The patient is a 61 year old male with a past medical history notable for hypertension, who presented for evaluation after a syncopal episode.  The patient reported ongoing headaches for the past two days that persisted despite over the counter medications. The headache was not sudden onset or thunderclap. He denied numbness, weakness or visual changes. He also had a poor appetite.  The patient denied trauma or head injury and was not on anticoagulation medication. 

Pearls and pitfalls: Scan in BOTH longitudinal and transverse planes. To avoid rib shadows, oblique the probe to align with the rib space rather than holding the probe straight up and down. Slowly fan through the kidney in its entirety to evaluate for hydronephrosis and for the presence of a kidney stone…

I have never been taught how to handle the emotional residue, only shown how empathy slowly erodes, until the moment of silence becomes almost infinitesimal.

For emergency physicians and trauma teams, the bruise is a warning sign—a clue to look deeper, image liberally, and monitor closely. The presence of SBS should immediately trigger a structured evaluation for intra-abdominal injury, spinal fractures, and vascular complications.