Emergency radiology

Abstract

US has a relevant role in the initial assessment of non-traumatic emergencies of the abdomen, sometimes being conclusive and some other times for selecting the patients for further imaging with CT. Injection of a contrast medium may give to the radiologist additional information to that obtained at baseline US and Doppler examination, since real-time, contrast-enhanced US (CEUS) may allow observing findings in the abdomen not recognizable at baseline US or even at color Doppler imaging. Extravascular use of microbubbles may also be useful in clinical practice to rapidly solve a number of unclear aspects. CEUS has a number of distinct advantages in acute patients, including its quickness, low invasiveness, and its possible bedside use. The information based on contrast enhancement is useful for initial diagnosis, therapeutic decision making, and follow-up of the critically ill patients. The purpose of this review is to illustrate the possibilities and limitations of abdominal CEUS in the acute setting, with special emphasis on the detection and characterization of acute inflammatory processes, infarcts, and hemorrhages.

Abdominal ultrasonography for patients with abdominal pain as a first-line diagnostic imaging modality

“…lowers the exposure (30). It is recommended that patients should undergo further diagnostic imaging examinations when large gas bubbles are observed (31). It is also recommended that patients should be referred to a gynecologist when gynecological diseases are suspected.…”

Contrast-Enhanced Ultrasound (CEUS) in Non-Traumatic Abdominal Emergencies

“…Nevertheless, standard US imaging has several limitations in characterizing anatomic structures and vascularized lesions. Contrast-enhanced ultrasound (CEUS) is a technique that uses specific contrast agents that can improve the characterization of anatomical structures through the visualization of small vessels and microcirculation [4][5][6][7].…”

“…Furthermore, these contrast agents have a short half-life, are excreted rapidly from the lungs, and are very well tolerated. In fact, they can be injected into patients with renal insufficiency, hypotension, shock, without further preliminary laboratory tests, and are also indicated in critical patients [4,5,8]. CEUS contrast media are safe with a very low incidence of side effects.…”

Deuxième niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé

“…Cela a été montré sur plusieurs séries où l'échographie de contraste comparée au scanner, examen de référence, présentait un RV+ de 48 et un RV-de 0,04 [63]. Les autres avantages de cette technique sont de pouvoir être réalisée au lit du malade, de classifier rapidement la sévérité des lésions [64] et d'assurer le suivi des lésions non chirurgicales en limitant l'irradiation en cas d'examens répétés [65]. La Fédération européenne des sociétés d'ultrasons en médecine et biologie recommande une pratique régulière de cette technique [66].…”