Abstract
In critical care patients, point of care abdominal ultrasound examination, although it has been practiced for over 30 years, is not as widespread as its cardiac or pulmonary counterparts. We report two cases in which detection of air during abdominal ultrasound allowed the early detection of life-threatening pathologies. In the first case, a patient with severe Clostridium difficile was found to have portal venous gas but its significance was confounded by a recent surgery. Serial ultrasonographic exams triggered a surgical intervention. In the second case, we report what we call the “liver sign” a finding in patients with pneumoperitoneum. These findings, all obtained prior to conventional abdominal imaging, had immediate clinical impact and avoided unnecessary delays and radiation. Detection of abdominal air should be part of the routine-focused ultrasonographic exam and for critically ill patients an algorithm is proposed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-016-0039-7) contains supplementary material, which is available to authorized users.
Highlights
In 2009, the American College of Chest Physicians (ACCP) and La Société de Réanimation de Langue Française (SRLF) proposed guidelines in critical care ultrasound [1]
Among the technical and cognitive elements required for competence in abdominal ultrasonography, there was no mention of detecting abnormal air in specific areas despite the significant importance of this finding in critically ill patients
We report the cases of two patients where such routine use of the focused abdominal ultrasound exam led to the rapid detection of ominous findings of abnormal air patterns as the etiology of the clinical deterioration and expedited care
Summary
In 2009, the American College of Chest Physicians (ACCP) and La Société de Réanimation de Langue Française (SRLF) proposed guidelines in critical care ultrasound [1]. Those guidelines included cardiac and general critical care ultrasound. Among the technical and cognitive elements required for competence in abdominal ultrasonography, there was no mention of detecting abnormal air in specific areas despite the significant importance of this finding in critically ill patients.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
