Diagnostic point-of-care ultrasound (POCUS) for gastrointestinal pathology: state of the art from basics to advanced

Abstract

The use of point-of-care ultrasound (POCUS) by non-radiologists has dramatically increased. POCUS is completely different from the routine radiological studies. POCUS is a Physiological, On spot, extension of the Clinical examination, that is Unique, and Safe. This review aims to lay the basic principles of using POCUS in diagnosing intestinal pathologies so as to encourage acute care physicians to learn and master this important tool. It will be a useful primer for clinicians who want to introduce POCUS into their clinical practice. It will cover the basic physics, technical aspects, and simple applications including detection of free fluid, free intraperitoneal air, and bowel obstruction followed by specific POCUS findings of the most common intestinal pathologies encountered by acute care physicians including acute appendicitis, epiploic appendagitis, acute diverticulitis, pseudomembranous colitis, intestinal tuberculosis, Crohn’s disease, and colonic tumours. Deep understanding of the basic physics of ultrasound and its artefacts is the first step in mastering POCUS. This helps reaching an accurate POCUS diagnosis and avoiding its pitfalls. With increased skills, detailed and accurate POCUS findings of specific intestinal pathologies can be achieved and properly correlated with the clinical picture. We have personally experienced and enjoyed this approach to a stage that an ultrasound machine is always accompanying us in our clinical on calls and rounds.

Diagnostic Accuracy of Point-of-Care Ultrasound Integrated into Clinical Examination for Acute Diverticulitis: A Prospective Multicenter Study

“…Symptoms, signs and laboratory tests are not accurate for diagnosis [1,2]. Nowadays, the abdominal pain workup in the ED is based on a combination of clinical assessment and point-of-care ultrasound (POCUS), aiming to increase diagnostic accuracy and to reduce the time to diagnosis, ED length of stay and the number of computed tomography (CT) scan requests [3,4]. In specific conditions, such as suspected abdominal aortic aneurysm, biliary and renal pathologies, pregnancy-related disorders and appendicitis, there are consolidated protocols that imply the systematic use of POCUS as an initial screening tool [5][6][7][8][9][10][11].…”

Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques

“…Indeed, before the widespread utilisation of modern diagnostic imaging techniques, in particular CT and US, the diagnosis of EA was usually made during surgical exploration while searching for unexplained cause of acute abdomen. Nowadays, although normal epiploic appendages are usually not evident in radiological studies, they result visible in inflammatory conditions and can be definitively diagnosed by contrast-enhanced CT (CECT) and US [3,[29][30][31]. Moreover, other advanced imaging techniques can be useful in the diagnosis of this disease such as dual-energy CT (DECT), contrast-enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI) [20,32].…”

Acute Epiploic Appendagitis: A Nonsurgical Abdominal Pain

“…Instead, Magnetic Resonance Imaging (MRI) is rarely used for diagnosis. Abdominopelvic US and CT examinations do not allow seeing the normal epiploic appendices, unless there is surrounding intraperitoneal fluid [22]. In cases of acute epiploic appendagitis, US evaluation shows, in the patient's area of maximal tenderness, the presence of a small (2-4 cm in maximal diameter) rounded or ovoid, noncompressible, and hyperechoic mass adherent to the colonic wall, without internal blood flow on color or power Doppler studies, frequently surrounded by a subtle hypoechoic line [11, 16, 22, 23].…”