Emergency Ultrasound Course For Radiologists.

1. Emergency Ultrasound Course
Introduction to Bowel ultrasound
By:
Dr/ Ismail Sayed Ismail
Radiologist
is
Great doctor

2. Gut signature

4. From inside outwards :-
1. Echogenic layer > superficial mucosa/interface (epithelium/lamina propria).
2. Hypoechoic layer > Muscularis mucosa.
3. Echogenic layer > Submucosa.
4. Hypoechoic layer > Muscularis propria.
5. Echogenic > Serosa/interface.
1
2
3
5
4

5. • The lamina propria in both the small and large intestine forms the mucosal
immune system.

6. 1-year-old boy with normal lamina propria layer.
• Echogenic fecal matter in appendiceal lumen (L).
• Immediately adjacent to lumen is hypoechoic lamina propria (between long
arrows). Lamina propria measured 0.6 mm in short-axis thickness.
• Note normal echogenic submucosal layer (between short arrows).

7. 12-year-old boy with lymphoid hyperplasia, with false-positive sonogram and
misdiagnosis of acute appendicitis.
• Enlarged appendix with thickened hypoechoic lamina propria (long arrow)
reflecting lymphoid hyperplasia. Appendix measured 7.6 mm in maximum
outer diameter (between calipers).
• Lamina propria layer measured 2.0 mm in short axis thickness. Note
echogenic luminal contents (short arrow).

8. • Appendicitis ( Catarrhal phase).
• PRESERVED Gut signature.
It means preserved definition of gut layers.

9. • Appendicitis ( Gangrenous phase).
• LOST Gut signature.
It means lost definition of gut layers.

10. PRESERVED Gut signature.
It means preserved definition of gut layers.
>> Appendicitis ( Catarrhal phase).
LOST Gut signature.
It means lost definition of gut layers.
>> Appendicitis ( Gangrenous phase).

11. • A case of diverticulitis.
• Mural thickening predominantly affecting Muscularis propria (hypoechoic
layer).

12. • A case of infectious enterocolitis.
• Mural thickening predominantly affecting Submucosa (echogenic layer).

13. Mural thickening predominantly affecting
Muscularis propria (hypoechoic layer).
>> A case of diverticulitis.
Mural thickening predominantly
affecting Submucosa (echogenic layer).
>> A case of infectious enterocolitis.

14. Gut recognition

15. Stomach
• The stomach shows normal gastric rugae (thick elongated folds), less
prominent at distal stomach (pylorus / antrum).
• The collapsed stomach shows variable wall thickness.
StomachPylorus

16. Small intestine
• The small intestine shows valvulae conniventes / plicae circulares (thin
closely spaced folds), less prominent at ileum. These are more easily seen
when there is fluid in the lumen of the bowel or the valvulae are edematous.
• Air within the small intestine usually has smooth continuous appearance.
T. ileum Jejunum

17. Colon
• The large intestine / colon shows colonic haustrations (thick widely spaced
folds), less prominent at cecum.
• Air within the colon usually has bubbly appearance.

18. Sonographic assessment of bowel

19. Static assessment :
• Bowel Wall.
• Inside (Lumen).
• Outside.
Dynamic assessment :
• Peristalsis.
• Compressibility.
• Valsalva.
Comment on :

20. – Present or absent.
– Hyperperistalsis.
– To-and-fro.
Peristalsis

21. – Present or absent.
Compressibility

22. – Particularly in case of hernia.
Valsalva

23. Static assessment :
• Bowel Wall.
• Inside (Lumen).
• Outside.
Dynamic assessment :
• Peristalsis.
• Compressibility.
• Valsalva.

24. • Bowel Wall :
– Thickness.
– Signature.
– Vascularity.
– Mural air ?
Thickness
Mild or marked
Symmetric or asymmetric
Focal or diffuse
Short or long segment

25. • Bowel Wall :
– Thickness.
– Signature.
– Vascularity.
– Mural air ?

26. • Bowel Wall :
– Thickness.
– Signature.
– Vascularity.
– Mural air ?

27. • Bowel Wall :
– Thickness.
– Signature.
– Vascularity.
– Mural air ?

28. Static assessment :
• Bowel Wall.
• Inside (Lumen).
• Outside.
Dynamic assessment :
• Peristalsis.
• Compressibility.
• Valsalva.

29. Static assessment :
• Bowel Wall.
• Inside (Lumen).
• Outside.
Dynamic assessment :
• Peristalsis.
• Compressibility.
• Valsalva.

30. • Inside (Lumen) :
– Normal app.
– Attenuated.
– Dilated.

31. • Inside (Lumen) :
– Normal app.
– Attenuated.
– Dilated.
– Content.
– Intussusception.

32. Static assessment :
• Bowel Wall.
• Inside (Lumen).
• Outside.
Dynamic assessment :
• Peristalsis.
• Compressibility.
• Valsalva.

33. • Outside (mesentery) :
– Echogenic Fat.
– Vascularity.
– Fluid.
– L.N.

35. From inside outwards :-
1. Echogenic layer > superficial mucosa/interface (epithelium/lamina propria).
2. Hypoechoic layer > Muscularis mucosa.
3. Echogenic layer > Submucosa.
4. Hypoechoic layer > Muscularis propria.
5. Echogenic > Serosa/interface.
1
2
3
5
4
Gut signature

36. Gut Recognition

37. Static assessment :
• Bowel Wall.
• Inside (Lumen).
• Outside.
Dynamic assessment :
• Peristalsis.
• Compressibility.
• Valsalva.
Comment on :