1000825_Challenging Cases

Case 1: 55F with LLQ pain

CC:
LLQ pain for one day OPD referred for r/o ureteral stone

PE:
LLQ tenderness with local muscle guarding

ECHO

Whats your diagnosis ?

ECHO

CT

EUS
Echogenic fat along intact colon Tender and non-compressible DX: Epiploic appendagitis

Case 2: 83F with abdominal pain

CC: 83F complained epigastric pain for hours PE: tenderness and muscle guarding over epigastric area

Whats your diagnosis ?

CT

Air but not IPFA

Air in Lung Air in GI tract Subcutaneous emphysema Chilaiditi syndrome

EUS
Only isolated echogenic air useful Dx: Colonic interposition Chilaiditi syndrome

Case 3: 58M with neck pain

CC: 58M presented with painful neck redness and fever for 2 days PE: neck swelling and redness Hx: multinodular goiter s/p op

What is your diagnosis ?

ECHO & Guided aspiration

EUS
Hypoechoic collection Cobble-stone appearance Diagnosis: Neck abscess (MSSA bacteremia)

Case 4: 70F with left hip pain for 10 days

CC: left hip pain for 10 days with worsening progression PE: tenderness and limited left hip ROM

History: Diabetes mellitus

Lab: WBC 19000; ESR > 140

Whats your diagnosis ?

EUS

CT

EUS
LK upper pole hypodense lesion Hypoechoic collection along left psoas muscle Dx: Renal abscess and psoas muscle abscess (K.P.)

Case 5: 57M with severe abdominal pain

CC: presented with abdominal pain and anorexia for 4 days PE: diffuse tenderness and muscle guarding History: ESRD s/p PD shift to HD

CT

ECHO

EUS
Hyperechoic bowel wall with shadowing Ascites with fibrin Dx: Sclerosing encapsulating peritonitis

Case 6: 85M with anorexia for one month

CC: poor appetite for one month; low BP (80mmHg) noted then sent to ER PE: mal-nutrition status; no abdominal tenderness or guarding

ECHO for septic shock workup

CT

EUS
Right subphrenic abscess with gas content Intact liver surface Dx: Subphrenic abscess due to previous hollow organ perforation

Case 7: 50F with chest pain post MVA

CC: motorcyclist complained severe chest pain after an traffic accident PE: no obvious bruise or tenderness over chest or abdomen

FAST

EUS
Echogenic pericardial fluid Proceed to OR immediately after FAST Dx: RV rupture with hemopericardium

Case 8: 59M with swollen right leg

59-year-old man presented with right leg swelling for one day Hx: Rectal ca s/p op with multiple meta

PE: swollen right leg and thigh, no redness

EUS reason:
2 point scan for highly suspected DVT

ECHO

RFV

RPV

LPV LPA

LPA

EUS
Echogenic thrombus noted from right femoral to popliteal area Right leg vein: Non-compressible Left popliteal vein: compressible Dx: Deep vein thrombosis

Case 9: 57F with fever and abdominal pain

CC: Abdominal pain & body weight lose 6~7 kg within half year PE: TPR 39.2/ 121/ 20; Cachexic with epigastric tenderness

ECHO

EUS
Pericardial effusion Pleural effusion Ascites Abnormal small bowel wall edema, vasculitis Dx: SLE

Case 10: 82M with cold sweating and chills

CC: cold sweating and chills at night PE: coarse breath sounds with crackles; soft and distended abdomen ECHO for intra-abdominal infection survey

CXR & KUB

CT

ECHO

EUS
Distended small bowel with a U shape dilatation from left to right Dx: A loop syndrome


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