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Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
Not All Leg Swelling Is Volume Overload: Point-of-Care Ultrasound and Sirolimus-Associated Lymphedema After Combined
1Stanford Hospital and Clinics, Department of Nephrology Palo Alto California USA.
Abstract:
A 65-year-old man, one year post combined heart-kidney transplant, presented with acute kidney injury, dyspnea, and progressive leg edema unresponsive to escalating diuretics. Despite suspicion for volume overload, multi-organ point-of-care ultrasound (POCUS) revealed bilateral A-lines without B-lines or effusions, a small collapsible inferior vena cava, and preserved biventricular function, all inconsistent with cardiogenic congestion. The edema was attributed to sirolimus-associated lymphedema. Diuretic cessation and transition from sirolimus to everolimus improved renal function. This case illustrates the utility of integrated multi-organ POCUS in challenging assumptions about volume status and underscores the importance of contextualizing findings across multiple sonographic windows.
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