Table 1 ACUTE ABDOMEN sonographic aproach: findings and techniques
From: ACUTE ABDOMEN systemic sonographic approach to acute abdomen in emergency department: a case series
Pathology | Finding | Technique | |
|---|---|---|---|
A. ACUTE | |||
A | Abdominal aortic aneurysm | Abdominal aortic > 3 cm? | Probe: curvilinear or phased array Scan: long axis and short axis from epigastric till the bifurcation of common iliac |
C | Collapsed inferior vena cave (assessment of patient’s volume status) | IVC collapsing > 50%? | Probe: curvilinear or phased array Scan: subxiphoid long axis, assessing the respiratory dynamics of the IVC |
U | Ulcer (perforated viscus) | Pneumoperitoneum? Direct sign: Increased echogenicity of peritoneal stripe Presence of A lines Indirect sign: Intraperitoneal free fluid Air bubbles in ascetic fluid Thickened bowel loop Bowel or gallbladder thickened wall with ileus | Probe: curvilinear or high frequency linear Scan: epigastrium through the right upper quadrant (RUQ) along the transverse and longitudinal axes |
T | Trauma (free fluid) | Intraperitoneal hypoechoic fluid? | Probe: curvilinear or phased array Scan: right upper quadrant, left upper quadrant, suprapubic Localized free fluid: scan right and left paracolic gutter |
E | Ectopic pregnancy (empty uterus) | Intraperitoneal hypoechoic fluid, empty uterus or extra-uterine gestational sac? | Probe: curvilinear Scan suprapubic long and short axis |
B. ABDOMEN | |||
A | Appendicitis | Non compressible Diameter > 6 mm | Probe: high frequency linear Scan: right lower abdomen |
B | Biliary tract | Cholecystitis: Precystic fluid Sonographic murphy Gallbladder calculi Choledocholithiasis CBD > 6 mm | Probe: curvilinear or phased array Scan: right upper abdomen |
D | Distended bowel loop | Small bowel obstruction? Dilated small bowel loop > 3 cm Back-and-forth movement of spot echoes inside fluid-filled bowel Decrease bowel peristalsis | Probe: curvilinear or high frequency linear Scan: epigastrium, bilateral colic gutters, and suprapubic regions |
O | Obstructive uropathy | Hydronephrosis? Dilated renal calyces Renal stone: acoustic echogenic foci urterovesical junction. | Probe: curvilinear Scan: Longitudinal view Lower intercostal, right: mid axillary line, left: posterior axillary line. |
MEN | Men: testicular torsion | Hypoechoic testis compare to normal Reduce or no perfusion | Probe: high frequency linear Scan: scrotal transverse and longitudinal Doppler |
Women: ovarian torsion | Adnexal mass > 4 cm Pelvic free fluid Reduced blood flow on Doppler | Probe: curvilinear Scan: suprapubic, sagittal and transverse identify uterus, then move right and left | |