Australasian Journal of Ultrasound in Medicine最新文献

Focal liver lesions are commonly encountered. Grey-scale and Doppler sonographic characteristics of focal liver lesions are often non-specific and insufficient to conclusively characterise lesions as benign or malignant. Contrast-enhanced ultrasound is useful for the characterisation of FLLs in patients who are unable to undergo contrast-enhanced computed tomography or magnetic resonance imaging. It is also easily available and relatively cheap. However, interpretation of contrast-enhanced ultrasound can be challenging without a systematic approach. In this pictorial essay, we highlight an algorithm-based approach to FLLs and discuss the characteristic contrast-enhanced ultrasound features of commonly encountered and clinically significant focal liver lesions.

Pelvic fragility fractures, such as pubic ramus fractures, are a common and painful condition in the elderly population. Despite this, there are few regional anaesthesia options available to effectively relieve pain in these fracture types and avoid potential side effects from opioid administration. This case report describes an elderly patient with a superior ramus fracture, who received effective pain relief with motor sparing, using a standard-volume point-of-care ultrasound-guided pericapsular nerve group (PENG) block performed in the emergency department. The standard-volume PENG block performed by an emergency clinician appears to be a safe, effective and feasible regional anaesthesia technique for superior pubic ramus fracture, with the additional benefit of motor sparing that may potentially facilitate earlier mobilisation and discharge.

While reviewing this edition of the journal, I began reflecting on the diversity of ultrasound delivery. In this AJUM issue, we have a unique and rare furcate umbilical cord insertion diagnosis,¹ a primer on emergency breast lesions,² a systematic review investigating the role of ultrasound in surgical patients in low and middle income countries,³ and two articles about teaching non-experts to undertake ultrasound, including to guide knee procedures⁴ and to diagnose bone fractures.⁵ I can remember a time when the education was largely informal and at the bedside – the so-called ‘see one, do one’ approach. Of course, it was never a single examination, it took hundreds, even thousands of patients and hours of scanning to become proficient. Ultrasound education was subject to the type of hospital and services it provided; to the range of pathology in patients that presented; and to referral patterns. Ultrasound education was delivered by clinical experts to people wishing to become ultrasound experts. Increasingly, ultrasound education is patient-centred and focussed on clinical need rather than speciality- or profession-specific.

Initially ultrasound was used to identify anatomy, later function and blood flow, and now we find ourselves able to characterise tissue. In this AJUM edition, there is an excellent review article from colleagues at the Mayo Clinic,² in which they describe the ultrasound appearances and characteristics of breast lesions presenting in emergency or urgent care facilities. Not only is ultrasound being used to diagnose these breast lesions but also ultrasound is an important part of the emergency care triage pathway.

In the acute care setting, is an original research paper by Snelling and colleagues,⁵ in which they describe the learning curve of novices for the diagnosis of distal forearm fractures in children. That ultrasound is proving to be an adjunct, even replacement, for X-ray shows how far ultrasound technology, and our knowledge, has evolved. The evolution in ultrasound users is also apparent in this paper in which they show that nurse practitioners can achieve diagnostic competency after just 15 scans. This approach has the potential to improve access and result in shorter times to diagnosis, without using ionising radiation.

Another area of clinical advancement is the use of ultrasound to support procedures. As a potential patient, it seems very logical to me that using ultrasound to guide needle or cannula placement is better than ‘going in blind’. As an ultrasound professional, and as a citizen, I want to know that the additional cost of ultrasound guidance is warranted. Deleskey et al.⁴ used a bespoke knee phantom to evaluate the use of ultrasound-guided versus landmark-guided knee arthrocentesis by

There are very few true breast emergencies. While infrequent, women do present to emergency departments or urgent care centres with breast-related concerns. In this case-based review, both common and uncommon urgent and emergent breast lesions are presented, emphasising ultrasound characteristics and imaging optimisation to improve accurate diagnosis and appropriate recommendations.