Ultra sound imaging general presentation

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Ultra sound a basic imaging modality

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Ultra sound imaging general presentation

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

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