Adam Ash

New York University, New York City, NY, United States

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Publications (5)10.17 Total impact

  • American journal of obstetrics and gynecology 11/2011; 206(3):e12-3; author reply e13. · 3.28 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. · 1.33 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. · 1.33 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 01/2011; 3(2):115-117.
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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. · 4.23 Impact Factor