Tag Archives: Emergency Ultrasound

Emergency ultrasound case of the month….2014 !! Rest of the case and diagnosis

10 Jan

The ultrasound showed a right kidney with a little bit of hydronefrosis, mild at most, but the “money shot” was in the pelvis ..
A large cystic mass with anechoic to hyperechogenic content, some concrement-like structures were also seen within.

Right kidney                                       Left kidney

Casus EM dutch jan 2014 re nierCasus EM dutchjan 2014 li nier

Pelvic view

Casus EMdutch jan 2014 + uitleg
The patient was sent to gynaecology where a transvaginal ultrasound was done …. with similar findings.

On basis of the findings of  the ultrasound(s) she was brought to the OR. Where the gynaecologist found the large cyst (9 – 6 – 5 cm) which had facilitated a torsion of the right ovary. Luckily the ovary could be spared.

The pathology report showed : Cyst with skin, bone, cartilage and braintissue..  conclusion : mature teratoma

Final diagnosis : Large mature teratoma with torsion of the right ovary (and little bit of  hydronefrosis of  the right kidney)

A few pearls can be taken from this case in my humble opion:

-Be sceptic of other people’s diagnosis when a patient is handed over to your care, don’t let it narrow your frame of thinking

-Emergency ultrasound can guide your management in the right direction within seconds.Without it you might lose valuable time (and in this case an ovary)

-Always scan the pelvis/bladder after doing  renal ultrasound, don’t be satisfied with hydronefrosis, check if you can identify the cause downstream. (also always take a look at the aorta by the way, AAA /iliacal aneurysm can also be a cause of hydronefrosis and mimic renal colic)

– Torsion of the ovary can be a tricky diagnosis, pelvic exam not always helpful.

Love to hear your comments on this case …. Check EMdutch in a month or so for the next emergency ultrasound case !!


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

Emergency Ultrasound Case of November 2013

1 Nov

We are back again with another ultrasound case of the month !!

Brought to you by Amber Hoek. Emergency Medicine Resident, HAGA Teaching Hospital, The Hague . 

She came across this case during her Emergency Ultrasound Rotation at the Emergency Department of the Westfriesgasthuis in Hoorn.

A unexpected finding during a routine EFAST….with a brilliant clip….Enjoy !!

a 27-year-old male visited the ED with chest pain and respiratory distress.

3 weeks ago he was involved in a high speed motor vehicle crash, and fell from a dyke into the water. He refused to go to the hospital, however the day after he went to the ED because of chest pain on the left side. The Emergency Physician did a full physical exam and made a chest X-ray and shoulder X-ray. Only a left clavicle fracture was found.

Chest X-ray 3 weeks ago:

CHEST x ray ultrasound case of the month

Today the patient comes back with progressive chest pain on the left side and dyspnea since one week. He also has a fever of 39.0 °C

Vital signs: blood pressure 134/95 mmHg, heart rate 112/min, Sat. 100%, temperature is 37.8 °C. Auscultation: decreased breath sounds on the left with rales.

-What is your most likely diagnosis?

-What would you do next?

While the patient gets some fluids and waits for the chest X-ray, we do an EFAST:


-What’s your diagnosis now and what would you do now?

To see the answer and the outcome of this case of the month , check out EMDutch in 2 weeks ….