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Transcript of l 3diagnostic Ultrasonography
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DIAGNOSTICULTRASONOGRAPHY
CHAPTER 23
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PRINCIPLES OF ULTRASOUND
Sound waves are generated by theTRANSDUCER- the gizmo holding apiezoelectric crystal that changes
electrical current into sound waves andvice versa.
Sound waves are generated, reflected offof tissues and echo back, and arepicked up by the transducer(piezoelectric crystal) and converted to
electrical activity.
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PRINCIPLES OF ULTRASOUND
The image that is generated isdependent upon the time it takesthe sound waves to return to thetransducer.
The return time is a reflection of the
distance the tissue is from thetransducer and the degree to whichthe sound waves are reflected by
that tissue (organ vs. bone vs. fatvs. fluid .
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HAZARDS OF DIAGNOSTIC
ULTRASOUND
In short, for diagnostic ultrasound,there are none.
Ultrasound for longer periods oftime than are used in diagnosticultrasound can generate sufficientheat as to be harmful.
And in higher frequencies(>100,000 Hz) can causecavitation.
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METHODS OF UULTRASOUND
1) PULSE-ECHO
2) DOPPLER
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PULSE-ECHO METHOD
2 TYPES:
1) A MODE -amplitude modulation echoes
are displayed in graphic form, such as in anechocardiogram.
2) B MODE - brightness modulation echoesare displayed as different intensities of
brightness, giving a 2-dimensional cross-sectional image (picture, if you will). Can bestatic or dynamic (real-time).
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DOPPLER METHOD
Sound waves bounced off of differentobjects have different frequencies.
With doppler ultrasound, these different
frequencies are transformed into audiblesounds, of different frequency.
The different frequencies can also bemapped to give a visual representation as
well as an audible one.
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DOPPLER METHOD
USES
Flow through arteries and veins- to assesspatency of arterial grafts, obstruction to
flow by thrombi, atherosclerosis, etc.-arterial flow can often be heard in caseswhere it can not be palpated.
Opening and closing of cardiac valves
and flow through them- valvular stenosis,regurg.
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DOPPLER METHOD
OBSTETRICAL USES
Doppler stethoscope- to detect a fetalheart beat episodically, or continuously as
in labor.
Assessment of placental function / fetalgrowth evaluates flow through theumbilical artery and vein, looks for
differentials in flow
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DOPPLER METHOD
COLOR FLOW IMAGING
A type of doppler study.
Asseses whether blood flow is laminar (the
usual way) or turbulent (the abnormal way). Useful in: cardiac valvular regurgitation;
identification of a false lumen in aorticdissection; congenital heart defects such as
patent ductus arteriosus, atrial and venticularseptal defects, which would appear as turbulentflow.
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DOPPLER METHOD
DUPLEX SCANNING
Uses both real-time imaging and dopplerflow together.
Useful in evaluating a variety of vascularproblems: aneurysms, atherosceroticplaques.
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APPLICATIONS OF ULTRASOUND
CEREBRAL CIRCULATION
CAROTID ARTERY
GYNECOLOGIC / OBSTETRIC
TRANSVAGINAL / TRANSABDOMINAL TRANSRECTAL / TRANSTHORACIC /
TRANSESOPHAGEAL
STRESS ECHOCARDIOGRAM
ECHOENCEPHALOGRAM
BREAST
BLADDER
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CEREBRAL CIRCULATION
Measures blood flow in the cerebralcirculation, particularly in the:
1) Middle, anterior, and posterior cerebral
arteries.
2) Distal internal carotid.
3) Basilar artery.
Often combined with doppler duplexultrasound and arteriography.
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CAROTID ARTERY SCANS
Atherosclerosis is associated withthickening of the intima of the artery.
Risk of cardiovascular disease and stroke
is proportional to the thickness of theintima, which is a reflection of the degreeof atherosclerosis.
Useful for screening both symptomatic
patients who may need surgicalintervention and asymptomatic patientswho may need prevntive measures.
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GYNECOLOGIC ULTRASOUND
Uterus-size, shape (bicornuate),presence of masses within (fibroids,neoplasms).
Ovary-presence of masses, cysts,neoplasms.
Tubes-hydrosalpinx, pyosalpinx in
PID, ectopic pregnancy.
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BENIGN CYSTIC TERATOMA
RIGHT
OVARY
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ECTOPIC PREGNANCY
UTERUS:
SOLID MASS WITHIN
NO GESTATIONAL SAC
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ECTOPIC PREGNANCY
ADNEXA:
CYSTIC MASS,BETA HCG 17,000
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COLOR DOPPLER (FLOW)STUDY
INCREASED
FLOW
ECTOPIC PREGNANCY
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TWIN GESTATION
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OB (FETAL) ULTRASOUND
26 WEEK FETUS:
CONGENITAL
POLYCYSTIC
KIDNEYS
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23 YOF AT 20 WEEKS GESTATION
FETAL HYDROTHORAX (BILATERAL PLEURAL EFFUSIONS) AND
ASCITES, C/W HYDROPS FETALIS
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23 YOF AT 20 WEEKS GESTATION
FETAL HYDROTHORAX (BILATERAL PLEURAL EFFUSIONS) AND
ASCITES, C/W HYDROPS FETALIS
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OLIGOHYDRAMNIOS
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OB SCAN - OMPHALOCOEL
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PLAIN FILM - OMPHALOCOEL
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TRANSVAGINAL ULTRASOUND
Transducer placed in the vagina.
USEFUL FOR:
Evaluation of follicular development,
ovulation.
Ruling out ectopic pregnancy.
Evaluation of endometrial thickness inthe assessment of post-menopausalbleeding, need for biopsy.
Incompetent cervix.
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BICORNUATE UTERUS
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SAME BICORNUATE UTERUS
GESTATIONAL SAC
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SAME BICORNUATE UTERUS
OTHER HORN
FLUID-FILLED
ONLY
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TRANSVAGINAL SCAN
UTERUS:
COMPLEX, CYSTICMASS WITHIN THE
UTERUS
DDx
CYSTIC POLYP,
ENDOMETRIAL Ca,ENDOMETRIAL
HYPERPLASIA
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TRANSVAGINAL SCAN
On this image performed during sonohysterography,
two masses, one polypoid and another more broad-based,
extending from the endometrial lining are evident.
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ULTRASOUND LEFT OVARY
HEMORRHAGIC CYST
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SAME PATIENT
HEMORRHAGIC CYST RESOLVED
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ABDOMINAL ULTRASOUND
Often the 1sttest used to evaluateabdominal pathology (or 2nd, behind aKUB).
Or complementary to other studies suchas radionuclide studies, CT, MRI, X-Ray/Contrast studies, etc. No radiation,cheaper.
Needle-guided biopsies, paracentesis. Examples: appendicitis, cholelithiasis,
aortic aneurysms, cysts / masses /tumors / abscesses / ascites.
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CHOLECYSTITIS
GALLBLADDER:
GALLSTONE,WALL THICKENING
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SAME PATIENT
COMMON BILE DUCT ENLARGED
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ABDOMINAL SONOGRAM
A thickened gall bladder wall is noted, with some pericholecystic fluid
and shadowing echogenic foci likely representing stones
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TRANSRECTAL ULTRASOUND
Primarily for evaluation of the prostate-size, shape, etc., to evaluate for BPH,prostate cancer.
Used after evaluation by DRE (digitalrectal exam) and PSA (prostate-specificantigen).
Used in needle-guided biopsies,implantation of radioactive seeds fortreatment of malignancy of the prostate.
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TRANSTHORACIC
ECHOCARDIOGAPHY
USEFUL IN THE EVALUATION OF
Valvular defects, chamber size.
Structural abnormalities- patent ductus, atrial
and ventricular septal defects. Pleural effusion, cardiac tamponade.
Color imaging can detect flow laminar vs.turbulent.
Some changes in coronary flow. ECG sometimes done simultaneously.
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TRANSESOPHAGEAL ULTRASOUND
Generates an image unimpeded by thelungs and chest-wall structures.
Especially good visualization of the left
atrium and aortic root. Examples: infective endocarditis, aortic
dissection, cardiac origin of an arterialembolus such as atrial fib. much better
than TTE. RISKS: bleeding, aspiration, perforation,
arrhythmias.
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ECHOENCEPHALOGRAM
Ultrasound can not penetrate bone.
Limited use in the adult.
This modality is most useful for imaging
the newborn as the skull (sutures) havenot completely fused.
Useful for evaluating: mostly, things thatshift the midline, hydrocephalus, size of
the cerebral ventricles, intracranialhemorrhage in the newborn.
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ECHOENCEPHALOGRAM
ANEURYSM OF THE VEIN OF GALEN,
WHICH IS REALLY AN A-V FISTULA
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SAME PATIENT - ANGIOGRAM
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1 DAY OLD INFANT W/ HEART
FAILURE
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1 DAY OLD INFANT W/ HEART
FAILURE
Head ultrasound shows a cystic mass, posterior to the
third ventricle. The mass is continuous with the dilated straight sinus.
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1 DAY OLD INFANT W/ HEART
FAILURE
Doppler examination shows pulsatile high flow in the cystic mass.
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THORACIC SONOGRAMS
Limited utility due to the lack ofpenetration of ultrasound by air.
Can detect pleural fluid, abscess,malposition of the diaphragm.
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ULTRASOUND OF THE BREAST
Usually done adjunctively with or as a follow-upto mammography.
Differentiates between solid and cystic lesions.
Helpful in women w/ dense breasts as glandulartissue and malignancy both show up white onmammogram. On ultrasound, malignancyappears black.
Used to guide needle biopsy and to place asurgical clip to mark the area for futuretreatment.
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MAMMOGRAM
PALPABLE MASS
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BREAST ULTRASOUND
PALPABLE MASS,
CYSTIC ON
ULTRASOUND
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BONE SONOGRAMS
Primary use is as a screening toolfor osteoporosis, looking at theheel, as healthy bone echoes sound
waves faster than does osteoporoticbone.
Also used for congenital hip
dysplasia (dislocation).
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BLADDER ULTRASOUND
Used to determine volume of urine.
Main purpose is to determine urinevolume without having tocatheterize the bladder, avoidingthe risk of infection.
Image of the bladder is matched to
an image on the screencorresponding to a pre-calculatedvolume.
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Compression U/S - LLE: Noncompressibility of common femoral vein with
echogenic thrombus within the vein lumen consistent with chronic DVT.
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18 YOM W/ TESTICULAR MASS
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18 YOM W/ TESTICULAR MASS
EPIDERMOID CYST OF THE TESTICLE
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ULTRASOUND-GUIDED NEEDLE
BIOPSY OF THE LIVER
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