Pancreatic tail

超音波的基本功包含了
1。避開障礙
2。創造視窗
利用這兩個基本概念,可以有機會找到胰臟的尾部,
最適合的探頭為弧形的腹部探頭,
以肚臍為參考點,將探頭放在左側腰部後腋線處,
在被掃描者平躺的姿勢下,掃描者的手應該會幾乎靠在檢查床上,
然後往腋下平移向上約一個探頭的高度,
記得順時針轉約30-45度來避開障礙(肋骨),
這個位置很容易找到脾臟來當作我們的視窗,
在肋間的小小空間中,扇形的調整探頭的角度,
當找到脾臟的血管時,你就有機會看到亮度比脾臟高一些的胰臟尾部。

看看這段影片的參考構造:

如果你看不到任何東西,
代表探頭不夠後也不夠上,
麻煩將探頭往床上靠,往患者的頭部平移。

如果你遇到很多肋骨,
代表你沒有放到肋間,
麻煩將探頭順時針轉動來避開肋骨的陰影。

如果你遇到白白滑動的肋膜,
恭喜你至少找到看得懂的結構,
麻煩將探頭往腳部的方向一個肋間一個肋間的平移。

如果你看到脾也看到腎就是找不著胰,
代表高度對了但角度差一點,
麻煩將探頭以扇形角度往肚臍的方向微調來找到脾臟的血管。

58-year-old man presenting with left lower quadrant pain

2012年時代的Aloka SSD 900,幫助我們學習很多,
也非常感謝伯良當年架設錄影的設備,
讓我們可以不斷的反覆檢視和追求進步。
現在以為的理所當然,在當年都是萬分不易,
當年印出的超音波熱感印紙我都還留著紀念,
當年的教學就是用Scanner掃下來後制作教學簡報。

以下這段影片,當年提出了兩個問題:
What do you see ?
What’s your diagnosis ?
你能回答得出來嗎 ? (Can you answer above questions ?)

在懷疑腸道病變時,我會由固定端的腸道開始掃描,如升結腸和降結腸,
再來就是根據病史及理學檢查來決定那個部位要加強掃描。
下圖標示的就是這個個案的觀察和發現:
1. Sigmoid colon wall thickening
2. Out-pouching from Sigmoid colon (Dome sign)
3. Increased echogenicity of surrounding mesenteric fat
4. Decreased luminal content

Skills: Sliding / Rotation / Compression
Probe: Curvelinear 

所以我的超音波診斷為Sigmoid colon diverticulitis

POCUS Atlas

You can find many educational materials in this fantastic website.

Mission of POCUS Atlas

“The Point of Care Ultrasound (POCUS) Atlas is collaborative effort to highlight and advance the use of ultrasound around the world – focusing on rare, exotic and perfectly captured ultrasound images.

All of our content is free, open access, and peer-reviewed available to be shared and used for global ultrasound education.”

Click & Visit POCUS Altas Website

Left leg pain

34-year-old man complained medial side pain on his left leg for 7 days.
He reported calf swelling for 2 days.
He had a history of deep vein thrombosis 8 years ago.

Role of POCUS for this patient:
1. DVT survey: patent femoral and popliteal vein & artery
2. Exclude ruptured Backer’s cyst
3. Exclude muscle hematoma or lesions
4. Note echogenic thrombus within superficial saphenous vein with increased echogenicity on surrounding subcutaneous fat

Diagnosis: Saphenous thrombophlebitis

Normal bowel wall stratification

Normal GI wall stratification: from innermost to outermost layer
Linear transduer will be better for bowel stratification
Echogenic——-Mucosa
Hypoechoic——Muscularis mucosa
Echogenic——-Submucosa
Hypoechoic——Muscularis propria
Echogenic——-Serosa

Note normal stratification & peristalsis
Also note physiological thickening during contraction

 

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