Abstract
A 77-year old male was admitted in the emergency department for septic shock, yet no clear source of infection was noted upon physical examination and a portable chest x-ray. Due to his unstable condition, bedside ultrasound was performed. A heterogeneous mass in the liver was noted, hence a tentative diagnosis of liver abscess was made. This was latter confirmed by abdominal computed tomography. This case highlights that point-of-care ultrasound, when performed by expert physicians, can significantly decrease time to diagnosis for septic patients.
Highlights
A 77-year old male was admitted in the emergency department for septic shock, yet no clear source of infection was noted upon physical examination and a portable chest x-ray
An abdominal computed tomography scan was performed, which revealed the aforementioned abscess located in the VI and VII liver segments, measuring 13x7x10 cm (Figure 1B) and signs of a contained perforated diverticulitis
The patient’s status rapidly deteriorated and he was started on vasopressor therapy, intubated and admitted to the Intensive Care Unit (ICU)
Summary
He was admitted to the Emergency Room’s Critical Care bay upon suspicion of septic shock. Sepsis protocols were immediately started and upon further examination, there still was no obvious source of infection: he had a clear lung exam, there was no abdominal or costovertebral angle tenderness and he had a normal prostate exam. The patient’s blood pressure improved only transiently after fluid therapy; because the patient continued to be unstable, a bedside ultrasound examination was performed to further look for a source of infection.
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