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