We have had a few patient’s here recently with clearly surgical abdomen; Rigid and with peritonitis. However, they often have a subacute history, 2-3 weeks is reported. Although, as mentioned previously, our history seem to be less accurate in Sierra Leone than back in the UK, but this seemed incongruent to me. So, we undertook POCUS. This a RUQ scan for the first patient. You can see the liver tip clearly. Most folk will be used to seeing free fluid in the abdomen. However, you can see the fluid in this example is very speckled. This is the appearance you get with empyema in the lung. Making us suspect…
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A 10 year old with fever and not passing urine
During scanning practice the candidates asked if we could go and scan this 10 year old child who was admitted with fever, generally unwell and passing less urine. Not u/e’s were available , a raised wcc was noted. Had had an in/out catheter for urinary retention. No catheter was in place currently His right kidney looked like this and his left kidney looked similar I spent a long term confirmed these were indeed the kidneys as looked so grossly abnormal. They didn’t look like the typical appearance of polycystic kidneys and I had no idea what I was looking at. I am less experienced with paediatric…
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Confused, pending dialysis
This 32 year old gentleman was being treated in resus with acute confusion. He had reported declined to have dialysis due to religious objections. His blood results were pending (typically take around 24 hours here). He was confused and sweating profusely which made his scan quiet difficult to undertake His right kidney, looked like this. I think it was a little small, but it was definitively brighter (more echogenic) and no evidence of hydronephrosis. You can also see a small silver of free fluid Left kidney, showing reduced size and increaed echogenity as compared to liver. His right kidney had a very similar appearance Very bright small kidney…
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Presented with abdominal swelling, but what is the real problem?
In our population here in Freetown, the history can be a little unreliable and difficult to interpret at times. This gentleman in his 60’s main complaint was abdominal swelling, the doctor seeing him had requested formal abdominal ultrasound and prescribed antibiotics and fluids. Clearly from the end of the bed you could see he was grossly fluid overloaded. I was teaching at the time and Dr Daniel Sesay, a house officer with only a few days POCUS experience, took the following images. An apical 4 chamber view And a slightly off centre Parasternal short axis view, due to his cardiomegaly the probe marker had to moved quiet…
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Low resource POCUS case of the week
Welcome, I am currently teaching POCUS in Freetown, Sierra Leone. We have high rates of HIV,TB and malaria alongside quiet a burden of non-communicable diseases. These are a selection of cases from here undertaken myself and with my candidates here. We work in a resource limited setting, so please forgive the less detailed follow up or lack of definitive imaging. Hopefully this will help demonstrate the use of point of care/bedside ultrasound in a resource limited setting.