Key points of ultrasound panic findings in the hepatobiliary-pancreatic region

Abstract

When performing ultrasonography (US) on patients with acute abdomen, it is efficient and useful to rule out more urgent diseases while paying attention to the patients’ response and exacerbation in vital signs first, then screen for more frequent diseases as speculated based on abdominal symptoms, age, and sex. The “Panic Findings: Abnormal Findings Requiring Urgent Action” (panic findings) presented by the Japan Society of Ultrasonics in Medicine classifies abnormal findings in US that should be reported immediately into three groups: 1) “Urgent findings” requiring immediate action, 2) “Semi-urgent findings” requiring prompt action, and 3) “Abnormal findings” requiring early action. “Urgent findings” related to the hepatobiliary-pancreatic region include peritoneal/retroperitoneal fluid collection with debris echo, corresponding to intra-abdominal bleeding, organ damage, and rupture of tumors such as hepatocellular carcinoma. On the other hand, “semi-emergent findings” include multiple solid mass lesions or cluster signs (multiple liver metastases), liver mass lesions with fever and tenderness (liver abscess), extrahepatic bile duct dilation with fever (acute cholangitis), intrahepatic bile duct dilation (obstructive jaundice), enlarged gallbladder with fluid retention (acute cholecystitis), and enlarged pancreas with fluid retention (acute pancreatitis). These panic findings will enable rapid and reliable screening for emergency illness in patients with acute abdomen, which will prevent sudden deterioration of the patients’ condition (death) and contribute to improving the prognosis of emergency patients.