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Lung Ultrasound Findings in Radiographic Occult Pneumonias
Abstracts tightness. The diagnosis is made by echocardiography and confirmed with computer tomography. Methods: Case report and literature review. Results: A 36-year-old male was sent to emergency department due to syncope. He was fully consciousness when arriving ER and complained chest tightness. Bedside echocardiography revealed dilated aortic root about 6 centimeters with pericardial effusion which is highly suspect ascending aorta dissection. Emergent computer tomography revealed intimal flap in the ascending aorta and aortic arch with hemopericardium. Patient received emergent surgical intervention and recovered very well. Conclusions: Echocardiography plays an important role in the emergency department for detecting aortic dissection. The disease has high mortality rate and should receive emergent surgical intervention. Perform echocardiography in patient complained chest pain can early detect aortic dissection and reduce morbidity and mortality of patient.
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Results: A 84 years-old female patient, history of diabetes mellitus and hypertension, was presented with general malaise, poor appetite and high blood sugar for about 1 week at home. A bedside emergency department ultrasound was performed and showed reverberation of air within the right kidney that obscures the entire kidney shadow, right side pleural effusion. Later, abdominal CT scan without contrast showed prominent air collection in right renal parenchyma and perirenal space with a big calcified stone in right renal pelvis. Right subcapsular nephrectomy is done by urologist and the patient is discharged uneventfully on the 20th hospitalization day. Conclusions: Emphysematous pyelonephritis is a severe and acute necrotizing parenchymal renal infection caused by gas-forming bacteria. Diabetes mellitus and urinary tract obstruction are the two most predisposing factors. The initial diagnosis can only be made by emergent department ultrasound and confirms by abdominal CT scan. Aggressive broad-spectrum antibiotics should be initiated as soon as possible once diagnosis had made combined with or without percutaneous drainage and finally nephrectomy if medical theapy failed.
PPT8-004 Early Detection of Free Wall Rupture by Point of Care Ultrasound Jen-Tang Sun, Bo-Hwi Kang Department of Emergency, Far Eastern Memorial Hospital, Taiwan Objectives: Free wall ruptured is a rare but fatal complication of post myocardial infarction (MI). Point-of-care ultrasound provides a rapid diagnosis and increase chances of patient’s survival. Methods: Case report and literature review. Results: A 49-year-old man with past history of type A dissection status post grafting operation and hypertension under regular medication control; He visited our Emergency Department with complaint of sudden onset chest pain that radiates to back for a day with hypotension. Electrocardiogram revealed ST elevation over anteriolateral leads (V2-V4). Point-of-care ultrasound shows free wall rupture of lateral wall with pericardial effusion. Computed tomogram angiography also revealed hemopericardium and free wall rupture. Patient received emergent vascular exposure for extracorporeal membrane oxygenation removal and vessel repair operation and recovery has been uneventful and is discharged under stable condition. Conclusions: Free wall rupture is a deathly complication of post cardiac infarction; incidence rate of approximately 2-4% and 12–21% of deaths following MI. Complication typically does not occur within 24 hours of post MI but at the highest incidence of the following 7 days. Mortality is extremely high; hence, early finding is essential. The definite diagnostic criterion is echocardiography, with sensitivity of 100% and a specificity of 93%. The actual tear site, hemopericardium and right-heart collapse can be seen through echocardiography. Free wall rupture is a critical complication of post MI, requires rapid diagnosis and operation treatment. Point-of-care ultrasound provides an effortless and ultimate diagnosis, thus, increases the chance of survival. PPT8-005 Emphysematous Pyelonephritis in a Diabetic Patient Po-Chen Chou, Henry Kam-Hong Cheng, Wei-De Tsai, Wen Han Chang Department of Emergency, Mackay Memorial Hospital Objectives: Emphysematous pyelonephritis is an uncommon and lifethreatening infection of the kidney. Gas forming organisms infect the renal parenchyma, tissue, and collecting system, leading to rapid necrotizing destruction of the renal parenchyma and perirenal tissue. We present a case of emphysematous pyelonephritis diagnosed by bedside emergency department ultrasound. Methods: Case report and literature review.
PPT8-006 Lung Ultrasound Findings in Radiographic Occult Pneumonias Francis Lee Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore Objectives: To demonstrate the ability of lung ultrasound in discovering pneumonic lesions in radiographic occult pneumonias. Methods: A systematic protocol for lung examination is presented with three cases illustrating how the pneumonias could be missed by simply relying on the chest x-rays as the final arbiter for diagnosis. Results: The reasons for radiographic occult pneumonias could be related to radiographic techniques of acquiring a chest x-ray, age or location of the pneumonia. Three cases were used to demonstrate how ultrasound could help clinch the diagnoses. Conclusions: In patients presenting with clinical signs of lower respiratory tract infection, a lung ultrasound should be performed if the chest x-rays appear normal. PPT8-007 Role of Point of Care Ultrasound in the Diagnosis of Perforated Peptic Ulcer Kuo-Chih Chen Department of Emergency and Critical Care Medicine, West Garden Hospital, Taiwan Objectives: Perforated peptic ulcer is a common cause of acute abdomen and intra-abdominal infection in the emergency departments. The diagnosis is usually made by typical history, diffuse abdominal tenderness, muscle guarding and confirmed by x-ray or computed tomography. Despite previous studies point out that ultrasound is superior to plain radiography to diagnose pneumoperitoneum, most emergency physicians are still not familiar with this application. We report a case presenting with diffuse abdominal pain and muscle guarding to the emergency department and the diagnosis of perforated peptic ulcer was made by point of care ultrasound and confirmed by computed tomography and surgery. Methods: Case report and literature review. Results: A 75 year old woman presented with dull epigastric pain for one week and developed acute abdominal pain for half day Her vital signs were stable. Physical examination reveled diffuse abdominal tenderness and muscle guarding, especially over epigastrium. Ultrasound showed dirty ascites at Morrison’s pouch, right para-colic gutter and pelvic region, free air above surface of left lobe liver and a perforated hole at pre-pyloric region. Computed tomography and surgical finding confirmed the diagnosis.
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Results: A 84 years-old female patient, history of diabetes mellitus and hypertension, was presented with general malaise, poor appetite and high blood sugar for about 1 week at home. A bedside emergency department ultrasound was performed and showed reverberation of air within the right kidney that obscures the entire kidney shadow, right side pleural effusion. Later, abdominal CT scan without contrast showed prominent air collection in right renal parenchyma and perirenal space with a big calcified stone in right renal pelvis. Right subcapsular nephrectomy is done by urologist and the patient is discharged uneventfully on the 20th hospitalization day. Conclusions: Emphysematous pyelonephritis is a severe and acute necrotizing parenchymal renal infection caused by gas-forming bacteria. Diabetes mellitus and urinary tract obstruction are the two most predisposing factors. The initial diagnosis can only be made by emergent department ultrasound and confirms by abdominal CT scan. Aggressive broad-spectrum antibiotics should be initiated as soon as possible once diagnosis had made combined with or without percutaneous drainage and finally nephrectomy if medical theapy failed.
PPT8-004 Early Detection of Free Wall Rupture by Point of Care Ultrasound Jen-Tang Sun, Bo-Hwi Kang Department of Emergency, Far Eastern Memorial Hospital, Taiwan Objectives: Free wall ruptured is a rare but fatal complication of post myocardial infarction (MI). Point-of-care ultrasound provides a rapid diagnosis and increase chances of patient’s survival. Methods: Case report and literature review. Results: A 49-year-old man with past history of type A dissection status post grafting operation and hypertension under regular medication control; He visited our Emergency Department with complaint of sudden onset chest pain that radiates to back for a day with hypotension. Electrocardiogram revealed ST elevation over anteriolateral leads (V2-V4). Point-of-care ultrasound shows free wall rupture of lateral wall with pericardial effusion. Computed tomogram angiography also revealed hemopericardium and free wall rupture. Patient received emergent vascular exposure for extracorporeal membrane oxygenation removal and vessel repair operation and recovery has been uneventful and is discharged under stable condition. Conclusions: Free wall rupture is a deathly complication of post cardiac infarction; incidence rate of approximately 2-4% and 12–21% of deaths following MI. Complication typically does not occur within 24 hours of post MI but at the highest incidence of the following 7 days. Mortality is extremely high; hence, early finding is essential. The definite diagnostic criterion is echocardiography, with sensitivity of 100% and a specificity of 93%. The actual tear site, hemopericardium and right-heart collapse can be seen through echocardiography. Free wall rupture is a critical complication of post MI, requires rapid diagnosis and operation treatment. Point-of-care ultrasound provides an effortless and ultimate diagnosis, thus, increases the chance of survival. PPT8-005 Emphysematous Pyelonephritis in a Diabetic Patient Po-Chen Chou, Henry Kam-Hong Cheng, Wei-De Tsai, Wen Han Chang Department of Emergency, Mackay Memorial Hospital Objectives: Emphysematous pyelonephritis is an uncommon and lifethreatening infection of the kidney. Gas forming organisms infect the renal parenchyma, tissue, and collecting system, leading to rapid necrotizing destruction of the renal parenchyma and perirenal tissue. We present a case of emphysematous pyelonephritis diagnosed by bedside emergency department ultrasound. Methods: Case report and literature review.
PPT8-006 Lung Ultrasound Findings in Radiographic Occult Pneumonias Francis Lee Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore Objectives: To demonstrate the ability of lung ultrasound in discovering pneumonic lesions in radiographic occult pneumonias. Methods: A systematic protocol for lung examination is presented with three cases illustrating how the pneumonias could be missed by simply relying on the chest x-rays as the final arbiter for diagnosis. Results: The reasons for radiographic occult pneumonias could be related to radiographic techniques of acquiring a chest x-ray, age or location of the pneumonia. Three cases were used to demonstrate how ultrasound could help clinch the diagnoses. Conclusions: In patients presenting with clinical signs of lower respiratory tract infection, a lung ultrasound should be performed if the chest x-rays appear normal. PPT8-007 Role of Point of Care Ultrasound in the Diagnosis of Perforated Peptic Ulcer Kuo-Chih Chen Department of Emergency and Critical Care Medicine, West Garden Hospital, Taiwan Objectives: Perforated peptic ulcer is a common cause of acute abdomen and intra-abdominal infection in the emergency departments. The diagnosis is usually made by typical history, diffuse abdominal tenderness, muscle guarding and confirmed by x-ray or computed tomography. Despite previous studies point out that ultrasound is superior to plain radiography to diagnose pneumoperitoneum, most emergency physicians are still not familiar with this application. We report a case presenting with diffuse abdominal pain and muscle guarding to the emergency department and the diagnosis of perforated peptic ulcer was made by point of care ultrasound and confirmed by computed tomography and surgery. Methods: Case report and literature review. Results: A 75 year old woman presented with dull epigastric pain for one week and developed acute abdominal pain for half day Her vital signs were stable. Physical examination reveled diffuse abdominal tenderness and muscle guarding, especially over epigastrium. Ultrasound showed dirty ascites at Morrison’s pouch, right para-colic gutter and pelvic region, free air above surface of left lobe liver and a perforated hole at pre-pyloric region. Computed tomography and surgical finding confirmed the diagnosis.