Search

A 54-year-old robust man presented to the emergency department with sudden onset, sharp, left flank pain, radiating to the epigastrium which began several hours before arrival. He was in a good state of health until 1 week before when he developed pulsatile left lower chest pain. On physical examination, the patient was conscious, afebrile, with pulse rate of 84 beats/min and blood pressure of 150/105 mm Hg. His abdomen was soft but tender over left …

Background/aimsTo assess changes in optic nerve sheath diameter (ONSD) at high altitude and in acute mountain sickness (AMS).MethodsCochrane Library, EMBASE, Google Scholar and PubMed were searched for articles published from their inception to 31st of July 2020. Outcome measures were mean changes of ONSD at high altitude and difference in ONSD change between subjects with and without AMS. Meta-regressions were conducted to investigate the relation of ONSD change to altitude and time spent at that altitude.ResultsEight studies with 248 participants comparing ONSD from sea level to high altitude, and five studies with 454 participants comparing subjects with or without AMS, were included. ONSD increased by 0.14 mm per 1000 m after adjustment for time (95% CI: 0.10 to 0.18; p2=89.4%).ConclusionOur analysis shows that ONSD changes correlate with altitude and tend to increase in subjects with AMS. Small study number and high heterogeneity are the limitations of our study. Further large prospective studies are required to verify our findings.

Case presentationA 57-year-old man was in a healthy state until 6 hours before presenting to the emergency department, when he suffered from more than 10 episodes of vomiting after a large meal at lunchtime. On physical examination, vital signs were unremarkable. Tenderness was noted over the epigastrium on palpation. Point-of-care ultrasound (POCUS) of the abdomen is shown in figure 1 and online supplementary video 1.Supplementary videoFigure 1Transverse (A) and longitudinal (B) ultrasonography of the epigastrium.QuestionWhat is the most likely diagnosis?Hypertrophic pylorus stenosisAortic dissectionSuperior mesentery artery (SMA) syndromeVolvulusFor answer see page 2