Transcranial Doppler Tuesday

TCD uses ultrasound to evaluate blood flow inside the brain.  There are three cranial windows commonly used- temporal, occipital and ocular.  You can visualize blood flow through the middle, anterior and posterior cerebral, ophthalmic, vertebral and basilar arteries.   Doppler ultrasound waveform analysis of flow velocities through the vessels and resistive index have been used to evaluate patients in the acute setting for stenosis/occlusion/thrombosis.

Case of the month- courtesy of Dr. Menlove

A 35yo male was brought in under police custody with abdominal pain.  He reported a few days of upper abdominal pain, with mild nausea.  No other symptoms or prior episodes.  A bedside ultrasound was performed and revealed the following:

acalculous cholecystitis

















The findings demonstrate gallbladder wall thickening (> 3mm) and presence of pericholecystic fluid.  The patient had a positive sonographic murphy’s.  His labs revealed a mild transaminitis and leukocytosis (15.8).  He was evaluated by surgery, given antibiotics for cholecystitis and admitted.

During admission the patient underwent a radiology-performed US, which confirmed the findings above, with no documentation of stones.  He then had a CT and HIDA scan as well, both demonstrating acalculous cholecystitis.

Acalculous cholecystitis is an uncommon ED diagnosis.  It usually occurs secondary to sepsis, TPN, primary gallbladder infection or rarely viral infections such as EBV, and patients with such are often critically ill.   All radiology studies of this patient were consistent with acalculous cholecystitis.  He was taken to the OR and underwent uncomplicated cholecystectomy and was later discharged back to police custody.