40s pt few days s/p hepatic artery aneurysm repair. Developed hypotension, SOB, CP, incr lactate/trop. I was on cards consults, summoned for STAT echo showing normal cardiac fxn, no eff. FAST showed free fluid in Morison’s - CT revealing large IP hematoma w/ extrav, s/p successful ex-lap. #POCUS

50s pt with no PMHx transferred from OSH to us for cath. On arrival, TTE showed EF 18%, LAD-territory WMA, and 4×2 cm apical thrombus. LHC revealed 100% ostial LAD occlusion, not amenable to revascularization. #POCUS

35M. Advanced hypertensive heart disease with evidence of probable LVOT obstruction. Peak intracavitary gradient 110mmHg. Mild systolic anterior motion of MV.

Prior RCA infarct, pt floridly volume overloaded on exam. Massively dilated RV with very poor RV systolic fx. Severe TR. #POCUS

Autosomal dominant polycystic kidney disease. #POCUS

70s female. Pretty certain pt has a bicuspid aortic valve unless someone more experienced than me thinks otherwise? #POCUS

70M with NSCLC presenting with signs of SVC syndrome, + Pemberton sign. Large clot in R IJ extending from mandible to subclavian. #POCUS

Dressler syndrome many weeks after large LAD infarct. Note the fibrinous deposits in the pericardium. No convincing evidence of tamponade. At least moderate MR. #POCUS

Pt with MRSA empyema with chest tube in place. Underwent spontaneous hemorrhage after 3rd round tPA dornase with large hemothorax, underwent VATS. #POCUS

Pt with recurring UTI’s with Staghorn calculus causing xanthogranulomatous pyelonephritis. #POCUS

Severe hydronephrosis R>L due to bladder outlet obstruction presenting w/ acute renal failure.

Can anybody guess this RUQUS diagnosis? #POCUS

80M admitted for COPD exacerbation. Cachectic with BMI 12. Noting vague back pain. Grossly visible pulsatile abdominal mass. Threw a probe on him. Couldn’t adequately measure outer wall: outer wall on my probe but knew it was >6cm. CT showing 8.5cm AAA completely occluding L iliac. #POCUS

Asymmetric non-rheumatic mitral stenosis. Restricted posterior leaflet due to mitral calcification and leaflet tethering. Severe LVH.

End stage HF. Rheumatic mitral stenosis. S/p MVR/AVR and tricuspid annuloplasty. EF maybe 5%. Severe TR. LA standstill found to have LAA thrombus on TEE despite being therapeutic on warfarin.

Severe aortic stenosis. EF 25%. Incindentally found PFO.

POCUS success story. ~80m presented with mLAD occlusion s/p PCI. 24h after developed cp and new afib. I threw my probe on him and he had an effusion with echogenic material in pericardium - c/f free wall rupture. Taken to OR for exploratory thoracotomy. Weaned off all pressors/IABP. Discharged.

79M. SEVERE pulmonary hypertension. Occupational lung disease secondary to career upholstery business. RV severely dilated causing dynamic LVOT obstruction. Septal flattening in diastole and systole. Elevated RVSP ≥ 60 mmHg (estimated from TR jet velocity). #POCUS #CARDIOLOGY

Late presenting MI with persistent LAD territory ST elevations. TTE showing large LV apical aneurysm. #POCUS

~70 yo female presenting with sudden onset central chest pain radiating to LUE. EMS EKG concerning for STE’s in precordial leads. Initial trop 2,200. Activated as STEMI. Cath revealing minimal CAD but ventriculogram showing obvious Takotsubo.

Severe TR. Vena contracta at least 6.5mm. Plethoric IVC. Vexus showing systolic flow reversal in hepatic veins, highly pulsatile portal vein, could not get a good renal vein tracing. Planned for TriClip. #POCUS

Failed MitraClip placed for mitral valve prolapse. 2 distinct MR jets. latrogenic ASD from atrial septal puncture failing to close with L→R shunting causing RV failure. #POCUS #Cardiology

PEA arrest

The best way to evaluate a pacer wire with TTE: RV inflow view. - Start with PLAX view - Tilt the tail superior towards the L shoulder (with beam aiming towards the R hip) - Often times you can subtly rotate the indicator clockwise to optimize the view #POCUS

Analyzing carotid stenosis: Using PW Doppler, measure PSV in the CCA and ICA. Analyze PSV in the ICA and calculate ICA: CCA ratio. The most important number to remember is ICA PSV > 125 is abnormal. #POCUS

Akinetic apex. It’s easy to mistake the subtle movement of the wall with systole as contraction. Look instead at how much the wall actually thickens from systole to diastole. #POCUS

Atrial flutter - Note the fluttering of the interatrial septum with flutter waves - EF mildly reduced - Dyskinetic septum due to IVCD - Moderate TR - Moderate-Severe AR

When evaluating for low CVP, measuring the IJ is likely more accurate (and easier to obtain) compared to IVC collapsibility - Measure R IJ 2cm above the clavicle at end expiration - IJ AP diameter ≤ 7mm is ~88% sensitive for detecting low CVP pmc.ncbi.nlm.nih.gov/articles/PMC... #POCUS

Invasive bladder cancer - acute renal failure w/ crt of 9 (from 2 a month ago) - R kidney w/ pcn. 2 cm exophytic nodule (likely malignant) + benign renal cyst - L kidney with mild hydro - Large posterior bladder neoplasm obstructing both ureters - Scheduled for cystectomy #POCUS

Severely dilated cardiomyopathy d/t cocaine use disorder. EF 5%. #POCUS

Large R malignant pleural effusion d/t metastatic breast cancer. #POCUS

Restrictive Cardiomyopathy - Normal systolic fx - Small LV chamber size - Granular myocardium - Mild atrial enlargement

Renal resistive index: A way to assess renal perfusion. Use PW doppler on the interlobular/arcuate renal arteries, measure PSV and EDV. The normal value is less than 0.7 - the higher the value the worse the prognosis. Webpage w/ calculator on my website: medsummariesweekly.com/renal-resist...

Eyeballing severity of MR. Best done in PLAX view. Measure the vena contracta (narrowest portion of jet at the mitral valve). - Mild MR: < 0.3 cm - Moderate MR: 0.3–0.69 cm - Severe MR: ≥ 0.7 cm #POCUS

RV dilation due to large saddle PE.

Parapneumonic pleural effusion. #POCUS

EF 20%. Moderate MR. Plethoric IVC. Portal vein is pulsatile indicating venous congestion. Diureses ensued.

Cystic pancreatic head mass

R common femoral vein DVT.

COVID myocarditis with moderate- large pericardial effusion and echo signs of tamponade including RA/RV diastolic collapse and sonographic pulsus paradoxus. Pericardiocentesis removed ~400cc’s with immediate symptom relief. #POCUS

Middle aged male presented with months of waxing and waning RUQ pain, CT scan without abnormality except equivocal gallbladder wall thickening. U/S performed showing stones in neck with significant wall thickening - Dx chronic cholecystitis and referred for elective cholecystectomy.

TAPSE (Tricuspid annular plane systolic excursion): Measures systolic function of the RV. In AP4 view place M-mode gate over the lateral annulus of tricuspid valve. Then measure the distance from the diastolic trough to the systolic peak. Normal TAPSE is > 17mm. #POCUS

4cm fusiform AAA with intramural thrombus. >3cm is considered an aneurysm. Majority are infrarenal. Ensure to measure from outer wall to outer wall. #POCUS

Spontaneous subcapsular renal hematoma. #POCUS

Severe empyema that eroded through diaphragm causing diaphragmatic fistula w/ contiguous splenic abscess containing large foci of air. #POCUS

Patient presented with vomiting, weakness and syncope. Previously CKDII - labs showing crt 17 and K 9.4

Endocarditis with flail mitral leaflet and wide open mitral regurgitation, pt later had successful open mitral valve repair.

If you can’t find a good view of the IVC and body habitus makes JVD assessment difficult, use POCUS. Look for the taper point of the IJ in the longitudinal plane. Use the height of the probe at this point to estimate the height above the clavicle (<3cm is normal).

Severe carotid stenosis > 80%

Right atrial myxoma mistaken for dialysis catheter associated thrombus w/ mild to moderate TR