Objective. The purpose of this presentation is to review the sonographic spectrum of disease entities evaluated by right upper quadrant (RUQ) sonography on an emergent basis. Methods. Right upper quadrant sonography was performed on an emergent basis in patients who came to the emergency department with signs and symptoms suspicious for or simulating acute cholecystitis or diseases of the liver and biliary tree. Results. A wide gamut of acute and chronic cholecystitis and diseases of the liver and biliary tree were visualized on RUQ sonography. Several other entities in addition to hepatic and biliary disease were also suspected on sonography and further evaluated by computed tomography. ight upper quadrant (RUQ) sonography is one of the most common emergent ultrasound examinations performed. It is relatively inexpensive and noninvasive and is the initial diagnostic imaging modality in the emergency setting for evaluating acute RUQ pain.
Conclusions. Right upper quadrant sonography is the first line of imaging in patients with1,2 It is also an appropriate initial diagnostic modality when clinical concerns include biliary disease, elevated liver function test values, and routine evaluation of the liver in the setting of hepatitis C and elevated α-fetoprotein levels.At our institution, RUQ sonography includes evaluation of the liver, gallbladder, central biliary tree, pancreas, inferior vena cava (IVC), and right kidney. Color Doppler evaluation of portal vein patency and the direction of flow is also included. Table 1 lists some basic normal values to allow a framework for evaluating pathologic conditions.
Focal periphyseal edema (FOPE) zones are areas of periphyseal edema seen near the time of physeal closure which are believed to be a physiologic phenomenon related to changes in distribution of forces around the physis as it closes. Since the original case series describing these areas of periphyseal edema, there has been little published in regard to FOPE zone outside of review articles. We present a set of three patients identified with focal periphyseal edema zones around the knee and compare our findings with the initial case series. We include a patient presenting with bilateral, nearly symmetric, focal periphyseal edema zones of the proximal tibia physis and a patient with partial closure of the physis at time of presentation, which were not reported in the original case series.
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