Introduction: This case report discusses the use of point-of-care ultrasound (POCUS) in the diagnosis of a fractured pedunculated osteochondroma in an 8-year-old boy after minor trauma. Although osteochondromas are the most common benign bone tumors, especially in this age, historically only radiographs have been obtained in the emergency department to diagnose these benign bone tumors. Case Report: An 8-year-old boy reported ongoing pain for 2 months but had an acute onset worsening of his pain after minor trauma to the medial distal right femur. Point-of-care ultrasound was used to diagnose a fractured pedunculated osteochondroma prior to radiographic imaging. Conclusion: We demonstrated the practicality and ease of POCUS in assisting with the diagnosis of an osteochondroma and the subtle fracture of the base. Both POCUS and radiographic imaging may be beneficial when used in conjunction for the diagnosis of benign bone tumors in this age group.
Introduction: Morel-Lavallée lesions are closed, soft tissue degloving injuries that occur when shearing forces separate the subcutaneous tissue from the underlying fascia. This creates a potential space for hemolymphatic fluid accumulation. Morel-Lavallée lesions are frequently under-reported and often misdiagnosed as hematomas or abscesses, leading to potential mismanagement. While magnetic resonance imaging (MRI) is considered the gold standard for diagnosis, point-of-care ultrasound (POCUS) has been shown to be an effective adjunct that can rapidly confirm sonographic features consistent with Morel-Lavallée lesions, support MRI-established findings, and guide procedural intervention in the emergency department (ED) setting. Case Report: We describe a 20-year-old woman presenting to the ED with persistent right-sided hip pain two months after a pedestrian–motor vehicle collision. Initially misdiagnosed as a hematoma, an outpatient follow-up MRI identified a large Morel-Lavallée lesion, with POCUS confirming subcutaneous anechoic fluid collection in the ED. Ultrasound-guided aspiration yielded 150 mL of serosanguinous fluid, with real-time imaging confirming decompression. Laboratory analysis demonstrated elevated red blood cell and nucleated cell counts consistent with Morel-Lavallée lesion. Conclusion: This case highlights the integrated diagnostic and therapeutic role of point-of-care ultrasound as an adjunct to MRI, confirming sonographic features of a Morel-Lavallée lesion, guiding aspiration, and providing real-time postprocedural assessment within a single ED encounter in a patient presenting two months after injury.
Introduction: Variceal hemorrhage is a life-threatening complication of portal hypertension that requires rapid hemorrhage control. Gastroesophageal balloon tamponade devices are effective temporizing measures when endoscopic or definitive therapies are delayed or unsuccessful, but placement can be technically challenging during active bleeding. A bougie-assisted technique has been proposed to improve ease and success of placement. Case Series: We describe three patients with cirrhosis and varices who presented with massive upper gastrointestinal bleeding and hemorrhagic shock. All received standard medical therapy and required escalation due to ongoing bleeding. In each case, a Sengstaken-Blakemore tube was placed using a bougie tracheal tube introducer as a semirigid stylet. The device was advanced under laryngoscopy through the esophagus and into the stomach without procedural complications. Hemostasis was achieved in all cases following balloon inflation, allowing hemodynamic stabilization and transition to definitive therapies. Two patients ultimately died due to complications of hypoxic-ischemic injury, while one survived to discharge. Use of the proximal gastric aspiration port appeared to reduce the risk of tip displacement compared to distal port insertion. Conclusion: Bougie-assisted gastroesophageal balloon tamponade device placement is a practical and effective modification for managing catastrophic upper gastrointestinal hemorrhage, and this approach may improve placement success and speed when standard technique has been unsuccessful. Wider adoption of this readily available adjunct could enhance procedural reliability, although further study is needed to better define outcomes and optimal technique.
Introduction: Subacute combined degeneration (SCD) is an uncommon neurologic complication of vitamin B12 deficiency characterized by demyelination of the dorsal and lateral columns of the spinal cord, resulting in weakness, paresthesias, sensory deficits, and gait ataxia. Recreational nitrous oxide inhalation has emerged as an important cause of functional vitamin B12 deficiency and may precipitate SCD, particularly in otherwise healthy individuals. Case Report: We report a case of nitrous oxide-associated SCD in a patient who presented to the emergency department with progressive neurologic symptoms. This case illustrates a rare but increasingly recognized complication of recreational nitrous oxide use. Conclusion: Nitrous oxide-induced SCD should be considered in patients presenting with subacute weakness, paresthesia, and ataxia, particularly when there is a history of recreational inhalant use. Early recognition and treatment with intramuscular vitamin B12 replacement, together with cessation of nitrous oxide exposure, are essential to optimize neurologic recovery.
Introduction: Drug-induced immune thrombocytopenia (DITP) is a rare process in which specific drugs induce antibodies against platelet antigens, resulting in the destruction, consumption, or impaired production of platelets.1,3 Sulfamethoxazole-trimethoprim can result in DITP.2 Case Report: This is a case of a 64-year-old man who developed severe thrombocytopenia after sulfamethoxazole-trimethoprim use. He presented to the emergency department with oral hemorrhagic lesions, mucositis, and petechiae. Laboratory evaluation revealed a low platelet count. Drug-induced immune thrombocytopenia was suspected, and the sulfamethoxazole-trimethoprim was discontinued. The patient’s platelet count responded rapidly after discontinuation of the offending drug and administration of dexamethasone. Conclusion: This case highlights the importance of early recognition of DITP and the avoidance of re-exposure to the causative agent. Prompt drug withdrawal and adjunctive corticosteroid therapy can facilitate complete clinical recovery.
