Recognizing Abnormal...

The "Image of the Week" comes from Deepa Patel, Dilani Weerasuriya, and incoming EM intern and Emory Medical Student, Lauren Hudak. These three helped evaluate a patient with Dr. Huot and Candace Gates, an off-service resident rotating in the ED. 

The patient, a 79 year old woman, had been seen in the ED 3 days before with abdominal pain and was discharged home with a diagnosis of constipation. She returned with continued pain. 

Bedside US showed the following:

In this video, note the large mass with mixed echogenicity. The results of the bedside ultrasound prompted further imaging and a CT of the abdomen/pelvis demonstated a 12x12cm heterogenous lesion arising from the uterus. This ultrasound is a prime example of recognizing abnormal - and sometimes incidental - findings on bedside ultrasound and using them to prompt further testing. 

The gynecological service was consulted and the patient had an endometrial biopsy which demonstrated uterine carcinosarcoma. The patient is doing well and awaiting surgical evaluation by the Gynecological Oncology service in the coming weeks.