Ultrasound Case 037

Presentation

A 60 year old man presents with suprapubic pain of 3 days duration. He describes a ‘pelvic ache’ on urination; there is suprapubic tenderness and possible guarding on examination; and leukocytes in the urine.

You are considering just treating as a urinary tract infection but the degree of tenderness makes you take a look with ultrasound.

View 2

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Oblique suprapubic image just to the left of midline at the site of maximal tenderness.

A segment of sigmoid colon with thickened wall is seen. Off the deep surface arises a large diverticulum with a 15mm diameter. It contains some air and has echogenic surrounding mesenteric fat consistent with inflammation. Transducer pressure was maximal at this site.

Image 2: Addition of Power Doppler.

Increased flow is seen in the wall of the diverticulum and surrounding mesenteric fat consistent with inflammatory hyperaemia.


CLINICAL CORRELATION

Diverticulitis

The search for suspected diverticulitis:

  1. Scan the site of maximal tenderness considering all potential differentials
  2. Scan the descending and sigmoid colon in transverse section beginning about half way down the left side
LITFL Top 100 Ultrasound 037 Diverticulum examination technique

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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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