Air and its Sonographic Appearance: Understanding the Artifacts

Buttar, Simran; Cooper, Denrick; Olivieri, Patrick; Barca, Michael; Drake, Aaran; Ku, Melvin; Rose, Gabriel; Siadecki, Sebastian D.; Saul, Turandot

doi:10.1016/j.jemermed.2017.01.054

Cited by 17 publications

(14 citation statements)

References 22 publications

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“…These artifacts can include “dirty shadowing” and reverberation artifacts commonly referred to as “a-lines.” To understand dirty shadowing, one must first understand clean shadowing. Clean shadowing is created by sound wave absorbing structures such as bone [11]. Because of this absorption, a shadow is cast deep to the structure (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…These repetitive, regularly spaced artifactual horizontal stripes that appear deep in an air-filled structure are a form of reverberation artifacts called a-lines [12]. A good nonpathologic example of a-lines is in normal lung [11]. In EPN, a-lines seen in the collecting system or renal parenchyma tissue are by definition pathologic because they are an illustration of gas filled structure tissue interface within the renal collecting system (Figures 2 and 3).…”

Section: Discussionmentioning

confidence: 99%

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Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department

Brown

Petersen

Kinas

et al. 2019

Case Reports in Emergency Medicine

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Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue often presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin dependent diabetes mellitus who presented with abdominal pain, nausea, vomiting, and “peeing air.” CT scan revealed air extending from the left renal parenchyma, perinephric fat and into the bladder, consistent with emphysematous pyelonephritis. Bedside point-of-care ultrasound (POCUS) subsequently revealed dirty shadowing and reverberation artifacts in the left kidney and the bladder consistent with gas in the urinary collecting system. By understanding the identifying artifacts seen with EPN, reflective shadow and reverberation artifact, the emergency physician may be alerted to the diagnosis sooner. Often this illness presents similarly to simple, acute pyelonephritis or undifferentiated sepsis. Therefore, POCUS allows for real time consideration of this condition while in the emergency department and thus prompter time to treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department

Brown

Petersen

Kinas

et al. 2019

Case Reports in Emergency Medicine

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show abstract

“…Subcutaneous emphysema on ultrasound has a diffuse hyperechoic appearance that obscures or obliterates deeper tissues due to the inability of the ultrasound wave to effectively pass through the air. Typically it is associated with subcutaneous crepitus on clinical examination 34 . It is most likely to be encountered following thoracic or abdominal surgery, trauma, or interventional procedures in the head, neck or trunk.…”

Section: Findings In Skin and Subcutaneous Tissuementioning

confidence: 99%

“…Typically it is associated with subcutaneous crepitus on clinical examination. 34 It is most likely to be encountered following thoracic or abdominal surgery, trauma, or interventional procedures in the head, neck or trunk. Although typically benign and self-limited, subcutaneous emphysema, if caused by gas gangrene, esophageal rupture, or tension pneumothorax, 3,34 can be life-threatening.…”

Section: Subcutaneous Emphysemamentioning

confidence: 99%

Managing uncommon and unexpected findings during neuromuscular ultrasound

2020

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One barrier to widespread adoption of neuromuscular ultrasound by clinical neurophysiologists is concern over how to identify and manage non-neuromuscular findings. This review addresses this concern by describing the sonographic appearance of a variety of commonly observed pathologies and anatomic variants in dermal, subcutaneous, bony, glandular, lymphatic, vascular, and other superficial tissues. Additionally, it outlines techniques to ensure proper clinical and ultrasound evaluation of unexpected or uncommon findings. Finally, it highlights strategies to manage unexpected findings, including how to best communicate findings to patients and referring clinicians to avoid unnecessary testing and ensure appropriate follow-up. Ultrasound extends the ability of the neuromuscular sonographer-clinician to contribute to patient care.

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“…Point-of-care ultrasound (POCUS) has a significant and effective role in the prompt bedside diagnosis of many causes of acute abdomen, specifically perforated viscus and pneumoperitoneum [4,5]. The sonographic detection of pneumoperitoneum was initially described as the 'Enhanced Peritoneal Stripe Sign (EPSS)', which involves identification of focal hyperechogenic thickening of the peritoneum with associated posterior dirty shadowing and/or horizontal reverberation artifacts [6][7][8]. The POCUS findings of pneumoperitoneum have been reported with notably high accuracy; thus, it is an ideal imaging modality for the emergency physician (EP) requiring a timely diagnosis [9,10].…”

Section: Introductionmentioning

confidence: 99%

Point-of-Care Ultrasound Diagnosis of Pneumoperitoneum in the Emergency Department

Bacci

Kushwaha

Cabrera

et al. 2020

Cureus

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Prompt and accurate diagnostic evaluation of the nontraumatic acute abdomen in the emergency department (ED) is crucial to lessen mortality burden. In patients with perforated viscus and pneumoperitoneum, point-of-care ultrasound (POCUS) can assist the emergency physician (EP) in the rapid bedside diagnosis. This report describes a case in which EPperformed POCUS led to the early detection and timely management of an atypical presentation of pneumoperitoneum.

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Air and its Sonographic Appearance: Understanding the Artifacts

Cited by 17 publications

References 22 publications

Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department

Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department

Managing uncommon and unexpected findings during neuromuscular ultrasound

Point-of-Care Ultrasound Diagnosis of Pneumoperitoneum in the Emergency Department

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