 Good morning. I am Dr. Monika Ramasamy, junior resident in Department of Radio Diagnosis BG, GMC and Sasun General Hospital Pune. I will be presenting a paper on the topic of role of Sonography in Accurately Diagnosing Non-Traumatic Abdominal Pathologies. Aim and objectives to analyze the sonographic findings in patients presenting to emergency unit with non-traumatic abdominal pain and to study the diagnostic accuracy of ultrasound. Objectives, evaluation of acute abdominal pathologies involving male and female population like appendicitis, perforation, malignancies and other miscellaneous conditions. Assessing the role of ultrasound in detail evaluation of disease process thereby enhancing the diagnostic accuracy for initial diagnosis and further line of management. Oralating acquired results with multi-detector CT diagnosis or postoperative or clinical findings. Introduction. Acute abdomen is a medical emergency in which there is sudden and severe pain in abdomen. Its causes can range from benign and self-limiting disease to a surgical emergency. Abdominal pain can be classified as visceral, somatoperital or referred pain that can be a manifestation of a wide array of systemic and local causes. More common causes are olesostitis, acute amputasitis, bowel obstruction, visceral perforation, miscentric ischemia and ischemic colitis. Today, the use of multi-detector computed tomography has revolutionized the clinical approach to these conditions. However, ultrasound remains the primary imaging technique in majority of cases. Especially in young and female patients when the limitation of radiation exposure is there in rural areas where access to multi-detector CT is not available. The lower cost and in particular the lack of radiation exposure are the most important advantages of ultrasound compared to CT. Furthermore, ultrasound is a real-time dynamic examination and this characteristic conveys dynamic information about bowel motility and changes in position and to depict blood flow. Advantages of ultrasound examination is the possibility to correlate the ultrasound findings with the point of maximal tenderness. The most common ultrasound technique used to examine patients with acute abdominal pain is the graded compression procedure. Another example of dynamic examination is the evaluation of bowel hernias, misentry and omentum through the Valsalva maneuver. Color and power Doppler imaging supplement, the information provided by grayscale imaging with increased vascularity visualized in the number of inflammatory infectious or neoplasic diseases. Finally, previous imaging, transvaginal imaging could be very useful in the evaluation of abdominal pain from gynecological causes and it could also be useful for evaluation of deeply positioned appendix, terminal ilitis, sigmoid or rectal inflammation. However, ultrasound is very operator dependent, quality of ultrasound imaging and diagnosis is influenced greatly by the experience of the examiner. Methodology, study design, descriptive, observational study, place of study, the study was carried out in the department of radio diagnosis Sasun General Hospital Pune from October 2023 to December 2023. Population study, inclusion criteria, all adult patients with complaints of abdominal pain presenting to emergency unit were included in the study. Exclusion criteria, patients with history of trauma and unstable patients with hypotensive shock. Sample size estimation, a total of 100 patients that is 50 male and 50 female underwent transabdominal and transvaginal sonography at department of radio diagnosis. Instrumentation, Philips Affinity 70 ultrasound machine comparison was done between USG and postoperative phoenix. All the 100 admitted patients were examined by the clinician and provisional clinical diagnosis was made by the information obtained from the clinical history and physical examination. Simultaneously, routine laboratory investigations were carried out. Following this, all the patients were examined using sonography with adequate bowel preparation with correlation of clinical history, physical findings and ultrasonographic findings. Ultrasonographic diagnosis was made. In few patients with discrepancy between clinical and sonographic imaging features CT and MRI was done to confirm the diagnosis. Final diagnosis was confirmed with post-surgery and histopathology in few cases. Images of few cases diagnosed on ultrasound. Case 1 of ruptured tubal ectopic pregnancy. Complex cystic structure was noted which showed increased peripheral vascularity giving ring of fire appearance in on transvaginal sonography. Free fluid was seen in pouch of Douglas which showed multiple mobile echos with him suggested of hemoperatonium. Second image shows case of ovarian torsion. It shows a complex ovarian cyst in ovary with absent internal and peripheral vascularity on putting color Doppler. In both cases, patients were operated based on the sonography report and diagnosis was confirmed postoperatively. Case 3, case of obstructive hemi vagina and ipsilateral renal egenesis ovira syndrome. Patient had diagnosed with biconvate uterus and hematometra in one horn with ipsilateral absent renal kidney. The image shows a transvaginal axial section with a hematometra on one horn and normal other horn of uterus. Finding was confirmed after doing MRI and postoperatively. Case 4 shows a case of admixture mass. A heterogeneous lesion was seen on transvaginal sonography adjacent to the uterus from which ovary was not separately visualized. It was diagnosed to be ovarian neoplasm. Post surgical resection diagnosis of ovarian carcinoma was confirmed with biopsy. Case 5, a case of acute appendicitis. A peristaltic non compressible blind ending tubular structure was seen in RI right iliac fossa region with thick walls suggesting inflamed appendix. Surrounding sub-centimetric lymph nodes and echogenic misentry were seen suggesting acute inflammatory changes. Case 5, case of acute entiritus. Small bubble loops showed thickening and thickened and edematous walls. Bubble loops contained a tubular thick walled worm-like structure within the lumen which was mobile with dynamic ultrasound. On stool microscopy, eschariasis worm infestation was confirmed. The sonography image shows bubble lumen with worm inside. Observation Of the 50 male patients that we studied, most of them were diagnosed with pancreatitis. Around 13 were diagnosed with pancreatitis. 11 were diagnosed with appendicitis. 12 patients where had tinal calculus. 9 patients were diagnosed as cholelythiasis. 3 had neoplasm. 2 were diagnosed with obstruction. 2 patients were diagnosed with misintric lymphoiditis. And one patient had liver abscess and one was diagnosed with perforation on sonography. Of the 50 female patients who were diagnosed, the most common cause was pelvic pathology which was seen in 14 female patients. 6 of them had diagnosed with appendicitis and 6 of them had neoplasm. 7 had renal calculus. 4 patients had tubercular entritus. 5 had cholelythiasis. And 2 patients had pancreatitis and liver abscess. 4 of them had miscellaneous diagnosis. In common of the 100 patients studied, pancreatitis was diagnosed in 15 patients of which 13 were male and 2 were female. Appendicitis was diagnosed in 17 patients of which 11 were male and 6 were female. Cholelythiasis was diagnosed in 14 patients of which 9 were male, 5 were female. Renal calculus was diagnosed in 15 patients of which 8 were male and 7 were female. Liver abscess was diagnosed in 3 patients in which 1 was male and 2 were female. Miscentric lymphadenitis and bowel pathologies were diagnosed in 6 patients of which 2 were male and 4 were female. Perforation and obstruction was suspected in 1 and 2 patients respectively of male. Pelvic pathologies in female were suspected in 14 patients. Miscellaneous conditions were diagnosed in 4 female patients. Of the pelvic pathologies that were diagnosed, the most common cause was ovarian torsion seen in 5 female, followed by ruptured ectopic pregnancy in 4. 3 of them had endometrioma or chocolate cyst. 1 patient was diagnosed with adenomyosis and 1 patient had pelvic inflammatory disease. All these diagnosis were later confirmed postoperatively also. Miscellaneous, the 4 miscellaneous cases seen where 1 was of obstructive hemivagina and it's lateral renal agent assist syndrome. 2nd was enthritis due to ascariasis worm infestation. Another patient was diagnosed with superior miscentric artery thrombosis on ultrasound thrombus. Ecogenic thrombus was seen in superior miscentric artery and 4th diverticulitis results and interpretation. Of the 15 cases which were diagnosed as acute pancreatitis had final diagnosis as pancreatitis. Hence ultrasound had 100% sensitivity and specificity. Appendicitis was diagnosed through ultrasound in 17 patients which was postoperatively confirmed. Hence the sensitivity and specificity was 100%. Cholelithiasis liver abscess also had a sensitivity and specificity of ultrasound diagnosis as 100%. Of 15 patients who were diagnosed with adrenal calculus, only 14 had adrenal calculus on CT. Hence sensitivity of USG diagnosis was 93% and specificity was 98%. Perforation and obstruction had 100% sensitivity and specificity on USG diagnosis. Bowel pathologies were diagnosed in 6 patients through ultrasound but were seen only in 5 patients in multi-detecticity. Hence it had a sensitivity of 83%. Neoplasm and pelvic pathologies were diagnosed 100% on ultrasound and had a sensitivity and specificity of 100%. Miscellaneous cases had a sensitivity of ultrasound diagnosis which is 75%. Overall diagnostic accuracy of ultrasonography acute abdominal conditions. In this study, ultrasonography was diagnosed in 75% of patients. 3 patients were misdiagnosed and in 32 patients other diagnostic investigations like multi-detector CT or MRI or tumor markers were required for confirmation of diagnosis. Discussion. According to the above results, ultrasonography is highly sensitive and specific for diagnosis of prevalent pathologies of acute abdominal conditions and almost global standard in cases of acute pancreatitis, appendicitis, cholerythiasis, liver abscess, perforation, obstruction, neoplastic etiologies and pelvic pathologies. Ultrasonography is highly accurate in gallbladder conditions especially diagnostic polycystitis associated with cholerythiasis. Ultrason is found superior to multi-detector CT in quick and accurate diagnosis of acute pelvic pathologies due to the availability of trans-veginal imaging option. Ultrason should easily visualise intraluminal structures like mobile worms due to dynamic imaging. In miscentric lymphodinitis, ultrasonography accurately diagnosed the condition and all the patients were managed conservatively. In appendicitis, it gave an accurate diagnosis in all cases. The sensitivity and specificity of ultrasonography in diagnostic pancreatic conditions is 100%. One patient was misdiagnosed with renal calculus due to the presence of renal medullary sinus fat artefact and patient body habitus. Presence of diverticulitis was better seen on multi-detector CT due to its location from posterior wall of sigmoid colon and hence missed on sonography. In one patient, non-occlusive miscentric ischemia NOMI diagnosis was made on multi-detector CT but was not well appreciable on sonography due to patient's body habitus. Conclusion The result of the study demonstrates the usefulness of emergency ultrasonography in acute abdominal condition involving various organ systems and associated pathologies. In majority of the systems, ultrasonography is highly accurate and definite. Diagnosis could be made. Ultrasonography is cheap, non-invasive, reliable, simple to perform, has no contraindications and can be repeated as and when required. It also allows complete portability so that studies can easily be carried out at the bedside in the emergency room in case of critically ill patients and even in operating room. It helps in showing organ specifications and its accurate measurement which is helpful in follow-up and response to treatment. Ultrasonography is also helpful in diagnosing alternate diseases and to reduce negative laparotomy rate. Thank you. These are my references.