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

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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.”

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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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