Medical ultrasonography最新文献

Point of Care Ultrasound (POCUS) can be useful as a tool before, during and after the performance of cardiopulmonary resuscitation (CPR). Before or after resuscitation it can help with monitoring unstable hemodynamics, has the potential to identify reversible causes if patient deteriorates. During resuscitation POCUS can help detect potentially treatable causes of the cardiac arrest. Performance of POCUS while resuscitation requires experienced sonologists and a good team structure to embed the examination in advanced cardiovascular life support (ACLS) algorithms. This article gives an overview and tips about how to detect potential reversible causes of patient deterioration in all three phases of CPR. We describe some special situations in which resuscitation could take place. Further we give a comment about sonographic education of physicians and nonacademic medical staf.

We present the case of a patient with five peritoneal loose bodies (PLBs). The patient, admitted due to prostatic hyperplasia, had multiple movable masses in the abdomen detected during a routine physical examination. Ultrasound, CT, and MRI revealed several roundish masses in the abdominal and pelvic cavities, which were subsequently removed via laparotomy. PLBs are rare entities, often identified incidentally during surgery. Their formation is believed to result from necrosis and exfoliation of abdominal and pelvic tissues. To our knowledge, this is the first reported case with such a high number of PLBs, contributing to an enhanced understanding of this uncommon condition.

Aim: This study assessed the effectiveness of ultrasonography-measured optic nerve sheath diameter (ONSD) in predicting large vessel occlusion (LVO) in ischemic stroke patients.

Materials and methods: This single-center, prospective observational study involved patients presenting to the emergency department within 24 hours of symptom onset with moderate to severe stroke, and healthy volunteers.

Results: The study included 133 ischemic stroke patients and 63 healthy volunteers. The patient group had significantly higher right [5.8 (0.9)] and left [5.9 (0.8)] ONSD values compared to controls (right [5.7 (0.6)], left [5.7 (0.8)], p<0.001 for both). LVO was present in 58.6% (n = 78) of patients. Median right ONSD was 6.1 mm (0.8) in LVO patients vs. 5.7 mm (0.65) in non-LVO patients (p=0.002). Median left ONSD was 5.9 mm (0.9) in LVO patients vs. 5.7 mm (0.7) in non-LVO patients (p=0.002). A right ONSD ≥6 mm had 51.28% sensitivity and 78.18% specificity for LVO. A left ONSD ≥5.5 mm had 83.33% sensitivity and 40% specificity for LVO.

Conclusion: Elevated ONSD values measured by ultrasonography can effectively indicate LVO in stroke patients.

Aim: Diaphragm dysfunction (DD) is a keystone factor in difficult weaning from invasive mechanical ventilation (IMV). Diaphragm ultrasound (DUS) is the preferred method for the evaluation of diaphragm function in the Intensive Care Unit (ICU) setting, namely through the diaphragm thickening fraction (DTF). However, its potential role in the decision-making process of mechanical ventilation weaning is yet to be established. We aimed to assess the incidence of early DD and its role as a predictor of prolonged IMV.

Material and methods: We conducted a prospective, non-interventional study in a university hospital ICU. Non-consecutive adult patients subject to at least 48h of IMV were enrolled. Exclusion criteria was a prior period of IMV in the past three months. DUS was performed at 48h of IMV. End-inspiratory and end-expiratory diaphragm thickness were measured using M-mode, with a high-frequency linear probe placed at the zone of apposition of the diaphragm. The mean values of three measurements were used to calculate DTF. Interobserver measurement variability was not evaluated.

Results: Forty-five patients were included. Thirty-eight percent were female, average age was 62.3 years. Mean Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) at admission were 50.9 and 9.02, respectively. Mean DTF was 23.46%±17.15. Average IMV duration was 9.36±7.66 days. Half of patients had DD at 48h of IMV. A weak negative correlation was observed between DTF, days of endotracheal intubation (Sp -0.27; p=0.07) and days of IMV (Sp -0.25; p=0.09). Using DTF cut-off values of 20% and 30%, DTF at 48h of IMV was not associated with prolonged IMV (p-values 0.17 and 0.58, respectively).

Conclusion: In our study, there was a high prevalence of DD at 48h of IMV, as suggested in previous literature. Diaphragm dysfunction at 48h when measured through DTF did not seem to predict prolonged IMV. Late VAP incidence was associated with DD. Diaphragm ultrasound is well-established for diaphragm functional assessment, but further research regarding its trajectory during critical illness is needed to clarify its application in clinical practice.

Reliable and reproducible measurement methods have been established, and reference values are used in almost all scientific disciplines. The knowledge of reference values is crucial to distinguish physiological from pathological processes and, therefore, subsequently, for the clinical management of patients. The image storage and documentation of measurements and normal findings should be part of quality assurance in imaging. This paper aims to review published literature and provide current knowledge of sonographic measurements of the spleen, examination techniques, and knowledge of normal values with their possible clinical implications. Moreover, the role of clinical influencing factors such as age, gender, or ethnicity is also analyzed.

Ultrasound has become an essential tool in clinical diagnosis. Traditionally, ultrasound was predominantly taught during postgraduate medical training. However, today ultrasound education is increasingly being incorporated into preclinical curricula of medical students. Although extensive literature on individual ultrasound training programs is available, research on the effective development and implementation of ultrasound education for students remains limited. This article identified five key considerations for incorporating student ultrasound education into existing medical curricula, based on an analysis of working examples in various parts of the world: The synergistic relationship between anatomy and ultrasound, didactic evolutions such peer-assisted learning, the role of Point-of-Care-Ultrasound (POCUS) and e-Learning in resource-limited settings, the considerations of possible side effects and lastly, the early engagement with key stakeholders. These five key considerationsshould help the successful and long-term development, adaptation and implementation of a new or existing ultrasound education program in undergraduate education, thereby contributing to the training of competent future healthcare professionals.

Ultrasound (US) can be performed at the point of care by the treating physician, is safe, well tolerated and, therefore, can be repeated as often as clinically required and shortens the time to decision. An invaluable advantage of US is that the imaging is real-time and pathophysiological phenomena can be visualized dynamically. In addition, the multiparametric capabilities of US facilitate the evaluation of intestinal, peri-intestinal and some of the extra-intestinal manifestations of inflammatory boweldiseases (IBD).In the current series of papers a synopsis of recommendations for ultrasound in IBD guidelines, ultrasound parameters in inflammatory bowel disease including activities scores, the value of contrast enhanced ultrasound (CEUS), small intestinal contrast ultrasound (SICUS) and elastography, perineal ultrasound (PNUS), endoscopic ultrasound (EUS) including endorectal ultrasound (ERUS) and interventional ultrasound (INVUS) have been discussed and illustrated. This review discusses advantages, accuracy and limitations of ultrasound techniques for the diagnosis of intestinal, periintestinal and extra-intestinal complications of MC and CU and for monitoring treatment response.