1001108_Diverticulitis & Pneumoperitoneum@‰

download 1001108_Diverticulitis & Pneumoperitoneum@‰

of 60

  • date post

    07-Apr-2018
  • Category

    Documents

  • view

    216
  • download

    0

Embed Size (px)

Transcript of 1001108_Diverticulitis & Pneumoperitoneum@‰

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    1/60

    Diverticulitis &

    Pneumoperitoneum

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    2/60

    Pneumoperitoneum

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    3/60

    : ?

    1 2

    3 4

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    4/60

    Anatomic consideration

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    5/60

    Scanning Method

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    6/60

    :

    ?1.

    2. X-ray

    3. X-ray

    4.

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    7/60

    Intraperitoneal free air

    Air

    Echogenic areas +

    Posterior reverberation (ring-down)artifacts

    Shifting phenomenon

    Location

    Epigastric region (Supine)

    Left lateral decubitus position

    Others: echogenic fluid

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    8/60

    Pneumoperitoneum

    Echogenic line

    Ring-down artifacts

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    9/60

    Intraperitoneal free air

    Moriwaki, Y. et al. Arch Surg 2009;144:137-141.

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    10/60

    Effect of position change

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    11/60

    Effect of respiration

    L: lung;P: neumo eritoneum

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    12/60

    Scissors Maneuver

    J Clin Ultrasound 2004; 32:381-385Okkes Ibrahim Karahan, JOURNAL OF CLINICAL ULTRASOUND 2004

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    13/60

    EPSSEnhancement of the peritoneal stripe sign

    Ashwin Asrani

    Emerg Radiol 2007

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    14/60

    Air but not IPFA

    Air in Lung

    Air in GI tract

    Subcutaneous emphysema Chilaiditi syndrome

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    15/60

    Sensitivity Specificity PPV NPV accuracy

    US 92 53 95 39 88

    X-ray 78 53 94 20 76

    BJS 2002; 89:351-354BJS 2002

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    16/60

    IPFA by US in Trauma and acute abdomen

    Moriwaki, Y. et al. Arch Surg 2009;144:137-141.

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    17/60

    Case 1

    18M, Severe epigastralgia

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    18/60

    Case 1

    18M, Severe epigastralgia

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_18m_16452446_Easy/PPU_18m_16452446.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    19/60

    Case 2

    37M with severe epigastralgia

    CC: sudden onset of

    severe epigastric pain

    followed nausea and

    vomiting PE: painful

    expression; epigastric

    muscle guarding

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_37M_14320707/1.mpg
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    20/60

    Case 3

    40M, epigastric pain for one day

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_40M_15744015_%E5%9B%9B%E8%99%95%E9%83%BD%E6%9C%89Air/PPU_40M_15744015.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    21/60

    Case 4

    46F, epigstric pain

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    22/60

    Case 4

    46F, epigstric pain

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_46F_15867957_Easy/PPU_48F_15867957.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    23/60

    Case 5

    55M, Epigastric pain & guarding

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    24/60

    Case 5

    55M, Epigastric pain & guarding

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_55M_13397476_%E6%9E%97%E5%95%9F%E6%BA%90_%E8%B6%85%E9%9B%A3/PPU_1.wmvhttp://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_55M_13397476_%E6%9E%97%E5%95%9F%E6%BA%90_%E8%B6%85%E9%9B%A3
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    25/60

    Case 6

    56M, severe epigastralgia

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_56M_11329022_Tract/PPU_56M_11329022.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    26/60

    Case 7

    56M,diffuse abdominal pain

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_56M_13720846/PPU.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    27/60

    Case 8

    60M with epigastralgia

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_60M_04358947_Easy/PPU_60M_04358947.wmvhttp://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_60M_04358947_Easy/PPU_60M_04358947.wmvhttp://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_60M_04358947_Easy/PPU_60M_04358947.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    28/60

    Case 8

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    29/60

    Case 9

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_78M_03536129_Curtan%20sign/PPU_78M_03536129_1000904%E8%80%83%E9%A1%8C.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    30/60

    Case 10

    81F with epigastralgia

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_81F_04668433_initial%20failed%20to%20find%20out
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    31/60

    Case 10

    Worsening pain next morning

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/PPU/PPU_81F_04668433_initial%20failed%20to%20find%20out/PPU_81F_04668433.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    32/60

    Diverticulitis

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    33/60

    :1.

    2. 6

    3. 5mm

    4.

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    34/60

    : curvelinear probe 3.5-5 MHz

    : (or)

    : NPO

    :

    : 2-4mm Stomach: >7mm abnormal

    Bowel: >4mm abnormal

    :

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    35/60

    :

    ?1. 2.

    3.

    4.

    5.

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    36/60

    Normal anatomy of GI tract

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    37/60

    * * * *

    *

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    38/60

    Graded compression technique

    :

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    39/60

    :

    ?1.

    2.

    3.

    4. (LN, fat, ascites)

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    40/60

    GI tract lesions on sonography

    1. (>4mm)

    2.

    3.

    4.

    5.

    6. (LN, fat, ascites)

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    41/60

    Alvarado Score

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    42/60

    Appendicitis

    Eur Radiol. 2002;12:1748-61

    Diameter > 6mm (Cross section)

    Non-compressiblity of appendix

    Localized pain during compressionwith the transducer

    Alteration of the periappendiceal fat

    (echogenic & non-compressible fat)

    Obstruction of the lumen by anappendicolith

    Hypervascularizaion in colorDoppler of appendix and

    surrounding fat

    http://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdf
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    43/60

    Landmark of Appendix

    RLQ

    Iliac crest

    Psoas muscle

    Iliac vessels Cecum & A-colon

    http://localhost/var/www/apps/conversion/current/tmp/scratch_2/Appendicitis/Landmark_Appendicitis_18M_15721675_%E9%A1%8F%E7%91%9E%E6%AF%85.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    44/60

    Colon

    http://localhost/var/www/apps/conversion/SKH_EUS%20cases/GI%20tract/%E6%93%8D%E4%BD%9C%E6%95%99%E5%AD%B8_Colon/Colon_demo.wmv
  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    45/60

    ?1. Corona sign

    2. Target sign

    3. Curtain sign

    4. Dome sign

    5. Veiled Kidney sign

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    46/60

    Dome sign:

    acute colonic diverticulitis

    J Clin Ultrasound. 2000;28:340-6.

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    47/60

    Copyright Radiological Society of North America, 2003

    O'Malley, M. E. et al. Radiographics 2003;23:59-72

    Right-sided diverticulitis in a 32-year-old woman

    with right lower quadrant pain and fever

    C 1

  • 8/3/2019 1001108_Diverticulitis & Pneumoperitoneum@

    48/60

    Case 1

    21M with RLQ pain

    C 2

    http://localhost/var/www/apps/conversion/SKH_EUS%