Table 3.

Case reports depicting POCUS contribution to the diagnosis and management of septic patients.

1st Author, Year, Country	Patient’ s Symptoms/Clinical Status on ED Presentation	Management and POCUS Findings	Final Diagnosis
Alhabashy, 2018, Egypt [23]	63 yo female with CAP	3 L fluids failed to improve hypoperfusion Addition of vasopressors failed to control septic shock ECHO showed AHFREF with severe aortic stenosis and mitral regurgitation	AHFREF with severe aortic stenosis and mitral regurgitation
Alonso et al., 2017, UK [24]	60-yo female, 3-day left leg pain, treated for suspected cellulitis	RUSH: severely decreased LVEF, no pericardial effusion, IVC diameter 1.2 cm with total inspiratory collapse, no free abdominal fluid MSK POCUS of left inner thigh consistent with necrotizing fasciitis	Necrotizing fasciitis
Alonso et al., 2019, UK [25]	70-yo female with diarrhea, vomiting for 1 week	Initial working diagnosis was sepsis secondary to gastroenteritis and prerenal acute kidney injury Remained hypotensive and oliguric after 2 L of IV fluids POCUS showed moderate hydronephrosis of the right kidney	Obstructive stone causing moderate right-sided hydronephrosis
Cohen et al., 2020, USA [26]	26-yo female, intravenous drug user, agitated	POCUS: hyperdynamic LV, IVC collapse > 50%, large tricuspid valve vegetation Based on labs and ECG changes, differential diagnosis included endocarditis due to Staphylococcus, septic pulmonary embolism, and STEMI due to embolic occlusion of the distal left anterior descending artery	Myocardial infarction caused by endocarditis-related septic embolization
Derr et al., 2012, USA [27]	69-yo male, hematemesis	POCUS: heart could not be visualized in the parasternal, apical or subxiphoid windows (suggesting pneumopericardium), free fluid and particulate matter were visualized in chest and abdomen	Esophageal perforation
Gibbons et al., 2018, USA [28]	40-yo female in severe sepsis, flank pain	POCUS: large calculus and severe hydronephrosis of the left kidney with complete loss of normal renal architecture	Xanthogranulomatous pyelonephritis
Hill et al., 2021, USA [29]	5-yo male, 2 days febrile, cough, rhinorrhea, pruritus, decreased appetite	Metabolic acidosis with hypoxemia. CXR radiopacity of the entire left hemithorax consistent with a massive pleural effusion POCUS: preserved LVEF, collapsing IVC consistent with septic shock, pleural effusion, multiple B-lines, subpleural consolidation in the right hemithorax, and complex, double-layered structure in the left hemithorax containing hypo- and hyper-echoic regions, floating in heterogeneous fluid POCUS guided proper management of septic and anaphylactic shock	Ruptured pulmonary hydatid cyst
Kinas et al., 2018, USA [30]	34-yo male, after smoking crystal methamphetamine Symptoms: palpitations, dyspnea, cough with one episode of hemoptysis	Initial resuscitation aiming at treating his tachycardia with a mixed picture of sepsis, dehydration and methamphetamine intoxication POCUS: IVC diameter 1.85 cm (maximum) in inspiration and 1.71 cm (minimum) in expiration, heart with gross biatrial and biventricular dilation, severely reduced LVEF, small pericardial effusion, lungs with bilateral lung sliding anteriorly, B-lines in bilateral inferolateral lung fields	Methamphetamine-associated cardiomyopathy
Kotlarsky et al., 2016, Israel [31]	ROS included pediatric patients with septic arthritis of the hip joint	All patients were treated with aspiration of the hip joint in the ED, with repeated aspirations as needed POCUS was used to diagnose hip joint effusion and guide aspiration, with the first one performed in the ED	Septic arthritis of the hip joint
Perez et al., 2021, USA [32]	79-yo male, with a medical history of DM, hypertension, CAD, febrile, mild dyspnea, chills, myalgias, arthralgias for the past 2 days.	MSK examination was remarkable for slight tenderness on palpation of the anterior and lateral aspect of his right shoulder MSK POCUS identified a distended, hypoechoic subdeltoid bursa, along with a communicating glenohumeral joint effusion US-guided needle aspiration of the right subdeltoid bursa was performed and the fluid analysis and culture revealed MRSA	Glenohumeral joint septic arthritis and subdeltoid septic bursitis
Romano et al., 2016, Canada [33]	61-yo female with rheumatoid arthritis, Sjogren syndrome, presented with confusion, decreased LOC, 2 weeks of productive cough, fatigue, mild dyspnea in the last 24 h	Portable CXR demonstrated an extensive heterogeneous and poorly defined right middle lobe consolidation Lung POCUS: complex loculated pleural effusion in the right posterolateral region suggestive of empyema	(Unsuspected) empyema in a patient being treated for CAP
Varela et al., 2019, Portugal [34]	77-yo male suffering from acute dyspnea, 1 week of malaise, nausea, vomiting	Fluids failed to improve blood pressure, CXR was clear POCUS: heterogeneous liver mass, pointing towards liver abscess as the cause of septic shock	Liver abscess

Abbreviations: AHFREF = Acute heart failure with reduced ejection fraction; CAD = Coronary artery disease; CAP = Community-acquired pneumonia; CXR = Chest x-ray; DM = Diabetes mellitus; ECG = Electrocardiogram; ECHO = Echocardiography; ED = Emergency department; IV = Intravenous; IVC = Inferior vena cava; LOC = Level of consciousness; LV = Left ventricle; LVEF = Left ventricular ejection fraction; MRSA = Methicillin-resistant Staphylococcus aureus; MSK = Musculoskeletal; POCUS = Point-of-care ultrasound; ROS = Retrospective observational study; RUSH = rapid ultrasound in shock; STEMI = ST-elevation myocardial infarction; US = Ultrasound; yo = Years old.