 | Zac Robinson, Viet Tran A 76yo male presents with epigastric pain followed by syncope. A POCUS is performed as part of the workup. |
PHx
Hiatus Hernia Repair 3 years ago
Examination
HR 70
BP 135/80
T35.8
RR 20
Sat 98%RA
General Inspection: Thin build
Abdomen: mild epigastric tendernss, equivocal murphy's, palpable non-tender midline mass in the umbilical region
2 POCUS images are shown:
Hiatus Hernia Repair 3 years ago
Examination
HR 70
BP 135/80
T35.8
RR 20
Sat 98%RA
General Inspection: Thin build
Abdomen: mild epigastric tendernss, equivocal murphy's, palpable non-tender midline mass in the umbilical region
2 POCUS images are shown:
What do the images show/suggest?
Complete scan of the first image showed an undiagnosed infrarenal aneurysmal abdominal aorta with a max diameter of 44mm and no concerning features of rupture.
The second image shows a gallbladder with a very thick 10mm wall and a large impacted gallstone in the gallbladder neck
The second image shows a gallbladder with a very thick 10mm wall and a large impacted gallstone in the gallbladder neck
How does this help our management?
The history of an elderly with abdominal pain, syncope and an abdominal mass is always concerning for a ruptured AAA. This gentleman did not have a known history of AAA.
The remainder of the history and examination was more concerning for a hepatobiliary cause.
Given that the concern for a complication of the newly identified AAA was high, a CT Aortogram was performed. This did not show any features of a complicated AAA. It also confirmed the impacted gallstone. Bloods further confirmed that this was complicated by cholecystitis. The patient has also been referred to vascular outpatients for ongoing surveillance.
The remainder of the history and examination was more concerning for a hepatobiliary cause.
Given that the concern for a complication of the newly identified AAA was high, a CT Aortogram was performed. This did not show any features of a complicated AAA. It also confirmed the impacted gallstone. Bloods further confirmed that this was complicated by cholecystitis. The patient has also been referred to vascular outpatients for ongoing surveillance.
Zac is an ED registrar at RHH with an interest in POCUS (Currently using a first generation Butterfly iQ)
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