IOTW 12-07-17


-23 yo M presents with RLQ abdominal pain
-CT abdomen with contrast ordered by primary team to r/o appy
-Upon further questioning, the pain is actually in RUQ as well
-Which CT should we order? With or without contrast??
-Let’s do an ultrasound!

What do you think?



Color Flow

There is no color flow, which means this is hydronephrosis!




Ultrasound Saves the Day!

The patient’s CT was changed to “without contrast” due to the likelihood of nephrolithiasis.
-Official CT read:
-Edematous right kidney with perinephric stranding. Mild right hydronephrosis caused by 2 mm stone that probably recently passed into the urinary bladder.
-2 mm nonobstructive stone in the upper pole of the right kidney.
-The patient’s ED course was altered by ultrasound!


Renal US Pearls

-Curvilinear probe
-Always do a full renal US exam, including right and left long and short views, and bladder long and short view
-Start with the unaffected side
-If you see a cyst, measure it and put on color flow
-Abdominal exams change- always do them serially!

IOTW 01-01-18

You can also click on the powerpoint to view videos
Powerpoint –> IOTW 1-1-18


  • 36 yo F presents to ED for abdominal pain. Abdominal pain is located in the RUQ and LLQ. Associated with one episode of diarrhea in the morning and emesis.
  • ED team requested a RUQ sono to assess for biliary pathology
  • During the exam, the patient asked “ Can you look here where it’s REALLY hurting?” and pointed to LLQ





Small Bowel Obstruction On Ultrasound?


Criteria of SBO

  • dilated bowel loop (diameter > 2.5 cm)
  • bowel wall thickening > 3mm
  • fluid-filled distended bowel with extra luminal free fluid between bowel loops
  • Back and forth peristalsis
  • May see transition point


What happened to the patient:

  • Patient was found to have an SBO on CT scan. She went to the OR for an emergent ex-lap and was found to have frank pus in her abdomen without any signs of perforation.