1000825 Challenging Cases

842019 1000825 Challenging Cases

httpslidepdfcomreaderfull1000825-challenging-cases 148

1000825_Challenging Cases

新光醫院急診醫學科

陳國智醫師中華民國醫用超音波學會指導醫師



Case 1 55F with LLQ pain

bull CC

ndash LLQ pain for one day

ndash OPD referred for ro ureteral stone

bull PE

ndash LLQ tenderness with local muscle guarding

bull ECHO



Whatrsquos your diagnosis



ECHO



CT



EUS 重點

Echogenic fat along intact colon

Tender and non-compressibleDX Epiploic appendagitis



Case 2 83F with abdominal pain

bull CC 83F complained epigastric pain for

hours

bull PE tenderness and muscle guarding over

epigastric area






CT



Air but not IPFA

bull Air in Lung

bull Air in GI tract

bull

Subcutaneous emphysemabull Chilaiditi syndrome



EUS 重點

Only isolated echogenic air useful

Dx Colonic interpositionChilaiditi syndrome



Case 3 58M with neck pain

bull CC 58M presented with painful neck

redness and fever for 2 days

bull PE neck swelling and redness

bull

Hx multinodular goiter sp op



What is your diagnosis



ECHO amp Guided aspiration



EUS 重點

Hypoechoic collection

Cobble-stone appearance

Diagnosis Neck abscess(MSSA bacteremia)



Case 4 70F with left hip pain for 10 days

bull CC left hip pain for 10 days withworsening progression

bull PE tenderness and limited left hip ROM

bull History Diabetes mellitus

bull Lab WBC 19000 ESR gt 140








EUS



CT



EUS 重點

LK upper pole hypodense lesion

Hypoechoic collection along left psoas muscleDx Renal abscess and

psoas muscle abscess (KP)



Case 5 57M with severe abdominal pain

bull CC presented with abdominal pain and

anorexia for 4 days

bull PE diffuse tenderness and muscle

guarding

bull History ESRD sp PD shift to HD





CT



ECHO



EUS 重點

Hyperechoic bowel wall with shadowing

Ascites with fibrin

Dx Sclerosing encapsulating peritonitis



Case 6 85M with anorexia for one month

bull CC poor appetite for one month low BP

(80mmHg) noted then sent to ER

bull PE mal-nutrition status no abdominal

tenderness or guarding





ECHO for septic shock workup



CT



EUS 重點

Right subphrenic abscess with gas content

Intact liver surfaceDx Subphrenic abscess due to previous hollow

organ perforation



Case 7 50F with chest pain post MVA

bull CC motorcyclist complained severe chest

pain after an traffic accident

bull PE no obvious bruise or tenderness over

chest or abdomen





FAST



EUS 重點

Echogenic pericardial fluid

Proceed to OR immediately after FASTDx RV rupture with hemopericardium



Case 8 59M with swollen right leg

bull 59-year-old man presented with right legswelling for one day

bull Hx Rectal ca sp op with multiple meta

bull PE swollen right leg and thigh no redness

bull EUS reason

ndash 2 point scan for highly suspected DVT



ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點

Echogenic thrombus noted from

right femoral to popliteal areaRight leg vein Non-compressible

Left popliteal vein compressible

Dx Deep vein thrombosis



Case 9 57F with fever and

abdominal pain

bull CC Abdominal pain amp body weight lose

6~7 kg within half year

bull PE TPR 392 121 20 Cachexic with

epigastric tenderness





ECHO



EUS 重點

Pericardial effusion

Pleural effusion Ascites

Abnormal small bowel wall edema vasculitis

Dx SLE



Case 10 82M with cold sweating

and chills

bull CC cold sweating and chills at night

bull PE coarse breath sounds with crackles

soft and distended abdomen

bull

ECHO for intra-abdominal infection survey



CXR amp KUB



CT



ECHO



EUS 重點

Distended small bowel with a U

shape dilatation from left to right

Dx A loop syndrome



謝謝聆聽

歡迎指教及給予回饋

Juice119pixnetnetJuice119gmailcom



Case 1 55F with LLQ pain

bull CC

ndash LLQ pain for one day

ndash OPD referred for ro ureteral stone

bull PE

ndash LLQ tenderness with local muscle guarding

bull ECHO






ECHO



CT



EUS 重點







hours


epigastric area






CT



Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽








ECHO



CT



EUS 重點







hours


epigastric area






CT



Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





ECHO



CT



EUS 重點







hours


epigastric area






CT



Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





CT



EUS 重點







hours


epigastric area






CT



Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點







hours


epigastric area






CT



Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽







hours


epigastric area






CT



Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽








CT



Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





CT



Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





Air but not IPFA

bull Air in Lung


bull




EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽









bull










EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽











EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽








EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點


















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽

















EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽










EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽








EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS



CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





CT



EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點








anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽







anorexia for 4 days


guarding






CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽







CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





CT



ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





ECHO



EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點


Ascites with fibrin
















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽

















CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽










CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽








CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





CT



EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點



organ perforation







chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽









chest or abdomen





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽







FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





FAST



EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽









bull EUS reason




ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





ECHO

RFV

RPV

LPV

LPA

LPA



EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點








abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽






abdominal pain









ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽







ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





ECHO



EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點




Dx SLE




and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽






and chills




bull




CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





CXR amp KUB



CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





CT



ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





ECHO



EUS 重點



Dx A loop syndrome



謝謝聆聽





EUS 重點



Dx A loop syndrome



謝謝聆聽





謝謝聆聽



Documents

1000825 Challenging Cases