Case and images Sarah Vaughan Discussion Genevieve Carbonatto A 55 year old man presents to the ED with 5 days of loin to groin pain and microscopic haematuria. He was started on nitrofurantoin as an outpatient for a possible UTI. A point of care renal ultrasound is performed This is a clip through his right kidney without and then with colour Doppler. What can you seen on these clips? Click for answer There is mild hydronephrosis The normal renal sinus shows several echo free spaces so it is difficult to differentiate blood vessels from calyceal dilatation.  In a normal kidney with n ..read more

Images Daniel Loui  Text Genevieve Carbonatto A 60 year old lady presents with recurrent syncopes associated with frequent falls. 2 weeks prior to presentation she had a fall on her right buttock  causing  right hip pain. Subsequently she developed a small heamatoma over her right buttock and a larger right thigh haematoma. She presents with  severe pain on flexion of her right hip. Lying flat in bed also elicits severe right hip pain in her right inguinal area. She states she is on  warfarin for a metallic valve as a consequence of infective endocarditis several years ..read more

Images Chris Fox A 14 year old boy presents to ED with throat and neck pain after persistent vomiting. He states he vomited > 30 times over the previous 8 hours. On examination:  oxygen saturation 98% on RA, BP 128/89, HR 66/min. No obvious crepitaions to the neck. A chest Xray was ordered What can you see? Click for answer There is an extensive pneumomediastinum and a possible pneumopericardium There is subcutaneus emphysema in the right supraclavicular fossa This is his ultrasound from the area on the right side of the neck. How would you interpret this clip? Click for answe ..read more

This month I thought it might be good to review the basics of assessment of LV function. This is a PLAX. What are the 3 ways you would assess systolic LVF in this patient? To help you with this, compare the clip with the PLAX of a patient with normal LV function below. Click for answer Look at the thickening of the myocardium during the cardiac cycle. If the myocardium thickens more than 30% by simply eye balling the myocardium then this is normal . The walls are not thickening much in our patient. 2. Look at how much smaller the LV cavity gets in systole. This can be referred to as the a ..read more

(Case and images courtesy of Dr Ed Brentnall ultrasound reg, text Jay Perera, Genevieve Carbonatto) Triage: -3.06pm on Wednesday afternoon -Cat 3 to acute bed. 2/52 of worsening SOB on exertion +dry cough. Postural drop with CDA. -Observations: BP 116/65, HR 80, RR 24, sats 96% on room air, temp 35.9C History -2/52 exertional dyspnoea and slight cough. Pre-syncopal x2 today whilst attempting to ambulate. LUQ non pleuritic and non-positional -left total hip replacement 3 months prior. Mobilising with a stick. Discharged on aspirin – PMH: HTN, T2DM, Stable Angina. No history of heart failure or ..read more

Images and case Danielle Martinez An 89 year old lady  presented to hospital with  severe abdominal pain and collapse on a background of a known AAA. On arrival, she was hypotensive and pale with a reduced level of consciousness. A Point of Care Ultrasound was performed. A shows a transverse view through the mid aorta. B  AP diameter of mid aorta. C a longitudinal view of the proximal abdominal aorta. D a longitudinal view of the mid aorta. E a longitudinal view of the distal aorta. Describe the following scans.  At which point is an aorta considered aneurysm ..read more

History : A 22 year old man presents to ED with 1 week of a sore throat, a mild productive cough,  fevers and rigors for 8 hours. On examination : temperature 39.6, HR 143/min, RR 28/min, BP 133/60, Sats 98% on RA Bloods were ordered. His WCC was 11.3, his CRP 1.5 A chest Xray was ordered and was reported as normal. Whilst in ED he suddenly became tachycardic  HR 150/min and had an episode of haemoptysis. Because of his normal Chest Xray a CT pulmonary angiogram was performed which showed a dense left lower lobe consolidation with mucous plugging and post obstructive atelectasis A p ..read more

Case and images courtesy of Dr Micky Fiorentino (ultrasound under supervision of Dr James Dent) Triage at 1pm: 46F, representation with recurrent RUQ pain. Known gallstones. Representing with further pain, yellow skin colour and pale stool and dark urine. Further history: Diagnosed with gallstones with 3 weeks prior on outpatient ultrasound showing multiple small stones. Awaiting elective cholecystectomy. Skin changes and pale stool, dark urine new. O/E Minimally tender RUQ, Murphy’s negative Jaundiced Initial blood tests: Hb 135 WCC 3.8 x 109 Bil 91 Albumin 41 Protein 82 ALP 349 Gamma GT 524 ..read more

  A 72 year old lady presented to the Emergency Department with syncope.  A point of care ECHO was performed. What is the structure in the right atrium? This is a Eustachian valve. The differential diagnosis would be a tumour, a thrombus or a vegetation. In the context of syncope the presence of such a prominent Eustachian valve is possibly significant as it may be a factor in causing paradoxical emboli. The Eustachian valve is  located in the right atrium. It is crescent shaped and extends from the IVC to the fossa ovalis.  It is a remnant of the sinus venosus valve which ..read more

CASE 1 Triage: 25F presents with 2/7 of worsening palpitations, worse post ventolin. She has a history  of PTSD and anxiety. HR 78 regular Seen by the registrar: 3 years of fatigue and lethargy Diagnosed with OSA on CPAP. Complains of intermittent palpitations and dyspnoea. Trialed by her GP on ventolin with minimal relief. No lung function testing. Referred to a psychiatrist for anxiety. Her psychiatrist did an ECG which showed ? LVH prompting a referral to a  cardiologist. Presented to ED due to worsening palpitations.   This is her PLAX view How would you describe the hear ..read more