Karın Ağrısında Görüntüleme İlkeleri 2: Ultrasonografi (USG)
Özet
Karın ağrısı acil servis başvurularında sık görülmektedir. Aynı zamanda ayırıcı tanıları geniş olan bir durumdur. Bazen atipik prezentasyon ve spesifik olmayan bulgular ile karşılaşılmaktadır. Klinik şüpheyi doğrulamak gerekmektedir. Kendiliğinden iyileşen rahatsızlıklar söz konusu olduğu gibi acil müdahale gerektiren rahatsızlıklar da mevcuttur. Böyle bir klinik tabloda görüntüleme tetkikleri ile değerlendirme devreye girmektedir. Karın ağrısında ilk tercih invaziv görüntüleme tetkiki abdominal ultrasonografi (USG) olmaktadır. USG, yetersiz kaldığında ileri görüntüleme tetkikleri devreye girmektedir. Yatak başı yapılan USG (Point-of-care Ultrasound, POCUS) acil servis ve hekimler için karın ağrısı ile başvuran olgularda bir devrim niteliğindedir. Kullanımında deneyim ve teknolojik gelişmeler önemli olduğundan eğitimlerle pekiştirilmelidir.
Abdominal pain is a common symptom in emergency department presentations. It is also a condition with a wide range of differential diagnoses. Sometimes atypical presentations and non-specific findings are encountered. Clinical suspicion needs to be confirmed. While some conditions resolve spontaneously, others require urgent intervention. In such a clinical picture, imaging studies come into play. The first choice for abdominal pain is invasive imaging studies, specifically abdominal ultrasonography (USG). If USG is insufficient, advanced imaging studies are employed. Bedside USG (Point-of-care Ultrasound, POCUS) is revolutionary for emergency departments and physicians in the treatment of patients presenting with abdominal pain. Since its use requires experience and technological advancements, it should be reinforced with training.
Referanslar
Perysinakis I, Vassalou EE. Non-traumatic lower abdominal pain: ultrasonographic and clinical differential diagnosis. Ultrasonography 2024; 43(2): 151-168.
Colucciello SA, Lukens TW, Morgan DL. Assessing abdominal pain in adults: a rational, cost-effective, and evidence-based strategy. Emerg Med Pract. 1999;1(1):1-20.
Wolfe C, Halsey-Nichols M, Ritter K, et al. Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis. Open Access Emerg Med. 2022;14:335-345.
Çoşkun F. Acil Tıp Uzmanlık Eğitimi Müfredatında Acil Ultrasonografi (PoCUS). Turkiye Klinikleri J Emerg Med-Special Topics. 2018;4(1):106-112.
The American College of Emergency Physicians. Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Policy Statement. Ann Emerg Med. 2017;69:e27-e54.
Poggi C, Palavecino M. Ultrasound principles and instrumentation. Surg Open Sci. 2024; 18:123-128 .
Block B. Color Atlas of Ultrasound Anatomy. 2005. Thieme clinical sciences.
Di Serafino M, Iacobellis F, Schillirò ML, et al. Common and Uncommon Errors in Emergency Ultrasound. Diagnostics (Basel). 2022;12(3):631.
Baad M, Lu ZF, Reiser I, et al. Clinical Significance of US Artifacts.Radiographics. 2017;37(5):1408-1423.
Radonjić T,Popović M, Zdravković M, et al. Point-of-Care Abdominal Ultrasonography (POCUS) on the Way to the Right and Rapid Diagnosis. Diagnostics (Basel). 2022;12(9):2052.
Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg. 2014 Haz;57(3):162-8. doi: 10.1503/cjs.027312.
Wang RC, Kornblith AE, Grupp-Phelan J, et al. Trends in Use of Diagnostic Imaging for Abdominal Pain in U.S. Emergency Departments. AJR Am J Roentgenol. 2021 Oca;216(1):226-233. doi: 10.2214/AJR.19.22667.
Walid A, Muhammad A, Hussain Z. Value of Periappendiceal Fat Sign on Ultrasound in Acute Appendicitis. Cureus. 2021 Tem 11;13(7):e16321. doi: 10.7759/cureus.16321.
Alelyani M, Hadadi I, Shubayr N, et al. Evaluation of Ultrasound Accuracy in Acute Appendicitis Diagnosis. Appl Sci (Basel). 2021;11(6):2682. doi: 10.3390/app11062682.
Pinto Leite N, Pereira JM, Cunha R, et al. CT Evaluation of Appendicitis and Its Complications: Imaging Techniques and Key Diagnostic Findings. AJR Am J Roentgenol. 2005 Ağu;185(2):406-17. doi: 10.2214/ajr.185.2.01850406.
Kim MS, Kwon HJ, Kang KA, et al. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis. Br J Radiol. 2018 Oca 25;91(1082):20170529. doi: 10.1259/bjr.20170529.
Lin HA, Tsai HW, Chao CC, et al. Periappendiceal fat-stranding models for discriminating between complicated and uncomplicated acute appendicitis: a diagnostic and validation study. World J Emerg Surg. 2021 Eki 13;16:52. doi: 10.1186/s13017-021-00398-5.
Fu J, Zhou X, Chen L, et al. Abdominal Ultrasound and Its Diagnostic Accuracy in Diagnosing Acute Appendicitis: A Meta-Analysis. Front Surg. 2021 Haz 27;8:707160. doi: 10.3389/fsurg.2021.707160.
Fatima M, Farooq M, Butt MSJ, et al. Evaluating the Diagnostic Accuracy of Point-of-Care Ultrasound in Acute Abdominal Pain in the Emergency Setting. Cureus. 22 Eylül 2025;17(9):e92916. doi: 10.7759/cureus.92916.
Old JL, Dusing RW, Yap W, et al. Imaging for Suspected Appendicitis. Am Fam Physician. 2005 Oca 1;71(1):71-78.
Nakhaie Moghadam M, Salarzaei M, Shahraki Z. Diagnostic accuracy of ultrasound in diagnosing acute appendicitis in pregnancy: a systematic review and meta-analysis. Emerg Radiol. 2022 Haz;29(3):437-448. doi: 10.1007/s10140-022-02021-9.
Huang SS, Lin KW, Liu KL, et al. Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis. World J Emerg Surg. 30 Kasım 2023;18:54.
doi: 10.1186/s13017-023-00524-5.
Patel R, Tse JR, Shen L, et al. Improving Diagnosis of Acute Cholecystitis with US: New Paradigms. RadioGraphics. 2024 Ara;44(12):e240032. doi: 10.1148/rg.240032.
Wong C, Teitge B, Ross M, et al. The Accuracy and Prognostic Value of Point-of-care Ultrasound for Nephrolithiasis in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2018 Haz;25(6):684-698. doi: 10.1111/acem.13388.
Granat N, Alpert EA. Point-of-care ultrasound by emergency physicians for direct ureteral stone detection: a case series and review of the literature. Clin Exp Emerg Med. 2024 May;11(2):218-223. doi: 10.15441/ceem.23.096.
American Institute of Ultrasound in Medicine (AIUM). AIUM Practice Parameter for the Performance of Point‐of‐Care Ultrasound Examinations. J Ultrasound Med. 2019 Nis;38(4):833-849. doi: 10.1002/jum.14972.
Orso D, Peric D, Di Gioia CC, et al. Renal and Genitourinary Ultrasound Evaluation in Emergency and Critical Care: An Overview. Healthcare (Basel). 2024;12(13):1356. doi: 10.3390/healthcare12131356.
Rubano E, Mehta N, Caputo W, et al. Systematic review: emergency department bedside ultrasonography for diagnosing suspected abdominal aortic aneurysm. Acad Emerg Med. 2013 Şub;20(2):128-38. doi: 10.1111/acem.12080.
Shaban EE, Yigit Y, Alkahlout B, et al. Enhancing clinical outcomes: Point of care ultrasound in the precision diagnosis and management of Abdominal Aortic Aneurysms in emergency medicine: A systematic review and meta-analysis. J Clin Ultrasound. 2024. doi: 10.1002/jcu.23850.
Wilson SP, Connolly K, Lahham S, et al. Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay. World J Emerg Med. 2016;7(3):178-82. doi: 10.5847/wjem.j.1920-8642.2016.03.003.
Tenore JL. Ectopic Pregnancy. Am Fam Physician. 2000 Şub 15;61(4):1080-1088.
Park KE, Latack KR, Vestal NL, et al. Association of HCG Level with Ultrasound Visualization of the Gestational Sac in Early Viable Pregnancies. Reprod Sci. 2023 Ara;30(12):3623-3628. doi: 10.1007/s43032-023-01308-7.
Eisaman DM, Brown NE, Geyer S. Relationship of Beta-Human Chorionic Gonadotropin to Ectopic Pregnancy Detection and Size. West J Emerg Med. 2024 May;25(3):431-435 . doi: 10.5811/westjem.18396.
Ren Y, Shao X. Impact of emergency point-of-care ultrasound on time to diagnosis and treatment amongst patients with ectopic pregnancy: a systematic review and meta-analysis. Arch Med Sci. 2024 Eyl 6;21(5):1997-2006. doi: 10.5114/aoms/192513.
Kavalakatt J, Ibrahim J, Thomas M, ve ark. See to Believe: The Clinical Gaps in the Utility of Ultrasound Imaging in Screening for Ovarian Torsion. Cureus. 16 Temmuz 2025;17(7):e88077. doi: 10.7759/cureus.88077.
Garde I, Paredes C, Ventura L, et al. Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2023 Mart;61(3):310-324. doi: 10.1002/uog.24976.
Seth N, Yadav H, Varshney DK, et al. Comparative Evaluation of Point-of-Care Ultrasound (POCUS) and Computed Tomography (CT) in Diagnosing Acute Abdomen in Emergency Settings: A Prospective Observational Study. Int J Curr Pharm Rev Res. 2025;17(7):571-575
American Institute of Ultrasound in Medicine (AIUM). AIUM Practice Parameter for Documentation of an Ultrasound Examination. J Ultrasound Med. 2020 Oca;39(1):E1-E4. doi: 10.1002/jum.15187.
Tayal VS, Raio CC, Mandavia DP, et al. Ultrasound Guidelines: Emergency, Point-of-care, and Clinical Ultrasound Guidelines in Medicine. Dallas (TX): American College of Emergency Physicians; 2016.
Referanslar
Perysinakis I, Vassalou EE. Non-traumatic lower abdominal pain: ultrasonographic and clinical differential diagnosis. Ultrasonography 2024; 43(2): 151-168.
Colucciello SA, Lukens TW, Morgan DL. Assessing abdominal pain in adults: a rational, cost-effective, and evidence-based strategy. Emerg Med Pract. 1999;1(1):1-20.
Wolfe C, Halsey-Nichols M, Ritter K, et al. Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis. Open Access Emerg Med. 2022;14:335-345.
Çoşkun F. Acil Tıp Uzmanlık Eğitimi Müfredatında Acil Ultrasonografi (PoCUS). Turkiye Klinikleri J Emerg Med-Special Topics. 2018;4(1):106-112.
The American College of Emergency Physicians. Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Policy Statement. Ann Emerg Med. 2017;69:e27-e54.
Poggi C, Palavecino M. Ultrasound principles and instrumentation. Surg Open Sci. 2024; 18:123-128 .
Block B. Color Atlas of Ultrasound Anatomy. 2005. Thieme clinical sciences.
Di Serafino M, Iacobellis F, Schillirò ML, et al. Common and Uncommon Errors in Emergency Ultrasound. Diagnostics (Basel). 2022;12(3):631.
Baad M, Lu ZF, Reiser I, et al. Clinical Significance of US Artifacts.Radiographics. 2017;37(5):1408-1423.
Radonjić T,Popović M, Zdravković M, et al. Point-of-Care Abdominal Ultrasonography (POCUS) on the Way to the Right and Rapid Diagnosis. Diagnostics (Basel). 2022;12(9):2052.
Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg. 2014 Haz;57(3):162-8. doi: 10.1503/cjs.027312.
Wang RC, Kornblith AE, Grupp-Phelan J, et al. Trends in Use of Diagnostic Imaging for Abdominal Pain in U.S. Emergency Departments. AJR Am J Roentgenol. 2021 Oca;216(1):226-233. doi: 10.2214/AJR.19.22667.
Walid A, Muhammad A, Hussain Z. Value of Periappendiceal Fat Sign on Ultrasound in Acute Appendicitis. Cureus. 2021 Tem 11;13(7):e16321. doi: 10.7759/cureus.16321.
Alelyani M, Hadadi I, Shubayr N, et al. Evaluation of Ultrasound Accuracy in Acute Appendicitis Diagnosis. Appl Sci (Basel). 2021;11(6):2682. doi: 10.3390/app11062682.
Pinto Leite N, Pereira JM, Cunha R, et al. CT Evaluation of Appendicitis and Its Complications: Imaging Techniques and Key Diagnostic Findings. AJR Am J Roentgenol. 2005 Ağu;185(2):406-17. doi: 10.2214/ajr.185.2.01850406.
Kim MS, Kwon HJ, Kang KA, et al. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis. Br J Radiol. 2018 Oca 25;91(1082):20170529. doi: 10.1259/bjr.20170529.
Lin HA, Tsai HW, Chao CC, et al. Periappendiceal fat-stranding models for discriminating between complicated and uncomplicated acute appendicitis: a diagnostic and validation study. World J Emerg Surg. 2021 Eki 13;16:52. doi: 10.1186/s13017-021-00398-5.
Fu J, Zhou X, Chen L, et al. Abdominal Ultrasound and Its Diagnostic Accuracy in Diagnosing Acute Appendicitis: A Meta-Analysis. Front Surg. 2021 Haz 27;8:707160. doi: 10.3389/fsurg.2021.707160.
Fatima M, Farooq M, Butt MSJ, et al. Evaluating the Diagnostic Accuracy of Point-of-Care Ultrasound in Acute Abdominal Pain in the Emergency Setting. Cureus. 22 Eylül 2025;17(9):e92916. doi: 10.7759/cureus.92916.
Old JL, Dusing RW, Yap W, et al. Imaging for Suspected Appendicitis. Am Fam Physician. 2005 Oca 1;71(1):71-78.
Nakhaie Moghadam M, Salarzaei M, Shahraki Z. Diagnostic accuracy of ultrasound in diagnosing acute appendicitis in pregnancy: a systematic review and meta-analysis. Emerg Radiol. 2022 Haz;29(3):437-448. doi: 10.1007/s10140-022-02021-9.
Huang SS, Lin KW, Liu KL, et al. Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis. World J Emerg Surg. 30 Kasım 2023;18:54.
doi: 10.1186/s13017-023-00524-5.
Patel R, Tse JR, Shen L, et al. Improving Diagnosis of Acute Cholecystitis with US: New Paradigms. RadioGraphics. 2024 Ara;44(12):e240032. doi: 10.1148/rg.240032.
Wong C, Teitge B, Ross M, et al. The Accuracy and Prognostic Value of Point-of-care Ultrasound for Nephrolithiasis in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2018 Haz;25(6):684-698. doi: 10.1111/acem.13388.
Granat N, Alpert EA. Point-of-care ultrasound by emergency physicians for direct ureteral stone detection: a case series and review of the literature. Clin Exp Emerg Med. 2024 May;11(2):218-223. doi: 10.15441/ceem.23.096.
American Institute of Ultrasound in Medicine (AIUM). AIUM Practice Parameter for the Performance of Point‐of‐Care Ultrasound Examinations. J Ultrasound Med. 2019 Nis;38(4):833-849. doi: 10.1002/jum.14972.
Orso D, Peric D, Di Gioia CC, et al. Renal and Genitourinary Ultrasound Evaluation in Emergency and Critical Care: An Overview. Healthcare (Basel). 2024;12(13):1356. doi: 10.3390/healthcare12131356.
Rubano E, Mehta N, Caputo W, et al. Systematic review: emergency department bedside ultrasonography for diagnosing suspected abdominal aortic aneurysm. Acad Emerg Med. 2013 Şub;20(2):128-38. doi: 10.1111/acem.12080.
Shaban EE, Yigit Y, Alkahlout B, et al. Enhancing clinical outcomes: Point of care ultrasound in the precision diagnosis and management of Abdominal Aortic Aneurysms in emergency medicine: A systematic review and meta-analysis. J Clin Ultrasound. 2024. doi: 10.1002/jcu.23850.
Wilson SP, Connolly K, Lahham S, et al. Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay. World J Emerg Med. 2016;7(3):178-82. doi: 10.5847/wjem.j.1920-8642.2016.03.003.
Tenore JL. Ectopic Pregnancy. Am Fam Physician. 2000 Şub 15;61(4):1080-1088.
Park KE, Latack KR, Vestal NL, et al. Association of HCG Level with Ultrasound Visualization of the Gestational Sac in Early Viable Pregnancies. Reprod Sci. 2023 Ara;30(12):3623-3628. doi: 10.1007/s43032-023-01308-7.
Eisaman DM, Brown NE, Geyer S. Relationship of Beta-Human Chorionic Gonadotropin to Ectopic Pregnancy Detection and Size. West J Emerg Med. 2024 May;25(3):431-435 . doi: 10.5811/westjem.18396.
Ren Y, Shao X. Impact of emergency point-of-care ultrasound on time to diagnosis and treatment amongst patients with ectopic pregnancy: a systematic review and meta-analysis. Arch Med Sci. 2024 Eyl 6;21(5):1997-2006. doi: 10.5114/aoms/192513.
Kavalakatt J, Ibrahim J, Thomas M, ve ark. See to Believe: The Clinical Gaps in the Utility of Ultrasound Imaging in Screening for Ovarian Torsion. Cureus. 16 Temmuz 2025;17(7):e88077. doi: 10.7759/cureus.88077.
Garde I, Paredes C, Ventura L, et al. Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2023 Mart;61(3):310-324. doi: 10.1002/uog.24976.
Seth N, Yadav H, Varshney DK, et al. Comparative Evaluation of Point-of-Care Ultrasound (POCUS) and Computed Tomography (CT) in Diagnosing Acute Abdomen in Emergency Settings: A Prospective Observational Study. Int J Curr Pharm Rev Res. 2025;17(7):571-575
American Institute of Ultrasound in Medicine (AIUM). AIUM Practice Parameter for Documentation of an Ultrasound Examination. J Ultrasound Med. 2020 Oca;39(1):E1-E4. doi: 10.1002/jum.15187.
Tayal VS, Raio CC, Mandavia DP, et al. Ultrasound Guidelines: Emergency, Point-of-care, and Clinical Ultrasound Guidelines in Medicine. Dallas (TX): American College of Emergency Physicians; 2016.
