Emergency ultrasound case of the month……2014 !!

6 Jan

From Vincent Rietveld, SEH-arts/ Emergency physician at the Westfriesgasthuis Hoorn, @vindoctwit:

Happy new year to all !! Hope you got through december without an ultrasound case of the month on EM Dutch ;-).

Here’s one to start of 2014 , I  picked this one up on one of my shifts at the Westfriesgasthuis in Hoorn. To me it illustrates beautifully why emergency ultrasound can be so helpful in providing better care for your patients and should be a core competency for all (dutch) emergency physicians!  Read for yourself and see what you think ..

A 23 year old female, with no relevant past medical history, came to the ED the day before I saw her, with sudden onset right sided flank pain radiating to the lower adbomen and groin.

It was noted that during physical exam she experienced colik-like pain, her right lower quadrant was mildly tender on palpation and pelvic exam was not painful. No fever and labs were normal.

Preliminary diagnosis stated in the chart: ureter stone  or maybe even an appendicitis. She was told to come in the next day to be re-evaluated.
The next day she first was seen by the surgical resident who, thinking ureterstone, asked us to do an ultrasound for hydronefrosis. The EM-resident ( @HoekAmber ), who did an elective ultrasound rotation with us,  eagerly jumped at the ultrasound- opportunity that was presented to her. ” Ok”  I said to her ” Go ahead set up the machine and get started I’ll see you in two minutes”. One minute later she called me: “Vincent.. you might want to take a look at this …!!”

When I saw the patient , despite plenty of opiates,  she was still in a lot of pain which was now continuous and non-coliky and mostly in the right lower quandrant.

Her abdomen was still mildy tender on palpation in the right lower quadrant. Still no fever. No labs or urine yet  (all normal later on, HCG also neg)

Heeeeeeerrrrre’s ………….. the ultrasound  !!:

Right kidney

Casus EM dutch jan 2014 re nier

Left kidney

Casus EM dutchjan 2014 li nier

Pelvic views

casus EMdutch jan 2014

casus EMdutch jan 2014 2

Still thinking ureter stone ??

For diagnosis and rest of the case … click here

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