1000324_journal, cases, test and workshop (dops)
TRANSCRIPT
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Journal, Cases, Test,
and Workshop (DOPS)
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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Flexed
positioning
increased space
between the
lumbar spinous
process
AEM 2011; 18:215–218
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72F with one day chest pain and
SOB, Hx of lung ca
No obvious pericardial effusion on parasternal long axis view AEM, 2011 Mar
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72F with one day chest pain and
SOB, Hx of lung ca
Large loculated pericardial effusion on subxyphoid view AEM, 2011 Mar
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72M, abdominal pain for 3 hours
with shock
No obvious subphrenic free air AEM, 2011 Mar
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72M, abdominal pain for 3 hours
with shock
Free fluid Dirty ascites with fibrin and free air
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52M, Chest pain and syncope (BP 73/45; HR 120; SpO2 82% on mask)
McConnell’s Sign
AEM, 2011 Mar
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52M, Chest pain and syncope (BP 73/45; HR 120; SpO2 82% on mask)
right popliteal vein thrombus AEM, 2011 Mar
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52M, Chest pain and syncope (BP 73/45; HR 120; SpO2 82% on mask)
AEM, 2011 Mar 2 days after thrombolysis
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Basic (B-Mode)
Two-Dimensional Ultrasound Image
N Engl J Med 2011;364:749-57
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Basic (B-Mode)
Two-Dimensional Ultrasound Image
N Engl J Med 2011;364:749-57
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Point-of-Care Ultrasonography
• Procedural guidance – Static versus Dynamic
• Diagnostic assessment – Focused, limited, goal-directed
– FAST • Free fluid in peritoneal, pelvic, pericardial , and pleural cavity,
and PTX
– Pulmonary ultrasonography • PTX
• Alveolar interstitial syndrome
• PLE
– Screening • AAA
N Engl J Med 2011;364:749-57
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US guidance for procedures
N Engl J Med 2011;364:749-57
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US guidance for procedures
N Engl J Med 2011;364:749-57
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Vascular access
N Engl J Med
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SKH-ED Cases
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53M, RLQ pain
Appendicitis
• 1: terminal ileum
• 2: blind-end tubular
structure
(Appendicitis)
• EUS: 確認landmark
and anatomy,然後找cecum, IC valve,
terminal ileum,接著appendix
2
1
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25M, right thigh redness and fever for 5 days
Left thigh cellulitis with lymphadenopathy
• 1. femoral vessels with complete collapse
• 2. lymphadenopathy
• 3. increase echogenecity of soft tissue
• EUS: 排除venous thrombosis and abscess formation
1
2
3
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30F, LLQ pain for days Crohn’s disease with fistula formation
• * fistula between two
loops
• EUS:
– Skipped and
segmental small wall
thickening
– Dirty ascites and ileus
– 腹痛及ileus,找造成ileus的原因
B
B *
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88F, bloody stool and nonspecific abdominal pain
Ischemic colitis
• EUS
– Long segment D and
S colon wall edema &
decreased flow
– Patent proximal SMA
– 血便 & 腹痛,懷疑大腸病變,故進行EUS掃描協助臨床決策
Psoas muscle
D-colon
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78M, fever and chills for 2 days
Liver abscess
• * abscess
• + CBD
• EUS
– 尋找腹腔內感染源,先從solid organ著手,再來就是biliary and
urinary system,接著腹腔內及後腹腔,不要忘了雙側的diaphragm
之上
*
+
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34F, RLQ pain with bulging mass
Mesenteric hernia
• * no bowel content
• Between arrow:
peritoneum defect
• EUS
– 確認有無incarcerated
hernia
*
UB
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37M, sudden and sever epigastric pain
PPU
• Echogenic
enhancement of
peritoneum & comet
tail artifact along liver
surface =
pneumoperitoneum
• EUS
– 因Sitting CXR: no free
air,但PE高度懷疑故進行EUS掃描
*
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61M, with left flank pain and dislodged PCN
Obstructive uropathy
• * isoechoic mass
located over proximal
ureter
• Mild hydronephrosis
• EUS
– 確認有hydronephrosis,方便泌尿科進行PCN放置
*
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15M, left swollen scrotum 6 hours after voiding
Testicular torsion
• * swollen left testis
with decreased
echogenecity (and
enlarged epididymis +
fluid); and no internal
flow signal
* R
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Test
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Q1. 請由左至右描述圖片中的發現?
1 2 3 4
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Q2. 30歲男性,肚臍周圍紅腫一週,
請問影片中的發現為何 ?
1. Abscess
2. Cellulitis
3. Necrotizing fasciitis
4. Hematoma
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Q3. 21歲男性,左側胸痛1小時,
根據影片,診斷應為下列何者 ?
1. Empyema
2. Pneumothorax
3. Pneumonia
4. Pulmonary embolism
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Q4. 45歲男性,右腿腫痛2天,
請問根據影片,診斷為何 ?
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Q5. 50歲男性,右大腳疼痛,
請問影片中的異常為何 ?
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Workshop Test
• FAST
• Pneumothorax
• Abdominal aorta scan & measurement
• Bilateral kidneys and bladder scan
• Identify and mark internal jugular vein
• Demonstrate DVT scan (popliteal vein)
• Find gallbladder
• US machine function (at least 3)