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Use of point-of-care ultrasound to diagnose an alternate cause of flank pain in a patient with presumed renal colic.

ABSTRACT: This is a case of a 34-year-old male patient who presented to the emergency department (ED) with severe left flank pain. Due to the patient's cardiac history, elevated troponin, lactic acidosis, and lack of renal calculi on a noncontrast CT, focused cardiac ultrasound was performed, which showed left ventricle thrombus. The patient was later found to have bi-interventricular thrombi causing both pulmonary embolism and renal infarction. This is an uncommon diagnosis in the ED, where point-of-care ultrasound helped in diagnosing and guiding the management and disposition of this case.

SUBMITTER: Shalabi AG

PROVIDER: S-EPMC7831614 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Use of point-of-care ultrasound to diagnose an alternate cause of flank pain in a patient with presumed renal colic.

Shalabi Abdullah Ghazi AG Henaidi Marwan Hussain MH Bakhsh Raghad Sami RS Sulaiman Afnan Ahmad AA Alhawsawi Dhuha Abdulaziz DA Hussein Waleed M WM

Journal of the American College of Emergency Physicians open 20210102 1

This is a case of a 34-year-old male patient who presented to the emergency department (ED) with severe left flank pain. Due to the patient's cardiac history, elevated troponin, lactic acidosis, and lack of renal calculi on a noncontrast CT, focused cardiac ultrasound was performed, which showed left ventricle thrombus. The patient was later found to have bi-interventricular thrombi causing both pulmonary embolism and renal infarction. This is an uncommon diagnosis in the ED, where point-of-care ...[more]

PMID: 33532750

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Earlier point-of-care ultrasound, shorter length of stay in patients with acute flank pain.

Project description:BackgroundThe effects of early integration of point-of-care ultrasound (PoCUS) into patient care are uncertain. This study aims to investigate the effects of early PoCUS on patients with acute flank pain.MethodsAdult non-traumatic patients with acute flank pain receiving PoCUS were enrolled. Expert physicians reviewed the medical records and made the "final diagnosis" for the cause of acute flank pain. The primary outcome was the relationship between the door to ultrasound (US) time and length of stay (LOS). The secondary outcomes included the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the sonographic diagnosis, compared with the final diagnosis.ResultsEight hundred and eighty-eight patients were included in the analysis. Patients receiving early PoCUS (≤120 min) had a shorter LOS (128 vs. 217 min, p < 0.0001). Patients in the late POCUS group (> 120 min) had a trend to receive more CT scans. The disease distribution, sensitivity, specificity, PPV, and NPV were similar in patients receiving early or late PoCUS for target diagnoses. After adjusting for the confounders, early PoCUS (OR, 2.77, 95% CIs, 1.93-3.98) had a positive impact on shorter LOS. In addition, the effect of early PoCUS became more prominent (OR, 4.91, 95% CIs, 3.39-7.13) on LOS in less than 3 h.ConclusionsEarly integration of PoCUS is significantly related to shorter LOS in patients with acute flank pain without increasing morbidity and mortality. Our results suggested "PoCUS early" in these patients to possibly alleviate emergency department crowding. Trial registration NCT04149041 at the ClinicalTrial.gov.

| S-EPMC9021562 | biostudies-literature

When flank pain leads to fainting: a case of a ruptured angiomyolipoma diagnosed by point-of-care ultrasound.

Project description:BackgroundAcute flank pain is a common presentation in the Emergency Department (ED). Point-of-care ultrasound (PoCUS) has emerged as an invaluable tool in the evaluation of acute flank pain and provides real-time images resulting in the early identification of the underlying pathology.Case reportHere we report a case of a young lady presented to the ED with a complaint of right flank pain followed by a syncopal episode. The diagnosis of ruptured angiomyolipoma was made using a PoCUS and an immediate consult to interventional radiology and urology was provided.ConclusionThis case highlights the importance of PoCUS in assessing patients presented to the ED with acute flank pain. Its incorporation into clinical practice promises to revolutionize the approach to renal emergencies, emphasizing its important role in delivering timely and effective care.

| S-EPMC11453007 | biostudies-literature

Point-of-care ultrasound for the detection of hydronephrosis in emergency department patients with suspected renal colic.

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| S-EPMC7276462 | biostudies-literature

Point-of-Care Ultrasound to Diagnose Molar Pregnancy: A Case Report.

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| S-EPMC10332747 | biostudies-literature

Point-of-care Transperineal Ultrasound to Diagnose Abscess in the Emergency Department.

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| S-EPMC6861055 | biostudies-literature

Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic.

Project description:IntroductionSupporting an "ultrasound-first" approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events.MethodsThis was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed.ResultsWe enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis (x2=51.7, p<0.001). Hydronephrosis on EP-performed ultrasound was predictive of a ureteral stone on CT (PPV 88%; LR+ 2.91), but lack of hydronephrosis did not rule it out (NPV 65%). Lack of hydronephrosis on EP-performed ultrasound makes larger stone size >5mm less likely (NPV 89%; LR- 0.39). Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03).ConclusionUsing an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.

| S-EPMC5468059 | biostudies-literature

Effect of magnesium sulfate on renal colic pain: A PRISMA-compliant meta-analysis.

Project description:BackgroundMagnesium sulfate (MgSO4) is widely used in analgesia for different conditions. Recent randomized controlled trials (RCTs) have evaluated the effects of MgSO4 on renal colic; however, this new evidence has not been synthesized. Thus, we conducted a systematic review and meta-analysis to assess the efficacy and safety of MgSO4 in comparison with control for renal colic.MethodsPubMed, EMBASE, and Scopus databases were searched from inception to February 2020. We included RCTs that evaluated MgSO4 vs control for patients with renal colic. Data were independently extracted by 2 reviewers and synthesized using a random-effects model.ResultsFour studies with a total of 373 patients were analyzed. Intravenous MgSO4 15 to 50 mg/kg did not significantly reduce renal colic pain severity at 15 minutes (mean difference [MD] = 0.35, 95% confidence interval [CI] -0.51 to 1.21; 2 RCTs), 30 minutes (MD = 0.19, 95% CI -0.74 to 1.13; 4 RCTs), and 60 minutes (MD = -0.28, 95% CI -0.72 to 0.16; 3 RCTs) in comparison with controls. In patients who failed to respond to initial analgesics, intravenous MgSO4 15 mg/kg or 2 ml of 50% solution provided similar pain relief to ketorolac or morphine at 30 minutes (P = .90) and 60 minutes (P = .57). No significant hemodynamic changes were observed with short-term use of MgSO4 in these studies.ConclusionMgSO4 provides no superior therapeutic benefits in comparison with control treatments. MgSO4 may be used as a rescue medication in patients not responding to initial analgesics. The short-term use of MgSO4 did not affect hemodynamic values.

| S-EPMC7668463 | biostudies-literature

Adjunctive Use of Point of Care Ultrasound to Diagnose Compartment Syndrome of the Thigh.

Project description:Compartment syndrome is a medical emergency and must be considered in patients who present with severe limb pain. Compartment syndrome is a clinical diagnosis, classically described as presenting with the 5 'P's (pain, pulselessness, pallor, paraesthesia, and paralysis). Apart from pain, the other findings signify acute arterial obstruction and would be late findings. We present a case of a 31-year-old male in which point of care ultrasound (POCUS) expedited this diagnosis by demonstrating a large thigh hematoma in the anterior compartment. This prompted emergent orthopedic surgery consultation, and the diagnosis of compartment syndrome was confirmed both at the bedside and in the operating room. Compartment syndrome can be a challenging diagnosis, especially early in the course of illness. While POCUS should not be used in isolation in the assessment of possible compartment syndrome, it can be used as an adjunct in the workup, especially if it identifies an underlying cause.

| S-EPMC9979932 | biostudies-literature

Use of point-of-care ultrasound to diagnose spontaneous rupture of fibroid in pregnancy.

Project description:Background: Complications of fibroids in pregnancy are well known, including postpartum hemorrhage, labor dystocia, and cesarean delivery. Outside of pregnancy and labor, the rare occurrence of spontaneous fibroid rupture has been documented. Case: The current case report involves a woman who presented with acute abdominal pain in the third trimester of pregnancy and was found to have spontaneous rupture of a fibroid before the onset of labor. Her initial presentation, diagnosis through use of point-of-care ultrasound, acute surgical management, and postoperative course are described. Conclusion: When assessing acute abdominal pain in a pregnant patient, fibroid rupture should be considered despite the absence of prior uterine surgery. Bedside point-of-care ultrasonography is a useful tool for assessment of abdominal pain in the third trimester of pregnancy.

| S-EPMC9979928 | biostudies-literature

Lornoxicam with Low-Dose Ketamine versus Pethidine to Control Pain of Acute Renal Colic.

Project description:ObjectivesThis study was established to compare single-dose lornoxicam 8 mg (NSAID) in addition to 0.15 mg.kg-1 ketamine with single-dose pethidine 50 mg, both administered intravenously (IV), on the quickness and extent of analgesia, disadvantage, and consequence on utilitarian situation.Patients and methodsOne hundred and twenty patients with acute renal colic pain received in emergency room were included in this prospective, randomized, and double blind clinical study. They were aimlessly designated into one of two groups using a computer-generated table. Group L received lornoxicam 8 mg IV plus 0.15 mg.kg-1 ketamine and Group P received pethidine 50 mg IV. Parameters were noticed at baseline and after 0, 15, 30, and 45 minutes and 1 hour after drug administration. The efficiency of the drug was determined by observing: patient rated pain, time to pain relief, rate of pain recurrence, the need for rescue analgesia, adverse events, and functional status.ResultsThe visual analogue scale was significantly lower in Group L after 30 minutes in comparison to Group P. In addition, there was statistically significant increase in Group P regarding their need for rescue analgesia after 30 min in comparison to Group L. Group P showed nonsignificantly increased sedation score compared to Group L.ConclusionPatients receiving lornoxicam-ketamine attained greater reduction in pain scores and less side effects with better functional state and also are less likely to require further analgesia than those administered pethidine to control acute renal colic pain.

| S-EPMC6436326 | biostudies-literature

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