Yigal had a 70yo patient who was sent in by the GP with central abdominal pain and a pulsatile mass in the epigastrium.
ED US was performed upon arrival and revealed:
transverse view of the aorta with a dissection flap undulating in its lumen
Longitudinal view of the aorta
A dissection flap is hyper echoic and undulates independent of aortic pulse. There may also be hypo echoic thrombus in the false lumen.Seeing a flap in the aorta is highly specific and sensitive for dissection. However, sometimes slice thickness artefact can lead to flap like lines in the aortic lumen. Just remember that a flap will be thick and seen in trans and long. An artefact will usually be thin, disappear in a different angle or view and can be linked to an adjacent structure like the IVC.
40yo male came into ED with severe RUQ pain 2 hours duration. Similar previous episodes, nil US, but this time the pain had woken him from sleep.
RUQ tender, but no guarding.
He was afebrile with normal obs
WCC normal, normal LFTs and lipase.
ED US revealed: not dilated, a thick walled GB with a several mobile stones but one stone impacted in the neck of the GB
Gb long. hyper echoic stone near the neck. The GB wall is thick and has a hypo echoic middle layer which could be GB wall oedema.
On sitting the patient up, the larger stones fall to the funds, but the stones at the neck remain (impacted)
The patient also had a positive sonographic murphey's.
The patient was admitted to EGS and scanned by radiology in the morning. The subsequent scan showed a severely dilated GB with perforation.
Without US, this patient may have been dc home...