Patient with history of hypertension presents periumbilical abdominal pain radiating to the back. Minimal abdominal tenderness, no rebound or guarding, thoughÂ a pulsatile mass is felt.
The following ultrasound is obtained:
As the title suggests, the patient was diagnosed with an abdominal aortic aneurysm and vascular surgery was consulted.
We’re experimenting a bit with the GMEP.org system. It’s a great educational collaborative run by the folks who brought you Life in the Fast Lane. Worth checking out.
As you may know, we have a Vimeo channel with a growing video archive as well. Our goal is to make this site and its content as helpful and accessible a possible, so please let us know how we can improve!
With the proliferation of online educational modalities (blogs, educational websites, podcasts, twitter feeds) designed for rapid dissemination and translation of our basic Ultrasound knowledge to the bedsides around the globe, we must occasionally go back to the source – The Scientific Journal.
Listed below are several ultrasound-specific journals.
What is your favorite source for point of care ultrasound literature goodness?
This patient presented with right upper quadrant abdominal pain. There was RUQ tenderness on exam, but no fever, rebound or Murphy sign. A point-of-care ultrasound was performed to assess for signs of cholecystitis and the following image was obtained. This prompted the operator to ask, “What the heck?”
What structures are visible here? How could you differentiate them? More after the break!
The Association of American Medical Colleges (AAMC) has written an article about ultrasound education at the medical school level. In the current edition of their widely distributed publication The Reporter, they describe programs at the University of South Carolina School of Medicine, University of California (Irvine) School of Medicine, and the Mount Sinai School of Medicine.
The article notes,
With rapid advancements in ultrasound technology, such scenarios as this are becoming more commonplace, as a handful of the nationâ€™s medical schools make ultrasound training a standard part of the curriculum. And there is a push to encourage more schools to use ultrasound.
The full article is available here.
To image something which moves, you must remain still. To image something which is still, you must move.
If you think on this long enough, the point is self-evident and requires no explanation. Or, just see some examples below.
We are pretty well adapted to seeing three dimensions at a time. Thus when imaging a moving structure like the heart, we hold the probe in a fixed position to obtain standard views. This allows us to focus on the movement, and cardiac presets optimize temporal resolution at the expense of spatial resolution. We are then seeing two spatial dimensions and one temporal dimension (heart moving in time).
D Shaped Left Ventricle from Sinai EM Ultrasound on Vimeo.
It is very difficult to appreciate the anatomy and function of the heart, for example,Â when the probe is moving.
In contrast, imaging the right upper quadrant for fluid in Morison’s pouch requires a slow fan through the liver, diaphragm, and kidney. This allows us to appreciate the entire potential space where fluid can collect. Abdominal imaging is optimized for spatial resolution at the expense of temporal resolution, so be sure to move the probe slowly. Fanning through the entire structure of interest will often reveal pathology which was missed with a single-plane scan. Small gallstones, small amounts of peritoneal or pleural fluid, saccular aneurysms, and other maladies can fool a novice sonographer who isn’t thorough. In this case we are seeing three spatial dimensions.
FAST1 RUQ pos from Sinai EM Ultrasound on Vimeo.
So, keep your audience in mind when you are creating scans. Should you fan through the static anatomy, or let the movement of the structures speak for themselves?