Ultrasonography (US) is extensively used for the diagnosis of breast diseases; it is convenient for the patient and enables high-resolution visualization of breast lesions without exposure of patients to radiation. As a real-time, dynamic modality, US is ideal for tissue sampling guidance. Sonographic features of irregular margins, hypoechogenicity, vertical orientation, and others speak in favor of invasive cancers, but a considerable overlap between benign and malignant US features exists, which requires correlation with mammography , magnetic resonance imaging, and often, image-guided biopsy.
Estudio tipo CAT (Critically Appraised Topics) que tiene como objetivo valorar el grado de evidencia científica que apoya la realización de eco-FAST (Focused Assessment with Sonography for Trauma) o tomografía computarizada multidetectora en los pacientes del servicio de urgencias hemodinámicamente inestables tras traumatismo. Se realizó una búsqueda eficiente en la bibliografía y se encontraron varios artículos recientes de alto nivel de evidencia. Se llegó a la conclusión de que se acepta el uso de la eco-FAST como prueba de imagen inicial en el paciente hemodinámicamente inestable, aunque su rendimiento es limitado en determinadas circunstancias. La realización de tomografía computarizada multidetectora debe valorarse dependiendo del grado de inestabilidad y de la distancia que hay que recorrer. Sin embargo, existen pocas referencias que valoren la aproximación de los equipos de tomografía a las salas de urgencia.This critically appraised topic (CAT) study aims to evaluate the quality and extent of the scientific evidence that supports the use of focused assessment with sonography for trauma (FAST) versus multidetector computed tomography (MDCT) in hemodynamically unstable trauma patients in the emergency room. An efficient search of the literature yielded several recent articles with a high level of evidence. The CAT study concludes that FAST is an acceptable initial imaging test in hemodynamically unstable patients, although its performance is limited in certain circumstances. The decision whether to use MDCT should be determined by evaluating the patient's degree of instability and the distance to the MDCT scanner. Nevertheless, few articles address the question of the distance to MDCT scanners in emergency departments.
High-resolution sonography is ideal for the evaluation of many oropharyngeal and neck structures because of their superficial nature. Clinicians can use point-of-care ultrasonography to evaluate for different types of infectious and inflammatory conditions in this area, including cellulitis and/or abscess formation of the superficial soft tissues, peritonsillar abscess , cervical lymphadenitis , salivary gland inflammation and sialolithiasis , dental abscess , inflammation of the thyroid gland , internal jugular thrombosis and thrombophlebitis , and sinusitis .
A basic knowledge of the anatomy of the abdominal aorta and its major branches is essential for proper interpretation of sonographic findings and for understanding the pathologic disease states that affect these vessels. An understanding of relevant anatomy and hemodynamics for normal vessels as well as for multiple disease states, including abdominal aortic aneurysm, vascular stenosis, dissection, and occlusion, is important for correct diagnosis. There are various Doppler techniques, protocols, and diagnostic criteria used in the evaluation of the aorta and mesenteric arteries.
As superficial structures, the salivary glands are easily assessed by ultrasound. This article reviews the role of imaging in the management of salivary gland tumors, with an emphasis on the use of ultrasound. The anatomy of the major salivary glands, the technique of salivary gland ultrasound, and the typical appearances of the common benign and malignant lesions are discussed. In addition, the use of ultrasound-guided interventional techniques and ultrasound elastography of salivary gland tumors is discussed.
Hyperparathyroidism can lead to symptoms related to hypercalcemia. Evaluation of the parathyroid glands with sonography requires knowledge of the classic and variant appearances of parathyroid lesions as well as the range of anatomic locations. The accuracy of ultrasonography in characterizing parathyroid disease is augmented by correlation with scintigraphy; although neither sonography nor scintigraphy excels in detecting multigland disease or after failed resection, they are still used in those settings with varying sensitivities. Because of the increasing use of minimally invasive techniques, ultrasonography and ultrasound-guided fine-needle aspiration play a crucial role in preoperative characterization of abnormal parathyroid glands.
Ultrasonography may be used for the detection, characterization, and follow-up of a wide variety of acute and chronic renal pathology. This article provides an overview of renal parenchymal pathology, such as renal pseudotumors , neoplasms, cystic disease, and infectious/inflammatory processes. Obstructive and nonobstructive hydronephrosis are reviewed. In addition, renovascular hypertension and vascular pathology are also covered. The objective of this article is to provide an overview of renal pathology with emphasis on the role of ultrasound in their diagnosis and follow-up evaluation.
This article describes normal joint anatomy and ultrasound scanning techniques, knowledge of which is fundamental for correct joint evaluation, and discusses the most common inflammatory, traumatic, and tumor-like joint diseases. Finally, interventional ultrasound-guided procedures are addressed and pearls and pitfalls are summarized.
With recent improvements in ultrasound (US) imaging equipment and refinements in scanning technique, an increasing number of peripheral nerves and related pathologic conditions can be identified. US imaging can support clinical and electrophysiologic testing for detection of nerve abnormalities caused by trauma, tumors, and a variety of nonneoplastic conditions, including entrapment neuropathies. This article addresses the normal US appearance of peripheral nerves and discusses the potential role of US nerve imaging in specific clinical settings. A series of US images of diverse pathologic processes involving peripheral nerves is presented.
Extratesticular lesions are often encountered during scrotal ultrasonography either incidentally or because the patient has palpated something in the scrotum. This article describes the sonographic technique of assessing these lesions. Classification of lesions is made based on their focal or diffuse appearance. The sonographic appearances are described, with emphasis on key differentiating features.
This article discusses the use of ultrasound imaging in the evaluation of hernias. Femoral hernias move from superior to inferior in the proximal thigh and are located adjacent to the femoral vein . Indirect hernias move obliquely from superiolaterally near the anterior superior iliac spine in an inferior medial direction toward the pubic symphysis. Direct hernias move from posterior to anterior in the medial part of the lower quadrants of the abdomen. Umbilical hernias occur anywhere within 2 to 3 cm of the center of the umbilicus .
Ultrasonography has become the first-line imaging modality in patients with inflammatory or malignant diseases for the evaluation of peripheral and abdominal lymph node (LN) status. A typical reactive LN has an oval shape, with even thickness of its preserved cortex and regular vessel architecture. LN metastases are mostly round and hypoechoic to cystic; an echogenic hilum is missed and the vessel architecture is chaotic. Ultrasound-guided biopsies are in most cases successful in defining LN characteristics. The use of contrast agents is advantageous in the detection of tissue perfusion, thus confirming the effect of chemotherapy or radiation therapy.
Ultrasound continues to grow in use for rapid diagnosis and assessment within the emergency department . This diagnostic tool aids the physician in early diagnosis for resuscitation of the critical patient. With new emerging research airway ultrasound shows promise as not only diagnostic but also therapeutic adjunct to a patient's care. In addition, thoracic ultrasound allows for evaluation of insults to the breathing component of resuscitation and also can diagnostically direct therapy earlier than previously available in critical care areas.
Ultrasonography is the modality of choice for the evaluation of the scrotum . It shows testicular abnormalities, peritesticular abnormalities such as varicocele , and epididymal disorders. Sonography has come to be the first and primary modality for imaging the testis because there has been marked improvement in the resolution of the equipment and it is easily available, fast, and cost-effective. Sonographic diagnosis of various pathologies of testis are described.
Palpable lumps and bumps are a common patient complaint, with most being benign. Ultrasonography is an ideal modality for the initial imaging of patients presenting with a palpable lump because of its low cost, high spatial resolution, ability to noninvasively assess blood flow, and dynamic imaging capability. A diagnostic algorithm is presented that provides a specific diagnosis for many patients and identifies a small group of patients who may benefit from additional imaging or tissue sampling.
Symptom-based ultrasonography describes 2 approaches to point-of-care ultrasonography for emergency department patients who present with chest pain and dyspnea, or abdominal pain. The aim of this article is provide a framework to rule in or out life-threatening causes rapidly at the bedside and allow narrowing down of a large list of differential diagnosis while additional tests are being ordered. Although this article is primarily written for the emergency physician, it can also be used in other care settings. In the hands of trained clinicians, bedside ultrasonography is a truly valuable tool.
Ultrasound elastography is a new technology that determines the stiffness of tissues. There are several ultrasound elastography techniques available that can be classified into 2 groups, strain and shear wave imaging. These techniques have been shown to be able to detect and characterize lesions in multiple organs. The major application in the abdomen is noninvasive assessment of liver fibrosis . The assessment of fibrosis in chronic liver disease is pivotal for staging, prognosis, and treatment management. The characterization and detection of abdominal masses have not been as extensively investigated.
