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.
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.
•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.