Hand-Carried and High-End Ultrasound Systems are Equally Inferior to Abdominal Radiography and Multidetector Computed Tomography in the Diagnosis of Pneumoperitoneum

Abstract

Purpose: Pneumoperitoneum (PP) is a severe finding in emergency departments. Its quick and correct diagnosis is indispensable for the further treatment of patients. The aim of this study was to analyze the clinical value of abdominal ultrasound performed with a modern hand-carried ultrasound (HCU) device as well as with a high-end ultrasound (HUS) system in the diagnosis of PP in patients with acute abdominal pain.

Materials and Methods: 31 patients with acute abdominal pain were enrolled in this study irrespective of their underlying disease, and examination with a latest generation HCU and a newest generation HUS was performed. Diagnosis of PP was based on findings of multidetector computed tomography (MDCT) and abdominal radiography (AR) as the standard of reference. The study was carried out by two independent and experienced examiners unaware of the diagnosis made by MDCT or AR.

Results: In five (16 %) patients PP was identified by MDCT and AR. Examination with HCU was calculated with a sensitivity and specificity of 80 % and 81 %, respectively. Examination with HUS yielded a sensitivity and specificity of 80 % and 89 %, respectively.

Conclusion: PP can be detected by HCU and HUS with almost equal accuracy in patients with acute abdominal pain but both methods are inferior compared to MDCT and AR. However, HCU and HUS can accelerate the triage of patients and help to make decisions regarding the necessity of further examinations without the need for radiation and while reducing economic and logistic resources.

Key Points:

• Pneumoperitoneum (PP) is a severe finding in emergency departments.

• Hand-carried (HCU) and high-end (HUS) ultrasound systems can be helpful in detecting PP.

• Abdominal radiography (AR) and multidetector computed tomography (MDCT) are superior in detecting PP.

• HCU and HUS can accelerate the triage of patients.

• HCU and HUS can be helpful when making decisions regarding the necessity of further examinations.

Citation Format:

• Schleder S, Jung EM, Heiss P et al. Hand-Carried and High-End Ultrasound Systems Are Equally Inferior to Abdominal Radiography and Multidetector Computed Tomography in the Diagnosis of Pneumoperitoneum. Fortschr Röntgenstr 2014; 186: 219 – 224

Zusammenfassung

Ziel: Das Pneumoperitoneum (PP) stellt ein schwerwiegendes Krankheitsbild dar. Eine schnelle und korrekte Diagnose ist für die weitere Therapie unumgänglich. Ziel dieser Studie war es, die Wertigkeit eines modernen tragbaren Ultraschallgerätes (HCU) im Vergleich zu einem high-end Ultraschallsystem (HUS) anhand der Diagnose PP bei Patienten mit akutem abdominellem Schmerz zu evaluieren.

Material und Methoden: 31 Patienten mit akutem abdominellem Schmerz wurden unabhängig von ihrer Grunderkrankung in die Studie eingeschlossen und mittels HCU und HUS untersucht. Goldstandard für die Diagnose PP waren die Ergebnisse der Multidetektor-Computertomografie (MDCT) und der konventionellen Abdomenübersichtsaufnahme (AR). Die Studie wurde von zwei erfahrenen Untersuchern in Unkenntnis der Ergebnisse der MDCT und der AR durchgeführt.

Ergebnisse: Bei fünf (16 %) Patienten wurde mittels MDCT und AR das Vorliegen eines PP diagnostiziert. HCU zeigte eine Sensitivität und Spezifität von 80 % bzw. 81 %. HUS zeigte eine Sensitivität und Spezifität von 80 % bzw. 89 %. Zwischen HCU und HUS bestand kein statistisch signifikanter Unterschied in der Diagnosefindung bezüglich PP.

Schlussfolgerung: Das Vorliegen eines PP kann mittels HCU und HUS mit annähernd gleicher Genauigkeit aufgedeckt werden, jedoch sind beide Modalitäten der MDCT bzw. dem AR unterlegen. Jedoch stellen HCU und HUS wertvolle kostengünstige Untersuchungen ohne die Notwendigkeit einer Strahlenexposition dar, die es ermöglichen Rückschlüsse auf das Vorliegen eines PP zu ziehen und die Notwendigkeit weiterer Untersuchungen zu erkennen.

Kernaussagen:

• Das Pneumoperitoneum (PP) ist eine schwerwiegende Diagnose.

• Tragbarer (HCU) und high-end (HUS) Ultraschall können helfen ein PP zu erkennen.

• Abdomenübersichtsaufnahme (AR) und Multidetektor-Computertomografie (MDCT) sind in der Diagnose des PP überlegen.

• HCU und HUS beschleunigen die Versorgung des Patienten.

• HCU und HUS können die Entscheidung bezüglich weiterer Untersuchungen erleichtern.

Key words

abdomen - ultrasound - conventional radiography - CT

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