受保護的內容: Suprapubic Bladder Aspiration
32歲男性，左腰痛
這個病人掃描後有左側水腎，
有無Hydronephrosis是POCUS設定的問題，
其實掃完雙側腎臟和膀胱後就算是完成POCUS的檢查。
如果有明顯的水腎，其實還可以嘗試利用漲大的輸尿管成為指引，
來幫助找到阻塞的原因和位置。
最常見的阻塞位置為
1。剛出腎臟的UPJ
2。跨過Iliac vessle處
3。轉入膀胱的UVJ
許哲彰醫師之前精采的圖文SonoAnatomy: KuB有詳細的解說
這裡要介紹的是利用都卜勒Doppler的功能，
來看因結石阻塞造成尿液滯留時產生的【流動】訊號: Twinkling artifact
由水腎處的腎臟，順著漲大的輸尿管橫向往骨盆的方向移動掃描，
細小的石頭有時不容易看到，不過加上彩色都卜勒的訊號後，
因阻塞造成結石近端尿液流動訊號反倒成了很好的指引，
希望大家能透過這個小技巧找【石】成功 !
Video 1: Transverse scan on ureter
配合Rotation的手法，可以觀察到細小漲大的輸尿管，同樣的可以確認結石的位置。
Video 2: Longitudinal scan on ureter
有興趣的話，還可以看看以前曾分享過的個案
中年男性，左腰痛
70歲男性，突發性左側腰腹痛半小時
Pneumobilia
Probe location: subxyphoid & transverse scan
Hyperechoic change with dirty shadow noted
at the surface of umbilical portion of left side portal vein
central distribution is a clue for pneumobilia
air patter noted within right side dilated biliary tree confirmed this
Reason for pneumobilia in this patient:
This patient had CBD stone history and history of ERCP for stone retrieval .
Upper arm lump
Location of this lump: middle part of left upper arm
no tenderness, no signs of infection, no pulsation
POCUS findings:
Superficial location
No increased vascularity
No signs of inflammation over surrounding structures
Compression can be used to differentiate which one is vein.
This solitary and anechoic lump should be lipoma
Descending colon
上次有秀過如何辨識和掃出Ascending colon,
這次用同樣的手法來呈現結腸不一樣的面貌，
不是每次都可以看到典型的Haustration,
尤其是裡面空空的時候。
Scanning tip:
Transverse scanning on lateral abdomen to identify colon
Then Rotate clockwise to do longitudinal scanning
POCUS for soft tissue & musculoskeletal system in ER
Handout for Advanced Emergency Ultrasound Course
(2017/09/05 Chi-Mei Hospital)
Reference:
Acute epigastralgia for 2 days
Acute epigastralgia for 2 days.
Echo findings: Antral perforation tract & Extraluminal free air
Also noted asymmetric gastric wall thickening around the tract
Extended reading
