The “Black Pattern”, a Simplified Ultrasound Approach to Non-Traumatic Abdominal Emergencies

Abstract

Background: A key issue in abdominal US is the assessment of fluid, which is usually anechoic, thus appearing “black”. Our approach focuses on searching for fluid in non-traumatic patients, providing a new, simplified method for point-of-care US (POCUS). Objective: Fluid assessment is based on a three-step analysis that we can thus summarize. 1. Look for black where it should not be. This means searching for effusions or collections. 2. Check if black is too much. This means evaluating anatomical landmarks where fluid should normally be present but may be abnormally abundant. 3. Look for black that is not clearly black. This means evaluating fluid aspects, whether wholly anechoic or not (suggesting heterogeneous or corpusculated fluid). Discussion: Using this simple method focused on US fluid presence and appearance should help clinicians to make a timely diagnosis. Although our simplified, systematic algorithm of POCUS may identify abnormalities; this usually entails a second-level imaging. An accurate knowledge of the physio–pathological and anatomical ultrasound bases remains essential in applying this algorithm. Conclusion: The black pattern approach in non -traumatic emergencies may be applied to a broad spectrum of abnormalities. It may represent a valuable aid for emergency physicians, especially if inexperienced, involved in a variety of non-traumatic scenarios. It may also be a simple and effective teaching aid for US beginners.

CTA Imaging of Peripheral Arterial Injuries

“…Ultrasound (US) is widely used in the setting of trauma, and peripheral vascular examination may detect features of vascular injuries such as luminal narrowing, intramural hematoma, flaps, posttraumatic stenosis, the" yin-yang" sign characteristic of pseudoaneurysm and acute occlusion [11,12,48,49]. The use of Color Doppler increase ultrasound accuracy and has a sensitivity up to 94% [11,12,50].…”

Imaging in Non-Traumatic Emergencies

“…“The “Black Pattern”, a Simplified Ultrasound Approach to Non-Traumatic Abdominal Emergencies”, by S. Tamburrini at al. [ 6 ], suggests a new approach to the search for fluid, which is usually anechoic and thus appears “black” during US, in non-traumatic patients for point-of-care US (POCUS) on the basis of three step analysis: 1. Look for black areas where they should not be.…”

“…The term “emergency” refers to a serious, often progressive clinical situation that calls for immediate diagnostic and therapeutic action. Although this is an old issue, approaches to this critical issue have deeply changed in the last three decades thanks to the impact of modern imaging, which has revolutionized the clinical “classic paradigm” based on observation, physical examination and diagnosis [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Today, diagnosis via imaging has almost entirely replaced physical examination in the emergency room, and the Radiologist has become of primary importance in this setting.…”