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Rectal FB

11/30/11 - I hope everyone had a great Thanksgiving and to those who worked – thank you for your hard work over the holiday.

The “Image of the Week” goes to Dr. Rich McCormick, EM PGY2.  Dr. McCormick used the US to further aid in the evaluation of a patient who presented with “constipation.” The patient was initially not forthcoming with further history.  Dr. McCormick placed the curved probe superior to the rectum, in a saggital plane.  Can you identify the cause of discomfort in this sagittal US view (see image 1) ? What is the name of the US artifact seen in this image? Perhaps the XR will add some missing details (see image 2).

fb1
fb2

In brief, the patient presented with abdominal pain and the images reveal why – rectal FB. The ultrasound artifact is called reverberation and occurs when the US beams bounces off a highly reflective structure. This typically produces A-lines (horizontal lines) below the metallic structure (see image 1). 

Procedural sedation and ED retrieval were successful without complication. 

Thank you for your continued use of bedside US.