Australasian Journal of Ultrasound in Medicine最新文献

Ultrasound as a Diagnostic Tool in Detection of Maxillofacial Fractures at Level 1 Trauma Centre ED in India

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2025-03-14 DOI: 10.1002/ajum.70001

Afroz Fatima, Priyanka Modi, Tej Prakash Sinha, Sanjeev Bhoi, Atin Kumar, Sushma Sagar

Background

Injuries, especially maxillofacial fractures, pose a significant global health burden exacerbated by increasing traffic activities. Early detection is vital for preventing complications. This study assesses ultrasound's diagnostic efficacy, aiming to improve patient management and minimise treatment delays by detecting maxillofacial fractures promptly and accurately.

Objective

The main aim was to assess point-of-care ultrasound (POCUS) in diagnosing maxillofacial fractures against computed tomography (CT) scans. Secondary goals included identifying ocular injuries, mandibular fractures, assessing probe feasibility and comparing Le Fort classification via ultrasound and CT.

Methodology

Between January 2019 and February 2021, 150 trauma patients (136 male) with a mean age of 28.5 ± 5 years (range, 18–62 years) suspected of maxillofacial fractures were enrolled. A trained physician performed facial ultrasound, and findings were documented alongside CT scan results. Using the SPSS software, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of POCUS against CT scans were analysed.

Results

Among 150 patients, CT scans diagnosed 137 with maxillofacial fractures, primarily due to road traffic accidents. Zygomatic fractures were most common, followed by nasal bone and mandibular parasymphysial fractures. POCUS exhibited high sensitivity (98.9%), specificity (99.1%), PPV (92%), and NPV (99.8%) for overall facial fractures, varying by bone. Associated occult ocular injuries occurred in two patients. Sensitivity and specificity were high for mandibular fractures. 5–10 MHz frequency linear probe, footprint-50 mm was optimal for midfacial bones, but Le Fort fractures could not be reliably identified using ultrasound.

Conclusion

The study underscores the value of POCUS in the Emergency Department for detecting maxillofacial fractures, despite limitations such as anatomical challenges. POCUS showed high diagnostic accuracy, emphasising its potential in clinical practice, requiring further validation and exploration.

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引用次数: 0

Ultrasound of the uterosacral ligaments: A reliability study for diagnosing endometriosis in Australian non-specialised medical imaging and radiology settings

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2025-02-18 DOI: 10.1002/ajum.12420

Shae Maple, Eva Bezak, K Jane Chalmers, Nayana Parange

Introduction/Background

Uterosacral ligaments (USL) are the most common sites of endometriosis. Transvaginal ultrasound (TVS) demonstrates high diagnostic accuracy for endometriosis of the USLs using standardised technique and characterisations. While high accuracy and reproducibility is established with these techniques by well-trained professionals, the question still remains if these techniques are reproducible in general settings. This study aims to assess the intra and interobserver agreement of TVS characteristics of USLs, between experienced and less experienced examiners in an Australian general ultrasound imaging practice, where sonographers are required to perform ultrasound for endometriosis.

Methods

Forty-two patients, with and without known endometriosis, underwent ultrasound imaging of the USLs. Images were obtained of uterosacral ligaments and collated for interobserver survey. Six professional observers independently reviewed the images, classifying characteristics such as echogenicity, echotexture, contour, thickness, and presence of nodules. Interobserver reliability was assessed using Gwet's agreement coefficients (AC1), and the correlation between USL thickness and endometriosis was analyzed using Spearman's correlation.

Results

Interobserver agreement for detecting USL endometriosis was substantial (AC1 = 0.63), with an overall agreement of (0.65) for the seven USL characteristics. Intraobserver agreement ranged from moderate (0.60) to almost perfect (0.96). Experience did not significantly affect intraobserver reliability. A strong positive correlation was found between USL thickness and endometriosis (r = 0.7965, P < 0.01).

Conclusion

This study demonstrates high inter and intraobserver agreement among sonographers and radiologists in a general imaging department for identifying USL characteristics and diagnosing USL endometriosis. Both experienced and less experienced operators can reliably assess USLs Consistency was shown in identifying thickened uterosacral ligaments however, there is no consensus on where uterosacral ligament be measured. Even so, a thickened USL can prompt further extension of the pelvic scan to look for other endometriosis markers.

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引用次数: 0

Hepatic abscess caused by foreign body ingestion: A case report

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2025-02-17 DOI: 10.1002/ajum.12422

Qingqing Li, Yujiang Liu

Introduction

Liver abscess is a common clinical condition caused by bacterial, fungal or parasitic infections, usually due to immunosuppression. In contrast, secondary liver abscesses are caused by specific factors such as foreign bodies, tumours, or appendicitis.

Methods

We admitted a patient with secondary liver abscess and found an intrahepatic foreign body after interventional drainage. Initially, a foreign body of medical origin was suspected, but after a multidisciplinary consultation, it was determined to be caused by a foodborne foreign body. Laparoscopic surgery was then chosen as the treatment.

Result

The liver abscess was caused by an alimentary foreign body, and the intrahepatic foreign body was identified as a fish bone measuring approximately 2.5 cm in length.

Discussion

Upon diagnosing either primary or secondary liver abscess, aggressive treatment of the abscess focus is essential. However, in cases of secondary liver abscess, addressing and removing the underlying cause is necessary for complete resolution. For patients with a previously healthy liver, comprehensive history-taking is crucial, and imaging studies play a significant role in diagnosis and treatment. Clinicians and radiologists should be vigilant for the possibility of foreign bodies, tumours, or unexpected intra-abdominal inflammation, regardless of the patient's history. When dealing with food-borne foreign bodies, endoscopic intervention should be considered first, followed by laparoscopy, and as a last resort, open surgery.

Conclusion

The diagnosis and treatment of liver abscess in clinical practice require a complete medical history and thorough imaging examinations. Ultrasound, as the initial imaging modality, allows real-time and dynamic observation of lesions. It is essential for ultrasonologists to consider the possibility of foreign body-induced liver abscess when diagnosing patients with liver abscess.

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引用次数: 0

An innovative hybrid training method for ultrasound in giant cell arteritis, polymyalgia rheumatica and large vessel vasculitis

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2025-02-03 DOI: 10.1002/ajum.12417

Li-Ching Chew, Cassandra Hong, Bhaskar Dasgupta

We propose a novel hybrid physical and virtual training method, complemented by online learning, as an effective method to teach and acquire ultrasound skills. We aim to illustrate this through our experience with a remote ultrasound training module for giant cell arteritis scanning. The significance of this innovation is the ability to mitigate the challenges faced by ultrasound training during pandemic-times, including the need for physical distancing, group size limitation and overseas travel restrictions. Furthermore, the hybrid training provides an invaluable access to distant specialist cognitive and procedural expertise when conventional means may not be feasible. Although this form of ultrasound training has limitations, such as diminished face-to-face contact, we were able to resume training despite the unfavourable circumstances. By harnessing virtual technology for hands-on training, we can strive to reduce worldwide training inequalities, particularly in areas requiring highly specialised skills where expertise may not be available locally. Even as the world has moved out of ‘lockdown’, the pandemic has serendipitously provided novel ways of doing things; the lessons learnt here can be utilised for future hybrid training models, especially where hands-on experience is crucial.

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引用次数: 0

Ultrasonographic view of fluid bronchogram secondary to endobronchial obstruction: A case report

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2025-01-09 DOI: 10.1002/ajum.12418

Yash Kedia, Nitesh Gupta, Rohit Kumar

Background

Ultrasound has become an important aspect of emergency medicine due to its wide availability and portability for bedside investigations. Understanding some important ultrasound findings can aid in diagnosis and management.

Key findings

We present a case of a 65-year-old smoker who presented with shortness of breath and hemoptysis and was in respiratory failure upon arrival in the emergency department. Bedside ultrasound demonstrated a fluid bronchogram, aiding the diagnosis of lung collapse secondary to endobronchial obstruction.

Discussion

Fluid bronchograms are seen on CT chest and ultrasonography as linear images corresponding to dilated bronchus, filled with mucus, distal to an endobronchial obstruction. They are characterised by anechoic, tubular structures, suggestive of fluid filled bronchi, over the hypoechogenic pulmonary parenchyma, and can be differentiated from blood vessels by the lack of Doppler signal. Ultrasonographic image of fluid bronchogram is very unique and can help to detect collapse secondary to endobronchial obstruction using point-of-care ultrasonography in emergency.

背景：由于超声检查的广泛性和便携性，超声检查已成为急诊医学的一个重要方面。了解一些重要的超声检查结果有助于诊断和治疗：我们介绍了一例 65 岁吸烟者的病例，该患者因呼吸急促和咯血前来就诊，到达急诊科时已出现呼吸衰竭。床旁超声检查显示支气管积液，有助于诊断支气管内膜阻塞导致的肺塌陷：讨论：胸部 CT 和超声波检查发现的液性支气管图是支气管内膜阻塞远端扩张、充满粘液的线性图像。其特点是在低回声的肺实质上出现无回声的管状结构，提示支气管内充满液体，可通过缺乏多普勒信号与血管相鉴别。液性支气管的超声图像非常独特，有助于在急诊中利用护理点超声检查发现继发于支气管内阻塞的塌陷。

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引用次数: 0

Application of the 2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2025-01-09 DOI: 10.1002/ajum.12421

Jacqueline Williamson, Amelia McLeod, James Marangou, Bo Remenyi, Peter Morris, Gillian Whalley

Rheumatic heart disease remains prevalent in some regions of Australia and New Zealand. Echocardiography is the gold standard for detection and diagnosis using the 2023 World Heart Federation guidelines. The guidelines describe specific features of mitral and aortic valve morphology and define pathological regurgitation associated with RHD. The aim of this education piece was to assist cardiac sonographers and reporting specialists in the accurate detection, diagnosis, and classification of RHD findings. We present the echocardiographic features of RHD as defined by the 2023 WHF guidelines, including a poster summarising the individual criteria for diagnosis.

引用次数: 0

Anatomy – The foundation of ultrasound imaging 解剖学-超声成像的基础。

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-12-26 DOI: 10.1002/ajum.12416

Gillian Whalley

<p>Ultrasound is <i>the</i> most accessible, and the most utilised, of all medical imaging. Miniaturisation has reduced the cost and the portability such that anatomical imaging is now available in places we would never have ventured in the past. Today, it is possible to image a growing fetus in the middle of desert with no wired electricity; or to image the chest of a sailor on a yacht in the middle of the ocean to identify whether they have a ruptured aortic aneurysm; or to determine the extent of internal bleeding of an injured soldier in the middle of a warzone; or to identify a child in a remote location that is suffering from rheumatic heart disease and needs life-preserving penicillin treatment. Diagnostic ultrasound should be available to everyone, and everywhere, but the image quality may not be the same, and we may be restricted to simple black and white anatomy.</p><p>Since my career with ultrasound began, we have moved from being able to image the anatomy in two dimensions with limited functional assessment, to three-dimensional moving images with blood flow measurement and tissue motion detection, to name but a few innovations. We use ultrasound beyond diagnosis, to predict prognosis and to plan treatment strategies, but the new wave of handheld transducers has brought us back to the beginning and reminds me that anatomy is key. The so much clinical information can be obtained from simple grey scale anatomical pictures. Anatomy remains the foundation of ultrasound imaging.</p><p>In this issue of AJUM, we are reminded that underlying anatomical knowledge is key to important clinical decisions. Ward <i>et al</i>.<span><sup>1</sup></span> use ultrasound to document the migration of the placental cord insertion during pregnancy and suggest that this should be routinely reported on antenatal ultrasound examinations.</p><p>Fenech <i>et al</i>.<span><sup>2</sup></span> present a detailed review article about anatomy and ultrasound appearances of femoral and saphenous veins, and their branches, and advocate for users to become familiar with the normal appearances in order that we may accurately identify abnormalities. The imaging of nerves is increasingly being utilised as a tool for nerve blockade. Ultrasound anatomical imaging is frequently used to assist procedures. and Zanfini <i>et al</i>.<span><sup>3</sup></span> present a series of over 500 intrathecal injections where ultrasound was used to help identity the injection site. Although intravenous access can be done without ultrasound imaging, would you want to ignore the benefits of improved precision with anatomical image guidance?</p><p>I, like many student sonographers, learned and refined my anatomical knowledge while looking at ultrasound images. I watch as newly qualified doctors remembering their anatomy as they look at an ultrasound screen. And increasingly, ultrasound is being applied in medical schools to supplement medical students' anatomy learning. Anatomy is the heart of

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引用次数: 0

Identifying enablers and barriers to teleultrasound use for remote settings: A scoping review 确定远程超声在偏远地区使用的促进因素和障碍：范围审查。

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-12-13 DOI: 10.1002/ajum.12415

Aubree Anderson, Rebecca G Theophanous

Introduction/Purpose

Teleultrasound connects expert point-of-care ultrasound (POCUS) users with remote community and rural sites. Evolving technologies including handheld devices, upgraded image quality, and the ability to transmit over low bandwidth connections increase POCUS education, accessibility, and clinical integration. Potential teleultrasound venues include low-resource settings, prehospital care, and austere environments (high altitudes, microgravity, conflict zones, etc.). This scoping review assesses current teleultrasound uses and identifies implementation enablers and barriers.

Methods

Using the PRISMA-ScR checklist, PubMed, Embase, and Cochrane were searched on 16 August 2024 for teleultrasound studies. Two reviewers independently screened results and abstracted data using a data collection table. 165 articles met the following inclusion criteria: research studies describing teleultrasound, involving humans, including healthcare workers, with remote point-of-care or medical ultrasound use, in any setting, and in English.

Results

Teleultrasound studies were reported in most specialties and across all continents. Most were prospective (100 studies), review articles (27), or case studies (14). Study quality was variable, with 28 high quality, 77 moderate, 54 low, and 6 very low (GRADE assessment tool). Common themes that emerged include (1) type of image transmission method utilised, (2) remote provider training and curriculum development, (3) feedback methods between expert and novice users, (4) technologies and devices used, and (5) enablers and barriers to guide future teleultrasound implementation and training strategies.

Conclusion

Overall, the teleultrasound literature is heterogeneous in setting, design, and quality outcomes. As teleultrasound technology evolves and the use expands, future studies should standardise protocols and ensure image quality fidelity to optimise remote patient care.

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引用次数: 0

Ultrasound evaluation of peripheral intravenous catheter thrombus formation associated with intravenous flucloxacillin administration: A prospective observational pilot study

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-11-27 DOI: 10.1002/ajum.12414

Andrew C. Bulmer, Rachael Nightingale, Wenu Hewage, Gerben Keijzers, Peter J. Snelling

Purpose

The purpose of this study was to sonographically evaluate whether intravenous (IV) flucloxacillin administration was associated with an increased risk of peripheral intravenous catheter (PIVC) thrombus formation.

Methods

This observational study included participants enrolled as a convenience sample from a larger prospective study of patients with cellulitis receiving IV antibiotics in the emergency department. Point-of-care ultrasound was used to evaluate the PIVCs for thrombus formation after insertion and at specified timepoints after IV administration of antibiotic or saline solution through to discharge. The primary endpoint included the presence and length of the thrombus in proximity of the catheter tip.

Results

Between May 2021 and June 2022, 25 participants were enrolled and received either IV flucloxacillin (n = 10), other IV antibiotics (n = 8) or no IV antibiotics (control; n = 7). PIVC thrombus formation was sonographically detected in 100%, 67% and 17% of patients in flucloxacillin, other and control groups at 6–12 h (flucloxacillin vs. control; P = 0.015), with a mean length of 17.4 ± 8.1 (flucloxacillin vs. control; P = 0.46), 15.5 ± 13.4 (other vs. control; P = 0.73) and 7.3 ± 17.9 mm (control), respectively. Thrombus formation increased significantly in the flucloxacillin group over time (0–>12 h; P = 0.03) but did not increase in the other or control groups.

Discussion

The administration of IV flucloxacillin appears to promote the formation of a PIVC thrombus visible on ultrasound, but the clinical implications are uncertain. Although the vast majority appear to be asymptomatic, they have the potential to become a precursor to thrombophlebitis and lead to early PIVC failure.

Conclusions

It was feasible to identify and measure PIVC thrombus sonographically. Ultrasound showed that IV flucloxacillin administration appeared to be associated with more frequent formation of PIVC thrombus, with these increasing in length over time. Further research is required to confirm these findings in larger studies and to identify any clinical implications of the findings.

目的：本研究旨在通过声像图评估静脉注射氟氯西林是否会增加外周静脉导管（PIVC）血栓形成的风险：这项观察性研究是从一项针对在急诊科接受静脉注射抗生素治疗的蜂窝组织炎患者的大型前瞻性研究中抽取的方便样本。在插入PIVC后，以及在静脉注射抗生素或生理盐水后至出院的特定时间点，采用床旁超声评估PIVC是否有血栓形成。主要终点包括导管尖端附近是否存在血栓以及血栓的长度：2021年5月至2022年6月期间，25名参与者接受了氟氯西林静脉注射（10人）、其他抗生素静脉注射（8人）或无抗生素静脉注射（对照组；7人）。声像图显示，氟氯西林组、其他组和对照组分别有100%、67%和17%的患者在6-12小时内发现PIVC血栓形成（氟氯西林组与对照组相比；P = 0.015），平均长度分别为17.4 ± 8.1（氟氯西林组与对照组相比；P = 0.46）、15.5 ± 13.4（其他组与对照组相比；P = 0.73）和7.3 ± 17.9毫米（对照组）。随着时间的推移，氟氯西林组的血栓形成明显增加（0->12 h；P = 0.03），但其他组和对照组的血栓形成没有增加：讨论：静脉注射氟氯西林似乎能促进超声波可见的PIVC血栓形成，但其临床意义尚不确定。尽管绝大多数血栓似乎没有症状，但它们有可能成为血栓性静脉炎的前兆，并导致 PIVC 早期失效：结论：用超声波识别和测量PIVC血栓是可行的。超声波显示，静脉注射氟氯西林似乎与PIVC血栓的频繁形成有关，而且这些血栓的长度会随着时间的推移而增加。要在更大规模的研究中证实这些发现，并确定这些发现的临床意义，还需要进一步的研究。

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引用次数: 0

Systematic review of musculoskeletal ultrasound learning methodologies

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-10-21 DOI: 10.1002/ajum.12413

Amber J. Vogt, Robert Samuel Mayer

Introduction/Purpose

As the frequency and morbidity of musculoskeletal (MSK) disorders increase, the use of MSK ultrasound has become an important diagnostic and procedural tool. This has amplified the importance of quality MSK ultrasound training for medical professionals. This systematic review evaluated and compared peer-reviewed journal articles on learning methodologies for MSK ultrasound training.

Methods

Thirty-three articles met inclusion and exclusion criteria and were evaluated.

Results

Results showed a lack of randomised studies that compared learning methodologies.

Conclusion

There was wide variability of methodology used based on educational and institutional needs. Further randomised control trials need to be conducted to ascertain best educational practices.

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引用次数: 0