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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
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Anatomic consideration
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Scanning Method
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Intraperitoneal free air
• Air
– Echogenic areas +
– Posterior reverberation (ring-down)artifacts
– Shifting phenomenon
• Location
– Epigastric region (Supine)
– Left lateral decubitus position
• Others: echogenic fluid
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Pneumoperitoneum
• Echogenic line
• Ring-down artifacts
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Intraperitoneal free air
Moriwaki, Y. et al. Arch Surg 2009;144:137-141.
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Effect of position change
Supine position L’t lateral decubitus position
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Effect of respiration
Inspiration Expiration
L: lung;
P: pneumoperitoneum
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Scissors Maneuver
J Clin Ultrasound 2004; 32:381-385 Okkes Ibrahim Karahan, JOURNAL OF CLINICAL ULTRASOUND 2004
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EPSS Enhancement of the peritoneal stripe sign
Ashwin Asrani Emerg Radiol 2007
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Air but not IPFA
• Air in Lung
• Air in GI tract
• Subcutaneous emphysema
• Chilaiditi syndrome
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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
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IPFA by US in Trauma and acute abdomen
Moriwaki, Y. et al. Arch Surg 2009;144:137-141.
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Alvarado Score
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Graded compression technique
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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)
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Appendicitis
Eur Radiol. 2002;12:1748-61
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Landmark of Appendix
• RLQ
– Iliac crest
– Psoas muscle
– Iliac vessels
– Cecum & A-colon
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Acute appendicitis
Diameter ≧ 6mm J Ultrasound Med 2006;25:87-97
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Appendiceal outer diameter for
appendiceal mucocele VS appendicitis
Lien WC, AJEM (2006) 24, 801–805