Emergency physicians, obstetrician‐gynecologists, and other medical specialists use pelvic sonography when caring for patients presenting with early pregnancy‐related symptoms. A thin endomyometrial mantle and eccentric placement of a gestational sac should raise the suspicion for an abnormally implanted pregnancy. In such cases, an interstitial ectopic pregnancy or a cornual pregnancy, two clinically distinct entities, must be considered. This article reviews the literature and guidelines on the sonographic measurement of the endomyometrial mantle as a criterion for determining a pregnancy at risk for an abnormal implantation location. We sought to clarify the history and evolution of this measurement to determine what should be considered an abnormal measurement and to understand its diagnostic utility and management implications for the clinician using sonography.
Acute limb ischemia (ALI) is a limb-threatening and life-threatening disease process. Mural aortic thrombosis (MAT) is a rare cause of ALI. While there is limited evidence on the use of bedside ultrasound for the detection of ALI or MAT, duplex ultrasound remains the standard in the diagnosis and ultimate medical decision-making in patients with acute and chronic limb ischemia. Point-of-care ultrasound may be used in the evaluation of patients with signs and symptoms of this disease entity. This is a case of a 79-year-old female with a complicated medical history, who presented with a pulseless right leg and abdominal tenderness. The patient quickly decompensated requiring intubation for airway protection. A post-intubation arterial blood gas (ABG) was unsuccessfully attempted in the right femoral artery, prompting an ultrasound-guided ABG. On B-mode ultrasound evaluation, echogenic material was visualized in the right common femoral artery without evidence of Doppler flow signal. Additionally, a partially obstructing echogenic material was also noted at the femorosaphenous vein junction with only partial compressibility by compression sonography. A computed tomography angiography of the aorta was performed indicating extensive infrarenal aortic thrombosis. The patient expired despite the relatively prompt diagnosis, highlighting the importance of early identification of acute arterial occlusion.Keywords Mural aortic thrombus Á Acute limb ischemia Á Point-of-care ultrasound Á Bedside ultrasound Á Arterial thrombus Á Deep vein thrombosis Riassunto L'ischemia acuta degli arti inferiori (ALI) è una malattia che mette in pericolo gli arti e la vita stessa del paziente. La trombosi parietale dell'aorta (MAT) è una causa rara di ALI. Mentre vi è una limitata evidenza sull'uso dell'ecografia al letto del paziente per la rilevazione di ALI o MAT, il Doppler rimane lo standard nella diagnosi e nel processo decisionale medico finale, in pazienti con ischemia acuta e cronica degli arti. L'ecografia può essere utilizzata nella valutazione dei pazienti con segni e sintomi di questa malattia. Presentiamo il caso di una donna di 79 anni, con una complicata storia clinica che si è presentata senza polso nella gamba destra e tensione addominale. La paziente si scompensava rapidamente, richiedendo l'intubazione per la protezione delle vie respiratorie. Dopo l'intubazione è stato tentato un arterial blood gas test (ABG) nell'arteria femorale destra, senza successo spingendo verso un ABG con guida ecografica. La valutazione ecografica in B-mode ha evidenziato materiale ecogeno nell'arteria femorale comune destra senza evidenza di segnali Doppler. Inoltre materiale ecogeno ostruente è stato osservato a livello della giunzione femoro-safena con solo parziale compressibilità con la compressione ecografica. E' stata effettuata un'angio tomografia computerizzata dell'aorta che ha evidenziato un'ampia trombosi dell'aorta sotto-renale. Il paziente moriva, nonostante la diagnosi in tempi relativamente brevi, mettendo in evidenza l...
Foreign body impaction at the cricopharyngeal level can be a life-threatening emergency. While traditionally, removal of these is performed in the operating room setting, patients with relatively unstable airways or significant discomfort may require immediate extraction to prevent further injury. This is the case of an 85-year-old man who presented to the emergency department in significant discomfort following aspiration of a large partial denture. We report here the first known use of ultrasound in an emergent airway situation to rapidly localize and retrieve an aspirated foreign body.
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