Cysts are very common.
Usually be diagnosed accurately with
In most women, they do not usually require
any intervention or follow-up.
Cyst aspirations are done when :
Causing significant tenderness
The diagnosis of a cyst remains in question
following the ultrasound
The patient lie on her back or slightly turned to
one side with the arm placed comfortably
under the head.
The skin is cleaned , numbed with topical
anesthesia. Using ultrasound guidance, a small
needle is advanced into the cyst and suction is
applied to draw the fluid out, causing the lump
The lump (arrow) in this
patient’s right breast was
thought to be a cyst, but some
features are not characteristic
and aspiration was necessary.
Using ultrasound guidance, a fine
needle (white line) is placed so
that its tip (double arrow) is in the
center of the lump (single arrow).
Aspiration is applied by using a
syringe attached to the needle. If
this is a cyst, fluid is drawn into
the syringe as the lesion collapses.
After the aspiration, the
needle (white line) and its
tip (double arrow) are
seen, but the lump is gone.
If is very helpful to get an ultrasound scan of
the ascites before the procedure.
The radiologist will mark the spot for
paracentesis. Two things are important:
What is the distance from the skin to the
fluid? Usually 1 cm.
What is distance to the midpoint of the
collection? Usually 3 cm.
Here we clearly see free fluid in Morrison's pouch that extends
superiorly around the liver
See the needle entering the peritoneal cavity obliquely from just
beneath the indicator marker.
Pleural effusion is an abnormal collection of
fluid in the pleural space. Removal of this fluid
by needle aspiration is called a thoracoentesis.
Patient should be sitting or in the lateral decubitus
position with pleural effusion side up.
The marker on the probe should be pointed
towards the head. Be sure that the transducer is
perpendicular to the chest .
The diaphragm and liver or spleen should be
The probe can then be moved towards the head
and from side to side to locate the largest pocket of
fluid between the ribs. Once this is located a mark
is made with indelible ink just above the lower rib.
The distance from the transducer to the pleural
fluid should also be noted.
The probe is then rotated 180 degrees to
visualize the pleural fluid between the ribs to
ensure that there is only fluid visualized ie. no
lung, diaphragm, or liver or spleen.
Procedure allow collections which would
otherwise require open surgery to be drained
via a skin incision only a few mm in size.
Minimally invasive technique
Little procedure related morbidity and equal
applicability to unfit patients,
Any abnormal fluid collection which is
Complicated Diverticular abscess
Crohn’s disease related abscess
Localized abscess related to ovary (tubo-ovarian)
Abscess collection after surgery
Hepatic abscess (amebic or post-op)
Renal abscess or retro-peritoneal abscess.
The only common contraindications are:
Abscess is not accessible
Patient has a bleeding tendency
Abscess is first delineated &a safe route from
skin to the abscess cavity is identified by
Prior to the catheter introduction, a diagnostic
needle aspiration may also be done.
The catheter is introduced into the abscess
cavity, either directly using a trocar catheter (as
used for chest intubation (or by modified
Seldinger’s technique using a guide-wire.
Maneuvering of the trocar or guide-wire within
the abdominal cavity should be done strictly
under ultrasound surveillance
Once in position, the catheter is secured and
attached to a drainage bag.
Drainage is recorded daily ,response to the
treatment is assessed by clinical parameters &
Icterus/liver enzyme elevation/elevated bile
Focal nodules or masses anywhere
Renal disease sometimes (i.e. renal dysplasia,
renal masses, lymphosarcoma suspects)
Free abdominal fluid
U/S guided FNA/biopsies generally not done
Transitional cell carcinoma suspect masses
Chronic renal failure, glomerulonephritis
to left side of screen
Rock and/or slide the probe
to line up the lesion
to a “reachable” position
Deep lesion needs
to be lined up
toward the edge of
can be toward the edge
or in the center
of the beam
Angle to use for a superficial lesion:
Aim needle more perpendicular to beam
Percutaneous needle biopsy of the breast
provides reliable diagnosis of both benign and
malignant disease and is a proven alternative
to open surgical biopsy
Ultrasound guidance is an accurate and reliable
biopsy guidance technique and is the method
of choice and suitable for all breast lesions
visible on ultrasound
CNB & FNAB are effective methods for the
diagnosis of most breast lesions
Although CNB has higher sensitivity & positive
predictive value for abnormalities like micro-
calcifications & distortions of architecture.
Focal mass or other lesion of unknown nature –
palpable or non-palpable
The long axis of the needle, should be visible along
the long axis of the transducer.
Occasionally, during an FNA biopsy or cyst
aspiration, the transducer can be rotated 90
degrees to visualize the echogenic dot of the
needle within the lesion.
Liver biopsies are performed for both focal and
The primary indication for parenchymal liver
biopsy is for the diagnosis of hepatic disease.
When imaging guidance is employed, it can
take one of two forms:
US-guided "marking" in which a mark is made
upon the skin during US examination for a
biopsy to be performed later without imaging
guidance or real-time US guidance.
The patient is positioned supine, with the
hands comfortably resting behind the head
A preliminary US scan is performed to identify
the target and mark the skin.
The preliminary scan also ensures that no major
vessels, dilated biliary channels or gall bladder are
in the path of the biopsy needle.
Before the procedure is started, breathing
instructions are practiced with the patient.
performed with the breath held in expiration.
This minimize risk of injury to the pleura or lung.
The skin site is prepped and draped to ensure
asepsis The local area is anesthetized with a
The cutting needle is then fired with US
documentation of the site.
Biopsy of a focal solid lesion /suspicious cystic
lesion for diagnosis.
Nonfocal biopsy to evaluate for nephropathy
or renal transplant rejection
US has the advantages of real-time needle
No radiation & is therefore well suited for most
nonfocal renal biopsies in thin pts and in biopsies
of some focal solid masses or cystic masses .
The patient is placed in the prone position and
the biopsy is typically taken from the lower
pole of the kidney if there are no specific
locations of interest.
The biopsy needle is guided using ultrasound
to ensure visualization of the needle as it
pierces the kidney parenchyma.
Care is taken not to enter the collecting system
(as it would result in haematuria) or to go near
the renal hilum (to prevent injury to the