Clinical Focus

  • Emergency Medicine

Academic Appointments

Professional Education

  • Residency:Los Angeles County - USC Medical Center (2003) CA
  • Medical Education:Columbia University College of Physicians and Surgeons (1995) NY
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2004)
  • Residency:New York Presbyterian Hospital (1999) NY
  • Residency:University of Florida - Jacksonville Medical Center (1997) FL
  • Internship:Saint Joseph Hospital (1996) CO


2015-16 Courses


All Publications

  • Spontaneous pneumomediastinum on bedside ultrasound: case report and review of the literature. The western journal of emergency medicine Zachariah, S., Gharahbaghian, L., Perera, P., Joshi, N. 2015; 16 (2): 321-324


    Spontaneous pneumomediastinum is a rare disease process with no clear etiology, although it is thought to be related to changes in intrathoracic pressure causing chest pain and dyspnea. We present a case of a 17-year-old male with acute chest pain evaluated initially by bedside ultrasound, which showed normal lung sliding but poor visualization of the parasternal and apical cardiac views due to significant air artifact, representing air in the thoracic cavity. The diagnosis was later verified by chest radiograph. We present a case report on ultrasound-diagnosed pneumomediastinum, and we review the diagnostic modalities to date.

    View details for DOI 10.5811/westjem.2015.1.24514

    View details for PubMedID 25834681

  • Diagnosis of pneumoperitoneum with bedside ultrasound. The western journal of emergency medicine Chao, A., Gharahbaghian, L., Perera, P. 2015; 16 (2): 302-?

    View details for DOI 10.5811/westjem.2014.12.24945

    View details for PubMedID 25834673

  • The diagnosis of right heart thrombus by focused cardiac ultrasound in a critically ill patient in compensated shock. Critical ultrasound journal Jammal, M., Milano, P., Cardenas, R., Mailhot, T., Mandavia, D., Perera, P. 2015; 7: 6-?


    Right heart thrombus (RHT) is a life-threatening diagnosis that is rarely made in the emergency department (ED), but with the increasing use of focused cardiac ultrasound (FocUS), more of these cases may be identified in a timely fashion. We present a case of an ill-appearing patient who had an immediate change in management due to the visualization of RHT soon after arrival to the ED. The diagnosis was confirmed after a cardiology-performed ultrasound (US). This case illustrates the value of the recognition of RHT on FocUS and how US protocols designed for the evaluation of shock and shortness of breath may potentially be expanded to patients in a 'compensated' or 'pre-shock' state to expedite the correct diagnosis and to facilitate more timely management.

    View details for DOI 10.1186/s13089-015-0023-7

    View details for PubMedID 25995832

  • Point-of-care ultrasound in diagnosing pyomyositis: a report of three cases. journal of emergency medicine Kumar, M. P., Seif, D., Perera, P., Mailhot, T. 2014; 47 (4): 420-426


    Pyomyositis is a bacterial infection of skeletal muscle that often results in deep intramuscular abscesses. The absence of external dermatologic manifestations in the early stages of pyomyositis makes this a challenging diagnosis. In addition, physical examination findings can be difficult to distinguish from more common processes, such as soft-tissue cellulitis. Clinicians can fail to diagnose this serious disease in a timely manner, resulting in delayed treatment and potential clinical deterioration from sepsis. Although advanced imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI) provide excellent detail, ultrasound (US) can also be used to detect this disease. US can be performed expeditiously at the bedside and is less expensive than CT or MRI. It allows the clinician to examine the deeper tissue planes of muscle, in which purulent fluid collections will develop as pyomyositis advances.Three patients presenting with leg pain were evaluated with point-of-care (POC) US and diagnosed with pyomyositis. The early diagnosis of this condition prompted rapid treatment with administration of appropriate antibiotics and involvement of orthopedic surgery. Aspiration of fluid allowed for detailed fluid analysis and bacterial cultures. Additional diagnostic imaging was performed, confirming the initial US diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POC US can be helpful in identifying and further delineating intramuscular abscesses and can subsequently lead to expedited and appropriate care in patients who present with extremity pain, but lack significant dermatologic changes.

    View details for DOI 10.1016/j.jemermed.2014.02.002

    View details for PubMedID 24725823

  • Diagnosis of Fournier's Gangrene on Bedside Ultrasound. The western journal of emergency medicine Coyne, C., Mailhot, T., Perera, P. 2014; 15 (2): 122-?

    View details for DOI 10.5811/westjem.2013.10.19476

    View details for PubMedID 24672593

  • The FAST and E-FAST in 2013: Trauma Ultrasonography Overview, Practical Techniques, Controversies, and New Frontiers CRITICAL CARE CLINICS Williams, S. R., Perera, P., Gharahbaghian, L. 2014; 30 (1): 119-?


    This article reviews important literature on the FAST and E-FAST examinations in adults. It also reviews key pitfalls, limitations, and controversies. A practical "how-to" guide is presented. Lastly, new frontiers are explored.

    View details for DOI 10.1016/j.ccc.2013.08.005

    View details for Web of Science ID 000329255600006

  • Cardiac Echocardiography CRITICAL CARE CLINICS Perera, P., Lobo, V., Williams, S. R., Gharahbaghian, L. 2014; 30 (1): 47-?


    Focused cardiac echocardiography has become a critical diagnostic tool for the emergency physician and critical care physician caring for patients in shock and following trauma to the chest, and those presenting with chest pain and shortness of breath,. Cardiac echocardiography allows for immediate diagnosis of pericardial effusions and cardiac tamponade, evaluation of cardiac contractility and volume status, and detection of right ventricular strain possibly seen with a significant pulmonary embolus. This article addresses how to perform cardiac echocardiography using the standard windows, how to interpret a focused goal-directed examination, and how to apply this information clinically at the bedside.

    View details for DOI 10.1016/j.ccc.2013.08.003

    View details for Web of Science ID 000329255600004

    View details for PubMedID 24295841

  • Thoracic Ultrasonography CRITICAL CARE CLINICS Lobo, V., Weingrow, D., Perera, P., Williams, S. R., Gharahbaghian, L. 2014; 30 (1): 93-?


    Thoracic ultrasonography (US) has proved to be a valuable tool in the evaluation of the patient with shortness of breath, chest pain, hypoxia, or after chest trauma. Its sensitivity and specificity for detecting disease is higher than that of a chest radiograph, and it can expedite the diagnosis for many emergent conditions. This article describes the technique of each thoracic US application, illustrating both normal and abnormal findings, as well as discussing the literature. Bedside thoracic US has defined imaging benefits in a wide range of thoracic disease, and US guidance has been shown to facilitate thoracic and airway procedures.

    View details for DOI 10.1016/j.ccc.2013.08.002

    View details for Web of Science ID 000329255600005

    View details for PubMedID 24295842

  • Caval Sonography in Shock A Noninvasive Method for Evaluating Intravascular Volume in Critically III Patients JOURNAL OF ULTRASOUND IN MEDICINE Seif, D., Mailhot, T., Perera, P., Mandavia, D. 2012; 31 (12): 1885-1890

    View details for Web of Science ID 000312237900002

    View details for PubMedID 23197540

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