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A 35-year-old gravida 8, para 8 female, 6 days post–cesarean section, presented to the emergency department with lower abdominal pain, constipation, and right upper quadrant pain that was sharp and worse with inspiration. The patient also had nausea, vomiting, chills, dysuria, and decreased appetite. The patient stated that she knew something was wrong, because she had never had these symptoms after other deliveries.

A point-of-care right upper quadrant ultrasound exam was done to evaluate for gallbladder pathology (Video Clip S1), but none was found. However, the incidental finding of a mobile mass in the inferior vena cava concerning for thrombus was visualized (Figure 1). The images and video were obtained with a standard curvilinear probe placed on the patient’s abdomen at the midaxillary line along the costal margin with the probe dot (indicator) pointing toward the patient’s head.

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Figure 1.  Screen capture from bedside ultrasound of the right upper quadrant. The large arrow indicates the inferior vena cava. The small arrow indicates a thrombus within the inferior vena cava.

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The patient underwent a computed tomography scan with intravenous contrast of the chest, abdomen, and pelvis (Figure 2), which confirmed a right ovarian vein thrombus extending 11 mm into the inferior vena cava. The patient was started on enoxaparin and admitted to the obstetrical service. This case demonstrates how point-of-care ultrasound can aid in the diagnosis of patients with a myriad of complaints. Point-of-care ultrasound can lead to incidental findings that broaden a differential diagnosis and help guide further evaluation, treatment, and disposition.

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Figure 2.  Image from the computed tomography of the abdomen with intravenous contrast. The arrow shows a thrombus extending into the inferior vena cava.

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Video Clip S1. Bedside ultrasound of the right upper quadrant.

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ACEM_725_sm_VideoClipS1.avi274KSupporting info item

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