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
超声是所有医学成像中最容易获得、使用最多的。小型化降低了成本和便携性，使得解剖成像现在可以在我们过去从未冒险过的地方进行。今天，我们可以想象一个正在成长的胎儿在没有电线的沙漠中；或者在海洋中央的游艇上给水手的胸部拍照，以确定他们是否有破裂的主动脉瘤；或者在战区中确定受伤士兵的内出血程度；或者在偏远地区发现一个患有风湿性心脏病、需要青霉素治疗的孩子。诊断超声应该对每个人都可用，在任何地方，但图像质量可能不一样，我们可能仅限于简单的黑白解剖。自从我的超声职业生涯开始以来，我们已经从能够在有限的功能评估的二维解剖成像，发展到具有血流测量和组织运动检测的三维运动图像，仅举几例创新。我们在诊断之外使用超声波来预测预后和制定治疗策略，但新一波的手持换能器把我们带回到开始，提醒我解剖是关键。从简单的灰度解剖图像中可以获得如此多的临床信息。解剖学仍然是超声成像的基础。在本期《美国医学会杂志》中，我们被提醒，基础解剖学知识是重要临床决策的关键。Ward等人1使用超声记录妊娠期间胎盘脐带插入的移动，并建议这应在产前超声检查中常规报告。Fenech et al.2发表了一篇详细的关于股静脉和隐静脉及其分支的解剖和超声表现的综述文章，并提倡用户熟悉正常的外观，以便我们能够准确地识别异常。神经成像越来越多地被用作神经阻断的工具。超声解剖成像常用于辅助手术。和Zanfini等人3提出了一系列超过500次的鞘内注射，其中超声用于帮助识别注射部位。虽然静脉注射可以在没有超声成像的情况下进行，但你会想忽视解剖图像引导下提高精度的好处吗？我和许多学生超声医师一样，在看超声图像的过程中学习和完善了我的解剖学知识。我看着刚获得资格的医生在看超声波屏幕时记住他们的解剖结构。超声越来越多地应用于医学院，以补充医学生的解剖学学习。解剖是ASUM成员和AJUM读者每天使用超声的核心。
{"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}
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.
{"title":"Ultrasound evaluation of peripheral intravenous catheter thrombus formation associated with intravenous flucloxacillin administration: A prospective observational pilot study","authors":"Andrew C. Bulmer, Rachael Nightingale, Wenu Hewage, Gerben Keijzers, Peter J. Snelling","doi":"10.1002/ajum.12414","DOIUrl":"10.1002/ajum.12414","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053624","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}
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.
{"title":"Systematic review of musculoskeletal ultrasound learning methodologies","authors":"Amber J. Vogt, Robert Samuel Mayer","doi":"10.1002/ajum.12413","DOIUrl":"10.1002/ajum.12413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty-three articles met inclusion and exclusion criteria and were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Results showed a lack of randomised studies that compared learning methodologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053401","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}
Victoria J. A. Baumann, Richard Banati, Jillian L. Clarke
Introduction
In both highly industrialised and developing countries, obesity is reaching epidemic proportions and increasingly becoming a critical indicator of general morbidity, cardiovascular disease (CVD) and renal dysfunction. A promising trend in detection and management of obesity is the measurement of perirenal adipose tissue (PRAT), increasingly recognised as a metabolically active endocrine organ in itself. Its measurement by ultrasound is used increasingly to indicate visceral obesity and its clinical management. This review synthesises current techniques for measuring PRAT and its potential use as an indicator of CVD.
Methods
We included clinical studies published between 2010 and 2023, investigating the current practice and use of specific ultrasonographic techniques and assessed the reliability and accuracy of included papers. The risk of bias was assessed using the Downs and Black Checklist, and the methodological quality examined using the Grade of Recommendations, Assessments, Development and Evaluation.
Results
It found, PRAT measures are predictive of CVD risk factors and the accuracy of ultrasound is comparable to CT and MRI, but there is no consistency in ultrasound technique. The lack of any randomised control trials and the use of 20 different non-standardised ultrasound techniques across the 21 studies resulted in inconsistent and imprecise clinical observations and interpretations, which decreased the overall quality of the studies.
Conclusion
This review found the inclusion of ultrasound measures in routine abdominal imaging potentially invaluable but demonstrates the need for standardisation of the perirenal fat ultrasound measuring technique to improve reproducibility and reliability.
{"title":"Ultrasound measurement of perirenal adipose tissue indicates cardiovascular disease, but standardisation is needed: A systematic review","authors":"Victoria J. A. Baumann, Richard Banati, Jillian L. Clarke","doi":"10.1002/ajum.12407","DOIUrl":"10.1002/ajum.12407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In both highly industrialised and developing countries, obesity is reaching epidemic proportions and increasingly becoming a critical indicator of general morbidity, cardiovascular disease (CVD) and renal dysfunction. A promising trend in detection and management of obesity is the measurement of perirenal adipose tissue (PRAT), increasingly recognised as a metabolically active endocrine organ in itself. Its measurement by ultrasound is used increasingly to indicate visceral obesity and its clinical management. This review synthesises current techniques for measuring PRAT and its potential use as an indicator of CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included clinical studies published between 2010 and 2023, investigating the current practice and use of specific ultrasonographic techniques and assessed the reliability and accuracy of included papers. The risk of bias was assessed using the Downs and Black Checklist, and the methodological quality examined using the Grade of Recommendations, Assessments, Development and Evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>It found, PRAT measures are predictive of CVD risk factors and the accuracy of ultrasound is comparable to CT and MRI, but there is no consistency in ultrasound technique. The lack of any randomised control trials and the use of 20 different non-standardised ultrasound techniques across the 21 studies resulted in inconsistent and imprecise clinical observations and interpretations, which decreased the overall quality of the studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review found the inclusion of ultrasound measures in routine abdominal imaging potentially invaluable but demonstrates the need for standardisation of the perirenal fat ultrasound measuring technique to improve reproducibility and reliability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053627","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}
There are varying international recommendations regarding the minimum level of disinfection required for ultrasound transducers used in percutaneous procedures. While some guidelines recommend high-level disinfection (HLD), others question the additional benefit this delivers over low-level disinfection (LLD).
Methods
This narrative review identifies current guidelines and evaluates the evidence used to support disinfection recommendations for ultrasound transducers used in percutaneous procedures. Thirteen guidelines were identified using a search encompassing PubMed, Embase, Scopus and Google from 1st January 2013 to 31st January 2024.
Results
No guidelines were supported by high-quality evidence, instead, guidelines relied upon: expert opinion through the application of national standards and infection control principles; consideration of recommendations from other published guidelines; and the incidence of infection from retrospective studies. Guidelines were uniformly supportive of using ultrasound transducer covers and sterile ultrasound gel during ultrasound-guided percutaneous procedures. However, the minimum recommended disinfection level was varied with seven guidelines recommending HLD, four LLD and two not specifying a level. Spaulding's classification was commonly used to support disinfection recommendations, however, the resultant wide variation in classification and subsequent recommendations suggest that its utility in accurately determining the minimum level of disinfection in this specific context is low.
Conclusion
Without high-level evidence, using a risk-based assessment will likely remain fundamental to future guideline recommendations in determining the minimum disinfection level for an ultrasound transducer used in percutaneous procedures. This risk assessment must include the highest level of evidence available in addition to acknowledging the contribution of all steps taken to prevent infection during ultrasound-guided percutaneous procedures.
{"title":"Ultrasound transducer disinfection for percutaneous procedures: A review of the evidence supporting guideline recommendations","authors":"Nathan Peters, Frances Williamson, Victoria Eley","doi":"10.1002/ajum.12408","DOIUrl":"10.1002/ajum.12408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Purpose</h3>\u0000 \u0000 <p>There are varying international recommendations regarding the minimum level of disinfection required for ultrasound transducers used in percutaneous procedures. While some guidelines recommend high-level disinfection (HLD), others question the additional benefit this delivers over low-level disinfection (LLD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This narrative review identifies current guidelines and evaluates the evidence used to support disinfection recommendations for ultrasound transducers used in percutaneous procedures. Thirteen guidelines were identified using a search encompassing PubMed, Embase, Scopus and Google from 1st January 2013 to 31st January 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No guidelines were supported by high-quality evidence, instead, guidelines relied upon: expert opinion through the application of national standards and infection control principles; consideration of recommendations from other published guidelines; and the incidence of infection from retrospective studies. Guidelines were uniformly supportive of using ultrasound transducer covers and sterile ultrasound gel during ultrasound-guided percutaneous procedures. However, the minimum recommended disinfection level was varied with seven guidelines recommending HLD, four LLD and two not specifying a level. Spaulding's classification was commonly used to support disinfection recommendations, however, the resultant wide variation in classification and subsequent recommendations suggest that its utility in accurately determining the minimum level of disinfection in this specific context is low.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Without high-level evidence, using a risk-based assessment will likely remain fundamental to future guideline recommendations in determining the minimum disinfection level for an ultrasound transducer used in percutaneous procedures. This risk assessment must include the highest level of evidence available in addition to acknowledging the contribution of all steps taken to prevent infection during ultrasound-guided percutaneous procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 4","pages":"242-250"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903693","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}
This case examines the sonographic and clinical challenge of diagnosing a Klebsiella pnumoniae pyogenic liver abscess with systemic metastatic infection.
Case Description
The patient in this case study is an 81-year-old man who presented with intermittent rigors. Following radiological and clinical assessments, a Klebsiella pnumoniae pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed. Sonographic features of the liver abscess were atypical for a cystic lesion and instead appeared as a solid mass, raising the possibility of malignancy. Treatment of intravenous ceftriaxone infusions resulted in full resolution of the liver lesion.
Discussion
The discussion criticises the terminology when describing hepatic lesions, which result from a Klebsiella pnumoniae infection. The term hepatic phlegmon is appropriate when a liver lesion caused by bacterial infection demonstrates a solid appearance on radiologic imaging. The term hepatic abscess is appropriate in cases where liver lesions caused by bacterial infection demonstrate a fluid filled core on radiologic imaging. Differentiation of these terms is important when treating the underlying lesion as a phlegmon, in contrast to an abscess, cannot be drained because it contains no pus. The variable sonographic appearances of Klebsiella pnumoniae pyogenic abscesses were also examined. Despite reported sonographic appearances in the literature, none are sufficient to distinguish a pyogenic liver abscess from malignancy without further investigation.
Conclusion
Ultrasound operators should be aware of the variable sonographic appearances of a Klebsiella pnumoniae liver abscess and how these features, combined with non-homogenous terminology, can obfuscate the correct diagnosis.
{"title":"Klebsiella liver phlegmon mimicking a solid liver tumour","authors":"Martin Necas, Jereme Mitchell","doi":"10.1002/ajum.12406","DOIUrl":"10.1002/ajum.12406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This case examines the sonographic and clinical challenge of diagnosing a <i>Klebsiella pnumoniae</i> pyogenic liver abscess with systemic metastatic infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Description</h3>\u0000 \u0000 <p>The patient in this case study is an 81-year-old man who presented with intermittent rigors. Following radiological and clinical assessments, a <i>Klebsiella pnumoniae</i> pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed. Sonographic features of the liver abscess were atypical for a cystic lesion and instead appeared as a solid mass, raising the possibility of malignancy. Treatment of intravenous ceftriaxone infusions resulted in full resolution of the liver lesion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The discussion criticises the terminology when describing hepatic lesions, which result from a <i>Klebsiella pnumoniae</i> infection. The term hepatic phlegmon is appropriate when a liver lesion caused by bacterial infection demonstrates a solid appearance on radiologic imaging. The term hepatic abscess is appropriate in cases where liver lesions caused by bacterial infection demonstrate a fluid filled core on radiologic imaging. Differentiation of these terms is important when treating the underlying lesion as a phlegmon, in contrast to an abscess, cannot be drained because it contains no pus. The variable sonographic appearances of <i>Klebsiella pnumoniae</i> pyogenic abscesses were also examined. Despite reported sonographic appearances in the literature, none are sufficient to distinguish a pyogenic liver abscess from malignancy without further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ultrasound operators should be aware of the variable sonographic appearances of a <i>Klebsiella pnumoniae</i> liver abscess and how these features, combined with non-homogenous terminology, can obfuscate the correct diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053398","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>As a novice researcher, I worked with a cardiology professor who was driven by clinical evidence. Clinical trials were his bread and butter, and leading guideline writing groups became his passion. The most memorable take-home message for me was this: Before you do any test, a clinician should ask themselves, ‘Will this change management? And if so, how?’ A clinician should know what they will do if the test is positive or negative and be able to articulate that. Sadly, this is not always the case. And whilst it might be ‘nice to know’, the cost of confirmatory tests is certainly not insignificant.</p><p>When I trained in ultrasound, we still called it ‘diagnostic ultrasound’ to differentiate it from therapeutic ultrasound, but this also highlighted the immense and unique diagnostic properties of ultrasound. Increasingly, ultrasound is used to not only diagnose, but also to monitor and screen for conditions, as well as to aid in management and prognosis. While all of these are laudable uses, I still think it is helpful when we can link our imaging directly to change in management.</p><p>In this issue of AJUM, Smith and Mistry<span><sup>1</sup></span> present research documenting the impact of formal echocardiography (echo) on patient management in a small clinical audit of formal echos in their intensive care unit (ICU). Although half of the patients had critical findings found on formal echo, only 25% resulted in management change. Perhaps, the remainder of the critical findings were either already suspected, and therefore being treated; or had been anticipated. Indeed, it is possible that a point of care ultrasound (POCUS) had already given them some clinical cues, and thus, the formal echo was simply confirmatory. In a reasonable number of patients, the formal echo helped make the decision to proceed with palliation and this seems an entirely reasonable reason to do an extra imaging test.</p><p>Also, in the ICU setting, Xin <i>et al</i>.<span><sup>2</sup></span> report on the use of Tissue Doppler Imaging (TDI) of the diaphragm to optimise the timing of weaning from mechanical ventilation in ICU patients. Using TDI to measure the low velocity motion of heart muscle is fundamental to echocardiography, so the extension to the diaphragm seems a logical extension of practice. But a good idea still needs to be tested and shown to aid patient management. Innovation needs to be effective.</p><p>Innovation is a key part of medicine, and finding new applications for imaging is part of that. Lau <i>et al</i>.<span><sup>3</sup></span> applied shear wave elastography to patients in a case–control study comparing patients with COVID-19 with controls and found that patients with recent (<6 months) COVID-19 had increased liver stiffness. They were prompted to do the study after observing elevated liver enzymes in these patients. But as the authors point out, these may be transient changes, and data are needed to see whether these abnormalities are asso
作为一名研究新手，我曾与一位以临床证据为动力的心脏病学教授共事。临床试验是他的面包和黄油，而领导指南编写小组则是他的激情所在。他给我留下的最深刻的启示是这样的：在做任何试验之前，临床医生都应该问自己：'这会改变管理吗？如果会，如何改变？临床医生应该知道，如果检测结果呈阳性或阴性，他们会怎么做，并能清楚地表达出来。遗憾的是，情况并非总是如此。在我接受超声波培训时，我们仍称其为 "诊断性超声波"，以区别于治疗性超声波，但这也凸显了超声波巨大而独特的诊断特性。越来越多的超声波不仅用于诊断，还用于监测和筛查疾病，以及辅助管理和预后。在本期的《AJUM》杂志上，Smith 和 Mistry1 介绍了一项研究，该研究记录了正规超声心动图（echo）对重症监护病房（ICU）正规超声检查的影响。虽然半数患者在正式回波检查中发现了危急病症，但只有 25% 的患者改变了治疗方案。也许，其余的重要发现要么是已经被怀疑，因此正在接受治疗；要么是早有预料。事实上，护理点超声检查（POCUS）可能已经给了他们一些临床线索，因此，正式回波检查只是确认而已。在一定数量的患者中，正式回声有助于做出继续姑息治疗的决定，这似乎是进行额外成像检测的一个完全合理的理由。此外，在重症监护病房环境中，Xin 等人2 报告了使用横膈膜组织多普勒成像（TDI）优化重症监护病房患者机械通气断流时机的情况。使用 TDI 测量心肌的低速运动是超声心动图的基础，因此扩展到膈肌似乎是顺理成章的做法。但是，一个好的想法仍然需要经过测试，并证明它能帮助患者进行管理。创新是医学的重要组成部分，而为成像技术寻找新的应用领域也是创新的一部分。刘（Lau）等人3在一项病例对照研究中对COVID-19患者和对照组患者进行了剪切波弹性成像比较，发现近期（6个月）COVID-19患者的肝脏硬度增加。他们是在观察到这些患者肝酶升高后才进行这项研究的。但正如作者所指出的，这些可能只是短暂的变化，还需要数据来确定这些异常是否与持续性肝损伤有关。关于肝脏的超声评估，衰减成像（ATI）是一种相对较新的超声技术，可对衰减进行定量评估，有助于评估肝脂肪变性或脂肪肝。Tan 等人4 介绍了他们对在同一天接受超声检查和肝活检的患者的数据，并得出结论：虽然 ATI 与脂肪变性的组织学分级密切相关，但放射科医生的定性印象实际上是组织学结果的最佳相关性。这是一个 ATI 无助于诊断的例子，同时也引出了一个问题：如果这些患者仍然要做肝活检，那么在超声检查中增加 ATI 真的有意义吗？这个问题的答案就是证据。当我开始超声波之旅的时候，诊断心脏瓣膜疾病的金标准是有创心导管检查。但是，具有前瞻性思维的临床科学家进行的创新研究提供了证据，因此超声心动图现在已成为量化心脏瓣膜疾病的黄金标准。虽然我认为我们为超声波找到了新的临床应用并使用了正在开发的新技术，但正如这些论文所做的那样，我们必须衡量这些技术的临床效果，这一点非常重要。如果新技术不能增加临床价值，我们就必须放弃，事实上，有些技术可能会造成伤害。成像技术为患者带来的额外临床益处应该是显而易见的，成像技术不应该被常规用作另一种确诊或安慰性检查。当然，在某些情况下，后者在临床上是完全合适的。探索新兴超声技术的临床应用具有重要作用；然而，正如这些论文所显示的，研究应包括这些技术作为独立检查的临床有效性，而不仅仅是确认性的保证。
{"title":"The impact of ultrasound imaging on patient management – Let's practice the evidence","authors":"Gillian Whalley","doi":"10.1002/ajum.12412","DOIUrl":"https://doi.org/10.1002/ajum.12412","url":null,"abstract":"<p>As a novice researcher, I worked with a cardiology professor who was driven by clinical evidence. Clinical trials were his bread and butter, and leading guideline writing groups became his passion. The most memorable take-home message for me was this: Before you do any test, a clinician should ask themselves, ‘Will this change management? And if so, how?’ A clinician should know what they will do if the test is positive or negative and be able to articulate that. Sadly, this is not always the case. And whilst it might be ‘nice to know’, the cost of confirmatory tests is certainly not insignificant.</p><p>When I trained in ultrasound, we still called it ‘diagnostic ultrasound’ to differentiate it from therapeutic ultrasound, but this also highlighted the immense and unique diagnostic properties of ultrasound. Increasingly, ultrasound is used to not only diagnose, but also to monitor and screen for conditions, as well as to aid in management and prognosis. While all of these are laudable uses, I still think it is helpful when we can link our imaging directly to change in management.</p><p>In this issue of AJUM, Smith and Mistry<span><sup>1</sup></span> present research documenting the impact of formal echocardiography (echo) on patient management in a small clinical audit of formal echos in their intensive care unit (ICU). Although half of the patients had critical findings found on formal echo, only 25% resulted in management change. Perhaps, the remainder of the critical findings were either already suspected, and therefore being treated; or had been anticipated. Indeed, it is possible that a point of care ultrasound (POCUS) had already given them some clinical cues, and thus, the formal echo was simply confirmatory. In a reasonable number of patients, the formal echo helped make the decision to proceed with palliation and this seems an entirely reasonable reason to do an extra imaging test.</p><p>Also, in the ICU setting, Xin <i>et al</i>.<span><sup>2</sup></span> report on the use of Tissue Doppler Imaging (TDI) of the diaphragm to optimise the timing of weaning from mechanical ventilation in ICU patients. Using TDI to measure the low velocity motion of heart muscle is fundamental to echocardiography, so the extension to the diaphragm seems a logical extension of practice. But a good idea still needs to be tested and shown to aid patient management. Innovation needs to be effective.</p><p>Innovation is a key part of medicine, and finding new applications for imaging is part of that. Lau <i>et al</i>.<span><sup>3</sup></span> applied shear wave elastography to patients in a case–control study comparing patients with COVID-19 with controls and found that patients with recent (<6 months) COVID-19 had increased liver stiffness. They were prompted to do the study after observing elevated liver enzymes in these patients. But as the authors point out, these may be transient changes, and data are needed to see whether these abnormalities are asso","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 3","pages":"139-140"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajum.12412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320923","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}
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