Replies to This Discussion

Permalink Reply by Juan Carlos pari salas on November 24, 2011 at 12:26pm

It happens......

 

Permalink Reply by Rob Goodman on November 25, 2011 at 9:59am

 I guess the learning point for this is that there is no gut signature visible on the tubular structure.

Permalink Reply by Juan Carlos pari salas on November 26, 2011 at 9:36am

That is so true.

But it is also true that the mistake happens. I had one child about one year ago, which had a LRQ pain and was sent to discard appendicitis. This boy was 9-10 years old, and very colaborative in the examination; asking him about the pain ( where it started, etc) he told that the at first, it started in the back, and now it was at hipogastrium. Of course there was nothing on the LRQ, but in RUVJ there was a little stone. I think it is a very uncommon issue, and therefore ,as general practitioners, we don´t think about it in theifferential Dx., even if we see an elongated tubular structure on ultrasound. And that´s the reason there´s a pretty goof point on posting this.

On the other hand, speaking from a country in which sometimes we still use ultrasound machines from 20 years ago, i must say that the gut signatures are not often well defined. However, we have the clinical approach, and what is also well defined, when present, is the hiperechogenicity of the sorrounding fat tissue.