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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