title: Ultrasound findings in critical care patients: the "liver sign" and other abnormal abdominal air patterns.
abstract: In critical care patients, point of care abdominal ultrasound examination, although it has been practiced for over 30 years, is not as widespread as its cardiac or pulmonary counterparts. We report two cases in which detection of air during abdominal ultrasound allowed the early detection of life-threatening pathologies. In the first case, a patient with severe Clostridium difficile was found to have portal venous gas but its significance was confounded by a recent surgery. Serial ultrasonographic exams triggered a surgical intervention. In the second case, we report what we call the "liver sign" a finding in patients with pneumoperitoneum. These findings, all obtained prior to conventional abdominal imaging, had immediate clinical impact and avoided unnecessary delays and radiation. Detection of abdominal air should be part of the routine-focused ultrasonographic exam and for critically ill patients an algorithm is proposed.
authors.affiliation: Department of Intensive Care, Université de Montréal, Montreal, QC, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Dahine
authors.affiliation: Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Giard
authors.affiliation: Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors.forename: David-Olivier
authors.initials: DO
authors.lastname: Chagnon
authors.affiliation: Department of Anesthesiology and Division of Critical Care, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada. andre.denault@umontreal.ca.|Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. andre.denault@umontreal.ca.
authors.forename: André
authors.initials: A
authors.lastname: Denault
keywords: Critical care/shock; Diagnostic imaging; Echo; Gastroenterology diagnosis; Ultrasound GI