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J Korean Med Assoc > Volume 50(1); 2007 > Article
Lim and Lee: Ultrasonography of the Acute Abdomen


The initial radiologic evaluation of a patient with acute abdominal symptoms begins with plain abdominal radiographs. Plain abdominal radiographs are helpful for the diagnosis of intestinal obstruction and pneumoperitoneum. However, cross-sectional imaging modalities, such as ultrasonography or computed tomography, are necessary for specific diagnosis of acute abdomen. Ultrasonography is a non-invasive and comfortable tool for patients visiting emergency room. This article describes the ultrasonographic findings of most common diseases presenting with acute abdominal symptoms.


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Figure 1
Normal appendix. Ultrasonogram using high frequency transducer on RLQ shows thin-walled, collapsed appendix (white arrows)
Figure 2
(A) Appendicitis. Longitudinal scan of ultrasonogram on RLQ shows thick-walled, distended appendix (diameter>6mm)
(B) Color Doppler ultrasonogram shows increase blood flow in inflamed appendix
(C) There is appendicolith in the tip of appendix on ultrasonogram
Figure 3
Acute cholecystitis. Longitudinal scan of RUQ shows large gallstone (white arrows) with wall thickening of gallbladder
Figure 4
Diverticulitis in the ascending colon. Ultrasonogram using high frequency transducer (A) shows thickened wall of ascending colon (AC) and out-pouching sac with wall thickening (arrows). Computed tomography of lower abdomen (B) shows inflamed diverticulum (white arrow) and mesenteric infiltration (starlet)
Figure 5
Appendagitis in the descending colon. Ultrasonogram in LLQ (A) shows well circumscribed echogenic mass with thin low echoic rim (white arrows) adjacent to descending colon. CT scan shows oval fatty mass (white arrows) with thin rim and internal high attenuation attached anterior wall of descending colon (B)
Figure 6
Gallstone ileus
(A) Ultrasonogram of lower abdomen shows large curvilinear bright echo (white arrows) with posterior echo shadowing in dilated small intestine
(B) This bright echo reveals to be stone (white arrows) on CT
(C) Ultrasonogram on RUQ shows collapse of GB and bright echoes in the lumen of gallbladder indicating airs (arrows)
Figure 7
Intussusception of small intestine. Transverse (A) and longitudinal (B) ultrasonograms of lower abdomen show multiple layered wall of small intestine with low echogic leading mass. CT scan (C) shows homogeneous enhancing mass (starlet) at the end of the intussusceptum, revealed to be B-cell lymphoma of small intestine
Figure 8
Acute pancreatitis. Transverse ultrasonogram on upper abdomen shows diffuse enlargement and decrease echogenecity of pancreas
Figure 9
Stone in common bile duct. Oblique longitudinal ultrasonogram shows oval echogenic lesion with acoustic shadowing (white arrows) and dilatation of extrahepatic bile duct


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