August 2: Monrovia, Liberia

Trainees are happy to bring the scanning table abnormal abdominal fluid Abdominal ultrasoundAnother busy week of scanning has flown by for our ultrasound team in Monrovia! We spend each morning rounding with pediatrics, internal medicine, surgery or obstetrics/gynecology at JFK Hospital. The resident physicians are enthusiastic learners and the cases they present are educational for the ultrasound instructors and trainees. Point-of-care ultrasound during bedside rounds last week led to the diagnoses of traumatic bladder rupture, hemothorax, hemoperitoneum, pneumonia, ventricular thrombus, congestive heart failure, hydronephrosis and abscesses leading to significant changes in management.

One of our most interesting cases this week was a middle-aged man who presented a week prior with abdominal pain and distention with a history of remote fever. On x-ray there was air in the abdomen – free air should generally never be obvious below the diaphragm on x-ray. As he looked overall well at the time, the air was thought to be contained in a liver abscess and he was admitted on IV antibiotics. An ultrasound evaluation with our resident physician team revealed free intra-abdominal air consistent with bowel perforation and a complex fluid concerning a severe infection in his abdomen. A bedside sample of the fluid confirmed our findings – pus inside the abdomen. He was taken to the operating theatre that afternoon to wash out his abdomen. This morning, we found him roaming the wards looking incredibly well.   Another busy week on the wards to come we are sure…