Radial artery pseudoaneurysm 5 days following transradial coronary angiography
Thrill. Instant diagnosis with POCUS.
Stephen Alerhand, MD - Mount Sinai Hospital
25yo w/ no PMH had left molar extracted 10days prior, presents with four days of subjective fever, malaise, and increasing pain to L neck, tachypneic and hypoxic and was intubated w/ central line placed.
POCUS scans through the jugular vein to reveal a clot. CT angiogram showed left internal jugular vein thrombosis, low attenuation L temporal lobe concerning for parenchymal abscess.
Dr. John F. Kilpatrick - Kings County/SUNY Downstate Emergency Medicine
55 y/o F with recent shoulder surgery 4 days prior, with three days of dysphagia and swelling under R jaw.
POCUS reveals swollen submandibular gland with multiple hypo echoic areas, similar to cobblestoning, scattered through normal glandular tissue. CT demonstrated inflammation of submandibular gland and surrounding platysma with prominent ducts and an obstructing stone.
Drs Surriya Ahmad and John F Kilpatrick - Kings County/SUNY Downstate Emergency Medicine
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
83 y/o M with R testicular swelling, tenderness, concern for epididymitis vs orchitis. POCUS with septated fluid collection concern for pyocele.
Pycoele's are a urologic emergency that can lead to fournier's and often require orchiectomy.
Dr. Tess Sexton - Kings County/SUNY Downstate EM
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 Resident
Christopher Heberer, Emergency Medicine Resident
Simhadri Botta, 4th year Medical Student
Cephalic Vein Thrombophlebitis
Patient with pain and swelling to area above the antecubital fossa where an IV had been the week before, a palpable cord was appreciated proximal to the former IV site.
POCUS demonstrated a clot, likely septic thrombophlebitis secondary to IV site infection. This is a similar techinque as what is done for DVT by finding the vessel, looking for a clot, and seeing if the vessel can be compressed.
Dr. Bowra et al. (Dr. Chiang)
Deep Vein Thrombosis of Left Common Femoral Vein
Patient with profound rapid onset lower extremity pain and swelling. POCUS can be used to rapidly assess for DVT with as high as 95% sensitivity and 96% specificity amongst ED providers.
In this image the artery can be seen as the pulsating thick walled vessel with strong pulsations under color doppler. The vein is the large vessel with echogenic material with flow only around the edge of the clot. Inability to compress the vessel would confirm the diagnosis of DVT (not pictured).
Dr. Justin Bowra et al.
Incompressible Left Common Femoral Vein
Patient with pain and swelling of the entire left lower extremity. Three point POCUS carries a sensitivity of 95% and specificity of 96% for detecting DVT when performed by emergency physicians.
Mild external rotation of the hip can help open up the inguinal crease to find the femoral vein. The POCUS should be performed 1-2cm distal to the bifurcation of the common femoral for a complete study.
Dr. Justin Bowra et al.
Air poorly transmits ultrasound waves and when fluids or solids interface with air, the lead to echogenic irregularities with comet tails that can often obscure the tissue behind it.