The pt, a 79 yo female, had been seen 3 days prior with abdominal pain and discharged home with an ED diagnosis of constipation. She returned with continued pain. Bedside US showed the following:
In this image note the large mass-like structure with mixed echogenicity. This image prompted a further workup. A CT of the abdomen/pelvis showed a 12x12cm heterogeneous lesion arising from the uterus. This US is a prime example of recognizing abnormal - and sometimes incidental - findings on bedside US and using them to prompt further testing. The pt was followed by Emory GYN and had an endometrial biopsy showing carcinosarcoma of the uterus. The pt is doing well and awaiting surgical evaluation by GYN-ONC in early April.
Date: March 2012
Image credit: Deepa Patel, Dilani Weerasuriya, and Lauren Hudak.