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.

Tox and Hound – The Dirty on Dantrolene

by Sarah Shafer Dantrolene is one of the few, true “muscle relaxers”. It was discovered in 1967 and approved by the FDA in 1979. Unlike paralytic neuromuscular blockers, dantrolene works post-synaptically, at the sarcoplasmic reticulum in the myocyte. It binds to the ryanodine receptor in skeletal muscle (RYR1), preventing sarcoplasmic calcium-induced calcium release. When RYR1 […]

EMCrit Project by Tox & Hound.

Visual field defects

Understanding the anatomy of the optic nerve and visual pathways is important for understanding how lesions in different locations will cause differential visual field defects, as illustrated below.


Visual pathways

Once leaving the orbit via the optic canal, the optic nerves enter the middle cranial fossa. Here, the two optic nerves unite to form the optic chiasm. Within the chiasm, fibres from the medial side of each retina cross over to form right and left optic tracts. The optic tracts then pass to the lateral geniculate nuclei where they synapse. Secondary neurones subsequently pass from the lateral geniculate nucleus to the visual cortex via optic radiations. Note that when a lesion lies within the optic radiations, the maculae remain unaffected.

 

Anatomy of the visual pathways


Visual field defect examples

Examples of visual field defects

Examples of visual field defects


ILLUSTRATOR

Aisha Ali

Medical student and illustrator


 

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