Central venous catheterization is a common procedure in the management of critically ill patients, in the context of medical emergencies, and before surgical interventions. Placing a central venous catheter (CVC) in the internal jugular vein (IJV) using anatomical references is associated with a high risk of complications, in particular pneumothorax and arterial puncture. Thus, the placement of CVCs with ultrasound support is recommended by several medical societies and health regulators at the international level. When compared with chest radiography, ultrasound is accessible, safe, cost-effective, and time efficient. This technical report is meant to detail a point-of-care ultrasound protocol designed for the insertion and confirmation of the correct placement of a CVC in the IJV.

Platypnea-orthodeoxia syndrome (POS) is a rare clinical entity characterized by dyspnea and arterial desaturation in the upright position. Hypoxia in POS has been attributed to the mixing of deoxygenated venous with oxygenated arterial blood via a shunt, with patent foramen ovale being the most commonly reported abnormality. A systematic evaluation is necessary to identify the underlying cause and promote an appropriate intervention. Here, we present the case of a 79-year-old female with a new diagnosis of POS during the workup of hypoxemic respiratory failure.

Leptospirosis is a zoonotic infection infrequently reported in non-tropical regions. Although classically described as a biphasic illness, unusual clinical manifestations have been reported, including a previous case of a lung abscess associated with this causative agent. We present the case of a 49-year-old man with a new diagnosis of two liver abscesses associated with leptospirosis.