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Differentiating portal venous gas from pneumobilia on ultrasound. See thread. #POCUS #FOAMus #FOAMed #IMPOCUS #MedEd #MedTwitter #ultrasound @ACEP_EUS @USIGcleveland @MetroHealth_EM @aedrake65
Case 1. Liver TRV sweep. Which is present? Answer poll.
Case 1. Which is present?
Case 2. Liver Sag Sweep. Which is present? Answer poll.
Case 2. Which is present?
Case 1 answer. Patient is s/p Whipple surgery and has pneumobilia.
Case 2 answer. Patient has ischemic bowel with portal venous gas.
Both cause intrahepatic branching gas pattern. Pneumobilia tends to result in larger collections of centrally located air while pneumatosis tends to result in small air densities located peripherally.
I like the mnemonic from Radiopedia.com.
Portal venous gas--P for peripheral
Common bile duct gas (pneumobilia)---C for central
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More from @RJonesSonoEM see all

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Robert Jones
@RJonesSonoEM
Pt-Bilat LE pain/swelling 5 days.Prior hx of unprovoked DVT/PE years ago but off meds due to insurance. See thread. POCUS DVT #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #FOAMcc @ACEP_EUS @medpedshosp @cianmcdermott @jminardi21 @grepmeded @siddharth_dugar @msiuba @NephroP @SonoStache
What POCUS DVT protocol to use? 2-point or 3-point or extended? With or without Doppler? Meta-analysis showed good performance of 2 and 3 point POCUS but need to understand POCUS compression limitations if only compression used: pubmed.ncbi.nlm.nih.gov/31145304/?from…
Adhikari and colleague article showed 6.3% false neg rate due to prox isolated DVT with 2-point compression. Limitations of POCUS prox compression DVT exam go beyond just missing isolated/focal DVT. pubmed.ncbi.nlm.nih.gov/25465473/
Read 9 tweets
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Robert Jones
@RJonesSonoEM
Patient with RUQ abdominal pain. Difficulty finding GB. Pt denies history of prior abdominal surgery and no scars seen. See thread. #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #MedStudentTwitter @medpedshosp @NephroP @grepmeded @cianmcdermott @ACEP_EUS @PhilipsPOCUS
GB Sag and TRV sweeps. GB not seen. No surgical clips seen. Contracted GB, agenesis of GB, ectopic location of GB, prior removal (and patient forgot--it does happen)?
On Sag image, don't confuse bowel contents with GB filled with sludge
Read 6 tweets
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Robert Jones
@RJonesSonoEM
Short image tweetorial on thoracic ultrasound findings in pneumonia. #POCUS #IMPOCUS #FOAMed #FOAMus #Medtwitter #Meded #COVID19 @medpedshosp @cianmcdermott @msiuba @siddharth_dugar @grepmeded @NephroP @emresidents
Normal lung ultrasound. A-profile with thin pleural line with lung sliding. Linear transducer used.
Irregular pleural line with patchy B-lines. Seen in viral (including COVID19) and bacterial pneumonia. This patient had mycoplasma pneumonia. Linear probe used.
Read 11 tweets

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