Journal, Cases, Test,

and Workshop (DOPS)

新光醫院急診醫學科

陳國智醫師

中華民國醫用超音波學會指導醫師

Flexed

positioning

increased space

between the

lumbar spinous

process

AEM 2011; 18:215–218

72F with one day chest pain and

SOB, Hx of lung ca

No obvious pericardial effusion on parasternal long axis view AEM, 2011 Mar

72F with one day chest pain and

SOB, Hx of lung ca

Large loculated pericardial effusion on subxyphoid view AEM, 2011 Mar

72M, abdominal pain for 3 hours

with shock

No obvious subphrenic free air AEM, 2011 Mar

72M, abdominal pain for 3 hours

with shock

Free fluid Dirty ascites with fibrin and free air

52M, Chest pain and syncope (BP 73/45; HR 120; SpO2 82% on mask)

McConnell’s Sign

AEM, 2011 Mar

52M, Chest pain and syncope (BP 73/45; HR 120; SpO2 82% on mask)

right popliteal vein thrombus AEM, 2011 Mar

52M, Chest pain and syncope (BP 73/45; HR 120; SpO2 82% on mask)

AEM, 2011 Mar 2 days after thrombolysis

Basic (B-Mode)

Two-Dimensional Ultrasound Image

N Engl J Med 2011;364:749-57

Basic (B-Mode)

Two-Dimensional Ultrasound Image

N Engl J Med 2011;364:749-57

Point-of-Care Ultrasonography

• Procedural guidance – Static versus Dynamic

• Diagnostic assessment – Focused, limited, goal-directed

– FAST • Free fluid in peritoneal, pelvic, pericardial , and pleural cavity,

and PTX

– Pulmonary ultrasonography • PTX

• Alveolar interstitial syndrome

• PLE

– Screening • AAA

N Engl J Med 2011;364:749-57

US guidance for procedures

N Engl J Med 2011;364:749-57

US guidance for procedures

N Engl J Med 2011;364:749-57

Vascular access

N Engl J Med

SKH-ED Cases

53M, RLQ pain

Appendicitis

• 1: terminal ileum

• 2: blind-end tubular

structure

(Appendicitis)

• EUS: 確認landmark

and anatomy，然後找cecum, IC valve,

terminal ileum，接著appendix

2

1

25M, right thigh redness and fever for 5 days

Left thigh cellulitis with lymphadenopathy

• 1. femoral vessels with complete collapse

• 2. lymphadenopathy

• 3. increase echogenecity of soft tissue

• EUS: 排除venous thrombosis and abscess formation

1

2

3

30F, LLQ pain for days Crohn’s disease with fistula formation

• * fistula between two

loops

• EUS:

– Skipped and

segmental small wall

thickening

– Dirty ascites and ileus

– 腹痛及ileus，找造成ileus的原因

B

B *

88F, bloody stool and nonspecific abdominal pain

Ischemic colitis

• EUS

– Long segment D and

S colon wall edema &

decreased flow

– Patent proximal SMA

– 血便 & 腹痛，懷疑大腸病變，故進行EUS掃描協助臨床決策

Psoas muscle

D-colon

78M, fever and chills for 2 days

Liver abscess

• * abscess

• + CBD

• EUS

– 尋找腹腔內感染源，先從solid organ著手，再來就是biliary and

urinary system，接著腹腔內及後腹腔，不要忘了雙側的diaphragm

之上

*

+

34F, RLQ pain with bulging mass

Mesenteric hernia

• * no bowel content

• Between arrow:

peritoneum defect

• EUS

– 確認有無incarcerated

hernia

*

UB

37M, sudden and sever epigastric pain

PPU

• Echogenic

enhancement of

peritoneum & comet

tail artifact along liver

surface =

pneumoperitoneum

• EUS

– 因Sitting CXR: no free

air，但PE高度懷疑故進行EUS掃描

*

61M, with left flank pain and dislodged PCN

Obstructive uropathy

• * isoechoic mass

located over proximal

ureter

• Mild hydronephrosis

• EUS

– 確認有hydronephrosis，方便泌尿科進行PCN放置

*

15M, left swollen scrotum 6 hours after voiding

Testicular torsion

• * swollen left testis

with decreased

echogenecity (and

enlarged epididymis +

fluid); and no internal

flow signal

* R

Test

Q1. 請由左至右描述圖片中的發現?

1 2 3 4

Q2. 30歲男性，肚臍周圍紅腫一週，

請問影片中的發現為何 ?

1. Abscess

2. Cellulitis

3. Necrotizing fasciitis

4. Hematoma

Q3. 21歲男性，左側胸痛1小時，

根據影片，診斷應為下列何者 ?

1. Empyema

2. Pneumothorax

3. Pneumonia

4. Pulmonary embolism

Q4. 45歲男性，右腿腫痛2天，

請問根據影片，診斷為何 ?

Q5. 50歲男性，右大腳疼痛，

請問影片中的異常為何 ?

Workshop Test

• FAST

• Pneumothorax

• Abdominal aorta scan & measurement

• Bilateral kidneys and bladder scan

• Identify and mark internal jugular vein

• Demonstrate DVT scan (popliteal vein)

• Find gallbladder

• US machine function (at least 3)