Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series

Abstract

Introduction: The use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established. However, no current guidelines exist to outline the use of POCUS in the management of acute peripheral arterial pathology. Case Series: Here, we present a case series that illustrates the utility of POCUS in the assessment of both traumatic and nontraumatic peripheral arterial disease. Direct visualization of the vasculature via B-mode, color Doppler, and pulsed-wave Doppler assisted in the diagnosis of the following: 1) an acute, post-catheterization thrombus of the proximal radial artery; 2) a complete, traumatic radial artery transection; 3) a forearm hematoma with active arterial extravasation; 4) a traumatic arteriovenous fistula; 5) an acute thrombosis of an artery bypass graft; and 6) an infected pseudoaneurysm. Conclusion: The incorporation of POCUS into patient care allowed for rapid identification of significant peripheral arterial pathology and led to changes in clinical management, expedited patient care, and circumvented potentially harmful complications.

Acute Upper Extremity Arterial Occlusion Diagnosed on POCUS in the Emergency Department

“…Despite the established role of POCUS in assessment of aortic disease and DVT, evaluation of acute ALI with POCUS has been sparsely described in the literature and has yet to be commonly incorporated into clinical guidelines 10 , 11 , 15 . Given that treatment delay of greater than 6 hours from onset to intervention vastly increases the rate of limb amputation, the expediency of POCUS can prove useful in rapid diagnosis 10 , 16 , 17 .…”

“…Furthermore, POCUS can facilitate diagnosis by identifying small vessel disease or localizing occlusions distal to the wrist by establishing patent proximal arterial vessels. By better localizing the pathology, the emergency provider can focus the differential on autoimmune diseases such as Raynaud's phenomenon, systemic sclerosis, and thromboangiitis obliterans, in addition to thromboembolism and thrombotic etiologies 8 , 9 , 11 , 12 .…”

“…Furthermore, non-ischemic etiologies of nontraumatic arm pain, such as rhabdomyolysis, deep vein thrombosis (DVT), and compartment syndrome, can also overlap with ALI. Although point of care ultrasound (POCUS) has been utilized for vascular access and diagnosis of DVTs, this modality has been limited in the evaluation of ALI 10 , 11 . Here, we present a case of ALI of the upper extremity diagnosed with POCUS requiring emergent vascular intervention.…”

Role of point of care diagnostics in Lower-and Middle-income countries and austere environments

“…Traditional radiography was not able to detect soft tissue injury, but musculoskeletal ultrasonography enables the diagnosis of not only musculoskeletal disorders including soft tissue injury, but also fractures by dynamic examination. [22] Diagnosis in orthopaedics often requires further imaging beyond history taking, clinical examination and plain radiographs. In these cases POCUS can be useful for ruling out occult fractures, diagnosing joint effusions and tendon ruptures.…”

Elderly woman with arm swelling

“…Early detection and treatment of pseudoaneurysms can prevent complications such as rupture, thrombosis, and embolization, and can ultimately lead to improved patient outcomes [1].…”