HighlightsDuplication of the gallbladder is a very rare surgical encounter.We report a patient with symptomatic gallstones incidentally found to have abnormal biliary anatomy.Intraoperative cholangiography enables diagnosis and avoids repeat cholecystectomy.
The previous article by Robinson and Clancy examined the value of ultrasound in the international perspective, placing the role of emergency department ultrasound in this country in the context of practice elsewhere in the world.This article seeks to explore the role of ultrasound in casualty-where it fits and where its limitations lie in relation to the advantages of alternative imaging modalities. The "who" of imaging will also be addressed-who should be performing ultrasound and who should train them. Anticipated future trends will be explored. In most centres imaging is currently performed on a discipline dictated basis. Thus when an obstetric question arises this is commonly imaged in an ultrasound department by radiographers on dedicated obstetric lists or by obstetricians. When a medical question arises, such as the possibility of deep venous thrombosis, a referral to a radiologist's ultrasound list is made. After referral the patient is transferred to the appropriate imaging department. This is a system convenient to the hospital staff that run the system rather than the patient.Ultrasound is a modality well suited to the casualty department. For the imaging facility to visit the patient is a neat solution attractive to the patient. Were there a machine "just next door" it seems logical that it would be used often and find application to a multitude of questions.All imaging modalities have evolved with great rapidity in the last decade. There is merit therefore in making a regular and conscious attempt to determine if current medical practise lies at odds with the potential and limitations of the imaging modalities that support it.
Competing modalities COMPUTED TOMOGRAPHYThere is a trend for computed tomography scanners to be sited close to or within the casualty department, particularly in centres with a large trauma workload. At the very time that ultrasound has risen as a modality offering ease of availability, the availability of its alternative also rises. Models supporting the value of ultrasound that assume a time, transport, and availability cost for computed tomography are already part outdated. Ultrasound must stand on the quality of the information it offers not just the rapidity of its availability.The quality of information provided by computed tomography has transformed radiological decision making. Spiral scanning with subsecond rotation times and high heat capacity tubes have enormously accelerated the speed of acquisition. Very high quality images in the current generation of scanners have increased accuracy of diagnosis. They routinely detail subtleties over a wide range of applications meaning that quoted pick up rates for other modalities, including ultrasound, have meaning only in articles comparing the latest equipment.Computed tomography has consistently higher sensitivity for parenchymal injuries in trauma; it also outperforms ultrasound for questions regarding intestinal pathology and injury. It performs with excellence in areas that ultrasound is weak, for example in imaging bon...
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