What do you see ?
Indication: search for Acute ABDOMEN
ABDOMEN is a mnemonic.
You should star from important and dangerous things: AAA & Free fluid
Moving gas is the focus in this case.
Acquisition:
Curve transducer and systematic scanning based on ABDOMEN
For moving gas detection, supine position first and sagittal scan at subxyphoid area.
Searching for isolated & echogenic air above liver surface.
If needed, ask the patient to keep left decubitus position and scan intercostally to check free air on liver surface.
Interpretation:
1. Isolated & echogenic air above liver surface (shown in the clip)
2. Enhanced peritoneal strip sign (EPSS) (shown in the clip)
3. Scissors maneuver
4. Dirty ascites
5. Perforated tract (most common location: prepyloric peration) (shown in the clip)
Making decisions:
1. Exclude life threatening diagnosis: such as AAA or internal bleeding
2. Ultrasound is more sensitive than X-ray in the diagnosis of pneumoperitoneum.
3. POCUS is a useful diagnostic tool at bedside , especially for critical or unstable patients.
More information
68F, diffuse abdominal pain with muscle guarding
Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneum.
Selective use of ultrasonography for the detection of pneumoperitoneum.
