Emergency Ultrasound (EUS)教學(12)

急診超音波在兒科急症之應用

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

Clinical application

• Trauma

• Intussusception

• Appendicitis

• Hypertrophic stenosis

• Procedure

• Acute abdomen

Pediatric trauma management algorithm

Dependent compartment

FAST transducer placement

FAST

Normal RUQ View Normal LUQ View

FAST

Normal Subxiphoid View Normal Pelvic View

E-FAST

Doppler – lung sliding M mode - seashore sign

RUQ hemoperitoneum

Hemoperitoneum

Pericardial fluid

Hemo-Pneumothorax

Pediatric FAST & elevated liver transaminases:

an effective screening tool in BAT

Journal of Surgical Research 2009;157: 103–107

IVC/Ao ratio as an objective tool in

assessment for dehydrated children

Acad Emerg Med 2007; 14:841–845

IVC/Ao ratio as an objective tool in

assessment for dehydrated children

AUC: 0.91

Acad Emerg Med 2007; 14:841–845

Sonographic inferior vena cava/aorta diameter index:

a new approach to the body fluid status assessment

IVC/Ao = 0.59

IVC/Ao = 1.02 Reference value for 20-30 years IVC/Ao index: 1.2 ± 2 SD for SD = 0.17

AJEM2008;26:320–325

Sonographic inferior vena cava/aorta diameter index:

a new approach to the body fluid status assessment

Normal appendix

Graded-compression US

• Nocompressible

• Diameter > 6mm

• Appendicolith

• Pericecal or

periappendiceal fluid

• Enlarged mesenteric

LN

Appendicitis

Appendicitis

Intussuception

Pseudokidney sign Donut sign

Intussusception

• Peak: 5-10 months, up to 3 years

• s/s:

– Cramping abdominal pain

– Irritability

– Vomiting

– Bloody stool

Intussusception

Intussusception

Doughnut sign Ileoileal intussuscuption (6 m/o infant)

Tiao MM, et al. AEM 2001;8:368-373

• SBI

• 2-3-cm sized, short,

doughnut-like lesion

• Left abdomen or

paraumbilical region

Crescent-in-doughnut sign Ileoileal intussuscuption (7 y/o boy)

Tiao MM, et al. AEM 2001;8:368-373

mesentery

Multiple-concentric-rings sign ideopathic jejunojejunal intussuscuption (4 y/o boy)

Tiao MM, et al. AEM 2001;8:368-373

Ileocolic intussusception

Crescent-in-doughnut sign Target (multiple concentric rings) sign

Sandwich (pseudokidney sign) Hay-fork sign

Small-bowel intussusception

Double target sign Pseudokidney sign Double target sign

US-guided hydrostatic reduction

Post-reduction-doughnut sign Edematous ileocecal valve

Ko HS, et al. European Radiology (2007)

Triple-circle appearance

(Double intussusception)

Bladder Imaging

Bladder diameter 2cm urine 2.5 cm3

US can improve urine collection

AJEM 2008; 26:18–23

Mimickers of appendicitis

Mesenteric adenitis

8-year-old girl

RLQ pain

Fever

Crohn’s disease

13-year-old boy

RLQ pain

Fever

Thickened terminal ileum

Sonography of the acute

abdomen in the pediatirc patient

Necrotizing enterocolitis

Small bowel obstruction

Malrotation

Midgut Volvulus

Whirlpool Sign

Inguinal hernia

Normal testes with hydrocele

Acalculous cholecystitis

Gallstones

Point-of-care ultrasound diagnosis of

pediatric cholecystitis in the ED

AJEM 2010;28: 338–342 Wall: 3mm; CBD: 3mm

Pyelonephrosis

Acute pancreatitis

Mesenteric adenitis

Hemorrhagic ovarian cyst

Ovarian torsion

Constipation

Pylorus

Hypertrophic pyloric stenosis

Antral nipple sign

MWT > 3mm

Muscle Wall Thickeness

Referred pain

New applications

Bedside Limited Echocardiography by the EP Is

Accurate During Evaluation of the Critically Ill Patient

Pediatrics 2004;114:e667–e671.

Positioning for Lumbar Puncture in Children

Evaluated by Bedside Ultrasound

Pediatrics 2010;125:e1149–e1153

Use of bedside ultrasonography for endotracheal

tube placement in pediatric patients

Pediatrics 2007;120;1297-1303

Bedside ultrasonography to identify

hip effusions in pediatric patients

Ann Emerg Med. 2010;55:284-289

The Utility of Bedside Ultrasonography in Identifying

Fractures and Guiding Fracture Reduction in Children

Pediatr Emer Care 2009;25: 221Y225

The Utility of Bedside Ultrasonography in Identifying

Fractures and Guiding Fracture Reduction in Children

Pediatr Emer Care 2009;25: 221Y225

Bedside US changed management of

pediatric soft tissue infection

Management changed: 11/50 The Journal of Emergency Medicine, 2009

Optic nerve sheath diameter

• ONSD

– 3mm behind the globe

– Adult: 5mm

– Child

• > 1 y/o : 4.5mm

• < 1 y/o 4.0mm

Br. J. Ophthalmol. 2002;86;1109-1113

The sensitivity and specificity of bedside sonographic

measurement of ONSD is inadequate children with

suspected IICP

Ann Emerg Med. 2009;53:785-791

Ultrasound allows physicians to

visualize peripheral veins of young

children in the ED

WestJEM. 2008;9:219-224