Is pneumoperitoneum the terra ignota in ultrasonography?
In most cases, pneumoperitoneum is caused by gastrointestinal perforation, which usually requires surgical treatment. Many authors believe that ultrasound imaging of pneumoperitoneum is at least as effective as conventional radiography, or even that its efficacy is superior. In such a situation,...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Sciendo
2015-06-01
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| Series: | Journal of Ultrasonography |
| Subjects: | |
| Online Access: | http://jultrason.pl/index.php/issues/volume-15-no-61/is-pneumoperitoneum-the-terra-ignota-in-ultrasonography?aid=346 |
| Summary: | In most cases, pneumoperitoneum is caused by gastrointestinal perforation, which usually
requires surgical treatment. Many authors believe that ultrasound imaging of pneumoperitoneum
is at least as effective as conventional radiography, or even that its efficacy
is superior. In such a situation, it is imperative to make this modality one of the main tools
in the diagnostic arsenal of emergency medicine. This is the main aim of this paper. First,
ultrasound anatomy of so-called thoracic-abdominal border is discussed. The equipment
requirements emphasize that the diagnostic process can be conducted with the simplest
portable US scanner, even without the Doppler mode. The technique of a US examination, the aim of which is to detect, free air in the peritoneal cavity is also simple and conducted
with the patients lying down, either in the supine or lateral position. A convex transducer
with the frequency of 3.5–5 MHz is applied above the lower intercostal spaces on the
right and left side, to the epigastric region below the xiphoid process and in various sites
of the abdominal wall. The most effective examination, however, is conducted in the left
lateral position via the right intercostal spaces. The differential diagnosis on the right side
under the diaphragm should include the presence of a subdiaphragmatic abscess with
gas and a hepatic abscess with a similar content as well as transposition of the colon in
between the diaphragm and the liver (Chilaiditi syndrome). It seems that the inclusion
of a US examination to the E-FAST method in order to detect free gas in the peritoneal
cavity is justified since it is a sign of gastrointestinal perforation in numerous cases, and
is clinically as relevant as the presence of free fluid. |
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| ISSN: | 2084-8404 2451-070X |