January SonoProps
Welcome to 2024! Happy New Year!
Our first SonoProp this year goes to Dr. Youstina Michael and Dr. Vivek Sharma.
They were evaluating a 68-year-old female with flank pain and saw this:
This patient has an abdominal aortic aneurysm (AAA). This patient had a known history a AAA. Previously her AAA measured 3.6cm. CTA was performed which showed that her aneurysm grew to about 4.3cm, consistent with the POCUS.
Learning points:
Symptoms of AAA can vary from abdominal pain, back pain, flank pain, groin pain, syncope, hypotension, or referred pain and patients present with multiple symptoms.
High suspicion in a patient older than 50 years old should prompt the consideration of a AAA POCUS scan. ED POCUS has a high sensitivity (100%) and specificity (98%) for the detection of AAA when performed by trained physicians with a high positive predictive value (93%) and negative predictive value (100%).
Patient’s with a known history of AAA with new symptoms should prompt consideration of complication or growth of AAA and should get a POCUS to start which has been demonstrated to improve time to diagnosis and time to OR.
Our second SonoProp goes to Dr. Obioma Nkemakolam.
He was evaluating a 30-year-old obese (BMI 39) male patient with right upper quadrant pain and nausea x months and saw this:
This is a gallbladder without signs of cholecystitis, however it has multiple gallbladder polyps.
Learning points:
Gallbladder polyps are a common incidental abnormality found on biliary ultrasound.
They can be differentiated from gallstones in a few ways:
Lack of shadowing (although rarely some stones may not shadow)
Lack of gravity dependence - gallbladder polyps can be attached anywhere and are not gravity dependent, changing the patient’s position does not affect polyp position. They may have a stalk present.
All patients with gallbladder polyps should be referred for close follow up.
While most polyps are benign, they can be associated with malignancy especially if large (>1cm).
Although beyond scope, patients polyps ≥6mm are generally recommended to have cholecystectomy.
