Case 17

86 male w/ PMHx significant for COPD, HTN, DM, GERD, seizures, and a.flutter BIBA from Silver Lake NH where staff found him to be diaphoretic, tachycardic, and had a decrease in O2 to 90% sat on vent.  Staff reported increased work of breathing and altered mental status.  He was sent to ED for evaluation.

Physical Exam:

VS: T - 98.6F, BP - 127/59, PR - 122, RR 22, 82% on vent

CONSTITUTIONAL: lying in bed, trach tube in place
CARD: tachycardic, regular, no murmurs
RESP: Vented, breath sound auscultation limited
ABD: soft, nt/nd, normal bs
EXT: bilateral 2+ pitting edema to level of upper shins
NEURO: unresponsive

Questions

  1. In the lung exam shown below, what clinical ultrasound findings do you see in Figure A and B?
  2. In Figure B, what are the two possible clinical diagnoses given the ultrasound findings in the still image?

Figure A.  LUQ view

Figure B.  L4 view of lung