CHEST Guidelines-Shifting-Gas-Sign

Shifting-Gas-Sign_chest

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Dr. Li-Ta Keng raised points regarding an article by Dr. Tolia and colleagues, highlighting the use of ultrasound in diagnosing pneumoperitoneum (presence of free air in the abdominal cavity). Dr. Keng discussed the limitations and need for certain ultrasound signs to distinguish between intraperitoneal and intraluminal gas, a challenge in cases like severe ileus, where the gut may appear distended.<br /><br />Dr. Keng praised the original article but suggested incorporating the "shifting gas sign" for accurate diagnosis. This phenomenon, identified in 1989, involves observing a shift in reverberation artifacts in ultrasound images when a patient's position is changed. This sign helps differentiate between intraperitoneal and intraluminal gas because unlike intraluminal gas, intraperitoneal gas moves with changes in position.<br /><br />Dr. Keng emphasized that this sign can enhance the accuracy of ultrasound diagnostics for pneumoperitoneum, which is crucial when CT imaging isn't viable, offering quick, in-situ assessments that can be life-saving.<br /><br />In response, Dr. Tolia and colleagues acknowledged Dr. Keng's points, agreeing on the shifting gas sign's efficacy in specific clinical scenarios. They highlighted that traditional signs, while generally reliable, may struggle to discriminate gas types in complex cases. The shifting phenomenon enhances confidence in diagnosing intraperitoneal gas by allowing clinicians to detect air movement within the abdominal cavity as the patient's position changes. They expressed their intention to integrate this sign into their ultrasound curriculum at Stony Brook University, recognizing its utility in clinical practice for augmented diagnostic accuracy.

Keywords

ultrasound

pneumoperitoneum

shifting gas sign

diagnostic accuracy

intraperitoneal gas

intraluminal gas

reverberation artifacts

Dr. Li-Ta Keng

Stony Brook University

clinical practice