Bedside lung ultrasound (LUS) is an increasingly utilized technique as an adjunct to clinical history and physical examination. This study aims to assess the added value of LUS by comparing the diagnostic accuracy of a blinded sonographer's ultrasound findings against the clinical suspicion of pulmonologists and emergency physicians at admission. A prospective single-center consecutive study of hospitalized patients (n=101) with imaging-detected consolidations was conducted. Ultrasound was performed by a blinded operator unaware of the physician's diagnostic suspicions. Definitive diagnoses were established through clinical-radiologic follow-up at 12 months, biopsy, and/or microbiological studies. The pulmonologist and emergency physician correctly estimated the probability of benignity/malignancy in 88.1% and 80% of the cases, respectively, whereas the blind operator achieved a 90% accuracy rate. Combining LUS findings with pulmonologists' clinical data improved benign/malignant classification accuracy to 96%. The agreement with the definitive dichotomous diagnosis (benign/malignant), assessed through Cohen kappa, was 0.664 for pulmonologists, 0.129 for emergency physicians, and 0.747 for the ultrasonographer. Ultrasound demonstrated a sensitivity (Se) of 85% and specificity (Spe) of 92% for diagnosing cancer. For pulmonologists, Se was 65% and Spe was 96%, whereas for emergency physicians, Se was 12% and Spe was 97%. The approach to hospitalized patients with imaging-detected consolidations that achieves the highest diagnostic accuracy (96%) combines clinical suspicion with ultrasound findings. Our findings confirm the importance of LUS, particularly in suspected malignancy.
Point-of-care ultrasound (POCUS) has become an essential diagnostic tool in emergency medicine, providing rapid bedside information that supports clinical decision-making. However, the full potential of POCUS may extend beyond image acquisition, with effective documentation and integration into electronic health record (EHR) systems potentially contributing to improved clinical and operational outcomes. This systematic review evaluated the clinical, operational, and financial impacts of POCUS image archiving within EHRs in emergency department settings. Following PRISMA guidelines, a comprehensive search was performed in PubMed/MEDLINE, Embase, and Web of Science, eligible studies included emergency department-based research reporting original data on POCUS image storage or archiving within EHR systems, whereas studies without specific archiving outcomes were excluded. Two independent reviewers conducted study selection and data extraction, with risk of bias assessed using an adapted NIH quality assessment tool. A total of 225 records were identified, and 11 studies met the inclusion criteria. The included studies demonstrated that structured POCUS image archiving improved documentation completeness, image quality, accessibility to prior examinations, and clinical review processes. Implementation of automated or semi-automated workflows was consistently associated with improved compliance, enhanced organization of ultrasound services, and more efficient resource management. Financial outcomes were also positively affected, with reported increases in billing compliance, reimbursement, and institutional revenue after workflow integration. Despite these benefits, substantial heterogeneity among studies and limitations regarding study design, confounding factors, and generalizability remain. Future research should focus on standardized implementation strategies, cost-effectiveness analyses, and adoption models applicable to diverse health care settings, including low-resource environments.
Peripheral nerve blockade provides many advantages in the perioperative period for surgery on the shoulder, elbow, wrist, or hand. Aberrant anatomic structures or anomalous courses of nerves may create challenging conditions for use of ultrasound to accurately guide needles for nerve blocks. This paper presents a review of such anomalies affecting the conduct of various peripheral nerve blocks in the upper extremity. A comprehensive literature review was performed, utilizing the PubMed and Embase databases. Variations of anatomy of the brachial plexus and associated structures are described, as well as aberrancies of distal nerves in the upper extremity. These include descriptions of anatomic variations at the sites of interscalene, supraclavicular, infraclavicular, and axillary brachial plexus blocks, as well as nerve blocks at the level of the elbow and forearm. Understanding variant anatomy is essential for those providing upper extremity ultrasound-guided peripheral nerve blockade.
Successful management of liver transplant recipients relies on accurate imaging evaluation of the liver allograft throughout the postoperative period. This review provides a practical multimodality approach to imaging evaluation of the transplant liver, highlighting the complementary roles of ultrasound with Doppler, contrast-enhanced ultrasound, multidetector computed tomography, magnetic resonance imaging with magnetic resonance cholangiopancreatography, and selected nuclear medicine studies. Normal postoperative anatomy and expected imaging findings are reviewed, followed by a review of the characteristic imaging features of common vascular, biliary, and parenchymal complications. The strengths, limitations, and appropriate clinical applications of each imaging modality are discussed to facilitate accurate diagnosis and guide timely management.
Peripheral nerve blockade provides many advantages in the perioperative period for surgery on the shoulder, elbow, wrist, or hand. Aberrant anatomic structures or anomalous courses of nerves may create challenging conditions for use of ultrasound to accurately guide needles for nerve blocks. This paper presents a review of such anomalies affecting the conduct of various peripheral nerve blocks in the upper extremity. A comprehensive literature review was performed, utilizing the PubMed and Embase databases. Variations of anatomy of the brachial plexus and associated structures are described, as well as aberrancies of distal nerves in the upper extremity. These include descriptions of anatomic variations at the sites of interscalene, supraclavicular, infraclavicular, and axillary brachial plexus blocks, as well as nerve blocks at the level of the elbow and forearm. Understanding variant anatomy is essential for those providing upper extremity ultrasound-guided peripheral nerve blockade.
