Pocus Ruq

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    Pocus Ruq

    A 40 y/o G10P10 presents with RUQ pain worse with fatty foods.

    1. When evaluating for acute cholecystitis, what 5 sonographic findings do you look for?
    2. What is the Mickey Mouse sign?
    3. What is the mantle clock sign?

    1. Gallstones/sludge, peri-cholecystic fluid, ant wall thickening, sonographic Murphy’s, enlarged CBD diameter.

    One recently published prospective cross-sectional study (Villar et al., 2015) suggested simplifying the definition of a positive POCUS test to be presence of gallstones alone. With the simplified definition in evaluating for acute cholecystitis, POCUS had a sensitivity of 100% and NPV 100%. In other words, absence of gallstones alone rules out acute cholecystitis. [1]

    2. Mickey Mouse sign refers to a short axis visualization of the portal triad.

    [2,3]

    3. Mantle clock sign refers to the appearance of the SMA in short axis view shortly after branching off the aorta.

    [4,5]

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    Sources:

    1. Villar J, Summers SM, Menchine MD, Fox JC, Wang R. The absence of gallstones on point-of-care ultrasound rules out acute cholecystitis. J Emerg Med. 2015 Jul. [Epub ahead of print]
    2. http://www.em.emory.edu/ultrasound/ImageWeek/Abdominal/mickey_mouse.html
    3. http://images.clipartpanda.com/mickey-mouse-clip-art-MICKEYD-600×600.jpg
    4. http://www.fpnotebook.com/mobile/surgery/Rad/UltrsndInAbdmnlArtcAnrysm.htm
    5. http://www.portablefireplace.com/images/P/Remington.png
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