Implications of Ultrasound Mismatch: A Novel Case Report of Discrepancy between Bedside Versus Formal Biliary Ultrasound
Journal Title: Journal of Emergency Medicine & Critical Care - Year 2015, Vol 1, Issue 1
Abstract
Ultrasound (US) is the gold standard imaging modality utilized to diagnose biliary disease. Point of care (POC) US in the emergency department (ED) can and has played an integral role in assessing patients for biliary disease to accelerate care. We report a case where bedside US in the ED was used as an important aspect of the patient’s initial work up. Our case involves a 29 year-old female who presented to the emergency department with skin jaundice and sclera icterus. The patient had a history of liver transplant for hepatoblastoma at age 22 months, and was advised to come to the ED when her primary care physician noticed elevated liver enzymes on a routine lab check. When presenting to the emergency department, the patient denied any abdominal pain or nausea, but was experiencing dark colored urine and tan colored stools. Due to the suspicious nature of the patient’s symptoms and history of present illness, a POC US in the ED was done which demonstrated a dilated common bile duct (CBD) secondary to visible stone, however the follow up complete abdominal ultrasound in the radiology suite subsequently was negative for pathology. Ultimately the patient received a magnetic resonance cholangiopancreatography (MRCP), demonstrated a gallstone in the common bile duct and reaffirmed the findings on POC US. The gallstone was removed and the patient received a revision of her hepaticojunostomy. This case demonstrates pathology recognized by the POC US performed in the ED, that was absent on radiology US, suggesting a transient and dynamic change in the gallstone’s positioning within the duct.
Authors and Affiliations
Michael Burla
Keywords
Related Articles
- EP ID EP206688
- DOI 10.13188/2469-4045.1000005
- Views 94
- Downloads 0
Ramadan Fasting and its Influence on Serum Osmolality in Emergency Patients
Introduction: Ramadan is the ninth month of the Islamic calendar and Muslims fasting during this month. The effect of Ramadan fasting has been studied in various studies which are conducted on normal healthy individuals...
Role of Biofield Energy Treated Vitamin D3 in Human Bone Osteosarcoma Cells (MG-63): A Multidisciplinary Aspect on Bone Health
Study the impact of Biofield Treated vitamin D3 and DMEM on bone health in human bone osteosarcoma cells (MG-63) was investigated. The test items (TI), were distributed into two parts. One part of each sample was receive...
A Comparative Analysisupon Mobile Healthcare System and Services: A Case Study of Rural India
Mobile healthcare provision in the home environment presents many difficulties. Mobile Healthcare is a term used for the practice of medicine and public health supported by mobile phones. It is most generally utilized as...
The Impact of Alcohol on Admissions to a Welsh Intensive Care Unit: A Short Report
Introduction: The average annual number of alcohol-related hospital admissions for residents of Wales is reported to be 1.5% of all admissions. We have completed a prospective evaluation of the impact of alcohol-attribut...
Recovery in Mental Health-A Community Based Wellness Group Model
This paper presents a case study of a community-based intervention that supports older persons with mental illness. It also explains how the intervention minimises relapse protracted hospital stays and repeats admissions...