Transesophageal echocardiography (TEE) is an essential diagnostic tool for many cardiac pathologies. This study’s hypothesis is that a simulator-based TEE training method would improve the confidence, knowledge, and skills of medical students without prior TEE instruction, and that more experienced ultrasound students would benefit the most. In phase one, second-year and fourth-year medical students watched a TEE video before training and took pre- and post-training confidence surveys and knowledge quizzes. The training session was a live TEE simulator demonstration, after which participants’ ability to obtain four TEE views and identify major anatomical structures was tested. In phase two, a larger cohort of second-semester first-year medical students underwent the same training curriculum. The second- and fourth-year students’ knowledge scores significantly improved by 37.9

INTRODUCTION:Demographic inequities in cardiovascular care have been well established, with evidence of effects from sex, age, and body mass index (BMI). For instance, women are less likely to receive guideline-based care for acute myocardial Infarction, bystander cardiopulmonary resuscitation, or recognition of cardiac arrest. We investigated the impact of patient sex, along with other patient demographics such as age and BMI, on the quality of focused cardiac ultrasounds (FOCUS). We hypothesized that females would have lower overall FOCUS quality and more frequently omitted apical four-chamber (A4C) views due to breast tissue. Secondary objectives included evaluating differences in image quality and omission rates by BMI, and by age and sonographer sex and training level. METHODS:In this multicenter, retrospective study we investigated 1,200 total adult patients (100 females and 100 males per site) at six participating sites. The FOCUS quality was determined by two blinded experts per site using a 1-5 ordinal scale per view (parasternal long, parasternal short, A4C, and subxiphoid). The primary outcome, overall quality, was the summed score of the four views, with a maximum score of 20. This scale was then collapsed into three categories for the individual FOCUS views: images inadequate to support diagnosis; images meeting the minimum to support diagnosis; and images supporting the diagnosis well. Secondary outcomes were A4C quality and omission rate. We evaluated associations between sex and FOCUS overall quality using unadjusted mixed-effects models followed by multivariable mixed-effects models adjusted for patient age, BMI, operator sex, and operator experience level. RESULTS:The A4C images of female patients were of significantly lower quality (P < .001) and had been omitted more frequently (P < .001); male patients had > 60% higher odds of a diagnostic A4C view (95% CI 1.3 - 2.0). Overall FOCUS quality decreased as BMI deviated from normal and as age increased. There was no significant difference in overall FOCUS quality between female and male patients. CONCLUSION:We did not find sex-based differences in overall FOCUS quality; however, we did find that females received lower quality apical four-chamber views and had this view omitted more frequently. Additionally, overall quality declined as BMI deviated from normal, and as age advanced. Future research should elucidate the clinical implications of these differences in quality and the explanation behind not obtaining high-quality views in older patients, in individuals whose BMI deviated from normal toward either underweight or overweight, or in female patients.

As an extension of the clinical examination and as a diagnostic and problem-solving tool, ultrasound has become an established technique for clinicians. A prerequisite for high-quality clinical ultrasound practice is adequate student ultrasound training. In light of the considerable heterogeneity of ultrasound curricula in medical studies worldwide, this review presents basic principles of modern medical student ultrasound education and advocates for the establishment of an ultrasound core curriculum embedded both horizontally and vertically in medical studies.

Background: Traditional water baths for ultrasound exams place a hand into a pan of water and submerge an ultrasound probe into the water. While this improves ultrasound transmission and moves structures into the focal zone to make higher resolution images, this method does have limitations. Patients must be manipulated directly under the probe, which can be limited by pain or normal movement restrictions. The probe must also be held very still in water to minimize motion artifact. The lateral approach water bath method addresses such limitations by imaging through the side of a thin -walled plastic container without submerging the probe. This reduces much need for patient manipulation by imaging through the side of a column-shaped bath, which has 360 degrees of imaging freedom. It also stabilizes the probe directly against the flat, firm container to reduce image degrading motion artifact. We hypothesized that because of these improvements the lateral approach water bath might create higher quality images than traditional water baths. Methods: We compared twenty images from each method, which were obtained with the same model and ultrasound operator at the same time. Two ultrasound fellowship trained blinded reviewers rated the images for quality and adequacy for clinical decision making on a scale from 1 to 5. Results: Image quality was better for the lateral water bath, with an average rating of 4.2 compared to the traditional bath's 2.6 (p < 0.001). Adequacy to aid clinical decision making was better for the lateral approach bath with an average rating of 4.0 compared to the traditional bath's 2.6 (p < 0.001). The lateral bath also had a smaller range for image quality and thus greater consistency. Conclusions: The lateral approach water bath is a method of hand imaging that produces higher quality, more consistent, and more clinically useful images than traditional water bath imaging. (c) 2023 Published by Elsevier Inc.

Ultrasound-guided nerve blocks (UGNBs) are becoming a more common method for pain control in the emergency department. Specifically, brachial plexus blocks have shown promise for acute upper extremity injuries as well as an alternative to procedural sedation for glenohumeral reductions. Unfortunately, there is minimal discussion in the EM literature regarding phrenic nerve paralysis (a well-known complication from brachial plexus blocks). The anatomy of the brachial plexus, its relationship to the phrenic nerve, and why ultrasound-guided brachial plexus blocks can cause phrenic nerve paralysis and resultant respiratory impairment will be discussed. The focus on patient safety is paramount, and those with preexisting respiratory conditions, extremes of age or weight, spinal deformities, previous neck injuries, and anatomical variations are at greater risk. We put forth different block strategies for risk mitigation, including patient selection, volume and type of anesthetic, block location, postprocedural monitoring, and specific discharge instructions. Understanding the benefits and risks of UGNBs is critical for emergency physicians to provide effective pain control while ensuring optimal patient safety.

Aims: At the Ohio State University College of Medicine, medical students have the option to train in ultrasound and take part in global electives where they can utilize clinical ultrasound. This presents the opportunity for medical students to engage in bidirectional sharing of medical and ultrasound knowledge in geographic regions with limited resources. We developed Bringing Ultrasound Internationally for Long-term development (BUILD), a longitudinal course, to provide standardized ultrasound education to students planning to enroll in global health electives. Material and methods: This was a pilot study of the BUILD curriculum. Third-year medical students planning to complete a global health elective were invited to participate. Enrolled students completed an online curriculum, hands-on scanning, and pathology sessions, which augmented the pre-departure Global Health course work. Students received two resource assessments: one to be completed by the student, and one to be completed by the on-site preceptor. Main outcomes measured were number of enrolled students, primary indications for imaging, and number of scans per-day. Results: In total, 152 students participated in the study and traveled to 22 different global sites in Low-Income Countries (LIC's). All enrolled students completed the curriculum. Between 3 and 25 scans were performed per day and the leading indication for ultrasound imaging was obstetric and abdominal pain evaluation. Conclusions: The BUILD curriculum is a feasible construct to prepare students for using ultrasound during global electives. Students successfully performed proctored scans in a variety of settings. This format can be adopted by other institutions to further support student and global ultrasound programs.

A previously healthy 60-year-old woman presented with several months of abdominal distension. She denied fever or night sweats but endorsed unspecified weight loss and difficulty performing daily activities. She appeared ill, with pulse rate 110 beats/min and blood pressure 89/54 mm Hg, and had abdominal distension and tenderness. Transabdominal bedside ultrasonography demonstrated hypoechoic cystic structures without peristalsis (Figure 1, Video 1). Laboratory testing results were normal. Computed tomography (CT) was obtained (Figure 2) and subsequent biopsy confirmed peritoneal carcinomatosis as a result of clear cell carcinoma of the fallopian tube. She was admitted and chemotherapy initiated.Figure 2Abdominal and pelvic CT with contrast demonstrating a large area of cystic and solid lesions in the pelvis (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Peritoneal carcinomatosis. results from exfoliation of a primary abdominal or gynecologic malignancy to the peritoneum and presents as cystic and solid enhancing masses throughout the peritoneal cavity.1Desai J.P. Moustarah F. Cancer, Peritoneal Metastasis. StatPearls Publishing, Treasure Island, FL2020https://www.ncbi.nlm.nih.gov/books/NBK541114/Date accessed: January 25, 2021Google Scholar Ultrasonographic peritoneal carcinomatosis features include hypoechoic peritoneal nodules without peristalsis, hypoechoic tissue surrounding bowel loops, ascites, irregular vasculature, and omental thickening.2Savelli L. De Iaco P. Ceccaroni M. et al.Transvaginal sonographic features of peritoneal carcinomatosis.Ultrasound Obstet Gynecol. 2005; 26: 552-557Crossref PubMed Scopus (22) Google Scholar Laparoscopy is required for confirmation, and although CT or magnetic resonance imaging is appropriate,3Coccolini F. Gheza F. Lotti M. et al.Peritoneal carcinomatosis.World J Gastroenterol. 2013; 19: 6979-6994Crossref PubMed Scopus (137) Google Scholar ultrasonography may be complementary4Qi Z. Zhang Y. Dai Q. et al.Peritoneal carcinomatosis in primary ovarian cancer: ultrasound detection and comparison with computed tomography.Ultrasound Med Biol. 2017; 43: 1811-1819Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar and a first step in emergency department diagnosis. https://www.annemergmed.com/cms/asset/80a337a6-0c30-4ef6-ae8d-ad7bc1901e5e/mmc1.mp4Loading ... Download .mp4 (1.27 MB) Help with .mp4 files Video 1Video clip of bedside ultrasonography demonstrating hypoechoic and cystic structures with no associated peristalsis in the left upper quadrant of the abdomen.

A 21-year-old man presented to the ED via ambulance for unresponsiveness. The patient’s girlfriend had called emergency medical services to the patient’s home after finding him unconscious. On arrival of emergency medical services, the patient was found to be cyanotic with miosis. Initial peripheral capillary oxygen saturation was 78%. He was placed on 10 L/min of oxygen by nasal cannula and given 1 mg of naloxone intravenously. Emergency medical services reported improvement in mental status with these combined interventions; however, bright red hemoptysis had developed in route. In the ED, further history revealed that the patient had a history of using a vaporizer with a frequency of 1 pod per day. He admitted to inhaled marijuana earlier that day as well but denied using THC-containing vaping products for more than a month. He was asymptomatic the day before symptom onset. On physical examination, the patient was afebrile (36.8 ° C ) with a heart rate of 117 beats per minute and a BP of 134/57 mm Hg. He was tachypneic with 28 respirations per minute with increased work of breathing. Lung auscultation revealed coarse breath sounds without overt wheezing. Although the patient initially denied cough, he continued to have hemoptysis in the ED. Initial laboratory values were notable for leukocytosis, elevated lactate, and normal hemoglobin, prothrombin time, and international normalized ratio. Despite a nasal cannula and nonrebreather set to 15 L/min of oxygen, the patient remained hypoxic at 91% with increased work of breathing. He was transitioned to heated high-flow nasal cannula with improvement of his oxygen saturation to 98% but continued to exhibit increased work of breathing. Given the patient's worsening respiratory status despite noninvasive interventions, the decision was made, in conjunction with the pulmonology service, to intubate the patient with a plan to perform emergent bronchoscopy. A focused cardiac and lung ultrasound scan were performed at the bedside. The cardiac ultrasound scan was unremarkable, which included a normal ejection fraction. The lung protocol included bilateral anterior and posterolateral zones of the lung. Lung ultrasound images were obtained (Video 1). What is the differential diagnosis for this patient based on clinical history and imaging findings and what is the next step in diagnosis? Answer: The differential would include electronic vaping associated lung injury (EVALI), ARDS, pulmonary contusion, pneumonia, or cardiogenic pulmonary edema. The next step in diagnosis is chest radiography, CT scanning, or bronchoscopy. The POCUS images performed by the emergency physician showed normal lung sliding in anterior lung fields, with bilateral B-lines in the posterolateral lungs without pleural effusion (Fig 1, Narration Video). There were no secondary findings of pneumoma, such as obvious consolidation or dynamic air bronchograms. A chest radiography showed confluent small nodular opacities favored to reflect extensive airspace disease, with a symmetric basilar predominance (Fig 2). Subsequent CT pulmonary angiography of the chest also showed extensive symmetric multifocal airspace disease (Fig 3). The patient was started on empiric antibiotics for community-acquired pneumonia with ceftriaxone and azithromycin. Methylprednisolone was administered after consultation with pulmonary medicine. On admission to the ICU, the patient underwent bedside bronchoscopy that demonstrated diffuse alveolar hemorrhage. Cultures from BAL washings did not result in subsequent bacterial or fungal growth. Blood cultures likewise showed no growth, and the respiratory viral panel was negative for common viral pathogens. The echocardiogram was read as normal without evidence of systolic or diastolic dysfunction. Autoimmune serology specimens were negative for anti-neutrophil cytoplasmic antibody, anti-myeloperoxidase antibody, anti-proteinase 3 antibody, and anti-glomerular basement membrane antibody. The patient was weaned gradually from the ventilator and extubated on hospital day 3. His work up for cardiac, infectious, and rheumatologic causes was negative, and he subsequently was discharged home. On follow up 14 days after admission and after abstinence from smoking and vaping, the patient underwent repeat CT scanning of his chest that showed complete resolution of previously noted lung changes. He continued to experience dyspnea with significant exertion but was generally asymptomatic and able to perform daily activities without difficulty. EVALI is a relatively recently described phenomenon with high morbidity. As of February 18, 2020, the United States’ Centers for Disease Control and Prevention (CDC) has reported a total of 2,807 hospitalized EVALI cases in the United States, including 68 confirmed deaths with an age range of 15 to 75 years. Components found in electronic cigarettes, vaporizers, electronic hookahs, and electronic nicotine delivery systems are listed as potential causative agents.1Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, ProductsCenters for Disease Control and Prevention. Accessed March 25, 2020.https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#latest-informationGoogle Scholar The CDC defines EVALI as a pulmonary infiltrate seen on chest radiography or CT scanning with e-cigarette use within 90 days prior to onset of symptoms. At present, EVALI remains a diagnosis of exclusion because no specific test or marker currently exists for its diagnosis. Respiratory, GI, and constitutional symptoms in combination with a history of recent e-cigarette use should raise clinical suspicion for possible EVALI.2For Healthcare ProvidersCenters for Disease Control and Prevention. Accessed March 25, 2020.https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/healthcare-providers/index.htmlGoogle Scholar Vaping-associated lung injuries have demonstrated a wide range of lung patterns on radiography and CT scanning. Henry et al3Henry T.S. Kligerman S.J. Raptis C.A. Mann H. Sechrist J.W. Kanne J.P. Imaging findings of vaping-associated lung injury.AJR Am J Roentgenol. 2020; 214: 498-505Crossref PubMed Scopus (47) Google Scholar summarized the imaging findings that included hypersensitivity pneumonitis, diffuse alveolar hemorrhage, acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, and giant cell interstitial pneumonia. A case series presented by Kaliniskiy et al4Kalininskiy A. Bach C.T. Nacca N.E. et al.E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach.Lancet Respir Med. 2019; 7: 1017-1026Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar suggested a diagnostic approach that included radiography and CT scanning for initial evaluation of EVALI. To date, however, there have been no documented cases that included the use of ultrasound scanning as an initial modality for evaluation. Ultrasound scanning continues to be recognized as an essential modality to the provision of high-quality, timely and cost-effective patient care, especially in the emergency setting. Beginning with the BLUE protocol described by Lichenstein,5Lichtenstein D.A. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.Chest. 2015; 147: 1659-1670Abstract Full Text Full Text PDF PubMed Scopus (266) Google Scholar many lung ultrasound protocols have been described in the acute care setting. In our case, we evaluated the anterior and posterolateral lungs bilaterally. Additional views were not feasible in the ED, given the patient’s high acuity; however, more views generally increase the sensitivity for pathologic evaluation. At a minimum, a lung protocol should include an evaluation of the least dependent part of the lung (anterior chest in a supine patient) and the most dependent part of the lung (posterior chest in a supine patient) bilaterally. It should be noted that, in this case, a low frequency curvilinear transducer was used primarily, which allowed for a broad field of view over multiple rib spaces. Tissue harmonic imaging and other artifact-reducing technologies should be turned off to allow for best visualization of the pathologic lung artifacts. A high-frequency linear probe can be useful for further characterizing the pleural line. In this case, detailed evaluation of the pleural line was limited because of the use of a low-frequency probe. From what could be observed, the pleural line was regular and continuous without overt subpleural consolidations. It has been suggested that pleural abnormalities are more indicative of an inflammatory or infectious cause of pulmonary edema as opposed to cardiogenic pulmonary edema, but these findings were not readily apparent in our case.6Copetti R. Soldati G. Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome.Cardiovasc Ultrasound. 2008; 6: 16Crossref PubMed Scopus (334) Google Scholar Patchy B-lines, with spared areas of the lung also, would challenge the possibility of a cardiogenic cause. The patient had few B-lines in the anterior right lung field, whereas there were diffuse B-lines in the bilateral bases of the lungs. It is unclear whether this was indicative of basilar predominance of the edema or a patchiness of the lung ultrasound findings. The bedside cardiac ultrasound scan showed a preserved left ventricular ejection fraction and collapsible inferior vena cava that supports a noncardiogenic cause. These sonographic lung findings together suggest a systemic inflammatory process to be causing increased interstitial edema. This is corroborated by the findings on chest CT scanning. In a patient with vaping-associated diffuse alveolar hemorrhage, these sonographic findings would be expected, based on what has been seen on other imaging modalities.7Agustin M. Yamamoto M. Cabrera F. Eusebio R. Diffuse alveolar hemorrhage induced by vaping.Case Rep Pulmonol. 2018; 2018: 9724530Crossref PubMed Google Scholar,8Edmonds P.J. Copeland C. Conger A. Richmond B.W. Vaping-induced diffuse alveolar hemorrhage.Respir Med Case Rep. 2020; 29: 100996PubMed Google Scholar In previous case reports and case series, chest radiography and CT scanning have been the initial imaging modalities of choice.4Kalininskiy A. Bach C.T. Nacca N.E. et al.E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach.Lancet Respir Med. 2019; 7: 1017-1026Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar,8Edmonds P.J. Copeland C. Conger A. Richmond B.W. Vaping-induced diffuse alveolar hemorrhage.Respir Med Case Rep. 2020; 29: 100996PubMed Google Scholar This is consistent with the aforementioned diagnostic criteria set by the CDC. We present a case of EVALI during which point-of-care ultrasound scanning (POCUS) was used during initial resuscitation and diagnostic workup in the ED setting. The sonographic features of this case of EVALI included bilateral B-lines representative of interstitial edema. B-lines are a reverberation artifact that originate from the pleural line caused by a thickening of the interstitium; these findings have been described with other pathologic findings that include cardiogenic pulmonary edema, pulmonary contusion, pneumonia, and ARDS.5Lichtenstein D.A. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.Chest. 2015; 147: 1659-1670Abstract Full Text Full Text PDF PubMed Scopus (266) Google Scholar,6Copetti R. Soldati G. Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome.Cardiovasc Ultrasound. 2008; 6: 16Crossref PubMed Scopus (334) Google Scholar,9Hosseini M. Ghelichkhani P. Baikpour M. et al.Diagnostic accuracy of ultrasonography and radiography in detection of pulmonary contusion; a systematic review and meta-analysis.Emerg (Tehran). 2015; 3: 127-136PubMed Google Scholar Because this is the first description of lung ultrasound scanning in a patient with EVALI, there are no established guidelines regarding how ultrasound scanning can assist in the diagnostic work up. Given the nonspecific nature of the sonographic findings, we propose that POCUS can be used to increase suspicion for the disease process in a patient with a high pretest probability for EVALI based on history and examination. POCUS has the advantage of being able to be performed rapidly at the bedside of a critically ill patient whose condition may be too unstable to move for CT scanning. In addition, POCUS can be more sensitive for interstitial edema than chest radiography.10Danish M. Agarwal A. Goyal P. et al.Diagnostic performance of 6-point lung ultrasound in ICU patients: a comparison with chest x-ray and CT thorax.Turk J Anaesthesiol Reanim. 2019; 47: 307-319Crossref PubMed Scopus (7) Google Scholar Furthermore, POCUS of the heart and lungs effectively can rule out alternate diagnoses such as pneumothorax, pneumonia, pleural effusion, pericardial effusion, and acute heart failure. Therefore, POCUS can be used early in the course of a patient with suspected EVALI to expedite treatment; however, the diagnosis should be confirmed with further diagnostic testing, given that the sonographic findings are not specific. 1.The sonographic lung findings of EVALI are a regular pleural line and bilateral B-lines with basilar predominance reflective of interstitial edema.2.POCUS can be used to increase suspicion for EVALI in a patient with high pretest probability and to evaluate for alternate causes of acute dyspnea.3.POCUS in isolation should not be used to diagnose EVALI. Due to the nonspecific nature of the findings on lung sonography, the diagnosis should be confirmed with additional diagnostic testing. Financial/nonfinancial disclosures: None declared. Other contributions: CHEST worked with the authors to ensure that the Journal policies on patient consent to report information were met. Additional information: To analyze this case with the Videos, see the online version of this article. https://journal.chestnet.org/cms/asset/f8131159-8813-43b0-8076-07ab6031944f/mmc1.mp4Loading ... Download .mp4 (6.69 MB) Help with .mp4 files Video 1Lung ultrasound images of the anterior chest and bilateral lung bases at the costophrenic angles. Diffuse B-lines are seen in all lung fields.https://journal.chestnet.org/cms/asset/ef2f5b0c-f2e9-4cd8-b864-90077d94ac55/mmc2.mp4Loading ... Download .mp4 (26.32 MB) Help with .mp4 files Narration VideoLabeled video clips of lung ultrasound images of the anterior chest and bilateral lung bases at the costophrenic angles. Diffuse B-lines are seen in all lung fields.

Objectives: Accurate communication is an integral component of ultrasound education. In light of the recent global pandemic, this has become even more crucial as many have moved to virtual education out of necessity. Several studies and publications have sought to establish common terminology for cardinal ultrasound probe motions. To date, no studies have been performed to determine which of these terms have been adopted by the ultrasound community at large. Methods: A survey was developed which asked respondents to describe videos of six common probe motions in addition to providing basic demographic and training data. The survey was disseminated electronically across various academic listservs and open access resources. Results: Data were collected over a 6-week period and yielded 418 unique responses. Responses demonstrated significant variation in terminology related to all 6 cardinal probe motions. While some degree of difference in response can be accounted for by discipline of training, inter-group variation still exists in terminology to describe common probe motions. Of the survey respondents, 57.5% felt that inconsistent probe motion terminology made teaching ultrasound more difficult. Conclusions: The results demonstrate that despite efforts to codify probe motions, variation still exists between ultrasound practitioners and educators in the description of cardinal probe motions. This lack of consensus can contribute to challenges in both virtual and in-person ultrasound education.

Ultrasound is being introduced into many medical schools and incorporated into the anatomy curriculum; however, in most cases, this consists of proctored sessions which can be limited by faculty time and availability. Additionally, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has significantly impacted medical education, especially ultrasound education, which has traditionally depended on hands-on practice and instruction. A structured, independent, hands-on learning curriculum using ultrasound would have many benefits. In this study, eight self-guided system-based modules were developed mirroring the undergraduate anatomy curriculum. For each scan, a beginner, intermediate, and advanced component was designed. Each module contains clear, stepwise directions for image acquisition, optimization, and interpretation of the anatomical structures and suggestions for troubleshooting. Students save ultrasound images as part of their digital portfolios for review with ultrasound faculty. This design provides an educational model to increase medical student opportunities for independent, structured, self-directed anatomy learning with ultrasound that can be integrated with existing educational programs.

Case Presentation: A 34-year-old woman presented to the emergency department with bilateral lower extremity edema and shortness of breath. She had been seen by her primary care provider. Lab work and a follow-up with endocrinology had been unrevealing. Using point-of-care ultrasound we identified a cystic mass in the right upper quadrant prompting further imaging. Discussion: Abdominal and pelvic computed tomography confirmed a mass in the right posterior liver, which was later identified as an adrenocortical carcinoma. Ultrasound is an important diagnostic tool in the setting of lower extremity edema and can be used to assess for heart failure, liver failure, obstructive nephropathy, venous thrombosis, and soft tissue infection. In this case, ultrasound helped expedite the diagnosis and treatment of a rare malignancy.

Abstract Acute scrotal pain is not an uncommon complaint, and ultrasound is the primary imaging modality for associated pathology. Compared to other applications of point-of-care ultrasound, testicular studies are more often deferred in favor of comprehensive studies. This is likely due to fear of missing or delaying the high-risk diagnosis of testicular torsion. This fear is not unfounded. Potential delays of indeterminant studies should be a consideration prior to performance. However, an experienced practitioner can also expedite management by confirming diagnosis of testicular torsion with ultrasound performed immediately at the point of care. In addition to testicular torsion, testicular ultrasound is indicated for almost any cause of acute scrotal pain or swelling. It can be used to diagnose a variety of pathologies, ranging from fairly benign to those threatening reproductive abilities.

ObjectivesUltrasound is a valuable tool for anatomy education, but limited evidence exists for using ultrasound to teach neuroanatomy and neurophysiology. Previous work demonstrated a potential increase in medical knowledge in preclinical medical students participating in a neurology ultrasound workshop, however, without comparison to a control group. After 2 years, we assessed how a neurology ultrasound workshop affected the medical knowledge of participating preclinical medical students compared to a traditional curriculum control group.MethodsThis quasiexperimental study compared academic performance of ultrasound workshop participants to nonparticipant classmates. The primary outcome was the overall neurologic disorders unit total score. An analysis of covariance was conducted to test for statistically significant differences while controlling for the average quiz score.ResultsA total of 360 medical students were included in the study. The intervention group (n = 57) showed no significant difference in the total unit score (F = 3.206; P = .074), with averages for the control and experimental groups being 87.3% ± 5.0% and 88.4% ± 4.8%, respectively. Additionally, anatomy practical scores and written final examination scores were not significantly different between groups (F = 1.035; P = .310; F = 2.035; P = .155).ConclusionsParticipation in a neurologic disorders ultrasound workshop did not appear to be correlated with improved curricular performance in our cohort. Further research should continue to assess ultrasound workshops in other organ systems to elucidate the relationship between learning ultrasound and the impact on medical school academic performance.