Limited abdominal MRI in the evaluation of acute right upper quadrant pain

Background: We investigated whether limited abdominal magnetic resonance imaging (MRI) is as effective as transabdominal ultrasound (US) in evaluating patients presenting with acute right upper quadrant pain.Methods: Twenty-four patients underwent evaluation with a limited abdominal MRI using single-shot fast spin-echo sequences and a right upper quadrant US within 24 h. Two MRI and two US readers independently evaluated the images for gallstones, gallbladder wall thickness, pericholecystic fluid, acute cholecystitis, visualization of the common bile duct, and requests for further imaging. US and MRI findings were compared. Surgical pathology was the gold standard.Results: MRI and US demonstrated no statistically significant difference in the diagnosis of gallbladder wall thickening, the presence of gallstones or pericholecystic fluid, or the diagnosis of acute cholecystitis (p > 0.05). The sensitivity of both for acute cholecystitis was 50%, with specificities of 89% and 86% for US and MRI, respectively. US readers more frequently requested additional tests and displayed more variability in whether they could adequately see the common bile duct.Conclusion: Limited MRI is equivalent to US in diagnosing gallstones, gallbladder wall thickening, pericholecystic fluid, and acute cholecystitis in patients presenting with symptoms of acute right upper quadrant pain. Especially in sonographically challenging patients, limited MRI may provide a faster, easier method of diagnosis.     

Diagnostic accuracy of ultrasound in acute cholecystitis

This work attempts to assess the diagnostic accuracy of ultrasound for acute cholecystitis in 98 clinically suspected patients from the emergency unit in whom at least 3 of 6 relevant criteria are present. Gallbladder distention to 5 cm or more transversely or in the anterior-posterior axis (criterion 1) was present in 64 patients; thickening of the gallbladder wall of at least 5 mm (criterion 2) in 95; cholelithiasis (criterion 3) in 86; sonolucent halo in the gallbladder wall (criterion 4) in 40; sonolucent fluid band surrounding the gallbladder (criterion 5) in 27; and intraluminal echogenic mass with no posterior acoustic shadow (criterion 6) in 35. A diagnostic accuracy index, corrected for chance, was statistically and clinically more relevant with 3 as the minimum number of criteria for the ultrasonic diagnosis of acute cholecystitis.     

妇科急腹症中的超声临床诊断研究

目的:探讨妇科急腹症中的超声临床诊断研究。方法:纳入40例患者作为研究样本,40例患者均为2017年3月-2019年7月入院接受治疗的妇科急腹症患者,采用随机分组的方式,将40例患者分为两组,每组各20例患者,两组患者接受不同的诊断方式,对照组接受常规诊断,研究组接受超声诊断,对比两组患者诊断准确率。结果:观察并对比两组患者的数据,常规诊断以及超声诊断的临床准确率对比,研究组的准确率高于对照组,两组患者的组间数据对比,表明本次研究具有统计学意义(P<0.05)。结论:妇科急腹症中采用超声诊断,对急腹症类型的诊断效果较为准确,为患者后续的临床治疗提供诊断依据,证实了超声诊断对妇科急腹症在临床诊断上具有重要作用,应提倡将其纳入常规诊断之中。     

Abdominal ultrasound in advanced ovarian carcinoma

The ultrasonic appearance of pelvic tumor and intra-abdominal dissemination is reported in 57 patients with advanced ovarian carcinoma. The primary pelvic tumor was found to be solid or mixed solid-cystic. In no case was the primary malignancy exclusively cystic. In 23 patients, intra-abdominal extrapelvic tumor was detectable, and in eight patients there were solid liver metastases. The usefulness of both static and real-time ultrasound scanning is detecting stage III and IV disease is discussed.     

Association of clinical and laboratory variables with ultrasound findings in right upper quadrant abdominal pain

BACKGROUND: The purpose of this study was to determine how laboratory values and physical examination findings correlate with ultrasound findings in the setting of right upper quadrant pain. METHODS: Patients undergoing emergent ultrasound for the evaluation of biliary disease between November 1999 and April 2000 were included. Physical examination findings, laboratory data, and ultrasound results were variables. Logistic regression was performed. Ultrasound diagnosis of acute cholecystitis, cholelithiasis, and normal biliary tract were end points. One hundred seventy-seven patients were enrolled. RESULTS: Forty-two percent were diagnosed with acute cholecystitis, 30.5% with cholelithiasis, and 27.1% with normal biliary tract. Alkaline phosphatase, Murphy sign, white blood cell count, and total bilirubin were statistically significant predictors of acute cholecystitis. A Murphy sign was defined as arrest of inspiration with pressure over the right upper quadrant. CONCLUSIONS: The findings from this study allow clinicians to apply objective significance to laboratory data and physical examination findings in patients with suspected gallstone disease. The data can be applied to create a predictive model.     

The use of analgesics in patients with acute abdominal pain

Analgesics in patients with acute abdominal pain are often withheld for fear that they may change physical examination findings and thus may be unsafe. We conducted a randomized, prospective, placebo-controlled trial to investigate changes in physical examination following the administration of placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal pain. One patient was withdrawn secondary to inadequate documentation. Of the 48 patients who completed the trial, a statistically significant change in physical examination was noted in both groups receiving analgesics, but not in the placebo group. No adverse events or delays in diagnosis were attributed to the administration of analgesics. We conclude that physical examination does change after the administration of analgesics in patients with acute abdominal pain and that a larger study is needed to evaluate analgesic safety in this subpopulation of emergency department patients.     

腹腔镜术在老年急腹症中的应用

目的：探讨腹腔镜术在老年急腹症的应用价值。方法：对282例老年急腹症腹腔镜治疗进行回顾性分析。结果：腹腔镜确诊率100％，中转手术18例，手术成功率93．6％。结论：腹腔镜技术安全、可靠，微创、确诊率高，在老年急腹症的应用上具有独特优势。     

Anterior position of the lower pole of the right kidney: Potential confusion with right upper quadrant mass

A group of patients with anterior position of the lower pole of the right kidney were examined with ultrasound to evaluate a palpable right upper quadrant mass. After it was determined, with the use of ultrasound, that the palpable mass represented the kidney, no further evaluations were necessary. This appearance is seen fairly often in normal individuals and should be considered a normal variant. The possible anatomic explanation for this appearance is discussed.     

ED endovaginal pelvic ultrasound in nonpregnant women with right lower quadrant pain

Introduction

We hypothesized that emergency physician–performed endovaginal ultrasound (EVUS) would change diagnostic decision making in nonpregnant women with right lower quadrant (RLQ) pain.

Methods

A prospective cohort of female patients was enrolled at an urban emergency department (ED). Inclusion criteria were RLQ pain, hemodynamic stability, and a strong suspicion for appendicitis or right adnexal pathology. Treating physicians were queried regarding pre– and post–ED EVUS probability of disease, differential diagnoses, consultation, and management. Positive findings included large cysts or multitissue densities, tubal dilation, uterine enlargement/mass, and extensive peritoneal fluid.

Results

With a positive ED EVUS, mean physician probability increased for gynecologic (24%) and decreased for both surgical (14%) and medical (20%) disease. With a negative ED EVUS, mean physician probability increased for surgical disease (5.3%) and decreased for gynecologic disease (18.6%).

Conclusion

Emergency department EVUS changes physician diagnostic decision making in nonpregnant women with undifferentiated RLQ pain.     

Urgent real-time cholecystosonography in suspected acute cholecystitis

Acute cholecystitis was suspected in 60 patients. Correct diagnoses were achieved by urgent real-time cholecystosonography in all the 38 patients that had acute cholecystitis. In about one-third of the other cases sonography revealed the pathological states responsible for the symptoms simulating those of acute cholecystitis. All of the examinations were technically satisfactory.     

The WES triad — A specific sonographic sign of gallstones in the contracted gallbladder

The WES triad — that is, the demonstration of the gallbladderWall, theEcho of the stone, and the acousticShadow — permits the specific diagnosis of stones in a contracted gallbladder. This triad positively identifies the gallbladder and helps to differentiate the contracted gallbladder with stones from a loop of bowel containing gas.     

Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain

Fitz-Hugh-Curtis syndrome--inflammation of the liver capsule associated with genital tract infection--occurs in up to one fourth of patients with pelvic inflammatory disease (PID). Classically presenting as sharp, pleuritic right upper quadrant pain, usually but not always accompanied by signs of salpingitis, it can mimic many other common disorders such as cholecystitis and pyelonephritis.     

Accuracy of ultrasound in counting and measuring gallstones

A prospective study of accuracy of ultrasound in measuring and counting gallstones was undertaken in 30 patients undergoing cholecystectomy. Stones were correctly counted (up to five) in 27 of 30 patients. Ninety-three of 106 stones (88%) examined were measured accurately (with a 2 mm error margin). The size of the smaller stones tended to be overestimated, whereas the size of the larger stones tended to be underestimated. When non-operative treatment of gallstones is considered, ultrasound can be used as the first examination to identify patients who will not be eligible for one or another protocol on the basis of size or number of stones.     

腹部B超联合阴道B超对妇产科急腹症的诊断研究

目的：探讨腹部B超联合阴道B超对妇产科急腹症的诊断价值.材料与方法：本研究选取2013年3月～2014年3月期间我院收治妇产科急腹症患者90例,所有患者均行腹部B超和阴道B超检查,比较联合联合使用与单独使用对疾病诊断符合率.结果：单独使用腹部B超的符合诊断率为71.1％,单独使用阴道B超的符合诊断率为90％,联合使用两种方法的符合诊断率为100％,联合使用两种方法的诊断率较单独使用任何一种明显高,差异具有统计学意义（P＜0.05）.结论：单独使用腹部超声或者阴道超声,由于各有利弊,可能造成误诊或漏诊情况,联合应用两种超声检查方法能够显著提高对妇科急腹症的诊断的准确性.     

超声诊断在妇科急腹症中的应用

目的:探讨妇科急腹症的临床特征及超声诊断特点,提高其诊断救治能力,降低误诊率。方法:2005年6月~2008年6月我院收治妇科急腹症126例患者行B超检查,年龄16~67岁,平均32.6岁。126例患者手术治疗者以术中所见及病理诊断为依据;非手术治疗者以病史、临床症状、体征、辅助检查及诊断性治疗相结合作出诊断。采用仪器为东芝纳米10,日立EUB2000型,探头频率为3.5MHz,膀胱充盈,不充盈者向膀胱内注入生理盐水,患者取仰卧位。常规经腹部纵横切面扫查,观察子宫、附件、阑尾区有无包块及腹腔有无游离液体等。结果:异位妊娠63例,卵巢囊肿破裂17例,卵巢囊肿蒂扭转25例,子宫内膜异位样囊肿7例,处女膜闭锁及阴道畸形2例,急性盆腔炎12例。除3例卵巢囊肿蒂扭转因扭转血管破裂误诊为黄体破裂外,其余诊断均与手术及病理相符,诊断符合率97.6%。     

二维超声研究肝硬变患者胆囊动力的变化

目的 用二维超声探讨肝硬变患胆囊动力的改变。方法 用Ｂ超测量肝硬变与非肝硬变和有胆结石与无胆结石患空腹以及脂餐后胆囊壁厚度、容积。结果 肝硬变患胆囊壁增厚依次为肝硬变胆结石组〉肝硬变非胆结石组〉非肝硬变组。胆囊最大排空率时间延长。结论肝硬变患胆囊动力减弱。     

Intestinal T‐cell lymphoma: A rare entity presenting with severe acute upper quadrant pain

Primary gastrointestinal T‐cell lymphomas are rare. Presenting symptoms can be non‐specific, and imaging studies can show overlap with nonmalignant processes. Definitive diagnosis requires clinical suspicion and histologic evaluation with ancillary studies for appropriate disease classification and therapeutic intervention.     

超声造影在腹部疾病中的应用

超声造影剂注入人体后,主要是提高低流量,低流速的血流信号,因此可提高超声区分各组织,包括正常和病变组织的能力,目前超声造影技术在肝脏占位性病变诊断中已日趋成熟,积累了丰富的经验,在其它脏器中也可应用连续的观察来进行动态研究。现对超声造影剂在肝脏、胆囊、胰腺、脾及胃肠道疾病中的应用进行综述。