Point-of-care ultrasonography role in detecting inferior vena cava thrombosis in a patient with low back pain: a case report

Abstract

A 73-year-old woman arrived at the ER claiming to be experiencing low back pain. To investigate the source of her pain, she was admitted to the Internal Medicine department. After a heterogeneous abdominal mass in the right upper quadrant was discovered by abdominal point-of-care ultrasonography (POCUS), it was confirmed by an abdominal CT scan, which also identified a metastatic lytic bone lesion in the L4. This finding is consistent with a malignant tumor of the right adrenal gland. POCUS was repeated right after the occurrence of dyspnea, and a 40x6 mm floating thrombus in the inferior vena cava was detected. A conservative approach with anticoagulants was chosen, with improvement of the clinical conditions. The diagnosis of adrenal carcinoma was ultimately made possible by the mass biopsy. POCUS is a safe, low-cost method that provides prompt results at the patient's bedside. We support the implementation of POCUS in all clinical departments, as it provides significant contributions to the assessment of prognosis and diagnosis.