We report the case of a transgender woman with HIV (CD4 349), shortness of breath, and chest pain, who was found to have multiple mycotic aortic aneurysms by point-of-care ultrasound (PoCUS). This report highlights the utility of point-of-care ultrasonography in the diagnosis and management of this rare clinical entity. Multiple mycotic aortic aneurysms and purulent pericarditis are uncommon. They have high morbidity and mortality and are associated with immunocompromised states (e.g., HIV). Diagnosis of the mycotic aneurysm, and its precursor, infectious aortitis, can be challenging, and delays in care can lead to poor outcomes. Often, as described in this case report, making the diagnosis requires a high clinical suspicion, multiple imaging modalities, and laboratory studies.
Objective Point‐of‐care ultrasound for the detection of hydronephrosis is frequently used by emergency physicians. The aim of this study was to assess the accuracy of longitudinal views of the kidney compared with a combination of longitudinal and transverse views of the kidney on emergency physician–performed renal point‐of‐care ultrasound to detect hydronephrosis. Methods This was a retrospective case‐control study of patients who received a renal point‐of‐care ultrasound examination performed and interpreted as hydronephrosis in the emergency department (ED). These were then matched with a cohort of kidneys from different patients without hydronephrosis. Longitudinal ultrasound views and transverse ultrasound views were reviewed for the presence of hydronephrosis by ultrasound‐trained emergency physicians. The gold standard of hydronephrosis was an overall interpretation based on the complete ultrasound examination consisting of both transverse and longitudinal views by ultrasound‐trained emergency physicians. Results Renal point‐of‐care ultrasound exams from 140 kidneys performed in the ED were enrolled in the study. The sensitivity and specificity of longitudinal ultrasound views compared with a combination of longitudinal and transverse ultrasound views of the kidney as a gold standard were 84.3% (95% confidence interval [CI], 77.2–89.9) and 92.9% (95% CI, 87.3–96.5), the positive predictive value was 92.2% (95% CI, 86.1–96.2), and the negative predictive value was 85.5% (95% CI, 78.9–90.7). The positive and negative likelihood ratios were 11.8 (95% CI, 6.5–21.5) and 0.2 (95% CI, 0.1–0.2), respectively. Conclusions Longitudinal views of the kidney on ultrasound showed good sensitivity and specificity to detect the presence of hydronephrosis compared with a combination of longitudinal and transverse ultrasound views of the kidney. However, a combination of longitudinal and transverse ultrasound views may still be warranted in high‐risk patients or in those with inadequate visualization of the upper pole of the kidney.
A 25-year-old man with a 3-year history of dilated cardiomyopathy presented to the emergency department with acute onset of pain in both legs. He also reported vague abdominal pain 9 days before admission. Physical examination result was notable for cold, purplish skin on both legs but a nontender abdomen. The ECG demonstrated evidence of left ventricular hypertrophy with left atrial enlargement. Laboratory testing results were noteworthy for a serum creatinine level of 1.54 mg/ dL and creatine phosphokinase level of 1,095 U/L. The emergency physician performed bedside ultrasonography (Figure 1, Videos E1 and E2, available online at http://www.annemergmed.com) and confirmed the diagnosis by computed tomography (CT) (Figure 2).For the diagnosis and teaching points, see page 469. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com
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