November 2018

First place

Dr. Brian Pritchard


Dr. Pritchard had a 60yr old male come in altered and hypotensive 2 weeks after an unknown cardiac procedure.  A bedside sono was done during resus which per his notes revealed a percardial effusion with no tamponade. Further investigation of the aorta showed dissection in the 2 images shown.  Patient was intubated, a CT was performed which showed type A dissection and the patient was transferred to Maimonides.  Great pickup which expedited care.

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rUNNER UP:

Dr. Jeffrey Francis

Dr. Francis had a 72 yr old female PMH OA and CKD among other issues come in with gradual onset pain and swelling of her elbow with no trauma. On exam it was visibly swollen and he performed an ultrasound which shows classic images of an elbow effusion, something we don't see often.  Patient had a CT scan which showed the same and was discharged with supportive care instructions.  Patient had an xray which shows posterior fat pad as well as anterior sail sign.  This is sometimes difficult to pick up so this technique is especially helpful in trauma when an occult fx is suspected.

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Notable Cases:

Dr. Allen Seba-Robles

Dr. Seba had a 56 yr old female with no PMH come in with pain and swelling to her breast since August and had not sought care due to being scared. Her mother had passed away from breast cancer.  On exam the breast was warm, tender and swollen.  Dr. Seba's primary concern was for abscess vs less likely cancer.  Dr. Seba got the following images on ultrasound which appear abscess-like.  A lengthy discussion was had with patient and surgery, patient finally got a CT w/ IV contrast which showed a mass suspicious for carcinoma. She was discharged with surgery f/u.  A good example of the limitations of ultrasound and a reminder to keep your differential broad in the face of familiar findings.

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