachypnea starting today. Exam with crackles bilaterally in an infant with subcostal retractions and respiratory distress. Right posterior lung with clear large consolidative process with C lines (air bronchgrams) present. Left posterior lung with small sub-centimeter/subpleural consolidation. Left posterior findings on its own would not currently be considered concerning for pneumonia. However, given concomitant right sided large consolidation, this is likely early consolidative process emerging in left lung. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Intussuception
Intussuception4 year old child with vomiting since yesterday, seen urgent care and was reassured. Today continued vomiting and mother came to ED. Mild tenderness over RUQ. POCUS completed revealing intussusception. Target, Bulls Eye or Doughnut sign seen in the right upper quadrant, the most common region for an ileo-colic intussusception.Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Target Sign - Intussuception
Target Sign - Intussuception4 year old with colicky abdominal pain, vomiting once this AM, on exam abdomen soft and non tender and well appearing. POCUS performed demonstrating target sign. A hyperechoic fatty core can seen within the intussuception inside hypoechoic edematous large bowel on both transverse and longitudinal views.Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Pneumothorax with Lung Point
Pneumothorax with Lung Point18 year old male stabbed in the back with a short knife, now short of breath with chest pain.  Left lung shows a lung point, a highly specific finding indicating a pneumothorax within that lung. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Pyloric Stenosis
Pyloric Stenosis4 week old, vomiting intermittently for 2 weeks, seen PCP 3 days ago, reassured. Revisit today and PCP concerned for pyloric stenosis, so referred to ED. Exam in ED reassuring for well appearing neonate. In ED point-of-care (POCUS) completed, revealing hypertrophic pyloric stenosis. Pylorus muscle hypertrophied and thickened in both transverse and logitudinal view. Transverse view demonstrates the classic target sign seen in pyloric stenosis. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Pylorus (normal)
Pylorus (normal)4 week old with vomiting, projectile according to parents. Infant tolerating formula feed well in ED. On exam well appearing infant with soft abdomen and no masses to palpation. POCUS reveals a normal appearing pylorus. Thickness of muscle < 3mm and length < 14mm. The patient was fed just before exam thus fluid can be seen swirling in the stomach. This can aid in visualization of the pylorus. (Not pictured) Sometimes fluid can be seen passing through the pylorus. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
Infant Skull Fracture
Infant Skull Fracture7 m.o fallen from a 4 foot high crib, unwitnessed. On exam small hematoma over right parietal skull, appears tender. POCUS completed to assess for skull fracture.  POCUS reveals a discontinuity in the hyperechoic cortex of the infant skull that is underneath the hematoma. This discontinuity is different from the image of a suture line within the same patient's skull. Dr. Sathya Subramaniam - Kings County/SUNY Downstate - Pediatric EM Fellow
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