Dahine Joseph, Giard Annie, Chagnon David-Olivier, Denault André
Department of Intensive Care, Université de Montréal, Montreal, QC, Canada.
Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada.
Crit Ultrasound J. 2016 Dec;8(1):2. doi: 10.1186/s13089-016-0039-7. Epub 2016 Mar 11.
In critical care patients, point of care abdominal ultrasound examination, although it has been practiced for over 30 years, is not as widespread as its cardiac or pulmonary counterparts. We report two cases in which detection of air during abdominal ultrasound allowed the early detection of life-threatening pathologies. In the first case, a patient with severe Clostridium difficile was found to have portal venous gas but its significance was confounded by a recent surgery. Serial ultrasonographic exams triggered a surgical intervention. In the second case, we report what we call the "liver sign" a finding in patients with pneumoperitoneum. These findings, all obtained prior to conventional abdominal imaging, had immediate clinical impact and avoided unnecessary delays and radiation. Detection of abdominal air should be part of the routine-focused ultrasonographic exam and for critically ill patients an algorithm is proposed.
在重症监护患者中，床旁腹部超声检查虽已开展30多年，但不如心脏或肺部超声检查那样广泛应用。我们报告两例病例，其中腹部超声检查时发现气体有助于早期发现危及生命的病变。第一例中，一名患有严重艰难梭菌感染的患者被发现存在门静脉积气，但其意义因近期手术而混淆。系列超声检查促使了手术干预。第二例中，我们报告了我们所称的“肝脏征”，这是气腹患者的一种表现。这些发现均在进行传统腹部成像之前获得，具有直接的临床影响，避免了不必要的延误和辐射。腹部气体的检测应成为常规重点超声检查的一部分，并且针对重症患者提出了一种检查流程。
