Fortuitously discovered liver lesions Dietrich, Christoph F; Sharma, Malay; Gibson, Robert N ...
World journal of gastroenterology,
06/2013, Letnik:
19, Številka:
21
Journal Article
Odprti dostop
The fortuitously discovered liver lesion is a common problem. Consensus might be expected in terms of its work-up, and yet there is none. This stems in part from the fact that there is no preventive ...campaign involving the early detection of liver tumors other than for patients with known liver cirrhosis and oncological patients. The work-up (detection and differential diagnosis) of liver tumors comprises theoretical considerations, history, physical examination, laboratory tests, standard ultrasound, Doppler ultrasound techniques, contrast-enhanced ultrasound (CEUS), computed tomography and magnetic resonance imaging, as well as image-guided biopsy. CEUS techniques have proved to be the most pertinent method; these techniques became part of the clinical routine about 10 years ago in Europe and Asia and are used for a variety of indications in daily clinical practice. CEUS is in many cases the first and also decisive technical intervention for detecting and characterizing liver tumors. This development is reflected in many CEUS guidelines, e.g., in the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 as well as the recently published World Federation for Ultrasound in Medicine and Biology-EFSUMB guidelines 2012. This article sets out considerations for making a structured work-up of incidental liver tumors feasible.
Sonography of the pleura Horn, Rudolf; Görg, Christian; Prosch, Helmut ...
Ultraschall in der Medizin
45, Številka:
2
Journal Article
Recenzirano
The CME review presented here is intended to explain the significance of pleural sonography to the interested reader and to provide information on its application. At the beginning of sonography in ...the 80 s of the 20th centuries, with the possible resolution of the devices at that time, the pleura could only be perceived as a white line. Due to the high impedance differences, the pleura can be delineated particularly well. With the increasing high-resolution devices of more than 10 MHz, even a normal pleura with a thickness of 0.2 mm can be assessed. This article explains the special features of the examination technique with knowledge of the pre-test probability and describes the indications for pleural sonography. Pleural sonography has a high value in emergency and intensive care medicine, preclinical, outpatient and inpatient, in the general practitioner as well as in the specialist practice of pneumologists. The special features in childhood (pediatrics) as well as in geriatrics are presented. The recognition of a pneumothorax even in difficult situations as well as the assessment of pleural effusion are explained. With the high-resolution technology, both the pleura itself and small subpleural consolidations can be assessed and used diagnostically. Both the direct and indirect sonographic signs and accompanying symptoms are described, and the concrete clinical significance of sonography is presented. The significance and criteria of conventional brightness-encoded B-scan, colour Doppler sonography (CDS) with or without spectral analysis of the Doppler signal (SDS) and contrast medium ultrasound (CEUS) are outlined. Elastography and ultrasound-guided interventions are also mentioned. A related further paper deals with the diseases of the lung parenchyma and another paper with the diseases of the thoracic wall, diaphragm and mediastinum.
Abstract
Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapidly because of its intuitive, simple applicability and low equipment costs. The speed of its ...emerging growth frequently outpaces the development of quality assurance and education. Indeed, education standards vary worldwide, and in some cases seem to neglect the principles of modern competence-based education. Additional challenges are encountered such as remote or low resource medical practice. Here, EMPoCUS might be the only ad-hoc imaging modality available. Once mastery of EMPoCUS is achieved, emergency physicians should be able to independently and efficiently care for their patients using a variety of PoCUS skills. However, most curricula only define these tasks as non-binding and in general terms or use outdated measures, such as length of training and self-reporting of achieved examinations with variable oversight, or administrative measures to create educational milestones. This threatens to take quality assurance down the wrong path. It created a scenario in which concrete EMPoCUS skill outcome measures that would realistically reflect the training objectives and simultaneously would be easily observable and verifiable are lacking. In view of the dangers of poorly controlled EMPoCUS dissemination and the current lack of European guidelines, we would like to set central standards for European EMPoCUS stewardship based on a critical review of the current situation. This position paper, which was jointly developed by EuSEM and EFSUMB and endorsed by IFEM and WFUMB, is also intended to accompany the EFSUMB/EuSEM guidelines on PoCUS currently being prepared for publication.
State of the art: Simulation in US Lucius, Claudia; Koch, Jonas B H; Jenssen, Christian ...
Zeitschrift fur Gastroenterologie
62, Številka:
5
Journal Article
Recenzirano
Technical simulation of diagnostic and therapeutic procedures is of growing relevance for student education and advanced medical training and has already been introduced in the field of ultrasound. ...This review gives a broad overview on different levels of simulation for ultrasound diagnostics and highlights the technical background of the methodology. A critical review of the literature reveals recommendations for implementing simulation techniques in medical studies and professional ultrasound training. An analysis of strengths and weaknesses shows the advantages of simulation especially in the context of individual learning situations and COVID-19-related restrictions for personal interaction. However, simulation techniques cannot replace the experiences of complex clinical examinations with direct interaction to real patients. Therefore, future applications may focus on repetition and assessment of achieved competencies by using standardized feedback mechanisms in order to preserve the limited resources for practical medical training.
Diagnostic ultrasound in obstetrics and gynaecology has experienced a fantastic evolution during the past seven decades. Initial steps with A-mode technology were followed by B-mode and B-mode ...real-time imaging, then by Doppler and colour Doppler ultrasound, and finally by 3D/4D ultrasound. Other evolutionary steps were the development of high-resolution transabdominal and transvaginal transducers providing high quality images in the first, second and third trimesters of pregancy, as well as in gynaecology and breast imaging.The progression from two-dimensional (2D) to three-dimensional ultrasound (3D) and 3D real-time imaging (4D) has brought new options in displaying anatomical structures. In comparison with CT or MRI, it is not a static but functional technique, cheap and safe, and applicable at any time.
How to perform Contrast-Enhanced Ultrasound (CEUS) Dietrich, Christoph F.; Averkiou, Michalakis; Nielsen, Michael Bachmann ...
Ultrasound international open,
01/2018, Letnik:
4, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Abstract
“How to perform contrast-enhanced ultrasound (CEUS)” provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for ...optimal CEUS performance. CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience. The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.
The comet tail artefact is probably one of the most commonly and imprecisely used to describe vertical artefacts found in lung ultrasound. Two distinct artefacts are commonly observed: the lung ...comets and the B-lines. Both artefacts differ with regard to generation mechanism and clinical significance. This review explores the current understanding and use of these two artefacts in lung ultrasound and suggests how to avoid the pitfalls related to confusing comet tail artefacts with other vertical artefacts.
With the Superb Micro-Vascular Imaging (SMI), the established Doppler technology has been extended by another mode. With this technique, microvascular structures with slow blood flow can now also be ...displayed in real time. As with the introduction of Doppler ultrasound, this new technique opens further diagnostic fields for the examiner, which were previously reserved for magnetic resonance imaging (MRI), computed tomography (CT) or contrast ultrasound (CEUS). Focal nodular hyperplasia (FNH) of the liver is characterized by a typical spoke-wheel vascular malformation (spoke-wheel sign, SWS) anda good example using SMI for the diagnostic profit of our patients. The aim of this report is to describe the use of SMI as a new non-invasive, quick, and probably cost-effective diagnostic imaging tool.
Subepithelial lesions (SEL) are identified during endoscopic procedures on a regular basis. They can occur anywhere in the gastrointestinal (GI) tract and are located beneath the normal epithelial ...layer, which explains why a tissue diagnosis is difficult to obtain with routine biopsies. Endoscopic ultrasound (EUS) is used to further characterize these lesions. EUS can distinguish intramural lesion from extramural compression. Furthermore, it allows allocation of intramural lesions to a specific layer of the GI wall and offers additional information as to whether a lesion could be benign or malignant. EUS also assists in choosing the optimal means of tissue acquisition. The choice of tissue acquisition is based on a number of factors, such as tumor size, EUS features, and location within the GI tract or within a specific layer of the GI wall. Furthermore, local expertise and patient factors should be considered when deciding whether tissue acquisition, surgical intervention or follow up is recommended. In this review we offer an EUS-guided approach to the evaluation of incidental SEL based on current evidence and point out areas of uncertainty, which explain why the proposed algorithmic approach may be optional rather than optimal.
PDF
