Capsule 05-2025: a look back at the TOP capsule in 3 years and the cases of the month!
- William Bédard Michel
- 4 days ago
- 4 min read
Yep, it's been over 3 years since the capsule was written. A website is pretty cool. You can track tons of stats. There have been capsules on just about anything that you can scan. But, to my surprise, can you guess the most viewed capsule? Hernias! I was really surprised! October 2023!
Personally, I love ultrasounding wall hernias to: confirm my Dx, confirm fat vs. intestinal, guide my reduction by identifying the location of the cervix and finally to look for gross signs of pain. One of my colleagues at Sacré-Coeur recently told me that this is the capsule that has changed his practice the most! So, here it is (and below, we give other examples!): https://www.capsule-echographie.com/post/capsule-octobre-2023-hernie-incarc%C3%A9r%C3%A9e-comment-l-%C3%A9cho-peut-vous-aider
Before we get into the topic, I would like to remind anyone new to the website:
It's all free, and the goal is to reach any MD who's interested in ultrasound. Feel free to share the website (boss, residents, externs, etc.). The more the merrier.
The website is not searchable. You have to type in the website ( www.capsule-echographie.com ). Afterwards, I suggest you add it to your favorites or create an app on your phone for quick access.
In addition to the capsules that are published every month, there are "permanent" sections.
Nerve Block: From how to manage the equipment to a quick refresher before going to perform a block on the floor. Nerve: median, ulnar, radial, femoral, and ESP.
ETT section with introductions to ARC, valvulopathies and a quiz to practice your eye in estimating the LVF.
How to perform an ultrasound-guided PL, ultrasound-guided venous access, DVT, eye, SSNV and shoulder lux.
everything being updated!
So there you have it, YOLO bar open. And don't hesitate to write to me with any suggestions!
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Hernia
Hey doc, I have a painful bump.
Patient #1:
Patient #2:
Okay, to start, nice! We just made hernia diagnoses. These aren't abscesses, AVMs, lipomas, or even ectopic pregnancies.
Okay now, which one do you think is the most urgent to reduce?
Patient #1 right!? Indeed, the ultrasound shows that it is a hernia with intestinal contents vs. patient #2 who has a hernia with fatty contents!
Now that everything is ready, you begin your reduction. The question now is: where should you orient your reduction vector? Right in the center? Upward? Downward? This is when the echo continues to assist you by identifying the cervix!
Honestly, that one was pretty tight! But hey, now that you know where to make your reduction vector, the odds are in your favor!
Another great case sent to me: Man with NYD scrotal mass. Wide x-ray, non-discriminatory physical exam, transillumination? lol!
Here is the echo:
A cute little spindly loop that crept up to the scrotum! Now the dx is clear as well as the treatment.
For more information on hernia assessment using ultrasound: https://www.capsule-echographie.com/post/capsule-octobre-2023-hernie-incarc%C3%A9r%C3%A9e-comment-l-%C3%A9cho-peut-vous-aider
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Case of the month #1
This case was sent to me yesterday by a colleague. I'll copy and paste the explanation of the case for you:
F77 left pleuritic pain sp coughing fit, possible drunk. Worse when coughing, mobilization and palpation of lower left ribs but slight hCG tenderness as well.
Phew, honestly, a case like we see a lot of. The slight atypicality here being the HCG sensitivity. CXR then discharge? D-dimer? 4-peps? Ultrasound looking for a non-displaced rib fracture?
On both clips, we can identify very hypoechoic areas within the spleen parenchyma. This is splenic infarction! Let me tell you that the management has completely changed following the identification of these images and the subsequent diagnostic confirmation on CT. Good job!
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Case of the month #2
Case submitted by one of my residents: cirrhotic patient with suspected PBS requiring a puncture. As he's taught, he starts by ultrasound-guided the best spot. But iissshhhh. There aren't that many good spots. A lot of floating bowel. He's adamant, and with his experience in in-plane nerve block... why not perform ultrasound-guided ascites puncture?
And there you have it, ezpeezy, as the other one says. Clearly, ascites punctures can generally be performed simply using ultrasound guidance. However, for more complex cases or simply for cases where you want to visualize the needle (and the intestines), performing an ultrasound-guided puncture is a possibility!
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Case of the month #3
Doc, I've had a stomach ache for 3 days, but I couldn't come before because of work.
Well, we're on a streak of gallbladder cases recently, so why not end the capsule with another gallbladder case that could have been easily missed? Here, what's difficult is identifying the gallbladder! The last clip demonstrates the long-axis scan of the gallbladder with, towards the end of the clip, the appearance of the famous portal triad which confirms the location of the VB. Here, the patient is already positioned in the left lateral decubitus position and we identify a stone enclaved in the neck with sludge that completely fills the VB. There is therefore no usual anechoic bile, the sludge being almost isoechoic with the liver.
Ok that's all for this month!
Thanks again to everyone who writes to me!
A+
Will