Interactive Transcript
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This is a transabdominal ultrasound
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in a pregnant patient presenting
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with right lower quadrant pain.
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The patient had already had a transabdominal
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and transvaginal pelvic ultrasound, which
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demonstrated a viable first-trimester
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pregnancy without acute pathology.
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Because the pelvic ultrasound was normal,
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but the patient was having persistent
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pain, the referring clinicians also
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ordered a limited right lower quadrant
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ultrasound to evaluate for appendicitis.
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We can see that some of the first images
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obtained by the sonographer are not of the right
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lower quadrant, but of the right upper quadrant.
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In patients who are presenting with acute
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abdominal pelvic pathology, particularly
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in the context of early pregnancy, it's
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important to examine the upper abdominal
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quadrants to make sure that there's not a
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large volume of free fluid within the abdomen.
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These are transabdominal ultrasound
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images of the right lower quadrant.
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And we can see that the sonographer is panning
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back and forth and is showing us an elongated,
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thickened, hypoechoic tubular structure.
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It has a gut signature about it
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when we turn on this structure and
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can view it in the axial plane.
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And so what I'm focusing on in these
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images is this ring-like, concentric,
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hypoechoic, and hyperechoic structure
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in the right lower quadrant.
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If we pan through these images, we can see
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that this structure disappears and is blind
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ending. We can also trace it back to the
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cecum, which is on this side of the screen.
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And so this was identified
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as the patient's appendix.
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This was extremely tender
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to transducer palpation.
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We can see a small amount of free fluid
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adjacent to the appendix, and the sonographers,
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when they identify the appendix, will
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attempt something called graded compression,
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which is where they'll apply pressure to the
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appendix with the abdominal ultrasound probe
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along the length of the appendix to attempt
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to elicit pain and also try to collapse the
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appendix to show that it is not obstructed.
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So in patients who have acute appendicitis,
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often there is some obstructing lesion
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or stone near the appendiceal orifice, and
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the appendix will not compress and will be
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extremely tender on transducer palpation.
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These are additional transabdominal
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ultrasound images of the right lower quadrant.
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We can see in better detail the
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stool and fluid-filled cecum here
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on the left side of the screen.
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And we can see this tubular structure
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that is arising from the cecum.
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We can see a gut signature here, that
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kind of three-layered appearance.
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And this appendix is distended and filled
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with fluid and debris and was extremely tender
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to transducer palpation when the patient
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was being evaluated by the sonographer.
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And if we measure this appendix, it
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only measures about six millimeters,
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but because the patient was symptomatic,
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and because the appendix had this distended
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non-compressible appearance, we were able
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to make a diagnosis of acute appendicitis.
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