Portal venous gas (PVG) is an uncommon but critical finding for emergency physicians (EPs) to recognize on point-of-care ultrasound (POCUS). Gas bubbles appear as hyperechoic foci flowing in the proximal vasculature and may appear as linear structures in the distal veins. This series describes three patients presenting with complaints of abdominal pain in whom POCUS examination identified PVG. In all three cases, serious abdominal pathology (one case of acute mesenteric ischemia and two cases of necrotizing intestinal infection) was confirmed with additional workup. PVG is associated with serious abdominal pathology, and although it is not pathognomonic for mesenteric ischemia, this condition remains the most frequent underlying cause of PVG. Mortality among patients with PVG varies but can be very high. EPs should familiarize themselves with the appearance of PVG on POCUS and remain vigilant for this finding while evaluating their patients.

INTRODUCTION:The dynamic paramedian (DP) approach to lumbar puncture (LP) is a novel technique that allows for active ultrasound (US) guidance. We sought to investigate the efficacy of this approach as compared to traditional static US guidance using a cadaver model. METHODS:This was a prospective study between November 2024 and May 2025 at a single institution. Four ultrasound-trained emergency physicians performed simulated LPs on soft-embalmed cadavers using both the static midline (SMLP) and dynamic paramedian (DPLP) ultrasound approaches. For each spinal level, the order in which the techniques were performed was randomized. Outcomes evaluated included overall success, time, number of bony contacts, and number of needle redirections. RESULTS:A total of 36 SMLP and 36 DPLP attempts were performed on four separate cadavers. Overall success was 72 % (95 %CI 56 %-84 %) for SMLP and 81 % (95 %CI 65 %-90 %) for DPLP, p = 0.6. Median time to completion for SMLP was 96 s (IQR 57.5-300) and 72 s (IQR 35.5-200.5) for DPLP, p = 0.07. Median bony contacts and needle re-directions were both lower with the DPLP approach compared to the standard approach (2 vs. 7, p = 0.0004; and 4 vs. 8.5, p = 0.011, respectively). The subcohort analysis of ultrasound-fellowship trained emergency physicians had a DPLP success rate of 96 % (95 %CI 82 %-99 %). CONCLUSION:The DPLP approach to LP is a promising technique for the emergency physician. In a cadaveric model, it was associated with fewer bony contacts and needle redirections as compared to SMLP. Overall procedural success was higher with the DPLP approach, though this did not reach statistical significance.

Background: Visualization of the guidewire during internal jugular (IJ) vein catheterization by point of care ultrasound (POCUS) has been recommended for avoiding inadvertent carotid artery dilation. The purpose of this study was to determine the accuracy of POCUS for identifying guidewires inappropriately placed in the carotid artery. Methods: This prospective, observational study involved emergency medicine (EM) residents with varying experience in guidewire visualization. Using an inanimate model, investigators placed guidewires randomly into the carotid artery or IJ vein. Residents, blinded to guidewire location, scanned the model and recorded their findings. The test performance of POCUS for arterially placed guidewires was evaluated through calculation of sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and overall accuracy, using investigator placement as the non-reference standard. Results: Twenty-five residents performed 51 observations. The test performance of POCUS for identifying arterially placed guidewires was sensitivity 95.0% (95%CI = 73.1-99.7%), specificity 96.8% (95%CI = 81.5-99.8%), NPV 96.8% (95%CI = 81.5-99.8%), and PPV 95.0% (95%CI = 73.1-99.7%). The overall accuracy was 96.1% (95%CI = 86.8-98.9%). Residents reported being very confident in their findings in 88.2% of all observations (95%CI = 76.6-94.5%), somewhat confident in 9.8% (95%CI = 4.3-21.0%), and not very confident in 2.0% (95%CI = 0.4-10.3%). No errors occurred among upper-level residents (post-graduate years 2-3) or those reporting >5 prior wire visualizations in live patients. Conclusions: This study is the first to demonstrate that physicians can easily identify misplaced guidewires located in the carotid artery with a high degree of accuracy using POCUS. We recommend routine scanning of the IJ vein and carotid artery prior to vessel dilation to reduce the likelihood of carotid artery injury.

Introduction:Accurate diagnosis of traumatic arthrotomy of the knee (TAK) is critical for patients presenting to the emergency department (ED) to ensure timely treatment. Current diagnostic modalities including plain radiography, computed tomography (CT), and the saline load test (SLT) have advantages and disadvantages. Point-of-care-ultrasonography (POCUS) offers a possible timely, low-cost, and efficient alternative method of diagnosing TAK. In this case series we present three cases where POCUS was used to diagnose TAK in the ED.Case Series:Three patients in their early 20s presented to the ED complaining of knee trauma with wounds in proximity to the joint. Mechanisms of injury included a gunshot wound in one case and blunt trauma (motor vehicle collision and bicycle crash) in two cases. In all three cases TAK was suggested on POCUS examinations by the presence of intra-articular hyperechoic foci consistent with air artifact. All three cases had TAK confirmed by orthopedic evaluation.Discussion:Ultrasound may have utility in the evaluation of patients presenting with knee trauma where TAK is a concern. The SLT is generally considered the gold standard test for diagnosis of TAK, but it is invasive and has a wide range of diagnostic accuracy. Intra-articular air has been found to be a sensitive marker for TAK in CT studies. Thus, additional investigations into the diagnostic accuracy of POCUS for this finding should be undertaken.

BACKGROUND:Abdominal pain and vomiting are frequent complaints for pediatric patients presenting to the Emergency Department (ED). When a diagnosis such as chronic abdominal pain, cyclic vomiting, or abdominal migraine has previously been made, it can lead to diagnostic momentum and confirmation bias on behalf of the treating physician. Dietl's crisis is a commonly missed diagnosis in the pediatric population that presents with intermittent episodes of pain and vomiting. It can be readily diagnosed at the bedside by the emergency physician (EP) through the employment of point of care ultrasound (POCUS). CASE SERIES:We present two cases of pediatric patients with episodic abdominal pain and vomiting who were previously diagnosed with cyclic vomiting syndrome. In both cases, pediatric gastroenterology evaluations had occurred with negative diagnostic testing having been performed. Both patients also presented to their primary pediatrician and the ED multiple times with each encounter resulting in treatment of symptoms and discharge. Each patient eventually presented to the ED when an EP was present who performed a renal POCUS. In each patient, the POCUS revealed severe unilateral hydronephrosis. Subsequent workup confirmed the diagnosis of Dietl's crisis as the etiology of symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In pediatric patients, EPs should be wary of the diagnosis of cyclic vomiting syndrome until ureteral obstruction has been ruled out. A bedside POCUS can rapidly establish this diagnosis and potentially preclude recurrent health care visits, unnecessary diagnostic testing, and permanent loss of renal function.

Rapid diagnostic tools available to the emergency physician caring for cardiac arrest patients are limited. Focused ultrasound (US), and in particular, focused echocardiography, is a useful tool in the evaluation of patients in cardiac arrest. It can help identify possible causes of cardiac arrest like tamponade and pulmonary embolism, which can guide therapy. US can also yield prognostic information, with lack of cardiac activity being highly specific for failure to achieve return of spontaneous circulation. US may also be used to aid in procedural guidance. Recently, focused transesophageal echocardiography has been used in the emergency department setting.

Introduction:Ultrasonography has an important role in the evaluation of Emergency Department (ED) patients presenting with early pregnancy complaints. Both transabdominal (TAUS) and transvaginal ultrasound (TVUS) can be utilized. While TVUS generally allows for greater detail, it is unclear how much added benefit exists in performing TVUS once an intrauterine pregnancy (IUP) has been identified on TAUS.Methods:This was a retrospective study utilizing Radiology Department ultrasound examinations obtained in first trimester pregnancy ED patients during a consecutive four month period in 2019. Studies wherein both TAUS and TVUS were both performed were included. Two ED physicians with specialized training in point of care ultrasound reviewed only the TAUS images from these studies. Their findings were compared to the Radiologist interpretation, which was inclusive of both TAUS and TVUS components of the study.Results:108 studies met inclusion criteria. Amongst these, 82 had IUP's identified on the radiologist report. 69 studies had an IUP identified by ED physician review of the TAUS images, with 1 false positive. Each case of intrauterine fetal demise (IUFD) was identified on ED physician review of TAUS. Two ectopic pregnancies were present, neither of which was mistaken for IUP on ED physician TAUS review. There were 15 studies with subchorionic hemorrhage and 3 studies with an ovarian cyst noted on the radiologist report.Conclusion:Following the identification of an IUP on TAUS, the added diagnostic value of TVUS amongst this cohort of ED patients was low. Given the added time and cost of TVUS, selective instead of routine usage should be encouraged.

Background: Ultrasound has been used previously in fracture identification, analgesia delivery, and fracture reduction for patients in the emergency department. It has not been previously described as a tool for the guidance of closed fracture reduction in fifth metacarpal neck fractures ("boxer's fractures"). Case Report: A 28-year-old man presented with hand pain and swelling after punching a wall. Point-of-care ultrasound revealed a significantly angulated fifth metacarpal fracture, which was confirmed with a subsequent hand x-ray study. After an ultrasound-guided ulnar nerve block, closed reduction was performed. Ultrasound was used to assess reduction and ensure improvement in bony angulation during the closed reduction attempts. Postreduction x-ray study confirmed improved angulation and adequate alignment. Why Should an Emergency Physician Be Aware of This? Point-of-care ultrasound has previously had efficacy in fracture diagnosis and anesthesia delivery for fifth metacarpal fractures. Ultrasound can also be used at the bedside to assist in the determination of adequate fracture reduction when performing closed reduction of a boxer's fracture. (c) 2023 Elsevier Inc. All rights reserved.

Introduction: Neuropathy of the lateral femoral cutaneous nerve, also known as meralgia paresthetica, causes pain and paresthesia to the anterolateral thigh. It commonly results from nerve irritation from extrinsic compression; however, it may occur spontaneously. Symptoms from this condition can be debilitating, and the pain may be ascribed to other conditions leading to delays in diagnosis. Peripheral nerve blockade can be useful both diagnostically and therapeutically for meralgia paresthetica.Case Report: Two female patients in their sixties presented to the emergency department for chronic, atraumatic, left upper thigh pain. In both cases the patients had hyperalgesia and paresthesia to the anterolateral, upper thigh. The emergency physician performed an ultrasound-guided nerve block of the lateral femoral cutaneous nerve for each patient, which resulted in temporary, complete resolution of their pain. Conclusion: Meralgia paresthetica is an uncommon but painful condition that can elude diagnosis. Physical exam findings such as allodynia and hyperalgesia of the anterolateral thigh in the absence of back pain is suggestive of the diagnosis. Utrasound-guided nerve blockade can be helpful to the emergency physician to confirm the diagnosis and provide non-opioid pain relief to the patient.

Background: Intramuscular (i.m.) injections are a commonly utilized route for medication delivery. Intramuscular-associated soft tissue infections are rare and can include pyomyositis and i.m. abscess. Intramuscular testosterone injections have not been previously implicated in causing pyomyositis. Point-of-care ultrasound is an important bedside tool that can identify pyomyositis and differentiate this infection from more common entities such as cellulitis. Case Reports: We present two cases of i.m. testosterone-associated pyomyositis. In both cases, the physical examination features were consistent with simple cellulitis. However, point-of-care ultrasound evaluation revealed changes consistent with pyomyositis in each case. Why Should an Emergency Physician Be Aware of This?: Although uncommon, i.m. injections such as testosterone carry a risk of soft tissue infection. As demonstrated in the above cases, ultrasound can be helpful in making the differentiation between simple cellulitis and pyomyositis. The emergency physician should be cognizant of this complication of therapeutic i.m. injections, as well as the diagnostic efficacy of point-of-care ultrasound in evaluating the extent and location of the soft tissue infection. (C) 2021 Published by Elsevier Inc.

Background: Distal forearm fractures are a commonly encountered injury in the emergency department (ED), accounting for 500,000 to 1.5 million visits and 17% of ED fractures. The evaluation and management of these frac-tures frequently employs x-ray studies, conscious sedation, closed reduction, and splinting. Point-of-care ultrasound (POCUS) can offer significant benefit in the diagnosis and management of these common injuries. Objective of the Re-view: To review the clinical utility of POCUS in the diagnosis of distal forearm fractures, as well as to demonstrate the performance of ultrasound-guided analgesia delivery and ultrasound-guided reduction technique. Discussion: The ini-tial evaluation of forearm injuries frequently includes x-ray studies. However, multiple studies have shown ultrasound to be sensitive and specific for distal radius fractures, with the added value of detecting soft tissue injuries missed by con-ventional radiography. POCUS may also facilitate analgesia through the use of ultrasound-guided hematoma blocks, which removes the need for conscious sedation prior to ma-nipulation. Finally, POCUS can be used after manipulation to assess cortical realignment of the bone fragments and spare the patient multiple reduction attempts and repeat radiographs. Conclusion: Distal forearm fractures are com-mon, and the emergency physician should be adept with the evaluation and management of these injuries. POCUS can be a reliable modality in the detection of these fractures and can be used to facilitate analgesia and augment success of re-duction attempts. These techniques may decrease length of stay, improve patient pain, and decrease reduction attempts.(c) 2022 Elsevier Inc. All rights reserved.

Introduction It is commonly taught that positioning the patient in the left lateral decubitus (LLD) position will improve transthoracic echocardiography (TTE) image quality. Despite this, no previous studies have been performed that study this practice. Our goal was to quantify the difference in image quality of TTE views between the supine and LLD positions. Methods This was a prospective study in a single academic Emergency Department (ED) of a convenience sample of 30 patients. Three separate ED physicians performed TTE views in both the supine and LLD position on each patient. The order of position was randomized. Images were then reviewed on a previously validated TTE image quality scale by two blinded ED physicians with specialized training in ultrasound. The scale used a 0 to 5 (highest quality) metric for quality assessment. Interpretability of right ventricular and left ventricular function was also assessed. Results The mean image quality for the supine position was 2.85 (standard deviation {SD} 1.1) and 3.05 (SD 1.2) for the LLD position (p=0.044). In the subset of parasternal and apical windows, the mean quality for the supine position was 2.87 (SD 1.1) and 3.23 (SD 1.1) for the LLD position (p=0.003). The number of studies in which right ventricular function was interpretable was significantly higher in the LLD position (62% versus 42%, p=0.044). Conclusions There was a statistically significant increase in image quality when TTE was performed in the LLD position as compared to supine. This was especially pronounced in the apical four and parasternal windows.

Introduction Abdominal compartment syndrome (ACS) is a rare condition in which increased intra-abdominal pressure causes multiorgan dysfunction through decreased perfusion. Causes of this condition are variable, and early recognition is critical for favorable patient outcomes. Measurement of bladder pressure is recommended for diagnosis. Case Report A 64-year-old female on clozapine with a two-year history of chronic constipation presented to the emergency department in extremis with a protuberant abdomen. After resuscitative measures, computed tomography showed a dilated, stool-filled colon with a decompressed inferior vena cava and decreased perfusion. She died despite surgical decompression. Conclusion Severe constipation is a rare cause of ACS, and there is a lack of evidence-based guidelines. Options for bedside decompression are limited. To reduce morbidity and mortality in this population, early recognition of ACS is imperative. Initial interventions should support hemodynamics and respiration. Definitive management is surgical decompression.

Background: Joint arthrocentesis is a commonly performed procedure by the emergency physician (EP). Point of care ultrasound (POCUS) has demonstrated promise in identifying joint effusions and guiding arthrocentesis procedures. EP-performed talonavicular joint arthrocentesis has not been previously described in the literature. We present a case in which an isolated talonavicular joint effusion was identified and then subsequently aspirated using POCUS. Case Report: A 65-year-old man presented with atraumatic right ankle pain. On arrival, he was noted to have diffuse warmth and edema around the ankle and midfoot. POCUS was performed to evaluate for an ankle joint effusion, which was not present. The ultrasound was then moved distally, where a talonavicular joint effusion was noted. Inflammatory markers were found to be elevated. A magnetic resonance imaging scan revealed an isolated talonavicular joint effusion without additional acute findings. POCUS was then used to perform an arthrocentesis, which revealed monosodium urate crystals consistent with an initial episode of gouty arthritis. Why Should an Emergency Physician Be Aware of This?: POCUS provides the EP with an efficient tool to diagnose joint effusions and guide arthrocentesis procedures. The foot is composed of several small joints where ultrasound can be particularly helpful. Similar to the ankle joint, these joints can be afflicted with pyogenic infections and crystalline arthropathies. To our knowledge, we present the first report of EP performed talonavicular arthrocentesis guided by POCUS. The approach to this joint and technique for arthrocentesis are presented. (C) 2020 Elsevier Inc. All rights reserved.

AbstractBackgroundThe evaluation of septic hip arthritis often incorporates the utilization of hip ultrasonography to determine the presence of a hip joint effusion, as well as to guide arthrocentesis. Point‐of‐care (POC) hip ultrasound has previously been demonstrated to be accurate when performed by the emergency physician. Time to diagnosis and subsequent intervention in septic arthritis (SA) is critical to favorable outcomes.MethodsRetrospective single‐center study of all emergency department (ED) patients who had a POC or radiology hip ultrasound or arthrocentesis as part of their ED evaluation for SA in a 3‐year period. We investigated the difference in time to obtain hip ultrasonography results and the time to arthrocentesis between radiology and emergency physician‐performed studies in cases of suspected septic hip arthritis.ResultsSeventy‐four patients met inclusion criteria. The median time to hip ultrasound completion was 68 (interquartile range [IQR], 38.8–132) minutes in the emergency physician‐performed ultrasound group versus 208.5 (IQR, 163.8–301.3) minutes for the radiology group (P < 0.001). A total of 17 patients had a hip arthrocentesis performed. Time to arthrocentesis was 211 (IQR 141.3–321.5) minutes in the emergency physician‐performed arthrocentesis group and 602 (IQR 500–692) minutes in the radiology arthrocentesis (P < 0.001).ConclusionThere was a statistically shorter time to ultrasound result and arthrocentesis when POC hip ultrasound was utilized by the emergency physician. Given that unfavorable outcomes in SA are associated with delay in treatment, further study is warranted to determine if emergency physician‐performed hip ultrasound and arthrocentesis could lead to improved patient‐centered clinical end points.

Background: Traumatic arthrotomy of the knee (TAK) involves the violation of the knee capsule. TAK differs from simple lacerations because it requires operative management to prevent resultant septic arthritis. The diagnostic test of choice in the emergency department is the saline load test (SLT). SLT sensitivity ranges from 34% to 99%, depending on volume used. Computed tomography (CT) is a possible alternative, using intra-articular air as a diagnostic marker. Ultrasound can identify air in various tissues, given its highly echogenic nature. Objective: We sought to determine the sensitivity and specificity of ultrasound for detecting intra-articular air in cadaveric knee joints. Methods: Soft embalmed cadavers were utilized. The knees were block randomized to having 1 mL of air injected into the joint or sham skin injection. Two blinded, expert operators scanned the knees with a high-frequency linear transducer. The sensitivity and specificity were calculated. Results: Twenty knees were included. Knees that had any prior dissection were excluded from analysis. Ten knees were randomized for air injection. The pooled sensitivity was 0.65 (95% confidence interval [CI] 0.41-0.85) with a specificity of 0.75 (95% CI 0.48-0.93). Mean time taken was 143 s. Conclusions: Ultrasound may have utility in evaluation of TAK. Therewere limitations. Some knees had effusions with echogenic material present, which could have led to false-positive results. It is also unknown how much air is typical of TAK. One milliliter was used based on previous work with CT. The use of ultrasound for diagnosis of TAK warrants further study. (C) 2019 Elsevier Inc. All rights reserved.

A 74-year-old woman with history of glaucoma, status post–remote right-sided glaucoma drain valve, presented to the emergency department for decreased right-sided vision and flashes that started 3 days before. Her visual acuity was 20/400 bilaterally, and visual fields were difficult to assess because of noncooperation with examination. We obtained point-of-care ocular ultrasonography (Figure). Choroidal detachment. Ultrasonography demonstrated a hyperechoic lens-shaped structure consistent with choroidal detachment. Such detachments have a convex appearance with a thicker band when visualized on ultrasonography and usually originate near the ciliary body. In contrast, retinal detachments are V shaped and thinner, and may have an undulating appearance with eye movement.1Polo M.D.L.H. Lluís A.T. Segura O.P. et al.Ocular ultrasonography focused on the posterior eye segment: what radiologists should know.Insights Imaging. 2016; 7: 351-364Crossref PubMed Scopus (36) Google Scholar Retinal detachments will also often appear tethered to the optic disc at the posterior portion of the globe.2Adhikari S. Stolz L. Amini R. et al.Impact of point-of-care ultrasound on quality of care in clinical practice.Reports in Medical Imaging. 2014; 7: 81-93Crossref Scopus (20) Google Scholar Choroidal detachment occurs when fluid or blood accumulates within the suprachoroidal space. Decreased intraocular pressure (hypotony), inflammation, and trauma have been implicated in choroidal detachment formation.3Brubaker R.F. Pederson J.E. Ciliochoroidal detachment.Surv Ophthalmol. 1983; 27: 281-289Abstract Full Text PDF PubMed Scopus (168) Google Scholar Differential diagnoses include retinal detachment (which can be concurrent with choroidal detachment), choroid tumors, and retinoschisis. Treatment is oriented to the underlying condition, but typically includes topical cycloplegics and steroids. Hypotony caused by aqueous leak necessitates repair. Surgical drainage of the effusion with sclerotomy is reserved for persistent choroidal detachment.4Torbit O.J. Ciliochoroidal effusion.Clin Eye Vis Care. 1998; 10: 3-10Crossref Scopus (2) Google Scholar The patient's course was complicated by valve obstruction, for which she received laser iridoplasty. She had persistent choroidal detachment and had the effusion drained surgically 1 week later. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJjNjllZmJjY2MzMmVlMTIwYjhkZGIwZGVmNWYwZDkyNCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc5MDc0MjM5fQ.iqzk3eJm9RInBMg-itJLS7RI27D7P_mxoRQ6mWg3QEgGCC35R59MwTxyU5wwBeppaBprjTEpV05kCAGzS293lGKugy5tjmECxgfItehSaFyfGSEZZihMeRaob0iOh0nCJK9pXWGu8akH1KZ9WnVVMBDnXPNn_OtYmPbvaJVu_nKgVp2XPqLUz45bFmG6BTEhl1UR0_mcMtFbXWD1p5_VVqJvWK9juij7Ulng0RlUVy9GKPTih9RdAfET6wxgmyVuczZHaTxBEWmTiQk2eApWY7iroKYEQNBQkLehgrmH86wjxf4pmyMUtmzpBsLwy73UPbkrBBGIsB86ne1cWeFotA Download .mp4 (3.8 MB) Help with .mp4 files Video 1

Objective: Acute pulmonary embolism (aPE) is a fatal condition that can lead to death if not quickly identified. The gold standard for the evaluation of aPE includes a Computed Tomography scan of the Pulmonary Arteries (CTPA). Despite the accuracy of CTPA, many patients are unable to undergo this test due to renal disease, pregnancy, or risk of radiation. Ultrasonography has shown some promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements to help diagnose patients with aPE. Our goal is to asses if TAPSE measurements are an effective mechanism in assessing patients with a suspicion of aPE. Methods: We prospectively enrolled patients who presented to the Emergency Department with a clinical suspicion of aPE. Each patient underwent a point of care ultrasound (POCUS) to obtain a TAPSE measurement, followed by a CTPA scan. This study consists of a comparative analysis of three cohorts of patients based on the results from CTPA scan. The three groups consisted of pateints with no PE, clinically insignificant PE, and clinically significant PE. Results: A total of 87 patients were enrolled in this study. Of these patients, 12 were found to have clinically significant aPE, 10 were found to have clinically insignificant PE, and 65 were found to not have a PE. Of the patients with clinically significant aPE, 58.3% were found to have TAPSE value less than 16mm. Comparatively, of the patients with clinically insignificant PE or no PE, only 10% and 3% of patients were found to have TAPSE values less than 16mm respectively. The average TAPSE values for patients with clinically significant aPE (15.2 mm) was significantly different when compared to the clinically insignificant aPE (22.2 mm) and no aPE (22.8 mm) groups. Conclusion: There was no significant difference in TAPSE measurements between the no PE and clinically insignificant PE, however a significant difference exists between all three groups. This data suggests that emergency physicians can use POCUS to aid in the diagnosis of patients with aPE through TAPSE measurements.

A 65-year-old woman presented to the emergency department with worsening dyspnea on exertion. She had a history of deep venous thrombosis and within the past month had been traveling extensively. Examination was notable for dyspnea without unilateral leg swelling or jugular venous distention, a room air oxygen saturation of 92%, and tachycardia of 102 beats/min. D-dimer level was elevated, at 2,636 ng/mL. Computed tomography (CT) pulmonary angiography confirmed the diagnosis.