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AJR Am J Roentgenol 2021 05 11;216(5):1392-1399. Epub 2021 Mar 11.

Instituto de Radiologia (InRad), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, Sao Paulo, Brazil 05403-000.

Yellow fever is a hemorrhagic disease caused by an arbovirus endemic in South America; outbreaks have occurred in recent years. The purpose of this study was to describe abdominal ultrasound findings in patients with severe yellow fever and correlate them with clinical and laboratory data. A retrospective cohort study was performed between January and April 2018. Read More

J Emerg Med 2021 Feb 24. Epub 2021 Feb 24.

Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.

Background: Emphysematous cholecystitis (EC) is a form of cholecystitis with high mortality rates more commonly seen in patients with medical histories such as diabetes, hypertension, and peripheral vascular disease. The common features of these medical diseases are impaired pain perception, particularly abdominal pain, due to advanced age and peripheral neuropathies. Accurate evaluation of characteristics observed at ultrasonography, the method of first choice in the diagnosis of EC, is therefore highly important in these patients. Read More

Am J Emerg Med 2021 04 4;42:15-19. Epub 2021 Jan 4.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Background: Acute cholecystitis can be difficult to diagnose in the emergency department (ED); no single finding can rule in or rule out the disease. A prediction score for the diagnosis of acute cholecystitis for use at the bedside would be of great value to expedite the management of patients presenting with possible acute cholecystitis. The 2013 Tokyo Guidelines is a validated method for the diagnosis of acute cholecystitis but its prognostic capability is limited. Read More

ANZ J Surg 2020 12 31;90(12):2467-2471. Epub 2020 Jul 31.

Department of Radiology, Waitematā District Health Board, Auckland, New Zealand.

Background: Acute gallstone disease, primarily biliary colic and acute cholecystitis, represents a significant burden on surgical services. Prolonged waiting times for ultrasonography to confirm a diagnosis contributes to inefficiency and delays surgery. Bedside ultrasound offers an opportunity for clinicians make a diagnosis more promptly and streamline acute surgery. Read More

Am Fam Physician 2020 03;101(5):275-285

Naval Hospital Jacksonville, Jacksonville, FL, USA.

Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. Read More

ANZ J Surg 2019 05;89(5):460-461

Department of Surgery, North Shore Hospital, Auckland, New Zealand.

J Emerg Med 2019 Jul 15;57(1):74-76. Epub 2019 Apr 15.

Department of Emergency Medicine, Huntington Hospital, Huntington, New York.

Background: Hemorrhagic cholecystitis is a rare complication of acute cholecystitis and is a potentially fatal diagnosis. It may be difficult to detect because the symptoms are similar to more common diagnoses. Point-of-care ultrasound is a useful imaging technique in the emergency setting and is readily available to allow for immediate interpretation and application of the results to guide medical decision making. Read More

Eur J Gastroenterol Hepatol 2019 02;31(2):192-196

Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Republic of Korea.

Background: Acute gallstone pancreatitis occurs when a gallstone is impacted at the ampulla of Vater. The role of endoscopic retrograde cholangiopancreatography in the treatment of small choledocholithiasis in these patients is uncertain. The aim of this study was to compare outcomes of expectant management with endoscopic sphincterotomy for the treatment of small choledocholithiasis (≤5 mm) in patients with acute gallstone pancreatitis. Read More

Trauma Surg Acute Care Open 2018 30;3(1):e000164. Epub 2018 Jul 30.

Division of Emergency Medicine, Western University, London, Ontario, Canada.

Background: Patients with uncomplicated biliary disease frequently present to the emergency department for assessment. To improve bedside clinical decision making, biliary point-of-care ultrasound (POCUS) in the emergency department has emerged as a diagnostic tool. The purpose of this study is to analyze the usefulness of POCUS in predicting the need for surgical intervention in biliary disease. Read More

Crit Ultrasound J 2018 Jul 12;10(1):14. Epub 2018 Jul 12.

Department of Emergency Medicine, New York-Presbyterian, Brooklyn Methodist Hospital, Brooklyn, NY, USA.

Background: The use of point-of-care ultrasound (POCUS) has become increasingly important in resource-limited settings. It can rapidly diagnose both tropical infectious diseases and more common pathology at the bedside. In these practice settings, POCUS can have a significant impact on management strategies and patient care. Read More

World J Surg 2018 11;42(11):3551-3559

Department of Clinical Science and Education, Department of Surgery, Karolinska Institutet, Södersjukhuset (Stockholm South General Hospital), Sjukhusbacken 10, 118 83, Stockholm, Sweden.

Background: The use of ultrasound (US) outside the radiology department has increased the last decades, but large studies assessing the quality of bedside US are still lacking. This study evaluates surgeon-performed US (SPUS) and radiologist-performed US (RPUS) with respect to biliary disease and appendicitis.

Methods: Between October 2011 and November 2012, 300 adult patients, with a referral for an abdominal US, were prospectively enrolled in the study and examined by a radiologist as well as a surgeon. Read More

Emerg Radiol 2017 Apr 22;24(2):171-176. Epub 2016 Nov 22.

Department of Emergency Medicine, Tehran University of Medical Sciences, Dr Shariati Hospital, Kargar Ave, Tehran, Iran.

Study Objectives: Bedside emergency ultrasonograAmerican Society of Emergency Radiologyphy is a rapid diagnostic tool in the emergency department (ED). Nevertheless, the learning curve for ultrasound (US) training in various indications has to date not been clearly defined. The aim of the present study was to assess how much a short specialized training program in hepatobiliary US might impact the skills of novice emergency medicine residents. Read More

Acad Emerg Med 2017 03;24(3):281-297

Department of Emergency Medicine, SUNY-Downstate Medical Center, Brooklyn, NY.

Background: Acute cholecystitis (AC) is a common differential for patients presenting to the emergency department (ED) with abdominal pain. The diagnostic accuracy of history, physical examination, and bedside laboratory tests for AC have not been quantitatively described.

Objectives: We performed a systematic review to determine the utility of history and physical examination (H&P), laboratory studies, and ultrasonography (US) in diagnosing AC in the ED. Read More

World J Surg 2016 07;40(7):1688-94

Department of Clinical Science and Education, Department of Surgery, Karolinska Institutet, Södersjukhuset (Stockholm South General Hospital), Sjukhusbacken 10, 118 83, Stockholm, Sweden.

Background: Symptomatic gallstone disease is a common diagnosis in patients with abdominal pain. Ultrasound is considered the gold standard method to identify gallstones. Today the examination may be performed bedside by the treating clinician. Read More

Gastrointest Endosc 2016 Jun 20;83(6):1284-5. Epub 2015 Dec 20.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.

Intern Emerg Med 2016 Mar 4;11(2):261-4. Epub 2015 Nov 4.

Centre of Research and Learning in Ultrasound, Department of Internal Medicine, Maggiore Hospital, Bologna, Italy.

Acute cholecystitis (AC) represents a principal cause of morbidity worldwide and is one of the most frequent reasons for hospitalization due to gastroenteric tract diseases. AC should be suspected in presence of clinical signs and of gallstones on an imaging study. Upper abdominal US represents the first diagnostic imaging step in the case of suspected AC. Read More

Korean J Gastroenterol 2015 Jun;65(6):370-4

Department of Gastroenterology, Presbyterian Medical Center, Seonam University College of Medicine, Jeonju, Korea.

Cholangitis and cholecystitis are intra-abdominal infections that show poor prognosis upon progression to sepsis and multiorgan failure. Administration of antibiotics with high antimicrobial susceptibility and removal of infected bile at the initial treatment are important. After undergoing ERCP for diagnostic purposes, a 58-year-old man developed acute cholangitis and cholecystitis accompanied by rhabdomyolysis, multi-organ failure, and severe sepsis. Read More

Intern Emerg Med 2016 Feb 16;11(1):19-30. Epub 2015 Jun 16.

Division of Internal Medicine, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy.

Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Read More

J Miss State Med Assoc 2015 Mar;56(3):64-6

Modern ultrasound machines are relatively inexpensive to own and simple to operate. Basic ultrasound exams can be easily learned and mastered. As with any clinical exam skill, practice makes perfect. Read More

Eur J Trauma Emerg Surg 2015 Oct 21;41(5):481-92. Epub 2015 Mar 21.

Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA.

Introduction: Point-of-care ultrasonography is increasingly utilized across a wide variety of physician specialties. This imaging modality can be used to evaluate patients rapidly and accurately for a wide variety of pathologic conditions.

Methods: A literature search was performed for articles focused on clinician-performed ultrasonography for the diagnosis of appendicitis, gallbladder disease, small bowel obstruction, intussusception, and several types of renal pathology. Read More

Praxis (Bern 1994) 2014 Jun;103(12):697-703

Chirurgische Klinik, Spitalnetz Bern, Tiefenau.

Ultrasound is an easy to learn and highly efficient diagnostic tool to complete the clinical examination and improve bedside decision-making. In the trauma room, surgeons are often required to make a quick decision as to whether or not a patient needs an emergency intervention or whether further diagnostics are required. For this reason, education of surgeons in performing focused emergency ultrasound is pivotal. Read More

Pain Pract 2014 Feb 15;14(2):E63-8. Epub 2013 Aug 15.

Department of Anaesthesiology, Pain and Palliative Care, IRCH, AIIMS, New Delhi, India.

Introduction: Percutaneous anterior abdominal ultrasound guidance for performing celiac plexus neurolysis is a relatively new but more economical, less time-consuming, more comfortable bedside technique for interventional pain management. Paucity of studies evaluating the efficacy of single-site vs. double-site injections at celiac trunk for ultrasound-guided celiac plexus neurolysis (USCPN) prompted us to conduct a prospective, randomized, single-blind clinical trial to compare USCPN using bilateral paramedian (double needle) technique with unilateral paramedian (single needle) technique. Read More

Emerg Med Clin North Am 2013 Aug 15;31(3):809-29. Epub 2013 Jun 15.

Texas A&M - Christus Spohn Emergency Medicine Residency, 2606 Hospital Boulevard, 5 West, Corpus Christi, TX 78405, USA.

Bedside ultrasound (US) was introduced to the emergency department more than 20 years ago. Since this time, many new applications have evolved to aid the emergency physician in diagnostic, procedural, and therapeutic interventions and the scope of bedside ultrasound continues to grow. Many US scanning techniques easily translate from adult applications to the pediatric population. Read More

J Emerg Med 2013 Oct 13;45(4):598-601. Epub 2013 Jul 13.

Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York.

Background: Hepatic subcapsular hematoma is an uncommon cause of right upper quadrant pain in the Emergency Department. It must be recognized early, as large volumes of acute blood loss and rupture into the peritoneum carry significant morbidity and mortality. In the absence of gallbladder disease, the differential diagnosis should include liver pathology. Read More

PLoS Negl Trop Dis 2013 13;7(6):e2277. Epub 2013 Jun 13.

Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Background: Identification of dengue patients at risk for progressing to severe disease is difficult. Significant plasma leakage is a hallmark of severe dengue infection which can suddenly lead to hypovolemic shock around the time of defervescence. We hypothesized that the detection of subclinical plasma leakage may identify those at risk for severe dengue. Read More

Ann Emerg Med 2013 Aug 13;62(2):176-9. Epub 2013 Mar 13.

Division of Emergency Medicine Ultrasound, Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA.

Common bile duct stones frequently accompany gallstones and can be identified by a variety of imaging modalities. Little is known about the time course of dilatation of the common bile duct after acute obstruction or of normalization after spontaneous passage of an obstructing stone. We describe a case showing rapid fluctuations in common bile duct diameter during 72 hours in a patient presenting with epigastric pain and vomiting. Read More

Pediatr Emerg Care 2013 Jan;29(1):117-21

Division of Pediatric Emergency Medicine, Department of Pediatrics, Newark Beth Israel Medical Center-Children's Hospital of New Jersey, Newark, NJ, USA.

Acute acalculous cholecystitis is uncommon in pediatrics and more likely to be encountered in adult patients. Signs and symptoms of acute cholecystitis are similar to other causes of acute abdominal pain such as pancreatitis, gastritis, and acute appendicitis, further making diagnosis difficult. We present a case of acute acalculous cholecystitis in a child with cystic fibrosis and discuss the role of emergency physician bedside sonography in the evaluation of right-upper-quadrant pain. Read More

Am J Emerg Med 2012 Nov 12;30(9):1943-9. Epub 2012 Jul 12.

Emergency Department, Hospital Infanta Cristina, Parla, Madrid, Spain.

Purposes: Emergency physician-performed ultrasonography holds promise as a rapid and accurate method to diagnose multiple diseases in the emergency department (ED). Our objective was to assess the initial diagnostic accuracy (first 55 explorations) of emergency physician-performed ultrasonography for multiple categories of ultrasound use after a short training period.

Basic Procedures: This was a prospective observational study conducted at an urban ED from June 2010 to March 2011 in patients with suspected cholecystitis, hydronephrosis, deep vein thrombosis, and different cardiovascular problems. Read More

Am J Surg 2013 Jan 29;205(1):102-8. Epub 2012 Jun 29.

Graduate Entry Medical School, University of Limerick, Limerick, Ireland.

Background: We undertook a systematic review and meta-analysis to compare surgeon-performed ultrasound (SPUS) for suspected appendicitis or gallstone disease to the "gold standard" of pathological examination or radiologist-performed ultrasound (RPUS).

Data Sources: MEDLINE, Embase, trial registries, conference proceedings, and article reference lists were searched to identify trials and/or studies comparing SPUS with pathology or RPUS as the reference standard. Data were abstracted from eligible studies to produce 2 × 2 contingency tables, permitting the calculation of pooled sensitivity and specificity values. Read More

Emerg Med Clin North Am 2011 May;29(2):293-317, viii-ix

Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, Columbia, SC 29203, USA.

Abdominal pain is a common presenting complaint in today's emergency department (ED). Disorders related to the liver, gallbladder, and pancreas are responsible for many of these presentations. With the increasing prevalence of gallstones, as well as alcohol use and abuse, the numbers of cases are likely to increase. Read More