Maria A Parker, Bryson G Hicks, Matt Kaili, Aaron Silver, Meihua Zhu, Magdelyn Feuerherdt, Yuan Zhang, Caelan Thomas, Cynthia R Gregory, Kenton W Gregory, Nikolai Schnittke
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引用次数: 0
Abstract
Background: The focused assessment with sonography in trauma (FAST) examination plays an essential role in diagnosing hemoperitoneum in trauma patients to guide prompt operative management. The FAST examination is highly specific for hemoperitoneum in trauma patients, and has been adopted in nontrauma patients to identify intraperitoneal fluid as a cause of abdominal pain or distension. However, causes of false positive FAST examinations have been described and require prompt recognition to avoid diagnostic uncertainty and inappropriate procedures. Most causes of false positive FAST examinations are due to anatomic mimics such as perinephric fat or seminal vesicles, however, modern ultrasound machines use a variety of postprocessing image enhancement techniques that can also lead to novel false positive artifacts.
Case report: We report cases where experienced clinicians incorrectly interpreted ultrasound findings caused by a novel mimic of hemoperitoneum: the "lipliner sign." It appears most prominently at the edges of solid organs (such as the liver and the spleen), which is the same location most likely to show free fluid in FAST examination in trauma patients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians who take care of trauma patients must be familiar with causes of false positive FAST examinations that could lead to a misdiagnosis of hemoperitoneum.
背景:创伤超声重点评估(FAST)检查在诊断创伤患者血性腹腔积液以指导及时手术治疗方面起着至关重要的作用。FAST 检查对创伤患者的血性腹腔积液具有高度特异性,已被非创伤患者采用,以确定腹痛或腹胀的腹腔积液原因。然而,FAST 检查出现假阳性的原因已有描述,需要及时识别以避免诊断不确定性和不适当的手术。造成 FAST 检查假阳性的大多数原因是解剖学模拟物,如肾周围脂肪或精囊,然而,现代超声设备使用的各种后处理图像增强技术也可能导致新的假阳性伪影:我们报告了一些病例,在这些病例中,经验丰富的临床医生错误地解释了由一种新的腹腔积血模拟物--"lipliner 征 "引起的超声检查结果。它主要出现在实体器官(如肝脏和脾脏)的边缘,而这正是创伤患者在 FAST 检查中最有可能出现游离液体的位置。急诊医生为什么要注意这一点?护理创伤患者的临床医生必须熟悉导致 FAST 检查假阳性的原因,这些原因可能会导致血性腹腔积液的误诊。
期刊介绍:
The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections:
• Original Contributions
• Clinical Communications: Pediatric, Adult, OB/GYN
• Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care
• Techniques and Procedures
• Technical Tips
• Clinical Laboratory in Emergency Medicine
• Pharmacology in Emergency Medicine
• Case Presentations of the Harvard Emergency Medicine Residency
• Visual Diagnosis in Emergency Medicine
• Medical Classics
• Emergency Forum
• Editorial(s)
• Letters to the Editor
• Education
• Administration of Emergency Medicine
• International Emergency Medicine
• Computers in Emergency Medicine
• Violence: Recognition, Management, and Prevention
• Ethics
• Humanities and Medicine
• American Academy of Emergency Medicine
• AAEM Medical Student Forum
• Book and Other Media Reviews
• Calendar of Events
• Abstracts
• Trauma Reports
• Ultrasound in Emergency Medicine