Blog

IOTW 12-07-17

Case

-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?

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Color Flow

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

 

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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

Case

  • 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

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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.