Emergency Ultrasound (EUS)教學(16)

急診超音波在感染控制之應用
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
 Scenario
• 49歲女性，糖尿病患者，發燒及左側腰痛
二週，診所診斷為泌尿道感染，但患者對
於口服抗生素反應不佳

• Your impression ??
• Next step ??
• Role of EUS ??
2008 ACEP EUS scope of practice
Whole-Body approach at the bedside

Fever of Unknown Sonographic Origin

(FUSO)
EUS application (abdomen)
Role of US in infection control

Identify infection sources

Guide therapeutic procedures
 Sepsis workup
• Lung and pleural spaces
• Genitourinary system
• Intra-abdominal infection
– Solid organs
– Hollow organs
– Peritoneal cavity
• Skin and soft-tissue
Chest
Normal US appearance of the chest
Bat / Lung sliding / Seashore sign
Pleural effusion
Basic US patterns of PLE
Purulent Pleurisy
Simple PLE
Empyema
Alveolar consolidation
Pneumonia
Necrotizing Pneumonia
Fluid-bronchogram
Pyopneumothorax
Air-bronchogram
Lung abscess
Lung and chest wall abscess
X-ray 不明顯的肺炎
Back scan for consolidation
Dynamic air-bronchogram
Necrotizing pneumonia
Lung abscess
Fungal infection
Hydronephrosis
Pyonephrosis
Renal abscess
Pyonephrosis
Infected cyst
Renal abscess
Gas within kidney
Psoas muscle abscess
Fournier’s gangrene
BTI
CBD stone with obstruction
GB stone
Acute cholecystitis
 Cardiac gallbladder and
acute acalculous cholecystitis
Acute calculous cholecystitis
GB empyema
Liver abscess
Infected hepatic cyst
Liver abscess
小心Subphrenic area
未液化不易看
未液化易miss
Gas: comet-tail artifact
Liver abscess ?
Subphrenic abscess
Complicated pancreatitis
 Spleen

If A × B is >20 cm2, splenomegaly is considered.

Splenic abscess
Abscess & Gas
Paracentesis
Clear ascites
Postoperative peritonitis
Dirty ascites
Pneumoperitoneum
Fever with AMS
Pseudomembranous colitis
Colitis
Diverticulitis with abscess
Retrocecal appendicitis rupture
Post-appendectomy fever
Post-LC fever
Epigastric pain with fever
 Skin and soft tissue
18 y/o M, R’t leg cellulitis
Thigh abscess
Soft tissue abscess
Gas-forming abscess
Urachal cyst infection
Thigh abscess
Padding
43M with fever and right hip pain
Localize & Assist aspiration
Fever with left inguinal pain
56M with left inguinal pain and fever
73M, NF, Aeromonas hydrophila
78M, NF (KP)
Infected Thrombophlebitis
Floating Thrombosis
Right subclavian thrombosis
Maxillary Sinusitis
Intracranial hypertension in bacterial
meningitis
62M with fever and septic shock
Right eye redness
Vegetation
 Clinical Decision Making
57 y/o M,
HR 119, BP 69/34, SpO2 82%
 EUS for Sepsis
Integrated Application
Diagnose lesion
Assist procedure
Guide therapy