1000127_eus教學_appendicitis & pneumoperitoneum
TRANSCRIPT
Emergency Ultrasound教學
Appendicitis & Pneumoperitoneum
新光醫院急診醫學科
陳國智醫師
中華民國醫用超音波學會指導醫師
Anatomic consideration
Scanning Method
Intraperitoneal free air
• Air
– Echogenic areas +
– Posterior reverberation (ring-down)artifacts
– Shifting phenomenon
• Location
– Epigastric region (Supine)
– Left lateral decubitus position
• Others: echogenic fluid
Pneumoperitoneum
• Echogenic line
• Ring-down artifacts
Intraperitoneal free air
Moriwaki, Y. et al. Arch Surg 2009;144:137-141.
Effect of position change
Supine position L’t lateral decubitus position
Effect of respiration
Inspiration Expiration
L: lung;
P: pneumoperitoneum
Scissors Maneuver
J Clin Ultrasound 2004; 32:381-385 Okkes Ibrahim Karahan, JOURNAL OF CLINICAL ULTRASOUND 2004
EPSS Enhancement of the peritoneal stripe sign
Ashwin Asrani Emerg Radiol 2007
Air but not IPFA
• Air in Lung
• Air in GI tract
• Subcutaneous emphysema
• Chilaiditi syndrome
Sensitivity Specificity PPV NPV accuracy
US 92 53 95 39 88
X-ray 78 53 94 20 76
BJS 2002; 89:351-354 BJS 2002
IPFA by US in Trauma and acute abdomen
Moriwaki, Y. et al. Arch Surg 2009;144:137-141.
Alvarado Score
Graded compression technique
GI tract lesions on sonography
1. 腸胃道壁增厚 (>4mm)
2. 腸胃道壁分層消失
3. 蠕動減少
4. 用超音波探頭壓迫時不變形
5. 病灶通道內容物減少
6. 病灶附近之其他變化(LN, fat, ascites)
Appendicitis
Eur Radiol. 2002;12:1748-61
Landmark of Appendix
• RLQ
– Iliac crest
– Psoas muscle
– Iliac vessels
– Cecum & A-colon
Acute appendicitis
Diameter ≧ 6mm J Ultrasound Med 2006;25:87-97
Appendiceal outer diameter for
appendiceal mucocele VS appendicitis
Lien WC, AJEM (2006) 24, 801–805