While ED doctors were scanning their patient’s inferior vena cava, something unexpected in the man’s stomach caught their attention: a tangle of parasitic worms undulating on ultrasound.

The 20-year-old presented to ED with one day of abdominal pain, vomiting and diarrhoea but no significant medical history.

On palpation, the abdomen was soft and non-tender; however, his haemoglobin level (195g/L, normal: 120-150) and WCC (20.8 x 10⁹/L, normal: 4-11 x 10⁹/L) were both elevated.

“A point-of-care ultrasound examination of the inferior vena cava was performed to assess the patient’s intravascular fluid status,” the doctors wrote in the New England Journal of Medicine.