Incidental POCUS Findings – The Gallbladder

There’s a whole host of abnormalities that one can find on POCUS. Some of them do not represent an acute problem. Most of them are of a minor nature and quite common, and do not need further imaging. But in a few cases, follow-up elective imaging is required. Here’s an example.

This elderly patient presented with near-syncope. A battery of tests was ordered at triage, including liver function tests. Most of these results were abnormal, showing a significant elevation compared to three months prior, when the LFTs were within normal limits. The patient was asymptomatic with respect to any gallbladder, liver or other biliary signs or symptoms. Due to the abnormal LFTs, a POCUS scan was done. This was the scan of the patient’s gallbladder.

 

What do you think? Is this sludge? It could be. But with sludge, you would prefer to see a fluid level/layer in order to confirm its liquid nature. The lumen of this gallbladder is almost completely filled with solid-looking material. It could be solid sludge. But this appearance should cause one to obtain elective imaging to rule out neoplasm. That was done in this case. The elective ultrasound and CT scan did confirm that this was solid sludge. But do not let this dissuade you from obtaining elective imaging to rule out a gallbladder tumour if you see something like this on the screen.

The Septal Slap

I like giving credit where credit is due. But often enough, it is simply not possible. As we learn and teach point-of-care ultrasound, we stand on the shoulders of many unidentified people. Long ago, there were the early scientists who researched sound waves. They discovered that part of the sound spectrum that we now use to perform POCUS. At some point, it was discovered that ultrasound waves could help see into the body. Early ultrasound machines were constructed by scientists of different stripes, physicists, biologists, etc. Then, early imaging specialists started to put ultrasound to clinical use in humans. I cannot tell you the names of any of these people. But we are deeply indebted to them.

Before it’s lost in the sands of time, I thought I would point out the origin of the term, “The Septal Slap”. As many readers will know, in creating the learning tools of the EDE Courses, we deconstruct how other specialties use ultrasound and rebuild it for ourselves and our learners, with simplicity of pedagogy in mind. We had been teaching EDE 2 for about a year when we held the course in Sudbury for the second time back in March 2010. To that point, we had been using the term EPSS, or E-point septal separation with learners as one feature that can be used to judge LV systolic function (i.e. contractility). We knew that the term glazed their eyes over, as evidenced by this quote from the book:

“E-POINT SEPTAL SEPARATION (AKA THE “SEPTAL SLAP”)
E-point what?! Does the abbreviation EPSS help? OK, let’s back up to explain this “nose-in-the-air” echo term.”

Immediately after that course in Sudbury, we had a brainstorming session and came up with the term, “The Septal Slap”. Although he cannot recall it, I think my colleague in Sudbury, Dr Lee Toner, came up with slap and it went from there. Although the term technically falls under the copyright of the book and the course material, we owe Lee a big thanks for the light bulb that went over his head that day!

If you search the Internet for “septal slap”, you will notice that it is starting to infiltrate into various blog discussions, which is a good thing. It is certainly WAY easier to understand than EPSS! It has even snuck its way into the material of another course. What’s that saying about the “sincerest form of flattery”? 🙂

Le livre ÉDU est maintenant sur iBooks

Tel que promis l’automne passé, nous avons publié le livre ÉDU sur iBooks. Tout comme la version anglaise du livre numérique, « L’essentiel de l’échographie ciblée » ajoute ses fonctionnalités :

• des questionnaires
• plus que quarante vidéos
• des références avec des hyperliens à PubMed
• des liens au contenu sur le Blogue ÉDU
• un glossaire interactif
• des résumés de chapitre
• des diaporamas
• des notes d’étude
• des notes définies par le lecteur

Le livre numérique est disponible chez iBooks et NON chez iTunes. Il peut être lu sur un iPad ou un Mac avec iBooks installé. Il peut être lu sur un iPhone, mais la grandeur de l’écran limite l’expérience. La manière la plus facile de trouver le livre électronique sur iBooks est de rechercher mon nom de famille, “Socransky”.