EUS教學_990930

Challenging Cases
新光醫院急診醫學科
陳國智醫師
中華民國醫用超音波學會指導醫師
29M, umbilical pain for one week
 Umbilical abscess
EUS重點:
1. 確定abscess沒進腹
腔
abscess 2. 呈現soft tissue
infection的形態
3. Abscess的形態
4. 選定下針位置
 53M, neck tumor s/p op & C/T
left neck swelling & fever * 3 days
• EUS重點:
1. 確定abscess及位置
abscess 2. 定位抽吸位置及周邊
解剖位置
3. 避開血管

CCA
Submandibular abscess
50M, Traumatic arrest
Subcutaneous emphysema
• EUS重點
1. 皮下氣腫的超音波辨
識
2. 認識空氣對超音波造
成的干擾
77F, dementia with fever
 Septic arthritis

air

abscess
Arthrocentesis
(Needle route)
Septic arthritis
• EUS重點
1. 辨識joint effusion
2. 和對側比較是重點
3. Real-time
arthrocentesis時可正
確導引抽吸針的路徑

SKH
 66M, lung ca with C/T
right arm swelling for 3 days
 Subclavian venous thrombosis
EUS重點
non-compressible vein

SCA thrombus
SCV
83M, SOB for 3 days & shock
 PE with acute right heart strain
EUS重點
Dilated right chambers
IVS bulging into left chamber Engorged IVC w/o variation
57F, fever, malaise and abdominal
pain
 SLC
Pericardial fluid Pleural fluid
SLE
• Ascites
• Swollen intestinal villi
suspect vasculitis

EUS重點
1. Pericardial, pleural
and peritoneal fluid
2. Bowel vasculitis
pattern
 Suspect SLE
90F, diarrhea and abdominal pain
EUS重點: Whirlpool sign
Mesenteric volvulus
68F, fever for 2 days
• EUS重點
1. Severe
hydronephrosis
2. Echogenic content
Pyonephrosis
60M, abdominal pain for one week
Apple core sign
EUS重點:
1. 辨識腸阻塞
2. 利用BAM找阻塞處
3. Bowel wall
thickening
4. Bowel lumen
narrowing
5. 腸壁分層消失
D-colon cancer
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