E2695. Emergency Ultrasound Pitfalls and Pearls: Challenging Cases
  1. Nadia Solomon; Yale School of Medicine
  2. Spencer Beck; Yale School of Medicine
  3. Anne Sailer; Yale School of Medicine
  4. Margarita Revzin; Yale School of Medicine
Right upper quadrant pain is a common presenting complaint in the Emergency Department, and right upper quadrant ultrasound is frequently ordered for initial investigation as it provides an initial look at the regional anatomy and can reveal evidence of a wide array of pathologies and processes. While right upper quadrant pain is most commonly attributable to biliary and hepatic pathology and some pathological processes and their findings are relatively straightforward - such as cholelithiasis with acute uncomplicated cholecystitis, or hydronephrosis from an obstructing ureteric calculus - a wide variety of other less common (and some quite insidious) pathologies may also be detected if one knows where to look, and for what.

Educational Goals / Teaching Points
To review challenging US cases of RUQ pain in the Emergency Department. Review the causes of right upper quadrant pain that are identifiable at right upper quadrant ultrasound using an organ-system approach. Recognize the key differentiating clinical and imaging features of various conditions causing right upper quadrant pain, as well as other conditions which may be identified incidentally. Briefly discuss the relevant pathophysiology and next appropriate steps in management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit presents a series of cases demonstrating various right upper quadrant pathological processes and their appearance on right upper quadrant ultrasound, ranging from straightforward pathologies to rare or more subtle findings. Among these include cholecystitis of varying severities, gallbladder wall lymphangioma, adenomyomatosis, Mirizzi's syndrome, Bouveret syndrome, and more. When relevant, CT and/or MRI correlates are provided.

Right upper quadrant ultrasound is a commonly ordered study in the Emergency Department which can reveal a wide variety of pathologies if the radiologist is aware of their existence and knows how to recognize them. Knowledge of strengths and limitations of ultrasound in the evaluation of the right upper quadrant is paramount in correct diagnosis.