56 years old male with epigastric pain and hypotension. Resistant to fluid resuscitation. He had lap cholecystectomy 2 weeks ago. O/E, he has epigastric fullness, tenderness with visible pulsations.
Bedside Ultrasound : Peri hepatic Fluid ? collection ? post surgical. IVC collapsible >50 %. While scanning IVC, this pulsating mass was seen just below epigastrium.
![Pancreatic Pseudocyst 1](https://i0.wp.com/pocusfrimley.org/wp-content/uploads/2023/07/Pseudocyst-1.jpg?resize=466%2C288&ssl=1)
Can you spot the anomaly? What’s wrong with this image?
It is important for POCUS users to know landmarks and not jump the gun.
![Pancreatic pseudocyst](https://i0.wp.com/pocusfrimley.org/wp-content/uploads/2023/07/Pseudocyst-4.jpg?resize=1024%2C441&ssl=1)
Optimization
•Increase depth, identify Vertebral body mass.
•Normal caliber aorta is visualized.
•Circular cystic mass with thick walls seen with max AP diameter >7cm with transmitted pulsations from underlying aorta.
Final Diagnosis :
- Pancreatic Pseudo cyst
n.b. Hypotension in this patient was from sepsis due to intra-abdominal collections, post Cholecystectomy and not from the Pseudo cyst.