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Acute abdomen: CT or ultrasound?

Chiu-Mei Lin, MD, Ph.DDepartment of Emergency MedicineShin Kong Wu Ho-Su Memorial Hospital

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Learning objective

Benefits of CT in the patient present with acute abdomen

When do you need the CT scan?When do you need ultrasound?

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Case: abdominal pain for 10 days

58 y/o male patient present with RUQ pain for 10 days, no fever

Blood WBC: 11200, Seg.: 86% Past history: DM

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Choice of computed tomography (CT) versus ultrasound

Radiation doseOperator's level of training Patient's age and sexCondition of patients cooperationObesity or not Other situations

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CT scan

High sensitivity High specificity Accuracy AvailabilityNot real-time, but dynamic study by artery-

vein-delayed phase Lack of operator dependence

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NEJM, 2007

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Ultrasound

Inexpensive Portable SafeNo requirement for radiationDynamic and real-time survey Operator dependence: solid or hollow

organ, experiences

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CT for appendicitis

CT for appendicitis has a higher sensitivity (90%-100%) and specificity (95%-97%) Radiology 2000;215:337-48

CT use in suspected acute appendicitis has greatly increased over the past several years. The dramatic increase in CT use at our institution has not resulted in dramatic decreases in negative appendectomy rate or statistically significant changes in perforation rate. Am Surg. 2001 ;67(11):1017-21.

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1. Swelling blinded-end loop2. Swelling of cecum3. Perifocal inflammation

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Choice CT or ultrasound

Diagnosis SurveillanceMonitoring disease response to therapy Exacerbation or dynamic survey:

ultrasound

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Abdominal CT

Abdominal CT can reveal: Appendicitis Gallstones or biliary sludge in the gallbladder or bile

ducts Kidney stones Enlarged lymph nodes anywhere in the abdominal cavity Thickened intestinal wall, like in lymphoma Diverticulosis Abdominal tumors Enlarged liver, spleen or kidneys Location and spread of abdominal cancers

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However, DDx is concerned (CT)

Mis- or delayed diagnosed?Unknown diagnosis? Young female patient, GI or GYN problem? Intractable abdominal pain (infarction or

vascular lesion?)High risk patient (sometimesVIP)With or without contrast medium?

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Case: abdominal pain for 1 day

62 y/o male patient present with upper abdominal pain for 1 day, no fever

Blood WBC: 9600, Seg.: 86% Past history: lymphoma

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Choice of ultrasound

Solid organ lesionHollow organ lesion (training and

education) operator dependence Trauma patient survey and follow-up Ascites localization

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Take home message

Emergency CT scan for acute abdomen: peritonitis, suspect bowel obstruction, vascular lesion (SMA occlusion etc)

Ultrasound: FAST, solid organs, hollow organ (need training and education)