EUS教學_990729_Journal & Challenging Cases

8/9/2019 EUS _990729_Journal & Challenging Cases

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EUS_990729

Challenging cases & Journal Reading


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245

?


3/28

GB stone

No wall thickening or

pericholecystic fluid

Positive sonographicMurphys sign

Ann Emerg Med. 2010;56:114-122


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A distended GBgallstones with ASGB wall thickening & multiple layeringpericholecystic fluid

Ann Emerg Med. 2010;56:114-122


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EPs and radiologists performance was similar

Ann Emerg Med. 2010;56:114-122


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Ann Emerg Med. 2010;56:114-122


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What this study adds to our knowledge ?

In this small, single-site study (164

patients, 43 EPs), emergency physiciansand radiologists performance was similar

Ann Emerg Med. 2010;56:114-122


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X-ray?


9/28ACADEMIC EMERGENCY MEDICINE 2010; 17:687693


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Bedside US can accurately diagnose

pediatric clavicle fractures

100 pts & 43 clavicle

fractures by X-ray

US

Sensitivity 95%

Specificity 96%

Accuracy 96%

PPV: 95%

NPV 96%

ACADEMIC EMERGENCY MEDICINE 2010; 17:687693


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84M with dyspnea

Desaturation s/p thoracentesisfor Rt PLE Repeat CXR 3hrs later


12/28

What do you see in this

postprocedural pneumothorax?
http://postprocedural%20ptx%20by%20us.avi/


13/28

Ski Lift technique to assist CVC

placement
http://ski%20lift.mov/


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Submassive Pulmonary Embolism71F, 4-hour history of chest pain,

worsening shortness of breath, nausea, dizziness, and chills

The McConnell sign (RV mid-segment dilation with apicalsparing) has been reported to be specific for submassive PE
http://submassive%20pulmonary%20embolism%20by%20us_1.mov/


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Submassive Pulmonary Embolism

RV pressure overload with a D-shaped left ventricle was present during both systoleand diastole, and a large dilated RV was present in parasternal short-axis view


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Submassive Pulmonary Embolism

The RV outflow tract parasternal short-axis view also showed right atrial (RA)pressure overload with the intra-atrial septum bulging into the left atrium


17/28

Bubble Test to confirm CVC position
http://bubble%20test%20for%20cvc%20confirmation.mov/


18/28

5F, with cough and septic shock
http://1_lll%20pn%20with%20septic%20shock_5f_12950346/


19/28

43M, cough with left chest pain
http://2_lul%20pneumonia_43m_12438514/LUL%20pneumonia_43M_12438514.wmv


20/28

67F, RUQ pain for 2 hours

SKH_ER
http://3_acute%20cholecystitis_67f_08882288/Acute%20cholecystitis_67F_08882288.wmvhttp://3_acute%20cholecystitis_67f_08882288/Acute%20cholecystitis_67F_08882288.wmv


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31F, RUQ pain for half day
http://4_acute%20chalecystitis_31f_12691070/Acute%20chalecystitis_31F_12691070.wmv


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85F, RUQ pain and sepsis
http://xn--5_gb%20empyema_85m_02856474_-ij10eyu1w2gqd/GB%20empyema_85M_02856474.wmvhttp://xn--5_gb%20empyema_85m_02856474_-ij10eyu1w2gqd/


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22M, RLQ pain
http://6_appendicitis_22m_16509800/Appendicitis_22M_16509800.wmv


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49F, fever and left flank pain for 2 weeks
http://7_emphysematous%20pyelonephritis_49f_16171951/Emphysematous%20pyelonephritis_49F_16171951_1.wmvhttp://7_emphysematous%20pyelonephritis_49f_16171951/


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64F, fever and left inguinal pain
http://8_lymphadenopathy_64f_01477605/Lymphadenopathy_64F_01477605.wmv


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53M, Buccal ca s/p op with left

submandibular swelling
http://9_submandibular%20abscess_53m_10412996/Submandibular%20abscess_53M_10412996.wmv


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65M, MVA victim, left chest and

abdominal pain with hypotension
http://10_splenic%20laceration%20%26%20ptx_65m_10848085/http://10_splenic%20laceration%20%26%20ptx_65m_10848085/20100417_1700_Splenic%20laceration%20&%20PTX_65m_10848085.mpg


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Cases of this month

1. Retrocardiac pneumonia2. LUL pneumonia

3. Acute cholecystitis

4. Acute cholecystitis

5. GB empyema

6. Retrocecal appendicitis

7. Emphysematous pyelonephritis

8. Left inguinal lymphadenopathy

9. Submandibular abscess

10.Traumatic pneumothorax and splenic laceration

EUS教學_990729_Journal & Challenging Cases

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