超声在异位妊娠诊断中的临床价值

目的：探讨超声在异位妊娠中的诊断及鉴别诊断价值。方法：回顾性分析我院超声诊断45例异位妊娠,并与手术及病理检查结果进行对照。结果：经超声诊断异位妊娠正确率达88.9%（40/45）。结论：超声对异位妊娠的诊断和鉴别诊断均具有较好的临床价值。     

Heterotopic Cesarean Scar Pregnancy

Heterotopic cesarean scar pregnancy is a rare, life‐threatening form of ectopic pregnancy. To provide information regarding the clinical manifestations, diagnosis, management, and prognosis of this condition, we reviewed all cases reported in the English literature. All literature on heterotopic cesarean scar pregnancy was retrieved by searching the PubMed database and tracking references of the relevant literature. Full texts were reviewed, and clinical manifestations, diagnostic methods, and the relationship between the treatment and prognosis were summarized. A total of 14 patients with heterotopic cesarean scar pregnancies were identified, including 6 spontaneous pregnancies and 8 following in vitro fertilization–embryo transfer. Gestational ages at diagnosis ranged from 5 weeks to 8 weeks 4 days. Only 5 cases presented with vaginal bleeding, and the others were asymptomatic. All 14 cases were diagnosed by transvaginal sonography. One patient with no future fertility requirements underwent pregnancy termination by methotrexate. Of the remaining 13 patients who desired to preserve their intrauterine gestations, 10 were treated by sonographically guided selective embryo reduction in situ (by embryo aspiration, drug injection, or both); 2 underwent laparoscopic and hysteroscopic excision of the ectopic pregnancy masses; and 1 was treated by expectant management. All operations were successful and maintained a living intrauterine gestation. Twelve cases resulted in live births by cesarean delivery (3 at term and 9 preterm). One patient underwent pregnancy termination at 12 weeks because of a fetal malformation confirmed by sonography. The possibility of heterotopic cesarean scar pregnancy after cesarean delivery should be considered, especially when pregnancy follows assisted reproductive technology. Transvaginal sonography is an important tool for diagnosis and management. Despite the many options, the best treatment for this condition remains unclear. Selective embryo reduction in situ with sonographic guidance is the main treatment modality and can result in a successful intrauterine gestation, albeit at high risk.     

剖宫产术后子宫疤痕处妊娠29例超声诊断

目的:探讨超声在剖宫产术后子宫瘢痕处妊娠的诊断与随访中的临床应用价值.方法:回顾性分析2006年7月至2011年7月诊断的剖宫产术后子宫瘢痕妊娠患者29例的临床资料.结果:29例中,超声检出妊娠囊型18例(1例误诊为正常宫内孕囊),包块型10例(2例误诊为不全流产),破裂型l例.结论:超声对剖宫产术后子宫瘢痕妊娠的诊断简便安全,结果可靠.     

经阴道彩色多普勒超声诊断异位妊娠的临床价值

目的探索经阴道彩色多普勒超声诊断异位妊娠的临床价值。方法 2011年1月-2011年12月到我院我妇科门诊的异位妊娠患者160例,随机分为经阴道彩超组和经腹彩超两组,每组各80例,比较二者的检出率。结果经腹彩超符合率为85%,经阴道彩超总的诊断符合率为97.5%,二者相比差异有统计学意义(P<0.05)。结论经阴道彩超的诊断符合率显著优于经腹彩超,将二者联合应用,以提高异位妊娠的临床诊断符合率。     

二维超声及彩超诊断未破型宫外孕

目的　探讨未破型宫外孕的超声诊断方法。方法　选择１６ 例经二维超声与彩色多普勒血流显像首诊,临床确诊的未破型宫外孕病例,对其超声检查资料进行分析。结果　全部病例均显示附件包块。１２ 例（７５ ％ ） 显示肿块内相对周围组织增多的彩色血流信号。频谱多普勒表现附件肿块内低阻血流频谱。ＲＩ值０４２ ±０．０８,子宫动脉及卵巢血流无特征性变化。结论　附件区肿块,肿块内相对周围组织增多的彩色血流信号是超声诊断未破型宫外孕的关键。输卵管妊娠的病理生理改变与超声图像表现相关。疑为宫外孕时,耐心细致地寻找附件包块至关重要。     

Cesarean Scar Pregnancy

A cesarean scar (ectopic) pregnancy occurs when a pregnancy implants on a cesarean scar. This condition is an uncommon but potentially devastating occurrence. The incidence is increasing as cesarean deliveries become more common. Early recognition of the salient sonographic findings is critical because a delay can lead to increased maternal morbidity and mortality. Magnetic resonance imaging is a valuable troubleshooting tool when sonography is equivocal or inconclusive before therapy or intervention. Early diagnosis by sonography directs therapy and improves outcomes by allowing preservation of the uterus and future fertility. We review the imaging features, differential diagnosis, complications, and treatment of cesarean scar pregnancies in the first trimester.     

经阴道超声诊断异位妊娠的价值

目的探讨(早期)异位妊娠(EP)的经阴道超声(TVS)诊断应用价值.方法对146例不规则少量阴道流血(或)下腹痛的育龄妇女或停经后经腹B超(TAS)提示宫腔内未见孕囊者疑EP的均行TVS检查,观察宫内是否有孕囊,仔细寻找识别卵巢及肿块结构并分清其关系,必要时结合彩色多普勒,观察肿块血流成像,分晰其血流频谱.结果 TVS能很好地显示子宫、卵巢、未破孕囊及含血(块)肿块的声像结构.识别出完整的卵巢,是输卵管异位妊娠确诊的关键;彩色多普勒血流成像(CDFI)所记录的滋养层血流频谱或怪异频谱是二维TVS的补充,二者结合诊断EP的准确性高达97%.结论 TVS诊断EP简单、无创、准确性高,是诊断早期异位妊娠的首选方法.     

经阴道超声结合腹部加压法对异位妊娠的诊断

目的：探讨经阴道超声结合腹部加压法诊断异位妊娠的价值。方法回顾性分析以异位妊娠收入住院的157例患者的经阴道超声声像图特征,并与临床最终诊断结果相对照。结果157例患者中临床最后诊断为异位妊娠156例（包括宫内妊娠并异位妊娠1例）,宫内妊娠1例;经阴道超声结合腹部加压法检出异位妊娠154例,漏诊异位妊娠2例,检出宫内妊娠1例,检出异位妊娠敏感性为98.72%（154/156）、准确性为98.73%（155/157）。结论经阴道超声能够为临床诊断异位妊娠提供可靠的线索。     

经阴道超声检查对早期宫外孕的诊断价值

目的 探讨应用经阴道超声检查对早期宫外孕的诊断价值。方法对临床疑诊为宫外孕但经腹部超声检查不明确的186例患者进行经阴道超声检查，记录宫外孕肿块超声图像、彩色血流特点及彩色血流阻力指数。结果经阴道超声诊断结合血液HCG检查结果诊断早期宫外孕179例，漏诊7例，超声诊断符合率96．2％。结论经阴道超声检查，对早期宫外孕的诊断具有重要的价值，为诊断早期宫外孕的首选方法。     

阴道B超与腹部B超诊断异位妊娠的临床价值

目的:比较阴道B超与腹部B超在异位妊娠诊断中的临床应用价值。方法:将2012年6月-2013年6月收治的74例疑似异位妊娠患者随机分为观察组与对照组各37例,分别给予阴道B超和腹部B超检查,比较两组的诊断准确率。结果:观察组患者的诊断符合率为91.89%(34/37),明显高于对照组的81.08%(30/37)(P0.05);观察组显示孕囊或包块的时间与选择手术时间明显优于对照组(P0.05)。结论:与应用腹部B超相比较,应用阴道B超诊断的异位妊娠诊断符合率更高,且显示孕囊或包块的时间与患者选择手术时间更短。     

甲氨蝶呤联合B超监视妇科手术仪在持续性异位妊娠治疗中的应用

目的:探讨甲氨蝶呤联合B超监视妇科手术仪在持续性异位妊娠治疗中的应用价值。方法:将60例持续性异位妊娠患者分成观察组和对照组各30例,观察组在B超监视妇科手术仪监视下经阴道宫旁注射甲氨蝶呤(MTX)50 mg,对照组予MTX75 mg肌肉注射。比较两组治疗后血β-人绒毛膜促性腺激素(β-HCG)下降百分比及不良反应的发生率。结果:观察组的血β-HCG下降百分比和不良反应发生率均明显优于对照组(P0.05)。结论:在B超监视妇科手术仪监视下经阴道宫旁注射MTX50 mg对持续性异位妊娠治疗较MTX75mg肌肉注射更安全有效。     

剖宫产疤痕部位妊娠经阴道彩色多普勒超声图像特征分析

目的探讨剖宫产疤痕部位妊娠（CSP）经阴道彩色多普勒超声检查的声像图特征。方法对14例剖宫产疤痕部位妊娠病例的超声图像进行回顾性分析。结果14例患者超声图像表现为子宫前壁下段剖宫产切口疤痕处肌层缺损或中断,局部探及1.6~5.3 cm的妊娠物包块,包块表现为高回声型7例（占50.00%）,无回声型4例（占28.57%）,孕囊型3例（占21.43%）。彩色多普勒显示包块周围见环状彩色血流或局部血供增多,呈高速低阻型频谱。结论剖宫产疤痕部位妊娠具有特征性的声图像表现,经阴道彩色多普勒超声能早期、准确地诊断剖宫产疤痕部位妊娠。     

Point-of-Care Ultrasound to Diagnose Colitis in the Emergency Department: A Case Series and Review of the Literature

BackgroundColitis refers to an inflammatory process of the colon, composed of a variety of different etiologies including inflammatory bowel disease, infectious colitis, ischemic colitis, and allergic colitis. Usually, abdominal computed tomography (CT) is the gold standard in diagnosing the various forms of colitis. However, by the use of point-of-care ultrasound (POCUS), one may occasionally be able to discern wall thickening, pericolic fluid, and adjacent hyperechoic mesenteric fat. One may also see abscesses, fistulae, or ascites.Case SeriesThis is a series of 6 patients who had findings consistent with colitis seen on POCUS performed by an emergency physician. These were confirmed by abdominal CT with contrast. Early detection by POCUS was able to lead to a rapid diagnosis and to expedite treatment.Why Should an Emergency Physician Be Aware of This?The ability to detect findings of colitis by POCUS can be quickly learned by the emergency physician with a strong background in basic ultrasound. For many of the different subtypes of colitis, the initial treatment in the emergency department is the same: i.v. antibiotics, i.v. fluids, and “bowel rest” by maintaining the patient in nothing-by-mouth status. For the stable patient with high clinical suspicion of an infectious etiology of colitis, ultrasound can help confirm the diagnosis and rule out other etiologies. This may be especially important in certain populations such as children and young women, where one can avoid a significant amount of radiation being directed toward the pelvic area.     

B超在异位妊娠诊断中的价值

本文报道1992年10月至1993年8月间B超诊断异位妊娠60例,所有病例均经手术病理证实,超声诊断符合率93％。文章对异位妊娠的超声诊断价值及声像图改变进行了讨论。     

B超在异位妊娠中的应用

目的 探讨经腹Ｂ型超声对异位妊娠的诊断及选择治疗方案的价值。材料与方法：与手术和病理检查为对照,分析４６例异位妊娠超声检查结果。结果 ４６例异位妊娠中输卵管妊娠流产型（１５例）;输卵管妊娠破裂（２２例）;子宫左角妊娠破裂（２例）;陈旧性宫外孕（３例）;典型胎囊型（４例）。本文分析了各型的声像图特征。结论 Ｂ型超声对异位妊娠的诊断、选择治疗方案及动态观察疗效起着重要作用。     

经阴道超声、电视腹腔镜诊断早期异位妊娠

目的 探讨经阴道超声及电视腹腔镜对早期异位妊娠的诊断价值。方法 临床怀疑异位妊娠者共104例，经阴道超声检查并在当天或次日行电视腹腔镜检查。结果 经阴道超声检查符合率91.3％，假阳性3例，假阴性1例，定位错误5例。电视腹腔镜下诊断异位妊娠101例，绝大多数同时行保守性或根治性手术。结论 经阴道超声是早期诊断异位妊娠最有价值的方法，电视腹腔镜可在其基础上准确定位、明确诊断，并能同时施行手术。     

Diagnosis of Rectus Sheath Hematoma by Point-of-Care Ultrasound

BackgroundRectus sheath hematoma is a rare but dangerous cause of undifferentiated hypotension and abdominal pain in the emergency department (ED). Point-of-care ultrasound is a useful tool in its identification.Case ReportA 75-year-old woman presented to the ED with hypotension of an unclear etiology. She was found, via point-of-care ultrasound, to have a large and expanding rectus sheath hematoma. She ultimately had embolization of a lacerated epigastric artery, likely caused by enoxaparin injection.Why Should an Emergency Physician Be Aware of This?Rectus sheath hematomas are a dangerous and often unrecognized source of abdominal pain and shock in anticoagulated patients. Commonly applied point-of-care ultrasound algorithms to assess hypotension may miss this entity.     

Diagnosis of Megaureter by Point-of-Care Ultrasound

Background

Presentation of congenital megaureter in adult life is rare; patients usually become symptomatic in childhood.

Case Report

A 32-year-old man presented to the Emergency Department (ED) with dyspnea, tongue swelling, and a rash, which he attributed to amoxicillin he had taken shortly prior to onset of symptoms. He was hypotensive on arrival to the ED. To further evaluate the hypotension, point-of-care ultrasound of the heart, lungs, and abdomen were performed while treatment for anaphylaxis was initiated. Ultrasound examination did not identify a cause for hypotension, but the treating physician noted an anechoic structural abnormality posterior to the bladder, suggestive of megaureter. The patient responded well to treatment of anaphylaxis; further history and diagnostic imaging subsequently confirmed a diagnosis of congenital megaureter.

Conclusion

We report an unusual case of congenital megaureter, identified by point-of-care ultrasound performed to evaluate hypotension. Clinicians performing limited ultrasound examinations must be attentive to incidental findings that will require follow-up.