Ultra sound imaging general presentation
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Transcript of Ultra sound imaging general presentation
Ultra sound imaging
A routine imaging modality
Why U/S is day to day imaging modality?
Quick Cheap compare to other imaging Strict patient prep. not required Patient position is flexible Bedside imaging possible Repeat/ review possible No radiation hazard
Ultrasound in emergency
It is focused in YES or NO question
eg. Is there ruptured entopic?
Is there cardiac tamponade?
Is there abdominal aortic aneurysm?
etc. etc.
Indication in emergency
Trauma Cardiac Bleeding in pregnancy Acute abdominal pain Torsion of testis
Trauma
Focussed abdominal sonography for trauma……….FAST
What is FAST?
Detection of free intra abdominal fluid in blunt abdominal trauma
Quite reliable and sensitive
FAST IN 4 views
Check fluid in_ 1. Morrison’s pouch
2.Perisplenic view
3.Pelvic view
(rectovesical/ cul de sac__ less than 250ml. fluid is detectable)
4.Pericardium
Cardiac
To detect cardiac activity if pulse less electrical activity
To detect pericardial effusion
if yes, Is patient in cardiac tamponade?
( thumping on right cardiac chamber)
Bleeding in pregnancy
Whatever is the gestational period
It could be_ ectopic pregnancy
threatened abortion
placenta praevia
any other
Acute abdominal colic/pain
Few eg._ acute cholelithiasis
acute choledocholithiasis
acute pancreatitis
acute nephrolithiasis
acute torsion of ovary
ruptured aortic aneurysm
Torsion of testes
Use of Doppler to assess vascular supply
U/S is not diagnostic for
Intestinal obstruction Perforation
Plain X-ray supine/ erect or lateral decubitus is the first line of imaging modality
Indications other than emergency
Abdominal Cardiac Vascular Pelvic
Contd.
Eye Neck Breast Neonatal head/ brain Any other in consultation with clinician
Abdominal problems
Ascitis_ to know the underlying cause
hepatic - chr. liver disease
renal - renal failure
cardiac - cardiac failure
extra pulmonary tubercular
malignancy
Contd.
Jaundice_ Is it?
extrahepatic or intrahepatic
and then
to see the cause for it
Mass in abdomen
To assess the size, shape and texture Origin of mass Extent of mass Adjoining vessels/ viscera Associated lesion( ascitis/ pl.effusion/ PE)
Fever of unknown origion
Sub clinical/ occult malignancy Abdominal tuberculosis HIV ( immunosuppression) related
complication eg. abscess
Cardiac problem
All cardiac lesion (except conduction defect or arrhythmia)
like_ cardio-megaly on X-ray chest
valvular lesion
congenital defects
Vascular problem
Any pulsatile swelling- aneurysm Arterial thrombus Deep vein thrombosis Varicosity Peripheral vessel disease( limited help)
Pelvic problems
Gynaecological_
infertility
bleeding disorder
mass in pelvic cavity
pelvic pain
lost IUCD
Trans/endo vaginal scanning
Pregnancy less than 6 wks. Ectopic pregnancy Post menopausal bleeding Follicular study
Obstetric ultrasound
To ascertain pregnancy_
size/ gestational age
site( IU/ ectopic)
viability( cardiac activity )
number
position/ lie
Contd.
Placental localization Amniotic fluid ( normal AFI- 10) Umbilical cord Any congenital anomaly
Doppler U/S in Obs.
To assess IUGR
( though the specificity is low ) Fetal distress
Commonly umbilical, middle cerebral, uterine artery are examined for systolic/ diastolic peak to assess RI/ PI
Eye problem
Proptosis Trauma/ foreign body Retinal detachment/ tear/ haemorrhage Vitrous haemorrhage/ collapse
Contd.
Ocular mass Cataract Retrobulbar mass Optic nerve( gross lesion ) Whenever funduscopy is inconclusive
Neck problem
Enlarged thyroid Submandibular swelling Cervical lymphadenopathy Carotid artery plaque/ thrombosis(doppler)
Breast problem
Enlarged breast eg. Fibrocystic disease Mass in breast Bleeding from nipple U/S guided FNAC or cyst aspiration
Neonatal head/ brain
Enlarged head- ? hydrocephalus Neonatal fits- hypoxia
haemorrhage Congenital anomaly Birth trauma- ? subdural hematoma
Last but not least
Any problem in consultation with clinician where ultrasound can help directly or by way of exclusion.
Eur.J.emergency.Med 2009 Jul4 Epub
Imaging studies performed by technologist and then reviewed by radiologist with no patient contact are better quality studies.
This para digm of imaging misses the point of clinicians performed U/S
Clinician performed sonography in emergency has better accuracy
Request from clinicians
Accurate clinical picture is really helpful for correct interpretation of U/S image
Recent advances in U/S imaging
Despite developments other imaging techniques, the role of U/S continues to expand.
Its unrivalled ability to show events in the body in real time with continuing technological advances will