Ultrasound for Small Bowel Obstruction: Better than Xray

Another reason why not to waste anyone’s time getting Xrays during the course of SBO workups:

Bedside ultrasonography for the detection of small bowel obstruction in the emergency department 2010

In this Study by T Jang et al, U/s was compared with Xray for the diagnosis of SBO (based on bowel loop dilation on EM-performed u/s).

Dilated bowel on US had a sens/spec of 91% / 84%

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X-ray had a sens / spec of 46.2% / 66.7% for SBO when diagnostic, but was non-diagnostic 36% of the time.

So, if you really want to use a test “to know earlier,” consider learning and using ultrasound. Linear, curvilinear, or phased array probes can be used. Look for dilated, fluid filled loops of small bowel (>2.5 cm) in the paracolic gutters or anywhere else in the abdomen.

Upright xray should still be used for evaluation of free air.

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EPSS (E-point septal separation)

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I was asked about E-point septal separation, abbreviated as EPSS, during our faculty workshop last week and thought it would be useful to post some information on this topic. EPSS is a measurement obtained using M-mode echocardiography of the heart in the parasternal long-axis (PSLA) view through the LV septum and anterior mitral valve leaflet.

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This measurement (in mm) represents the distance from the anterior septal endocardium to the maximum early opening point of the anterior mitral leaflet during early diastole and correlates with ejection fraction. An increased EPSS is specific for decreased ejection fraction. A normal EPSS is 6mm or less which correlates with a normal EF, between 6mm and 12mm correlates with a low normal EF and any measurement above 12mm correlates with a low EF.

Of note be careful using EPSS to approximate ejection fraction in patients with mitral valve disease, especially mitral stenosis, as this correlation goes out the door.

The image below shows a normal EPSS. Notice the short, white, vertical line just to the right of the white star. It’s very short, which means the EPSS is practically zero. It’s safe to say this patient probably has a normal ejection fraction.

This next image shows an increased EPSS of almost 19mm. This patient has a low ejection fraction.

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My stomach…

I was playing around with the new Zonare machine and made this high-resolution clip of my stomach.

Note the rugae. Note the layers of the bowel wall – the dark (hypoechoic) layer is muscle.


– steve

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Hepatic hemangioma – a common incidental finding

I was helping Olabiyi with a renal scan yesterday and we stumbled across an hepatic hemangioma.

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If you start looking at the liver, you will find hemangiomas fairly often (7% of adults).

Hemangiomas are benign lesions composed of multiple blood-filled spaces lined by endothelium.

The typical sonographic appearance is hyperechoic, homogeneous, well-marginated, usually

The differential diagnosis includes: focal fat (see my earlier post on this), HCC, and mets. If there is no suspicion of cancer and the appearance is typical for a hemangioma, no workup is needed.

– steve

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