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Clinic case
Application of “Point-Of-Care-Ultrasound” (POCUS) in an Acute-Geriatrics-Unit: Case report
Aplicación de «Point-Of-Care-Ultrasound» (POCUS) en una Unidad Geriátrica de Agudos: reporte de un caso
Myriam Teresa Apontea,
Corresponding author
myriamaponte09@gmail.com

Corresponding author.
, Juan Ignacio González-Montalvoa,b,c, Concepción Murillo Gayoa, Paola Pastora Reinoso Párragaa
a Geriatrics Department, La Paz University Hospital, Madrid, Spain
b Research Institute of La Paz University Hospital (IdiPAZ), Madrid, Spain
c Department of Medicine, School of Medicine, Autonomous University of Madrid, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Point-Of-Care Ultrasound &#40;POCUS&#41; with presence of left iliopsoas hematoma&#46; &#40;B&#41; Abdominal computed tomography&#44; with evidence of left iliopsoas hematoma measuring approximately 3&#46;5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>cm without active bleeding&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Point-Of-Care Ultrasound &#40;POCUS&#41; is a portable and accessible diagnostic technique that provides timely information at the bedside through multiple systems&#44; in real time&#46; Over the last decade there has been a significant increase in the adoption of POCUS and it is considered highly beneficial alongside traditional examination techniques in evaluating geriatric patients with acute illnesses&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have demonstrated the usefulness of this tool in multiple medical specialties&#44; since it allows not only to diagnose and treat&#44; but also to monitor the response to treatments administered&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this case is to describe the utility of POCUS in the diagnosis of an 81-year-old elderly patient&#44; hospitalized in an Acute-Geriatrics-Unit&#44; who presented with hypotension and abdominal pain&#44; and underwent POCUS&#44; leading to the diagnosis of a left iliopsoas muscle hematoma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case</span><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of an 81-year-old patient with past medical history of arterial hypertension&#44; atrial fibrillation&#44; type 2 diabetes mellitus&#44; chronic liver disease&#44; pulmonary hypertension&#44; heart failure&#44; sleep apnea hypopnea syndrome&#44; depressive syndrome&#44; mechanical aortic valve prosthesis anticoagulated with acenocumarol&#44; right hemithyroidectomy&#44; right radical nephrectomy due to renal mass&#44; hysterectomy and recent admission due to a fall with head trauma&#44; acute subdural hematoma and right humerus fracture&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A comprehensive geriatric assessment was performed upon admission with the following results&#58; Functional-Ambulation-Category &#40;FAC&#41; 3&#47;5&#44; Barthel-index 70&#47;100 and the Global-Deterioration-Scale &#40;GDS&#41; 1&#47;7&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">She was admitted to the Geriatric-Acute-Care Unit after an accidental fall with traumatic brain injury and chronic left hemispheric subdural hematoma with signs of acute rebleeding&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">On admission she was being treated with a dose of enoxaparin 40<span class="elsevierStyleHsp" style=""></span>mg&#44; hydroferol&#44; sertraline&#44; insulin&#44; calcium&#44; iron&#44; furosemide&#44; paracetamol&#44; denosumab&#44; allopurinol&#44; tramadol&#44; bisoprolol&#44; digoxin and spironolactone&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">During hospitalization&#44; she experienced an episode of hypotension and abdominal pain&#46; The physical examination revealed abdominal distension and discomfort in the palpation in the mesogastrium and hypogastrium&#46; Blood test showed anemia with hemoglobin level of 7&#46;7<span class="elsevierStyleHsp" style=""></span>g&#47;dL with a previous level of 10<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#46; In light of these findings&#44; POCUS was performed&#44; revealing signs of hypovolemia with free fluid perihepatic and in the pelvis&#44; and the presence of an anechoic image measuring 8&#46;8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>3&#46;50<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&#46;98<span class="elsevierStyleHsp" style=""></span>cm in the left iliac fossa highly suggestive of muscular hematoma at that level &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Afterwards&#44; the presence of a left iliopsoas hematoma measuring approximately 3&#46;5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>cm without active bleeding was confirmed trough abdominal tomography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Conservative medical treatment was prescribed&#44; including a transfusion of two units of packed red blood cells&#44; along with analgesic therapy&#44; leading to favorable clinical evolution&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Spontaneous&#44; non-traumatic hematoma of the iliopsoas muscle mainly occurs in older adults undergoing anticoagulant treatment or with coagulation disorders&#46; Clinical presentation is usually varied&#44; including abdominal pain&#44; hip or back pain and sometimes with neurological deficit in the lower limbs&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> Symptoms are often atypical and Lenk&#39;s triad &#40;flank pain&#44; hemodynamic shock and palpable mass&#41; occurs in very few cases&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It can be a critical condition and sometimes lead to serious complications&#44; particularly in elderly patients and patients with comorbidities&#44; so suspicion and rapid identification are crucial for appropriate treatment&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The incidence of spontaneous iliopsoas hematoma ranges from 0&#46;3 to 0&#46;4&#37; in patients hospitalized in intensive care units&#44; with and estimated mortality rate ranging from 30 to 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Diagnosis is usually made by through standardized imaging tests such as computed tomography&#44; highlighting the importance of implementing POCUS in Acute-Geriatric-Units due to its easy and quick access for diagnosing this condition and enabling early intervention&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Cases of early diagnosis using POCUS have been described in the literature for conditions such as muscle and soft tissue hematomas&#44; abdominal pathologies like acute cholecystitis&#44; hypovolemia and hypervolemia&#44; pleural effusion&#44; interstitial lung disease&#44; cellulitis&#44; and deep vein thrombosis&#44; as well as its utility in upper airway management and biceps tendon injury diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Various studies have shown evidence that supports the use of POCUS as a complement to traditional management techniques in older patients&#44; favoring diagnostic accuracy&#44; establishing the diagnosis in the shortest possible time and being able to initiate the appropriate treatment&#44; which translates into better outcomes for the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare not to have any interest conflict&#46;</p></span></span>"
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Article information
ISSN: 0211139X
Original language: English
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