An intrauterine pregnancy on EUS effectively rules out
an ectopic pregnancy in the majority of patients.
Abdominal aortic aneurysm. EUS can quickly rule
out abdominal aortic aneurysm (AAA) in patients
presenting with nonspecific abdominal or low back
pain, avoiding the need for a computed tomography
• The 2008 American College of Emergency Physicians
u ltrasound guideli nes describe the history and training
process for the now 11 core appl ications of emergency
(CT) scan. At the other end of the clinical spectrwn, in
a hypotensive patient with abdominal or back pain, EUS
may rapidly rule in the diagnosis of AAA, facilitating
life-saving transport to the operating room instead of
threatening decompensation during CT.
Acute cholecystitis. Physical examination and laboratory
findings are often nonspecific in acute cholecystitis. EUS
often helps rule in or out the diagnosis, prompting faster
Renal colic. In the uncomplicated patient with flank
pain and hematuria, mild to moderate hydronephrosis
often further supports the diagnosis of nephrolithiasis
without the need for additional imaging.
Procedural applications. Use of ultrasound to aid in
performing procedures includes placement of peripheral
and central lines, abscess and foreign body localization,
interspace visualization for lumbar puncture, and
US guidance of pericardiocentesis, thoracentesis, and
Relative contraindications to EUS include patient factors
such as obesity and excessive bowel gas, as well as physician
inexperience. If the specific clinical question is not
answered or unexpected findings are encountered, then
always proceed to the next test. EUS is another advanced
diagnostic and procedural tool, but is not always a replacement for more definitive testing.
US is analogous to a submarine's sonar system. Sound
waves are emitted by the US probe, travel through tissue,
are reflected off structures, and then return to the probe.
Travel time is translated by the computer into depth within
the body. Strength of returning echoes is translated into
brightness or intensity of the structure on the display.
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