Brown Emergency Medicine Blog — BROWN EMERGENCY MEDICINE BLOG

Sclerochoriodal calcification - What is it and what is its clinical significance?

…3 days of floaters and “lightning bolt” white flashes in the temporal field of her right eye in the absence of eye trauma. She also reported right periorbital pain. She did not have blurry vision, diplopia, loss of vision, scalp tenderness, jaw claudication, fevers, chills, or weight loss. She denied photophobia despite wearing sunglasses in the Emergency Department. Her mother had died from choroidal melanoma, but the patient had not seen an ophthalmologist in 15 years.

Her uncorrected visual acuities were 20/60 OD and 20/40 OS. Intraocular pressure, pupillary reaction, and extraocular movements were normal. Point of care ultrasound (POCUS) revealed three hyperechoic, solid lesions with posterior acoustic shadowing in her right eye….

Utilization of Ultrasound for Diagnosis of Patellar Tendon Rupture in the Emergency Department

…complained of significant superior lateral knee pain and swelling, as well as difficulty moving his leg due to pain. On exam, he had notable swelling and tenderness of the left knee, particularly along the superior aspect of the patella. After controlling his pain with intravenous medications, he was able to flex at the hip but was unable to extend his lower leg at the knee or to perform a straight leg raise….

Ultrasound, Radiology, OrthopedicsKatherine StewartSeptember 17, 2021Ultrasound, Orthopedics, musculoskeletal injuries, patellar tendon ruptureComment

Using POCUS for Ejection Fraction Estimation

…The differential diagnosis included acute coronary syndrome, CHF exacerbation, pneumonia, and cardiac amyloidosis.

EKG showed sinus tachycardia with low voltage. Laboratory evaluation was unremarkable, with a negative troponin and high normal BNP. Chest radiograph showed bilateral infiltrates concerning for mild pulmonary congestion.

POCUS was obtained….

Ultrasound, Radiology, CardiologySean BilodeauSeptember 3, 2021ultrasound, cardiac amyloidosis, left ventricular ejection fraction, LVEF, EPSSComment

A Sizable Stone: Sonography in Sialolithiasis

An octogenarian gentleman with a history of atrial fibrillation, congestive heart failure, chronic kidney disease, and insulin-dependent diabetes presented to the emergency department with three weeks of pain and swelling near the right side of his face. He awoke that morning with a new symptom -- difficulty swallowing…

Ultrasound, RadiologyThomas GomesAugust 20, 2021Ultrasound, HEENT, Sialolith, SialolithiasisComment

Avoiding a Pitfall of Biliary Ultrasound: Understanding Wall-Echo-Shadow (WES) Sign

40 year old female with normal vital signs and a chief complaint of right upper quadrant abdominal pain associated with nausea and vomiting. She has never had this pain before. She has no past medical and no past surgical history. She denies vaginal and urinary symptoms. She undergoes right upper quadrant ultrasound which confirms the diagnosis…

Ultrasound, RadiologyKaitlin LipnerAugust 6, 2021Ultrasound, WES sign, Cholecystitis, biliary Cholic, Abdominal PainComment

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