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E2111. Don’t Drop the Ball, Ace Your Cases on Call: Primer for Emergency Ultrasound
Authors
  1. Anvesh Macherla; University of California Irvine Department of Radiological Sciences
  2. Ben Sadeghi; University of California Irvine Department of Radiological Sciences
  3. Eric Han; University of California Irvine Department of Radiological Sciences
  4. Thanh-Lan Bui; University of California Irvine Department of Radiological Sciences
  5. Justin Glavis-Bloom; University of California Irvine Department of Radiological Sciences
  6. Roozbeh Houshyar; University of California Irvine Department of Radiological Sciences
  7. Mohammad Helmy; University of California Irvine Department of Radiological Sciences
Background
Ultrasonography is a great tool to use in the emergent setting because of its speed and accuracy. However, errors in emergency ultrasound can occur for various reasons from technical mistakes on the sonographer’s side to a lack of experience reading sonograms on the radiology trainee’s side. Generally, diagnostic error rates range from 3-5%, and this can be elevated in emergent settings or with a resident on call. Most errors on the reading side are due to under-reading, where a finding is present on the image but is missed by the reader. Retrospective studies have shown that approximately 40% of emergent trauma cases and 8-10% of all emergent admissions have missed or delayed diagnoses, sometimes due to errors in ultrasound reading. Incorrect or overlooked findings not only lead to incorrect diagnoses, but also may lead to unnecessary imaging and procedures, and patient harm. Through case-based discussions, we present a series of common emergency ultrasound cases encountered by junior residents on-call.

Educational Goals / Teaching Points
This exhibit’s goal is to review the most common emergency ultrasound findings in different systems including vascular, gastrointestinal, hepatobiliary, obstetrics, gynecologic, male reproductive, and urologic. Each case will have a series of representative ultrasound images accompanied by annotations explaining the key imaging findings that will assist residents in making an accurate diagnosis. Additionally, there will be a discussion of potential pitfalls that may lead to a misdiagnosis, as well as key “red flags” that require more immediate attention.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Ultrasound allows for rapid imaging and diagnosis of emergent cases. However, its utility is dependent upon a radiologist’s ability to accurately recognize findings specific to emergent pathologies. We will be discussing key imaging findings on ultrasound imaging of emergency topics, including deep vein thrombosis, pseudoaneurysm, appendicitis, intussusception, cholecystitis, choledocholithiasis, hepatitis, ectopic pregnancy, retained products of conception, intrauterine demise, ovarian torsion, tubo-ovarian abscess, testicular torsion, testicular rupture, hydronephrosis, pyelonephritis, and nephrolithiasis.

Conclusion
Within the fast-paced environment of emergency departments, ultrasound is a great imaging modality to quickly and accurately diagnose medical emergencies. Radiology residents need to be familiar with common diagnoses and associated ultrasound findings in order to ensure accurate and prompt treatment.