Traumatic pneumothorax mapping using computed tomography to assess optimal area to scan with POCUS

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 708-711
Author(s):  
Adam Bignucolo ◽  
Claire Acton ◽  
Robert Ohle ◽  
Steve Socransky
Keyword(s):  
Computed Tomography ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Inferior Aspect ◽  
Sternal Border ◽  
Traumatic Pneumothorax ◽  
Inferior Border ◽  
The Right ◽  
Optimal Area ◽  
Theoretical Sensitivity

ABSTRACTIntroductionIt is traditionally taught that the location to place an ultrasound probe to detect a pneumothorax with point-of-care ultrasound (POCUS) is the anterior chest, given the theory that air will collect at the least dependent area in the supine patient. There is a wide variety of scanning protocols with varying accuracy and completeness. We sought to assess the optimal area to scan for diagnosing pneumothorax by mapping the location of traumatic pneumothorax on computed tomography (CT).MethodsPatients were selected after a retrospective cohort of adult patients who presented to a regional trauma center with a pneumothorax diagnosed on CT. Data were extracted using a standardized data collection tool, and 20% of charts were reviewed by two reviewers. Predefined zones were used to map the areas of pneumothoraces. Theoretical sensitivity and 95% confidence intervals (CIs) are reported.ResultsA total of 203 traumatic pneumothoraces were reviewed from 2006 to 2016. The majority of the pneumothoraces were found in an area defined by the para-sternal border and the mid-clavicular line from the inferior aspect of the clavicle to the physiologic lung point (liver on the right, heart on the left). The theoretical sensitivity for pneumothorax of scanning this area was 91.6% (95% CI, 86.9–95%).ConclusionThis study suggests any POCUS scanning protocol for traumatic pneumothorax should include an area from the inferior border of the clavicle at the parasternal border down to the liver or cardiac lung points and then the mid clavicular line down to the liver or cardiac lung points.

scholarly journals Early Detection of Post-Endarterectomy Complication by Point-of-Care Ultrasound

Reports ◽  
2021 ◽  
Vol 4 (3) ◽  
pp. 21
Author(s):  
Bo-Ku Chen ◽  
Po-Wei Chiu ◽  
Chih-Hao Lin
Keyword(s):  
Femoral Artery ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Atheromatous Plaque ◽  
Point Of Care Ultrasound ◽  
Related Complication ◽  
Contrast Extravasation ◽  
The Right

Endarterectomy is an effective intervention to remove the atheromatous plaque in the inner lining of the artery, aiming to revascularize the occluded/stenosed vessel in patients with peripheral arterial occlusive disease (PAOD). The most common wound-related complication is postoperative bleeding, followed by infection, hematoma, and seroma. However, hematoma complications with air surrounded have rarely been reported in clinical cases. Case presentation: A 90-year-old female patient visited our emergency department because of a rapidly growing hematoma with pulsatile bleeding over her right groin area. She had received bilateral percutaneous transluminal angioplasty with endarterectomy for PAOD one month prior. A point-of-care ultrasound revealed a large hypoechoic mass, with a dirty shadow on the right groin area. Computed tomography angiography showed a hematoma over her right femoral region, with free air surrounding the right femoral artery. Angiography revealed an irregular shaped lesion on the right femoral artery without contrast extravasation. The patient was diagnosed with right-femoral post-endarterectomy infection with infected hematoma, with the inclusion of air. She underwent urgent excision and repair of the right femoral artery infectious lesion, debridement of the infectious hematoma and stenting of the right external iliac artery, common femoral artery and superficial femoral artery.

scholarly journals Life after a point-of-care ultrasound course: setting up the right conditions!

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
T. J. Olgers ◽  
N. Azizi ◽  
H. R. Bouma ◽  
J. C. ter Maaten
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
The Right

scholarly journals Point-of-Care Ultrasound-Directed Evaluation of Elbow Effusion

2019 ◽  
Vol 3 (3) ◽  
pp. 286-288
Author(s):  
Peter Patitsas ◽  
Richard Davis ◽  
Robert Strony
Keyword(s):  
Emergency Department ◽  
Best Practices ◽  
Point Of Care ◽  
Robotic Prostatectomy ◽  
Point Of Care Ultrasound ◽  
Prolonged Hospital Stay ◽  
Ultrasound Guided ◽  
The Right ◽  
Department Evaluation ◽  
Prolonged Hospital

A 53-year-old male presented with pain in the right elbow that was sudden in onset and progressively worsening over approximately eight hours. The pain was exacerbated with any movement of the elbow. Of note, he had been recently admitted for robotic prostatectomy and had a prolonged hospital stay requiring a course of antibiotics. This case report details the emergency department evaluation of septic arthritis of the elbow with a focus on best practices for ultrasound- guided elbow arthrocentesis.

scholarly journals Case Series of Bedside Renal Cell Carcinoma Detected by Point-of-Care Ultrasound in the Ambulatory Setting

2020 ◽  
Vol 11 ◽  
pp. 215013272091627
Author(s):  
Gayatri Setia ◽  
Ilan Kedan
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Point Of Care ◽  
Case Series ◽  
Smoking History ◽  
Point Of Care Ultrasound ◽  
Gross Hematuria ◽  
The Right

Background: Kidney and renal pelvic cancer was the sixth most common cancer in men and 10th most common in women in the United States in 2018. Renal cell carcinoma (RCC), accounts for 86% of malignancies of the kidney. RCC patients are often asymptomatic; up to 25-30% have metastases at diagnosis. Few present with the triad of gross hematuria, flank pain, and abdominal mass. In RCC patients, 36% had 2 symptoms of the triad, and 60% had gross hematuria as 1 symptom. Point-of-care ultrasound (POCUS) offers a way to identify clinically meaningful anatomic abnormalities. This case series presents 3 patients in whom routine POCUS examination performed in an outpatient cardiology clinic found asymptomatic renal masses, resulting in surgical resection and cure of early-stage RCCs. Case Presentation: Patient 1: 54-year-old female with hypertension (HTN). Two solid masses were identified with POCUS in the right kidney. Patient 2: 63-year-old male with coronary artery disease (CAD) and HTN was seen at an 8-month follow-up visit. A 6-cm mass was identified in the left kidney. Patient 3: 69-year-old male with CAD, HTN, and smoking history seen at 5-month follow-up visit. A 3-cm mass in the right kidney was identified. Conclusions: Incorporating POCUS into the routine physical examination in the ambulatory care setting may improve rates of detection and increase the pretest probability of identifying renal pathology with formal imaging studies. With minimal clinician training, earlier and increased detection of asymptomatic RCC may result in improved patient survival.

scholarly journals Point-of-care Ultrasound Diagnosis of Pulmonary Embolism with Thrombus in Transit

2019 ◽  
Vol 3 (2) ◽  
pp. 11-12 ◽  
Author(s):  
Nicolas Kahl ◽  
Christopher Gabriel ◽  
Shadi Lahham ◽  
Maxwell Thompson ◽  
Wirachin Hoonpongsimanont
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Point Of Care ◽  
Skilled Nursing Facility ◽  
Point Of Care Ultrasound ◽  
Right Heart ◽  
Skilled Nursing ◽  
Chamber View ◽  
The Right ◽  
In Transit

A 95-year-old female with a history of dementia and atrial fibrillation (not on anticoagulation) presented to the emergency department (ED) by ambulance from her skilled nursing facility due to hypoxia. Point-of-care ultrasound was performed, and showed evidence of a large mobile thrombus in the right ventricle on apical four-chamber view. Further evidence of associated right heart strain was seen on the corresponding parasternal short-axis view. These ultrasound findings in combination with the patient’s clinical presentation are diagnostic of acute pulmonary embolism with right heart strain. Point-of-care transthoracic cardiac ultrasound in the ED is an effective tool to promptly diagnose acute pulmonary embolism with right heart strain and thrombus in transit and guide further treatment.

The comparison of bedside point-of-care ultrasound and computed tomography in elbow injuries

2016 ◽  
Vol 34 (11) ◽  
pp. 2186-2190 ◽  
Author(s):  
Mustafa Avcı ◽  
Nalan Kozacı ◽  
İnan Beydilli ◽  
Fevzi Yılmaz ◽  
Arif Onur Eden ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Elbow Injuries

scholarly journals Novel Point-of-Care Ultrasound (POCUS) Technique to Modernize the JVP Exam and Rule out Elevated Right Atrial Pressures

2021 ◽  
Author(s):  
Larry Istrail ◽  
Maria Stepanova
Keyword(s):  
Right Atrium ◽  
Point Of Care ◽  
Venous Pressure ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Right Atrial ◽  
Point Of Care Ultrasound ◽  
Status Assessment ◽  
Left Ventricular Outflow ◽  
The Right

Accurate assessment of the jugular venous pressure (JVP) and right atrial pressure (RAP) has relied on the same bedside examination method since 1930. While this technique provides a rough estimate of right-sided pressures, it is limited by poor sensitivity and overall diagnostic inaccuracy. The internal jugular vein (IJV) is difficult to visualize in many patients and relies on an incorrect assumption that the right atrium lies 5 centimeters below the sternum. Point-of-care ultrasound (POCUS) offers an alternative method for more precisely estimating JVP and RAP. We propose a novel method of measuring the right atrial depth (RAD) using a sonographic measurement of the depth of the posterior left ventricular outflow tract as a surrogate landmark to the center of the right atrium when viewed in the parasternal long axis view. This is combined with determination if JVD was present at the supraclavicular point. Sensitivity, specificity, PPV, NPV of JVD at the supraclavicular point was 70%, 76%, 59%, 91% respectively. These values were confounded by the lack of standardization of zero reference landmarks (ZRLs) used during the right heart catheterizations. When the RAD estimate was adjusted to account for measurement error the sensitivity of JVD at supraclavicular point for elevated RAP improved to 90% with negative predictive value of 96%. This may offer a rapid and reliable method for ruling out elevated RAP and increase objectivity in our volume status assessment.

scholarly journals Ultrasound Detection of the Aquarium Sign at the Bedside

2020 ◽  
Author(s):  
Mihiro Kaga ◽  
Emi Yamashita ◽  
Takeshi Ueda
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Test Results ◽  
Mesenteric Ischaemia ◽  
Contrast Enhanced ◽  
Life Threatening ◽  
Hepatic Portal ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
The Relationship

Objectives: The aquarium sign is the name given to a large quantity of bubble-like echoes that suggests the presence of hepatic portal venous gas (HPVG). Few studies in the literature have addressed the relationship between the aquarium sign and HPVG. In some cases, HPVG can only be detected using ultrasonography. HPVG can be observed in a variety of conditions, including those that require emergency surgery, such as acute mesenteric ischaemia (AMI). Therefore, it is important to identify the presence of HPVG as soon as possible.  Materials and methods: We report a case of the aquarium sign, where bubble-like echoes flowed from the right atrium towards the right ventricle, which was identified using bedside cardiac ultrasonography as part of a point-of-care ultrasound test. Results: This aquarium sign finding led to the diagnosis of AMI, which was confirmed using contrast-enhanced computed tomography (CT).  Conclusion: The aquarium sign is a useful finding suggestive of HPVG and mesenteric ischaemia, which can be rapidly and easily observed using bedside cardiac ultrasonography. However, there are very few reports on the aquarium sign. The inability of other more cumbersome diagnostic imaging modalities, such as CT and magnetic resonance imaging, to detect HPVG emphasizes the utility and convenience of detecting the aquarium sign using bedside ultrasonography. This technique can lead to early detection of life-threatening diseases as well as improve the prognosis for patients. The diagnostic implications of the aquarium sign for HPVG are still unclear and require further research.

scholarly journals Pseudogout Diagnosed By Point-of-care Ultrasound

2019 ◽  
Vol 3 (4) ◽  
pp. 425-427
Author(s):  
Anthony Halupa ◽  
Robert Strony ◽  
David Bulbin ◽  
Chadd Kraus
Keyword(s):  
Emergency Department ◽  
Knee Joint ◽  
Knee Pain ◽  
Point Of Care ◽  
Calcium Pyrophosphate ◽  
Point Of Care Ultrasound ◽  
Ultrasound Guided ◽  
The Right ◽  
Double Contour

A 71-year-old male presented to the emergency department (ED) for worsening right knee pain for the prior 3-4 weeks. Point-of-care ultrasound (POCUS) of the right knee showed a pseudo-double contour sign. Subsequent ultrasound-guided arthrocentesis of the knee joint was performed, and fluid studies showed the presence of calcium pyrophosphate crystals, which was consistent with pseudogout. Ultrasound for detection of calcium pyrophosphate crystals in pseudogout and chondrocalcinosis has sensitivity of 86.7% and specificity of 96.4% making POCUS a valuable tool for diagnosing crystalline-induced arthropathy in the ED.

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