2015 Peds Ultrasound CME course

Over forty participants joined Sinai faculty Jim Tsung, Ee Tay, Bret Nelson, Joshua Guttman, Jacob Goertz, Turan Saul, Jenny Sanders, Kimberly Kahne, Michelle Vazquez, Joe Sorravit, and Rupi Mudan. Course Directors Ee Tay and Joshua Guttman organized great didactic content and lost of hands-on training (HOT) with pediatric models.

Participants from many pediatric and acute care specialties attended. They left with greater scanning skills, reduced reliance on CT scans, a multi-tool, and one lucky winner received Kaushal Shah’s new junior medical detective book, My Tummy Hurts

Our next hands-on ultrasound course will be in Ponte Vedra, Florida on June 17 at the Clinical Decision Making conference.

2014 Emergency and Critical Care Ultrasound CME Course

The Mount Sinai Department of Emergency Medicine hosted its annual ultrasound CME conference on April 25. Faculty, fellows, nurses and PAs from a number of institutions and specialties took part in our tenth annual course.

The course was directed by Bret Nelson, MD who introduced ultrasound physics and machine controls, followed by lectures on assessment of  airway and breathing (Jim Tsung, MD, MPH), cardiovascular ultrasound (Jennifer Huang, DO), trauma evaluation (Phil Andrus, MD) and procedure guidance (Amy Sanghvi, MD).

After lunch an intensive hands-on session with live models, task simulators and sim cases rounded out the experience.

Lung ultrasound goes viral for flu season

Z-linesMore lung ultrasound tips and examples from Drs. Jim Tsung and Brittany Pardue Jones!

Bacterial pneumonia will manifest as lung consolidation with air bronchograms. The A-line pattern of normal lung will begin to be replaced by B-lines in the area of affected lung:

https://gmep.org/media/12001

Here we’ve highlighted the consolidation from the above video as well:

https://gmep.org/media/11999

In contrast, subpleural consolidations and confluent B-lines are more suggestive of viral pneumonia.
So what do these look like?

Subpleural consolidation:

and another example:

Confluent B-Lines:

occur when multiple B-lines coalesce. In contrast, the next example demonstrates multiple discrete B-lines.

Multiple B-Lines:

And now for something completely different

Z-Lines:  Comet tails that arise from the pleural line but DO NOT make it to the bottom of the ultrasound screen. These are not B-lines. These artifacts have not been associated with any pathology, and they do not obliterate A-lines.

For more details on the sonographic appearance of viral lung pathology, check out this article by Jim Tsung.

Lung Ultrasound Pitfalls

US lung consolidation TsungThoracic sonography is one of the most rapidly growing areas of emergency and critical care ultrasound. One very important emerging indication is to assess for lung consolidation. The characteristic appearance of consolidated lung is very sensitive and specific for pneumonia, but novices should heed some important pitfalls in making the diagnosis.

Special thanks to Jim Tsung, MD, MPH and Brittany Jones, MD for their tips, videos, and ongoing research in this important field! For further reading on this topic, please see this article.

Pitfall #1 – confusing thymus for a consolidation

Normal thymus in sagittal view:

Thymus (top half of screen) and heart (bottom right). Don’t confuse thymus for lung consolidation. Note there are no air bronchograms, but thymus has a faint speckled appearance.

Normal thymus in transverse view:

Thymus (top half of screen) and heart (bottom right). Don’t confuse thymus for lung consolidation. Note there are no air bronchograms, but thymus has a faint speckled appearance
Pneumonia adjacent to Thymus in transverse view:

Lung consolidation with air bronchograms (top left) adjacent to normal thymus (speckled appearance on top right) with heart (bottom right)

Pitfall #2 – mistaking spleen for consolidation.

This is an important pitfall for everyone to know about. The same issue applies to the liver & stomach. The sensitivity of lung US for pneumonia rises >90% if this mistake is avoided.

Left lower chest- sagittal view:

Be careful scanning the left lower chest (left anterior and left axillary line) – air in stomach and spleen may look like pneumonia if you don’t realize that you have scanned inferior to the diaphragm and past the end of the pleural line. Most common error by novices.

Left lower chest- transverse view:

Be careful scanning the left lower chest (left anterior and left axillary line) – air in stomach and spleen may look like pneumonia if you don’t realize that you have scanned inferior to the diaphragm and past the end of the pleural line.

Pitfall #3- missing pleural effusion

Here are a few examples to refresh your memory.

Left pleural effusion:

Identify:

  • Pleural effusion (anechoic wedge just beneath ribs and pleura)
  • Lung
  • Diaphragm
  • Spleen
  • Air in stomach

Do not confuse spleen and air in stomach for pneumonia.

Right pleural effusion:

Identify:

  • Pleural effusion
  • Lung
  • Diaphragm
  • Liver

2012 Ultrasound CME conference

The Mount Sinai Department of Emergency Medicine hosted its annual ultrasound CME conference held on March 22 at the Stern Auditorium.

Faculty, fellows and PAs from a number of institutions took part in our eighth annual conference.

The course was directed by Bret Nelson, MD and topics included ultrasound physics (Leila PoSaw, MD, MPH) and assessment of  airway and breathing (Jim Tsung, MD, MPH), circulation (Daniel Singer, MD), disability/trauma (Phil Andrus, MD) and procedure guidance (Danny Duque, MD).

Great lectures by Sinai’s Emergency Ultrasound faculty were followed by an intensive hands-on scanning session.