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Hickam's Dictum Incarnate: A Case of Simultaneous Left-Sided Urolithiasis and Ruptured Iliac Artery Aneurysm
Melissa Bouwsema1, Colin Bell2
1Department of Emergency Medicine, Queen's University Kingston, ON Canada.
Insights
Point-of-care ultrasound (POCUS) aided in the rapid diagnosis of a ruptured iliac artery aneurysm and kidney stones in a patient presenting with groin pain. This highlights POCUS
Area of Science:
- Emergency Medicine
- Vascular Surgery
- Nephrology
Background:
- A 51-year-old male with a history of kidney stones presented with sudden left groin pain and syncope.
- Initial symptoms mimicked previous episodes of renal colic, posing a diagnostic challenge.
Abstract:
A 51-year-old man with a history of nephrolithiasis presented to the Emergency Department after a sudden onset of left-sided groin pain and syncope. At presentation, he described his pain as similar to prior renal colic episodes. At his initial assessment, point of care ultrasound (POCUS) was used, which revealed findings consistent with obstructive renal stones, as well as a substantially enlarged left iliac artery. Computed tomography (CT) imaging confirmed the comorbid diagnoses of left-sided urolithiasis and a ruptured isolated left iliac artery aneurysm. POCUS facilitated expedited definitive imaging and operative management. This case highlights the importance of performing related POCUS studies in reducing anchoring and premature closure bias.
