Adam Ash

William Beaumont Army Medical Center, El Paso, Texas, United States

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Publications (7)13.07 Total impact

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    ABSTRACT: The double-line sign (DLS) is a wedge-shaped hypoechoic area in Morison's pouch bounded on both sides by echogenic lines. It represents a false-positive finding for free intraperitoneal fluid when performing focused assessment with sonography in trauma examinations. The purpose of this study was to determine the prevalence of DLS. Secondarily, the study will further investigate the relationship between the presence of a DLS and body mass index (BMI). This was a prospective study that enrolled patients over a 7-month period. Inclusion criteria were patients ≥18 years of age presenting to the Emergency Department (ED) requiring a FAST examination as part of the patient's standard medical care. Each examination was performed by one of six experienced ultrasonographers. Presence or absence of the DLS was established in real time and gender, height, weight, and BMI were recorded for each patient. The overall prevalence rate of DLS and the corresponding 95 % confidence interval were calculated, as well as the prevalence rates broken down by BMI characterized as underweight, normal weight, overweight, and obese; and age category (18-29, 30-64, and 65+). The Chi-square test and a Fisher's exact test for BMI category were used to compare the prevalence rates of positive DLS among the different demographic groups. 100 patients were enrolled in the study; the overall prevalence was 27 %. There was no statistical significance among the different demographic groups or BMI. The DLS is a prevalent finding. We believe this sign has become more apparent due to improved imaging technology and resolution.
    Internal and Emergency Medicine 06/2015; DOI:10.1007/s11739-015-1264-y · 2.41 Impact Factor
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    ABSTRACT: This is a case report of a superficial penile hematoma that was difficult to distinguish clinically from a penile fracture. Such cases occur with relative frequency, and because definitive treatment is an urgent surgery, timely diagnosis is essential to avoid complications. Typical imaging modalities such as cavernosonography and magnetic resonance imaging can be invasive (cavernosonography) or time consuming (magnetic resonance imaging) and may not be readily available. Ultrasound has been used successfully in such cases, and,in this case, we used point-of-care ultrasound combined with a brief period of observation to exclude penile fracture.
    Critical ultrasound journal 07/2012; 4(1):17. DOI:10.1186/2036-7902-4-17
  • American journal of obstetrics and gynecology 11/2011; 206(3):e12-3; author reply e13. DOI:10.1016/j.ajog.2011.11.013 · 3.97 Impact Factor
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    ABSTRACT: Although rare, cervical ectopic pregnancy (EP) represents a potentially lethal variation of a common first-trimester disease entity. We report a case of low abdominal pain and vaginal bleeding diagnosed as a cervical EP by point-of-care ultrasound. Familiarity with cervical EP and its sonographic appearance is essential for emergency physicians because it can be easily mistaken for an intrauterine pregnancy or other obstetric/gynecologic pathology, such as an incomplete abortion or nabothian cyst. The management of each of these differs substantially, making accurate diagnosis crucial.
    Journal of Emergency Medicine 08/2011; 41(6):655-7. DOI:10.1016/j.jemermed.2011.05.048 · 1.18 Impact Factor
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    ABSTRACT: Urachal abnormalities are a rare cause of lower abdominal pain. They are often initially mistaken for more common causes of lower abdominal pain, and the diagnosis is usually made during evaluation for one of these more common conditions. We report a case of a painful periumbilical mass ultimately diagnosed as an infected urachal cyst. Although the cyst was evident sonographically, it was misidentified as an umbilical hernia, and the correct diagnosis was not made until the patient underwent computed tomography of the abdomen and pelvis before surgery. Emergency physicians should consider urachal disease in patients presenting with lower abdominal pain and should also be familiar with both the clinical and radiologic findings characteristic of this disease.
    Journal of Emergency Medicine 08/2011; 42(2):171-3. DOI:10.1016/j.jemermed.2011.05.046 · 1.18 Impact Factor
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    ABSTRACT: IntroductionPhysical examination and laboratory testing lack sufficient accuracy to distinguish cholecystitis from cholelithiasis. As a result, imaging studies are often required to safely disposition patients presenting with right upper quadrant or epigastric pain. Ultrasound is the initial test of choice in the majority of these cases, and generally relies a combination of findings (anterior gallbladder wall thickening, pericholecystic fluid/wall edema, hydrops, or a sonographic Murphy’s sign) to establish a definitive diagnosis. We suggest that the Stone-In-Neck (SIN) phenomenon, defined as an immobile stone lodged in the neck of the gallbladder, is specific for cholecystitis in the absence of other findings. MethodsWe prospectively compared the surgical pathologies of 57 patients diagnosed with either SIN or simple lithiasis to determine the incidence of cholecystitis in each group. ResultsSIN had a specificity of 97% and a positive predictive value of 93% in diagnosing cholecystitis. ConclusionPhysicians performing right upper quadrant ultrasound should have a high index of suspicion for cholecystitis when the SIN phenomenon is present, and should be aware that this group of patients are at much higher risk for cholecystitis than those with simple lithiasis. KeywordsGallbladder–Cholelithiasis–Cholecystitis–Stone–Stone-In-neck–Ultrasound–Right upper quadrant–Lithiasis
    Critical ultrasound journal 08/2011; 3(2):115-117. DOI:10.1007/s13089-011-0071-6
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    ABSTRACT: This is a case report of an eccentrically located intrauterine pregnancy initially diagnosed as an interstitial ectopic pregnancy. Although interstitial ectopic pregnancy represents a well-known pitfall in first-trimester sonography, the common error is to misidentify the ectopic pregnancy as intrauterine, not the reverse. Such an error is potentially catastrophic because it may lead to the inadvertent termination of a viable pregnancy. Although the role of ultrasonography for evaluation of ectopic pregnancy is well established, its diagnostic accuracy for interstitial ectopic pregnancy remains uncertain. Because of this, sonographic findings should be considered suggestive, but not diagnostic, in this setting.
    Annals of emergency medicine 05/2010; 56(6):684-6. DOI:10.1016/j.annemergmed.2010.04.001 · 4.33 Impact Factor