Tuesday 24 July 2012

An unexpected finding...

Great Ultrasound Case

A recent case of mine.

HPI:  Fifty yo man presents complaining of constipation.  It started five days before, and he attributes it to new medications.  Two days before that he had been seen at a walk-in-clinic with cough and shortness of breath.  A chest x-ray had been done (I did not have the results).  He had been told he had infection and fluid on the lungs, and started on clarithromycin and furosemide.  Now, he feels his breathing is better but he feels constipated and his belly feels distended.

Something smells fishy here.

PMHx: smoker, nil else

Exam: All vitals normal.  Patient in no distress and looks generally well.  Abdomen distended but non-tender, nothing else noted.

POCUS saves the day:
Abdomen: lots of free fluid
Cardiac: large pericardial effusion with signs of RV collapse.

He is moved to a monitored area, where an ECG shows electrical alternans and he is found to have a pulsus paradoxus of 20 mmHg.

Diagnosis: pericardial tamponade.  He is admitted to cardiology.  He is ultimately found to have an unrecognized lung mass and the effusion is malignant.

Share your recent great ultrasound cases and we will post them here!  - James

1 comment:

  1. Great case! Do you have the us image to post as well?