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Ultrasound in
Abdominal
Emergencies
Dr/Ahmed Bahnassy
Consultant Radiologist
Riyadh Military Hospital
The acute abdomen
The acute abdomen is a medical term
used to describe a patient who presents
with sudden onset of severe ...
Ultrasound is a well-established imaging
modality for evaluating the abdomen, as it
is noninvasive, portable, readily
obta...
The biliary tract
The most common cause of acute right upper quadrant
(RUQ) pain in adults is acute cholecystitis. Ultraso...
The two most important
diagnostic criteria for the
diagnosis of acute cholecystitis
on ultrasound examination are
the pres...
gall stones Dx
sitting position
decubitus
duodenal gas
Tissue Harmonic imaging THI
Complicated cholecystitis
perforated
cholecystitis
Gangrenous cholecystitis
sloughed
membranes
HIV cholangiopathy. hepatitis
Thickening of the gallbladder wall and the presence of peri-cholecystic fluid
are secondary ...
Perforated DU +abnormal GB
As acute cholecystitis is an obstructive
process, the gallbladder also typically is
distended.
Hence, a careful search sho...
Acalculous Cholecystitis
Emphysematous cholecystitis
Emphysematous cholecystitis
Xanthogranulomatous
Cholecystitis
Choledocholithiasis
Biliary colic should be suspected in patients
with acute RUQ pain who are found to
have small-to-tiny ...
The sensitivity of ultrasound in detecting
choledocholithiasis has been reported to
range from 70% to 89% in experienced
h...
Decubitus or right posterior oblique views can be very helpful in
evaluating the distal common bile duct. Note obstructing...
Liver abscess
• On ultrasound, a liver abscess most
commonly appears as a complex cystic
mass with an irregular, shaggy bo...
hepatitis stage can manifest
only by
decreased echogenicity
Gray scale image demonstrating a complex hypoechoic
cystic lesion in the liver (calipers). Echogenic material with
dirty d...
Focal liver lesions
• Occasionally patients who have metastatic liver
disease may present with acute RUQ pain.
• In patien...
Mets
• Hepatic adenomas, hepatocellular
carcinomas (HCCs), and vascular
metastases are the liver masses most
prone to hemorrhag...
Hepatic subcapsular haematoma
• Spontaneous hemorrhage or rupture has
been estimated to occur in up to 10% of
HCCs .
• An echogenic rind surrounding the...
Ruptured HCC
Pancreas
• It may be difficult to visualize the pancreas in the
setting of acute pancreatitis because of
shadowing from ov...
Acute pancreatitis
swollen hypoechoic pancreas
normal size
Oblique view through the right flank in a patient with upper abdominal
pain reveals fluid in the peri-renal space and para...
peripancreatic/perirenal fluid
Acute fluid collection/pseudocyst.
Value of twinkle artefact
value of ureteric jet
Renal colic
calculus and hydronephrosis
UV junction stone with
hydronephrosis
Pyonephrosis
Acute pyelonephritis
size
parenchyma
thickness
Pyelonephritis+GB wall thickening
Renal abscess
Emphysmatous pyelonephritis
Renal infarct
power
doppler
haemorrhage on AML/RCC
Perinephric haematoma
Adrenal haemorrhage
Spontaneous non traumatic splenic
rupture
use doppler..
haematoma is flow void !
Splenic infarction
Splenic abscess
Ruptured AAA
Abdominal aortic dissection
intimal
flap
Acute appendicitis
dilated,uncompressible,aperistaltic,blind ended bowel loop>6mm
Appendicolith
Perforated appendicitis
Acute diverticulitis
Typhlitis/ascending colitis
Pseudomembranous colitis
Small bowel obstruction
Intussusception
Free air
Ectopic pregnancy pillars of
diagnosis
Ectopic pregnancy variability
Interstitial ectopic
Haemorrhagic corpus luteal cyst
Haemorrhagic corpus luteal cyst
Pelvic inflammatory disease
Fitz-Hugh-Curtis
syndrome
Ovarian torsion
Rectus shealth haematoma
Subphrenic abscess
Pneumonia
air bronchogram
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
Ultrasound in abdominal emergencies
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Ultrasound in abdominal emergencies

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Lectures describing variable diagnosis of acute abdomen with technical hints

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Ultrasound in abdominal emergencies

  1. 1. Ultrasound in Abdominal Emergencies Dr/Ahmed Bahnassy Consultant Radiologist Riyadh Military Hospital
  2. 2. The acute abdomen The acute abdomen is a medical term used to describe a patient who presents with sudden onset of severe abdominal pain sometimes accompanied by nausea, vomiting, diarrhea, abdominal distension, and even hypotension or shock.
  3. 3. Ultrasound is a well-established imaging modality for evaluating the abdomen, as it is noninvasive, portable, readily obtainable, relatively inexpensive, and without the risks of ionizing radiation or iodinated intravenous contrast. In addition, ultrasound has extremely high diagnostic accuracy in many clinical scenarios equivalent or even superior to CT .
  4. 4. The biliary tract The most common cause of acute right upper quadrant (RUQ) pain in adults is acute cholecystitis. Ultrasound largely has replaced scintigraphy (HIDA scan) as the initial imaging modality of choice for evaluating patients with clinical suspicion of acute cholecystitis, Furthermore, ultrasound has the additional advantages of being able to demonstrate potential complications of acute cholecystitis, such as perforation and gangrene, and the potential to identify nonbiliary causes of RUQ pain.
  5. 5. The two most important diagnostic criteria for the diagnosis of acute cholecystitis on ultrasound examination are the presence of gallstones and a positive sonographic Murphy's sign. In combination, these two findings have been shown by Ralls and colleagues to have a positive predictive value of 92% . Acute Cholecystitis
  6. 6. gall stones Dx sitting position decubitus duodenal gas
  7. 7. Tissue Harmonic imaging THI
  8. 8. Complicated cholecystitis perforated cholecystitis
  9. 9. Gangrenous cholecystitis sloughed membranes
  10. 10. HIV cholangiopathy. hepatitis Thickening of the gallbladder wall and the presence of peri-cholecystic fluid are secondary findings of acute cholecystitis on ultrasound examination, but are neither sensitive nor specific
  11. 11. Perforated DU +abnormal GB
  12. 12. As acute cholecystitis is an obstructive process, the gallbladder also typically is distended. Hence, a careful search should be made for an obstructing stone in either the cystic duct or the neck of the gallbladder
  13. 13. Acalculous Cholecystitis
  14. 14. Emphysematous cholecystitis
  15. 15. Emphysematous cholecystitis
  16. 16. Xanthogranulomatous Cholecystitis
  17. 17. Choledocholithiasis Biliary colic should be suspected in patients with acute RUQ pain who are found to have small-to-tiny gallstones in a nondistended gallbladder but no sonographic Murphy's sign, gallbladder wall thickening, or peri-cholecystic fluid
  18. 18. The sensitivity of ultrasound in detecting choledocholithiasis has been reported to range from 70% to 89% in experienced hands . Images should be obtained in supine, semierect, left posterior oblique (LPO) and right posterior oblique (RPO) positions using multiple scanning planes .
  19. 19. Decubitus or right posterior oblique views can be very helpful in evaluating the distal common bile duct. Note obstructing echogenic stone (arrow) in the dilated (1.5 cm) distal common bile duct (calipers).
  20. 20. Liver abscess • On ultrasound, a liver abscess most commonly appears as a complex cystic mass with an irregular, shaggy border that demonstrates increased through transmission use tissue harmonic imaging
  21. 21. hepatitis stage can manifest only by decreased echogenicity
  22. 22. Gray scale image demonstrating a complex hypoechoic cystic lesion in the liver (calipers). Echogenic material with dirty distal shadowing represents air in the abscess look indifferent angles to avoid impedance from gas
  23. 23. Focal liver lesions • Occasionally patients who have metastatic liver disease may present with acute RUQ pain. • In patients who have diffuse metastatic disease, the pain likely is caused by swelling of the liver and stretching of the liver capsule . • Hemorrhage into a liver mass or metastasis, however, also may cause acute RUQ pain. Subcapsular hematomas or free intraperitoneal hemorrhage also may occur following rupture a liver mass.
  24. 24. Mets
  25. 25. • Hepatic adenomas, hepatocellular carcinomas (HCCs), and vascular metastases are the liver masses most prone to hemorrhage. • The risk of rupture is related to size and location, with larger size and subcapsular location being risk factors. • subcapsular hematoma will appear as a crescentic-shaped area The mass is typically heterogenous in echotexture.
  26. 26. Hepatic subcapsular haematoma
  27. 27. • Spontaneous hemorrhage or rupture has been estimated to occur in up to 10% of HCCs . • An echogenic rind surrounding the liver has been described as a common finding in this clinical scenario, representing either acute hemoperitoneum or subcapsular hematoma .
  28. 28. Ruptured HCC
  29. 29. Pancreas • It may be difficult to visualize the pancreas in the setting of acute pancreatitis because of shadowing from overlying bowel gas and guarding on examination. In addition, such patients are typically NPO, and therefore, the stomach cannot be filled with fluid to provide an improved acoustic window. Placing the patient in the RPO or right decubitus position often will improve visualization of the pancreas, as air in the duodenum and antrum of the stomach will rise to the fundus on the left, and the antrum and duodenum will fill with fluid, providing a better acoustic window. tech.hint
  30. 30. Acute pancreatitis swollen hypoechoic pancreas normal size
  31. 31. Oblique view through the right flank in a patient with upper abdominal pain reveals fluid in the peri-renal space and para-renal space. Note hypoechoic, thickened para-renal fat linear, hypoechoic plane between the pancreas (P) and splenic vein/portal confluence .
  32. 32. peripancreatic/perirenal fluid
  33. 33. Acute fluid collection/pseudocyst.
  34. 34. Value of twinkle artefact
  35. 35. value of ureteric jet
  36. 36. Renal colic calculus and hydronephrosis
  37. 37. UV junction stone with hydronephrosis
  38. 38. Pyonephrosis
  39. 39. Acute pyelonephritis size parenchyma thickness
  40. 40. Pyelonephritis+GB wall thickening
  41. 41. Renal abscess
  42. 42. Emphysmatous pyelonephritis
  43. 43. Renal infarct power doppler
  44. 44. haemorrhage on AML/RCC
  45. 45. Perinephric haematoma
  46. 46. Adrenal haemorrhage
  47. 47. Spontaneous non traumatic splenic rupture use doppler.. haematoma is flow void !
  48. 48. Splenic infarction
  49. 49. Splenic abscess
  50. 50. Ruptured AAA
  51. 51. Abdominal aortic dissection intimal flap
  52. 52. Acute appendicitis dilated,uncompressible,aperistaltic,blind ended bowel loop>6mm
  53. 53. Appendicolith
  54. 54. Perforated appendicitis
  55. 55. Acute diverticulitis
  56. 56. Typhlitis/ascending colitis
  57. 57. Pseudomembranous colitis
  58. 58. Small bowel obstruction
  59. 59. Intussusception
  60. 60. Free air
  61. 61. Ectopic pregnancy pillars of diagnosis
  62. 62. Ectopic pregnancy variability
  63. 63. Interstitial ectopic
  64. 64. Haemorrhagic corpus luteal cyst
  65. 65. Haemorrhagic corpus luteal cyst
  66. 66. Pelvic inflammatory disease Fitz-Hugh-Curtis syndrome
  67. 67. Ovarian torsion
  68. 68. Rectus shealth haematoma
  69. 69. Subphrenic abscess
  70. 70. Pneumonia air bronchogram

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