Fever, knee pain & POCUS

Here is another case!

Stem: Patient with PMHx of IVDA presented to ED for severe knee pain and fevers. Major concern was for septic arthritis and Ortho planned to take the patient to the OR for wash out.

What are your thoughts:
• What probe is being used?
• What views are obtained?
• What is your interpretation? What pertinent positive and negative findings do you note? (HINT: There are several findings noted throughout!)

Post you thoughts and comments! I’ll share more details next week!

-Christopher

Tags: 
POCUS, Knee Pain, cardiac, Fever, pericardial effusion, tamponade, vegetation

 

Comments (1)

Here is the follow up to this case/ post:
1. These clips are using the phased array probe.
2. In order, they are the apical 4 chamber view, apical 4 chamber view, parasternal long axis, parasternal short axis and IVC.
3. There appears to be normal LV function. There is a pericardial effusion. On the PSSX, the RV appears to have abnormal bowing (trampoline). There is a plethoric IVC without respiratory variation & “smoke” indicating stagnant flow. There is also an echogenic material seen in the apex of the RV (on A4 views).

Patient seen by thoracic surgery prior to Ortho washout. Patient found to have purulent fluid in pericardium after drain was placed. Blood and pericardial fluid grew MSSA, and TEE confirmed an RV vegetation. Keep in mind, POCUS/TTE can NOT RULE OUT vegetations, but can help rule them in.

Great findings! Thanks for sharing this case!

-Christopher

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