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
Dirty ascites with fibrin and
Free fluid 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)

2 days after thrombolysis AEM, 2011 Mar

 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
1 (Appendicitis)
2 • EUS: 確認landmark
and anatomy，然後找
cecum, IC valve,
terminal ileum，接著
appendix
25M, right thigh redness and fever for 5 days
Left thigh cellulitis with lymphadenopathy
• 1. femoral vessels
with complete
2 collapse
• 2. lymphadenopathy
• 3. increase
3 1 echogenecity of soft
tissue
• EUS: 排除venous
thrombosis and
abscess formation
 30F, LLQ pain for days
Crohn’s disease with fistula formation
• * fistula between two
loops
• EUS:
B – Skipped and
B segmental small wall
*
thickening
– Dirty ascites and ileus
– 腹痛及ileus，找造成
ileus的原因
88F, bloody stool and nonspecific abdominal pain
Ischemic colitis
• EUS
– Long segment D and
S colon wall edema &
decreased flow
D-colon
– Patent proximal SMA
– 血便 & 腹痛，懷疑大
Psoas muscle 腸病變，故進行EUS掃
描協助臨床決策
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
UB hernia
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 +
R * fluid); and no internal
flow signal
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)