The Piano Sign
The Piano Sign
A Case of Colicky Abdominal Pain
A Case of Colicky Abdominal Pain
Biliary Colic That Wasn't
Biliary Colic That Wasn't
Reducing Aspiration Risk
Reducing Aspiration Risk
Intussusception Adult
Intussusception Adult
The Piano Sign
The Piano SignThe Case:A 55 year old male came to ED c/o abdomen pain for 3 days associated with abdominal distention and vomiting. He was noted to be tachycardic and his abdominal exam demonstrated tenderness and bulging in the right inguinal area.  POCUS:  A curvilinear probe was used to evaluate for bowel obstruction. The clip demonstrates a dilated loop of bowel, "to and fro" movements of bowel content suggesting dysfunctional peristalsis, and the piano sign. The piano sign (or keyboard sign) is essentially visualization of the plicae circularis which is associated with the diagnosis of small bowel obstruction.  Dr. Mahmoud S Alsomali EM Resident R4; Saudi Board Of Emergency Medicine; King Saud Medical City; Riyadh KSA
A Case of Colicky Abdominal Pain
A Case of Colicky Abdominal PainThis is a transverse view of the right upper quadrant of an infant who presented with several days of worsening colicky pain. He had decreased appetite, activity and vomiting. Bedside ultrasound revealed evidence of intussusception with extensive surrounding bowel edema likely secondary to delayed presentation.Chris Heberer, DO EM PGY-3CMU-Saginaw
Biliary Colic That Wasn't
Biliary Colic That Wasn'tThis is an image from a 55 years gentleman with suspected biliary colic. A gallstone was confirmed however the patient's symptoms during exam did not match classic biliary colic. A more in depth evaluation of the right upper quadrant confirmed the presence of right colonic mass. Color flow was appreciated on a separate clip. Although bowel pathologies are an uncommon finding at emergency ultrasound, they can be easily found with further investigation in atypical presentations. Stefanie Tamburrini, MDEmergency Radiologist
Reducing Aspiration Risk
Reducing Aspiration RiskA 76 year old female ward patient was vomiting and in respiratory distress possibly due to aspiration. The patient is impending respiratory failure and the plan was to intubate and admit to ICU. A POCUS was done to evaluate her distended abdomen prior to intubation and the image demonstrated a grossly distended stomach with swirling hyperechoic particles. NG tube was placed and approximately 1 liter of bilious fluid was removed. Patient was safely intubated thereafter with aspiration risk minimized. Learning point:For peri-intubation patient with distended abdomen or with high aspiration risk, a quick POCUS can help determine the amount of gastric content and potentially alter management to include maneuvers to minimize aspiration risk. This has been studied in anesthesia literature and is routinely performed by Dr. Paul Mayo’s critical care team at Northwell LIJ. Reference:Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume.  Br J Anaesth. 2014 Jul;113(1):12-22. doi: 10.1093/bja/aeu151.POCUS image acquired and contributed by:Leon Chen, NP – Critical Care Medicine ServiceDepartment of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew York, NYAdjunct Clinical FacultyNYU Rory Meyer College of NursingNew York, NY
Intussusception Adult
Intussusception AdultIntussusception is typically a disease of the young, 6 months to 6 years but it can occur in adults. In adults they will ofter present similar to bowel obstructions, with vomiting, constipation, and rectal bleeding. Ultrasound can still be used to work them up although most of the time CT will be used first. In kids, the operating characteristics approach 100% sensitivity and specificity but can be operator dependent. It is usually performed with a linear probe in children but in this image, a curvilinear probe was used. Justin Bowra MBBS, FACEM, CCPU Emergency Physician, RNSH et al.
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