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