Christian P. Pappas, Matthew Watson, Christopher Harrington, Katherine Masselos
Introduction
Central serous chorioretinopathy (CSCR) is a common cause of acute, monocular vision loss amongst men aged 40–50 years. Diagnosis is typically multimodal, requiring advanced ophthalmic imaging. These techniques are not readily available in acute care settings.
Methods
We report the first case of CSCR diagnosed by an emergency practitioner–performed ocular point-of-care ultrasonography (POCUS).
Results
CSCR was identified by the presence of a dome-shaped, hypoechoic elevation of the neurosensory retina in association with a hypoechoic band posterior to the retinal pigment epithelium. The diagnosis was confirmed following ophthalmic referral. The patient was managed conservatively with routine observation and risk factor modification.
Conclusion
We describe the first reported use of emergency practitioner-performed ocular POCUS to identify findings suggestive of CSCR, a common cause of acute monocular vision loss among working-aged men. Although this case demonstrates the evolving utility of ocular ultrasound in emergent eye presentations, further research is needed to define the technique's role in the early evaluation of CSCR.
{"title":"Central Serous Chorioretinopathy Diagnosed by Emergency Practitioner-Performed Ocular Point-Of-Care Ultrasonography","authors":"Christian P. Pappas, Matthew Watson, Christopher Harrington, Katherine Masselos","doi":"10.1002/ajum.70005","DOIUrl":"https://doi.org/10.1002/ajum.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Central serous chorioretinopathy (CSCR) is a common cause of acute, monocular vision loss amongst men aged 40–50 years. Diagnosis is typically multimodal, requiring advanced ophthalmic imaging. These techniques are not readily available in acute care settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We report the first case of CSCR diagnosed by an emergency practitioner–performed ocular point-of-care ultrasonography (POCUS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CSCR was identified by the presence of a dome-shaped, hypoechoic elevation of the neurosensory retina in association with a hypoechoic band posterior to the retinal pigment epithelium. The diagnosis was confirmed following ophthalmic referral. The patient was managed conservatively with routine observation and risk factor modification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We describe the first reported use of emergency practitioner-performed ocular POCUS to identify findings suggestive of CSCR, a common cause of acute monocular vision loss among working-aged men. Although this case demonstrates the evolving utility of ocular ultrasound in emergent eye presentations, further research is needed to define the technique's role in the early evaluation of CSCR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajum.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vanessa Pincham, Andrew McLennan, Jonathan Forsey, Ritu Mogra
Introduction
Congenital heart defects (CHDs) are among the most prevalent congenital anomalies and are frequently detected in pregnancies classified as low-risk, rather than in high-risk groups. Advancements in ultrasound technology have heightened the emphasis on first-trimester fetal cardiac screening. However, due to the small size of the fetal heart at this stage, significant challenges persist, underscoring the need for simplified and reproducible protocols that can be effectively applied on a population-wide scale.
Methods
This paper describes a screening approach centred on the four-chamber view (4CV) and three-vessel tracheal view (3VTV) with colour Doppler imaging. This includes optimisation of ultrasound machine settings and the use of transabdominal and transvaginal approaches to enhance visualisation.
Results
Evidence demonstrates a CHD detection rate of 76% in low-risk populations, with a 95% success rate in obtaining the necessary views.
Discussion and Conclusion
Operator expertise and familiarity with cardiac anomalies are critical for accurate detection. The early identification of CHDs enables informed decision-making regarding pregnancy management. A simplified protocol for first-trimester cardiac screening offers a promising tool for the early identification of CHDs, enabling timely referral and intervention. To optimise detection rates and clinical outcomes, continuous professional education and systematic auditing processes are indispensable for practitioners performing early fetal cardiac screening.
{"title":"Simplified First-Trimester Fetal Cardiac Screening Protocol for Low-Risk Pregnancies: Enhancing Efficiency and Accuracy","authors":"Vanessa Pincham, Andrew McLennan, Jonathan Forsey, Ritu Mogra","doi":"10.1002/ajum.70000","DOIUrl":"https://doi.org/10.1002/ajum.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Congenital heart defects (CHDs) are among the most prevalent congenital anomalies and are frequently detected in pregnancies classified as low-risk, rather than in high-risk groups. Advancements in ultrasound technology have heightened the emphasis on first-trimester fetal cardiac screening. However, due to the small size of the fetal heart at this stage, significant challenges persist, underscoring the need for simplified and reproducible protocols that can be effectively applied on a population-wide scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This paper describes a screening approach centred on the four-chamber view (4CV) and three-vessel tracheal view (3VTV) with colour Doppler imaging. This includes optimisation of ultrasound machine settings and the use of transabdominal and transvaginal approaches to enhance visualisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Evidence demonstrates a CHD detection rate of 76% in low-risk populations, with a 95% success rate in obtaining the necessary views.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusion</h3>\u0000 \u0000 <p>Operator expertise and familiarity with cardiac anomalies are critical for accurate detection. The early identification of CHDs enables informed decision-making regarding pregnancy management. A simplified protocol for first-trimester cardiac screening offers a promising tool for the early identification of CHDs, enabling timely referral and intervention. To optimise detection rates and clinical outcomes, continuous professional education and systematic auditing processes are indispensable for practitioners performing early fetal cardiac screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Ultrasound as a Diagnostic Tool in Detection of Maxillofacial Fractures at Level 1 Trauma Centre ED in India","authors":"Afroz Fatima, Priyanka Modi, Tej Prakash Sinha, Sanjeev Bhoi, Atin Kumar, Sushma Sagar","doi":"10.1002/ajum.70001","DOIUrl":"https://doi.org/10.1002/ajum.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Ultrasound of the uterosacral ligaments: A reliability study for diagnosing endometriosis in Australian non-specialised medical imaging and radiology settings","authors":"Shae Maple, Eva Bezak, K Jane Chalmers, Nayana Parange","doi":"10.1002/ajum.12420","DOIUrl":"https://doi.org/10.1002/ajum.12420","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 (<i>AC1</i>), and the correlation between USL thickness and endometriosis was analyzed using Spearman's correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Interobserver agreement for detecting USL endometriosis was substantial (<i>AC1</i> = 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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajum.12420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Hepatic abscess caused by foreign body ingestion: A case report","authors":"Qingqing Li, Yujiang Liu","doi":"10.1002/ajum.12422","DOIUrl":"https://doi.org/10.1002/ajum.12422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"An innovative hybrid training method for ultrasound in giant cell arteritis, polymyalgia rheumatica and large vessel vasculitis","authors":"Li-Ching Chew, Cassandra Hong, Bhaskar Dasgupta","doi":"10.1002/ajum.12417","DOIUrl":"https://doi.org/10.1002/ajum.12417","url":null,"abstract":"<p>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.</p>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Ultrasonographic view of fluid bronchogram secondary to endobronchial obstruction: A case report","authors":"Yash Kedia, Nitesh Gupta, Rohit Kumar","doi":"10.1002/ajum.12418","DOIUrl":"10.1002/ajum.12418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Application of the 2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease","authors":"Jacqueline Williamson, Amelia McLeod, James Marangou, Bo Remenyi, Peter Morris, Gillian Whalley","doi":"10.1002/ajum.12421","DOIUrl":"10.1002/ajum.12421","url":null,"abstract":"<p>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.</p>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<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
{"title":"Anatomy – The foundation of ultrasound imaging","authors":"Gillian Whalley","doi":"10.1002/ajum.12416","DOIUrl":"10.1002/ajum.12416","url":null,"abstract":"<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 ","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 4","pages":"199"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Identifying enablers and barriers to teleultrasound use for remote settings: A scoping review","authors":"Aubree Anderson, Rebecca G Theophanous","doi":"10.1002/ajum.12415","DOIUrl":"10.1002/ajum.12415","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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