Tressel LogoTressel

#POCUS for Temporal Arteritis!?!? It's true!...

<div>#POCUS for Temporal Arteritis!?!? It's true!

1/12 Elderly male presents with right sided headache and blurry vision. He had tenderness with light palpation on the right temporal area. His story is concerning for Temporal Arteritis. labs are drawn. Could #POCUS clinch diagnosis?</div>

<div>2/12 The transducer is placed over the right temporal area in with the probe marker pointing posteriorly. This gives a short axis view of the temporal artery like in this example. It is the main vessel seen in this view. Note the bright, hyperechoic skull just below.</div> <div>3/12 Let's evaluate the TA on the right (symptomatic side). Classically, GCA has a "halo" sign. That is a hypoechoic rim around the TA, indicating edema. Is it present?</div> <div>4/12 Yes!</div><img key=0 alt="thread_img" style="width: 50%; margin-top: 1rem" src= /> <img key=1 alt="thread_img" style="width: 50%; margin-top: 1rem" src= /> <div>5/12 Let's compare to the asymptomatic side. Note no halo is present.</div> <div>6/12 Another #POCUS finding in GCA is the "compression sign". In GCA, the TA lumen is occluded with lower flow, making the artery more easily compressible than normal. Here, the TA is easily compressed.</div> <div>7/12 Compare to the asymptomatic side. It looks more like a normal artery, which is more resistant to compression</div> <div>8/12 The occluded lumen can also manifest as absent flow on color doppler. Note no color flow in the lumen. I even changed the scale and beam steer but no flow</div><img key=0 alt="thread_img" style="width: 50%; margin-top: 1rem" src= /> <div>9/12 On the asymptomatic side, there is good color flow</div> <div>10/12 This patient has #POCUS findings of GCA: -Halo sign -Compression sign -(lower flow on color doppler)</div> <div>11/12 This is well described, but little literature in #POCUS. So how will I use? It's another data point to help you make your decision. Low PTP and negative POCUS could lead to not treating but don't let a normal #POCUS help you not treat in high PTP.</div> <div>12/12 I believe #POCUS will have a larger role in GCA, especially as TA biopsies are poorly sensitive. In the future, I hope more data will help us definitively decide if we should treat and refer.

#POCUS clips done by myself and amazing @EmoryEM #POCUS fellow @bakhribah</div>

<div>13/12 The vascular surgeon that was consulted for biopsy is not a believer in biopsies due to so many negatives he was thrilled I did the POCUS</div><img key=0 alt="thread_img" style="width: 50%; margin-top: 1rem" src= />

This post was saved using Tressel. Get started for free today!

Effortlessly send content from all over the Internet to your notes (Notion, Obsidian & Evernote) to complement your workflow

Get started for free
App screenshot