Mount Sinai Emergency Medicine Ultrasound

Arcuate vessels are commonly seen on ultrasound evaluation of the uterus. Occasionally they can be confused with subchorionic hemorrhage, ovaries, and other structures so it’s worth looking at their characteristic appearance.

Once again, thanks to Dr. Gray for his lovely, copyright-free images:

Here we see the Uterine venous plexus giving rise to the helicine branches, aka arcuate vessels. They run circumstantially through the outer margin of the myometrium.

In the images below, anechoic areas are visible in the posterior aspect of the myometrium (arrows in top two images). The bottom two images reveal the same structures with and without color flow, demonstrating their vascularity. These vessels are normal anatomic variations, and can become more engorged during pregnancy as uterine bloodflow increases.

This is again visible posteriorly in this video of a gravid uterus:

We’ve all seen ultrasound augment the physical examination and even allow for assessments we could not otherwise accomplish at the bedside. One great example is the use of ultrasound to check the pupillary light reflex. If you are wondering why a pen light would not suffice for this physical examination standby, you have never encountered a patient with facial trauma whose eyes were swollen shut.

We already know what to look for without ultrasound (thanks to Greyson Orlando and Wikipedia for the GIF):

By directing the beam of a high-frequency linear array transducer through the plane of the iris, you can obtain the following image (while shining a light through the closed eyelid of the same or contralateral eye):

It takes a bit of practice to align both planes, and not worth the trouble if the patient can open their eyes.

Placing a Tegaderm over the closed eye prior to applying gel can make cleanup much easier afterwards (a useful tip for any type of ocular ultrasound).

Further reading:

• Sargsyan AE, Hamilton DR, Melton SL, et al. Ultrasonic evaluation of pupillary light reflex. Critical Ultrasound Journal. 2009 1(2): 53-57.
• Harries A, Shah S, Teismann N, Price D, Nagdev A. Ultrasound assessment of extraocular movements and pupillary light reflex in ocular trauma. Am J Emerg Med. 2010 Oct; 28(8):956-9.

Thoracic ultrasound is one of the hottest topics in emergency and critical care sononography. Assessment for pneumothorax is accurate and relatively easy to learn.

One important sign when assessing for pneumothorax is the lung point. This is the point where normal pleural interface contacts the boundary of the pneumothorax. It is the most specific sign for pneumothorax using ultrasound.

Using B-mode ultrasound, the lung point will appear as the boundary between normal lung sliding and still lung.

Lung point:

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Makini Speaking

Kit and Alan Hands-On

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