Dr. Jordan Chanler-Berat
Dr. Pritchard had an 83 yr old man hx of ESRD come in with nausea and vomiting, had missed one episode of dialysis. Patient was hypotensive on presentation, sepsis workup initiated. Labs revealed an elevated lactate with no source of infection. Dr. JCB came onto the shift and did an ECHO for undifferentiated hypotension and found a clot in transit. Patient had a CT done which showed extensive PE burden and right heart strain. Drs. M. Chang & Kramer did a followup scan which showed no clot. Images 1 and 2 show the clot on the tricuspid valve.
Drs. Stephen Simon & Avinash Viswanath
Dr. NYCMike had a 30 yr old dude come in with shortness of breath, physical exam with absent breath sounds on the left lung, leading diagnosis pneumothorax. Ultrasound was performed with patient sitting upright and revealed very large pleural effusion. Patient was tachypneic, decision was made to place a chest tube. Dr. Simon performed an interscalene nerve block and Dr. Chang was able to place a chest tube in with no discomfort to the patient who was chillin during the whole procedure. Another lung ultrsaound was done which showed lung point and XR confirmed pneumothorax. Chest tube drained 3L of sanguinous fluid, patient admitted and found to have PE and possible pancreatic cancer.
Drs. Stephen Simon & JCB
Dr. Simon had an 82 yr old male comes in with flank pain and abdominal pain, decision made to do a renal sono. The ultrasound was done which showed perinephric fluid, CT read by VRAD incorrectly as intraperitoneal fluid. Patient had leukocytes and blood in urine, appropriately admitted and treated as possible perinephric abscess. CT read by our radiologist as perinephric fluid. You can differentiate perinephric fluid from intraperitoneal by determining where you see fluid in relation to Gerota's fascia which surrounds the kidney. In this case there is fluid within. Also cool image of adrenal gland visualized due to fluid around it.