Submandibular Sialolithiasis on POCUS A patient presents with right anterior neck/floor of mouth

Submandibular Sialolithiasis on POCUS Male with right submandibular pain/swelling. Poor dentition. Sent to ED for suspected odontogenic infection. See ultrasound. Do you agree? Answer: Patient has submandibular sialolithiasis. Note on image, the stone can be seen between the calipers. Stone measures 0.942 cm. Ultrasound very helpful in evaluating salivary glands as well as distinguishing from other soft tissue masses. Labeled Schematic: https://twitter.com/RJonesSonoEM/status/1227087841605361665 Dr. Robert Jones @RJonesSonoEM #Submandibular #Sialolithiasis #POCUS #clinical #ultrasound #neck

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UVJ Stone with twinkle artifact on Bladder POCUS This 75yo well appearing female presents with left flank pain. What is your next step? Resolution: @ left uvj (left post inf aspect of bladder, transverse plane) is a uvj stone exhibiting twinkle (resonance) artifact. D/C home. #UVJ #Stone #bladder #Ultrasound #twinkle #artifact #clinical #POCUS

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Pancreas on Abdominal POCUS What structure is anterior to the splenic vein in this clip? Resolution: The pancreas is anterior to the splenic v (in general & in this clip), as most of you correctly answered. The probe is on pt’s epigastrium, with indicator pointing to pt’s R, so top of the screen is anterior, & indicator side (L of screen) is pt’s R. Labeled Schematic: https://twitter.com/EUSmkh/status/1014127374827474944 #Pancreas #Normal #Abdominal #POCUS #clinical #ultrasound

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Blood Clot in the Bladder on POCUS 75yo F with dementia presents from skilled nursing facility with “vaginal bleeding.” Patient unable to cooperate for a vaginal exam. PoCUS clarified the problem as hematuria and not “vaginal bleeding.” Involved urology for CBI. Convex transducer in sagittal plane showing bladder with echogenic mass (clotted blood vs solid mass). Dr. Meghan Herbst @EUSmkh #Blood #Hematuria #Clot #Bladder #POCUS #ultrasound #sagittal #clinical #urology #labeled

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Free Air on Abdominal POCUS - Enhanced Peritoneal Stripe Sign (EPSS) 50 year old female with LLQ pain that became acutely worse. Convex transducer placed anteriorly over the RUQ with indicator cephalad (sagittal plane). Enhancement of peritoneal stripe sign w/ reverberation artifact concerning for a bubble of free air between peritoneum and liver (ie, intestinal/gastric perforation). Dr. Meghan Herbst @EUSmkh #Free #Air #Abdominal #POCUS #EPSS #clinical #ultrasound #radiology

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Dental Periapical Abscess on POCUS A 28yo male presents with left facial swelling. The probe is placed over his upper lip just below his left nare. What is your diagnosis based on the ultrasound? Resolution: Periapical abscess. Note the well defined hypoechoic area around the tooth indicated by the arrow. On exam this was the maximal area of tenderness. #Dental #Periapical #Abscess #POCUS #Jaw #clinical #ultrasound

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Stone-In-Neck Sign on POCUS A patient presents with abdominal pain and tenderness over this area. The scan is performed within 10 minutes of arrival. PoCUS findings include stone-in-neck (SIN sign) with sonographic murphy’s and borderline wall thickening, concerning for cholecystitis. Next step: surgery consult. Dr. Meghan Herbst @EUSmkh #Stone #Neck #SiN #Sign #POCUS #clinical #gallbladder #ultrasound #abdominal #labeled #cholelithiasis

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Renal Pelvis Stone on POCUS A patient presents with fever and RLQ pain. Coronal plane showing liver & right kidney, IVC & aorta seen below (further to the left) A large renal stone in the pelvis is seen with associated hydronephrosis concerning for septic stone in the setting of fever. Dr. Meghan Herbst @EUSmkh #Renal #Pelvis #Stone #POCUS #nephrolithiasis #clinical #ultrasound #kidney #anatomy #labeled #hydronephrosis

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Ureteral Stone on Renal POCUS A 23yo male with no significant PMHx presents with acute LLQ pain, N/V, and dysuria. Bladder ultrasound unremarkable. UA shows no evidence of UTI. After you control his pain, what is your next step? Resolution: DC home (w/ op urology f/u). Note mild-mod hydroneph w/ hydroureter, prox stone,& perinephric fluid likely from a calyceal rupture—not uncommon in setting of renal colic.If pt looks well, pain controlled, & no signs of infection,a CT is not going to change your dispo. #Ureteral #Stone #Renal #POCUS #clinical #ultrasound #Hydroureter #Hydronephrosis #Mild

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Cholecystitis on POCUS This 40yo otherwise healthy F presents with epigastric pain. Which of the following is most likely true? Resolution: Pt recently ate: us shows a contracted gb, with classic hyperechoic outer, less hyerechoic inner, & hypoechoic middle gb wall layers. Stone visualized in the body of the gb & not obstructing. Gb ant to R kidney (both in long) viewed in sagittal (not coronal) plane. #Cholecystitis #POCUS #RUQ #Gallbladder #Cholelithiasis

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