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THE ACUTE ABDOMEN 249 D A RT B C E Figure 10.5 (A) Obstructed kidney with pelvicalyceal system (PCS) dilatation and a dilated upper ureter. (B) Mobile stones were demonstrated in the bladder, but the level of obstruction in the ureter could not be positively identified. Intravenous urogram (IVU) confirmed a stone in the ureter. (C) Severe laceration to the liver following a road traffic accident. (D) The same patient’s CT scan confirms the liver injury and demonstrates an avascular right kidney (compared with the normal left kidney (LK)) due to laceration of the renal vessels. (E) Acute renal colic. IVU demonstrates a left hydronephrosis with a stone in the lower ureter. (This area is not usually demonstrable with ultrasound.)
250 ABDOMINAL ULTRASOUND are available, ultrasound can be a time-saving triage tool to exclude an aneurysm from the differential diagnosis of abdominal pain. Suitably trained emergency department clinical staff can perform this quickly and successfully. 19 Rupture of an aortic aneurysm is a catastrophic event, and although an urgent contrast-enhanced CT can be helpful, emergency surgery based on clinical findings should not be delayed by imaging investigations. Ultrasound is also the first investigation of choice for demonstrating suspected psoas abscess or haematoma 20 (Fig. 10.6). SAG RT Figure 10.6 A large, right-sided psoas haematoma. References 1. Forster R, Pillasch J, Zielke A. 1993 Ultrasonography in blunt abdominal trauma: influence of the investigator’s experience. Journal of Trauma 34: 264–269. 2. Porter RS, Nester BA, Dalsey WC et al. 1997 Use of ultrasound to determine the need for laparotomy in trauma patients. Annals of Emergency Medicine 29: 323–330. 3. McGahan JP, Rose J, Coates TL et al. 1997 Use of ultrasonography in the patient with acute abdominal trauma. Journal of Ultrasound in Medicine 16: 653–662. 4. American College of Emergency Physicians. 1997 Use of ultrasound imaging by emergency physicians [policy statement]. Annals of Emergency Medicine 30: 364–365. 5. Scalea TM, Rodriguez A, Chiu WC et al. 1999 Focused assessment with sonography for trauma (FAST): results from an international consensus conference. Journal of Trauma-Injury, Infection and Critical Care 46: 466–472. 6. Bode PJ, Neizen RA, Van Vugt AB. 1993 Abdominal ultrasound as a reliable indicator for conclusive laparotomy in blunt abdominal trauma. Journal of Trauma 34: 27–31. 7. Lentz KA, McKenney MG, Nunez DB et al. 1996 Evaluating blunt abdominal trauma. Journal of Ultrasound in Medicine 15: 447–451. 8. Rothlin MA, Naf R, Amgwerd M. 1993 Ultrasound in blunt abdominal and thoracic trauma. Journal of Trauma 34: 488–495. 9. Craig MH, Talton DS, Hauser CJ, Poole GV. 1995 Pancreatic injuries from blunt trauma. American Surgeon 61: 125–128. 10. Chen SC, Wang HP, Chen WJ et al. 2002 Selective use of ultrasonography for the detection of pneumoperitoneum. Academic Emergency Medicine 9: 643–645. 11. Lameris JS, Van-Overhagen H. 1995 Imaging and intervention in patients with acute right upper quadrant disease. Baillière’s Clinical Gastroenterology 9: 21–36. 12. Cohen SA, Siegel JH. 1995 Biliary tract emergencies: endoscopic and medical management. Critical Care Clinics 11: 273–294. 13. Norton ID, Clain JE, Wiersema MJ et al. 2001 Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients. Mayo Clinic Proceedings 76: 794–798. 14. Tack D, Sourtzis S, Delpierre I, de Maertelaer V, Gevenois PA. 2003 Low-dose unenhanced multidetector CT of patients with suspected renal colic. American Journal of Roentgenology 180: 305–311. 15. Colistro R, Torreggiani WC, Lyburn ID et al. 2002 Unenhanced helical CT in the investigation of acute flank pain. Clinical Radiology 57: 435–441. 16. Catalano O, Nunziata A, Altei F, Siani A. 2002 Suspected ureteral colic: primary helical CT versus selective helical CT after unenhanced radiography and sonography. American Journal of Roentgenology 178: 379–387.
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Abdominal Ultrasound
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Abdominal Ultrasound How, Why and W
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v Contents Contributors Preface ix
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vii Contributors Rosemary Arthur FR
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ix Preface Ultrasound continues to
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ABBREVIATIONS xi MHA MHV MI MPV MRA
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Chapter 1 1 Optimizing the diagnost
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OPTIMIZING THE DIAGNOSTIC INFORMATI
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Chapter 2 17 The normal hepatobilia
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THE NORMAL HEPATOBILIARY SYSTEM 19
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Chapter 3 41 Pathology of the gallb
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PATHOLOGY OF THE GALLBLADDER AND BI
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Chapter 4 79 Pathology of the liver
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PATHOLOGY OF THE LIVER AND PORTAL V
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Chapter 5 121 The pancreas CHAPTER
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THE PANCREAS 123 the patient’s le
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THE PANCREAS 125 Acute pancreatitis
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THE PANCREAS 127 E F G Figure 5.3 c
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A C DISTANCE = 3.43 CM 5%. 13 Over
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THE PANCREAS 131 G H I Figure 5.5 c
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THE PANCREAS 133 head of pancreas.
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THE PANCREAS 135 pancreatic juice i
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Chapter 6 137 The spleen and lympha
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THE SPLEEN AND LYMPHATIC SYSTEM 139
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Chapter 7 153 The renal tract CHAPT
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THE RENAL TRACT 155 As with any oth
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THE RENAL TRACT 157 A B q 0 LRA AO
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THE RENAL TRACT 159 junctions of or
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THE RENAL TRACT 161 A B Figure 7.5
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THE RENAL TRACT 163 carcinomas, the
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THE RENAL TRACT 165 the vesicourete
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THE RENAL TRACT 167 Table 7.1 Sourc
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THE RENAL TRACT 169 A B Figure 7.13
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THE RENAL TRACT 171 Table 7.2 Diffe
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THE RENAL TRACT 173 Ultrasound stil
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THE RENAL TRACT 175 CT is useful fo
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THE RENAL TRACT 177 Xanthogranuloma
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THE RENAL TRACT 179 As with acute t
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THE RENAL TRACT 181 der with increa
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THE RENAL TRACT 183 ● ● Morphol
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THE RENAL TRACT 185 ● ● hydrone
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THE RENAL TRACT 187 A Figure 7.27 A
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THE RENAL TRACT 189 vascular reject
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THE RENAL TRACT 191 B A C Figure 7.
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THE RENAL TRACT 193 computerised ul
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Chapter 8 195 The retroperitoneum a
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THE RETROPERITONEUM AND GASTROINTES
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Page 268 and 269: INTERVENTIONAL AND OTHER TECHNIQUES
Page 288 and 289: 275 Bibliography and further readin
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Page 294 and 295: INDEX 281 Intravenous urography (IV
Page 296 and 297: INDEX 283 Phrygian cap, 29 Pneumobi
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