Case of the Month

Until we put up a new ‘Case of the Month’ – get your fill of cases from Ultrasound of the Week run by Ben Smith, MD.

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The “Case of the Month” is a monthly presentation of an ultrasound related case followed by a short quiz. Each month we will randomly select one winner from our pool of 100% correct submitters to receive a $10 Starbucks gift card! Good luck everyone and may the odds be ever in your favor!

September 2015 Case of the Month

The Case

Mr. Yurin Trouble is a 75 year old Caucasian gentleman who presents to the ER with a 6 day history of bright red urine. He denies any pain with urination, urgency, or increased urinary frequency. He has been afebrile over the past week, and has not passed anything other than urine (i.e. clots or stones). The blood began after he was discharged from an outside hospital 1 week ago for a CHF exacerbation and chest pain workup which was negative. During that admission he was given a Foley catheter to help monitor his I/O’s while undergoing diuresis, which was difficult to remove at discharge. Before retirement, he worked in construction where he was exposed to a variety of chemicals. His past medical history is positive for a 35+ pack-year history of smoking, hypertension, diabetes, hypothyroidism, COPD requiring 2L O2, atrial fibrillation, and idiopathic thrombocytopenic purpura. His medications include Lisinopril, Spiriva, Coumadin, low dose prednisone, Synthroid, and Lasix.

Vitals:

T – 98.9

BP – 135/84

HR – 75

RR – 18

O2 – 96% on 2L O2

Physical Exam/ROS is normal except for bilateral lower extremity pitting edema to the knees and diffuse crackles at the lung bases. Patient denies flank pain, CVA tenderness, and has impalpable kidneys. The patient denies any weight loss, fever, or night sweats and has no family history of cancer.

Labs:

INR 2.57 (2.0-3.0 is target range for warfarin therapy)

Platelets 85 (150-450 normal range)

In addition to ordering a urinalysis you conduct a bedside bladder and kidney ultrasound to help guide your management and diagnosis.

QUIZ

1)What is the abnormality in the following kidney ultrasound?

kidney1

A – Kidney stone       B – Hydronephrosis         C – Renal cyst    D – Normal kidney

 

2) Assuming there is nothing wrong with Mr. Trouble’s kidney, what should it measure in terms of length?

A – 5-8cm              B – 8-10cm           C – 9-12cm           D – 10-14cm

 

3) Given his history, which of the following images most likely corresponds to the cause of this patient’s symptoms? (Hint – think of acute causes)-each letter corresponds to the image below it-there are 2 images for answer c

A:                                                           B:                                                       C:

kidney2

 

4) The patient next to Mr. Trouble is also experiencing bloody urine. Which of the following is most consistent with the following ultrasound?

kidney3

A – Sudden onset flank pain

B – Three weeks of fever

C – History of unprotected sexual encounter with a new partner

D – Three months of weight loss accompanied by night sweats and chills

 

5) Which of the following is NOT a potential cause of this sonographic finding?

kidney4

A – Ureteral stone

B – Benign prostatic hypertrophy

C – Renal artery stenosis

D – Bladder cancer

CLICK HERE to take the quiz (and be entered to win some coffee!)

Resources :

Intro to Bedside Ultrasound Ch6 – Renal

http://radiopaedia.org/articles/kidneys

 

CHECK OUT our August 2015 Case of the Month

Suggested reading: Chao, A., Gharahbaghian, L., and Perera, P., (2015). Diagnosis of Pneumoperitoneum with Bedside Ultrasound. West Journal of Emergency Medicine, 16(2): 302.

August’s Winner:

Congratulations to Paul VandeKoppel our winner of the Case of the Month! Enjoy your Starbucks winnings!!

CHECK OUT our April 2014 Case of the Month: Rush Protocol

Suggested Resources:

Academic Life in EM: “RUSH protocol: Rapid Ultrasound for Shock and Hypotension

Introduction to Bedside Ultrasound: Vol. 1, Ch. 5 “RUSH”

Mount Sinai Ultrasound: “RUSH

CHECK OUT our March 2014 Case of the Month: Soft Tissue Ultrasound

Suggested Resources:

One Minute Ultrasound: Soft Tissue

SonoGuide: Abscess AND Soft Tissue Ultrasound

Introduction to Bedside Ultrasound: Vol. 2 Ch. 10 “Soft Tissue”

March’s Winner:

Congratulations to Sooyeon Kim our winner of the Case of the Month! Enjoy your Starbucks winnings!!

 

CHECK OUT our February 2014 Case of the Month:

Vascular Access Ultrasound

Suggested Resources for Vascular Access Ultrasound:

Introduction to Bedside Ultrasound: Vol. 2 Ch. 8

Ultrasound Podcast: Ultrasound-Guided Peripheral IV

ACEP Clinical Practice and Management: Dynamic Ultrasound-Guided Peripheral Intravenous Line Placement

February’s Winner:

Congratulations to Joe Chiles our winner of the Case of the Month! Enjoy your Starbucks winnings!!

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