Weird Symptoms

This patient was in his 70s with the usual litany of diseases and medications. He actually looked quite well. He complained of pain from his R neck to his R flank. The physical exam was not helpful. I had no inkling of what was wrong. I POCUS’ed his carotids/jugulars/CVS/Aorta/Kidneys/liver/spleen/bladder and all looked fine. His GB looked OK from the R FAST view. Since I couldn’t find anything else wrong I looked more closely at the GB. Sure enough it was distended, full of stones, thickened with fluid (see image). Where all seemed confused, history and physical unhelpful, 5 minutes of POCUS gave the diagnosis. I informed the patient and the surgeon, wrote some orders and moved on to the next patient. [Editor’s note: and who says POCUS slows us down! 5 minutes well spent]