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Ultrasound

Ultrasonography is a form of body imaging using sound waves to facilitate making a medical diagnosis. A skilled ultrasound technician can see inside the body using ultrasonography to answer questions asked by the medical practitioner caring for the patient. Usually, a radiologist will oversee the ultrasound test and report on the results. Still, other types of physicians may also use ultrasound as a diagnostic tool. For example, obstetricians use ultrasound to assess the fetus during pregnancy. Surgeons and emergency physicians use ultrasound at the bedside to evaluate abdominal pain or other concerns.

A transducer, or probe, is used to project and receive the sound waves and their echoes. A gel is wiped onto the patient’s skin so that the sound waves are not distorted as they cross through the skin. Using their understanding of human anatomy and the machine, the technician can evaluate specific structures and try to answer the patient’s physician’s question. This may take a fair amount of time and require the probe to be repositioned and pointed in different directions. The technician may also need to vary the amount of pressure used to push the probe into the skin. The goal will be to “paint” a shadow picture of the inner organ that the health care practitioner has asked to be visualized.

The physics of sound can place limits on the test. The quality of the picture depends on many factors.
• Sound waves cannot penetrate deeply, and an obese patient may be imaged poorly.
• Ultrasound does poorly when gas is present between the probe and the target organ. Should the intestine be distended with bowel gas, the organs behind it may not be easily seen. Similarly, ultrasound works poorly in the chest, where the lungs are filled with air.
• Ultrasound does not penetrate bone easily.
• The accuracy of the test is very much operator dependent. This means that the key to a good test is the ultrasound technician.

Ultrasound can be enhanced by using Doppler technology, which can measure whether an object moves towards or away from the probe. This can allow the technician to measure blood flow in organs such as the heart or liver or within specific blood vessels.

Purposes of an Ultrasound

Ultrasound is not limited to diagnosis but can also be used to screen for disease and aid in the treatment of diseases or conditions.

Diagnostics

Obstetrics
Ultrasound is routinely used for assessing the progression of a pregnancy. Pelvic ultrasounds can be obtained trans-abdominally where the probe is placed on the abdominal wall or trans-vaginally. The probe is placed in the vagina. For example, ultrasound in obstetrics/gynecology is used to diagnose the ovary, uterus, or Fallopian tubes’ growths or tumors.

Cardiology
Echocardiography
Echocardiography (echo=sound + cardio=heart + graphy=study) evaluates the heart, the heart valve’s motion, and blood flow through them. It also evaluates the heart wall motion and the amount of blood the heart pumps with each stroke.

Echocardiography can be performed in two ways:
• trans-thoracic: the probe is placed on the chest wall to obtain images, and
• trans-esophageal: where the probe is placed through the mouth into the esophagus.

Anatomically, the esophagus sits near the heart and allows clearer images. However, this approach is a little more invasive.

Different groups of illnesses can be assessed by echocardiography:
• Valves in the heart keep blood flowing in one direction when the heart pumps. For example, when the heartbeats, blood is pumped from the left ventricle through the aortic valve into the aorta and the rest of the body. The aortic valve prevents blood from back-flowing into the heart as it fills for the next beat. Echocardiography can determine if the valve is narrow or leaking (regurgitating, insufficient). By following how the patient fares clinically, repeated echocardiograms can help determine whether valve replacement or repair is warranted. The same principles apply to the mitral valve, which keeps blood flowing from the left atrium to the left ventricle.
• The heart muscle pumps blood to the body. If the heart weakens, the amount of blood it pumps with each beat can decrease, leading to congestive heart failure. The echocardiogram can measure the heartbeat’s efficiency and how much blood it pumps, which helps determine whether medications are needed. It also is used to monitor how well medications are working.
• Echocardiography can visualize the heart chambers to detect blood clots in atrial fibrillation conditions (an irregular heart rhythm). In other situations, the test can help diagnose endocarditis (an infection of the heart valves) by visualizing “vegetations” (an infected mass) on the valves themselves.
• Echocardiography also can detect abnormal fluid collections (pericardial effusions) in the pericardium.
• Echocardiograms are used to diagnose and monitor pulmonary artery hypertension.

Blood vessels
Ultrasound can detect blood clots in veins (superficial or deep venous thrombosis) or artery blockage (stenosis) and dilatation (aneurysms). Some examples of ultrasound testing include:
• Carotid ultrasound is performed in patients with transient ischemic attacks (TIAs) or strokes to determine whether the neck’s significant arteries are blocked, causing the decreased blood supply to the brain.
• The aorta is the large blood vessel leaving the heart that supplies blood to the rest of the body. The walls of the aorta are under significant pressure from the force of the heartbeat and, over time, may weaken and widen. This is called an aneurysm, and it can be detected in the abdomen by ultrasound (abdominal aortic aneurysm). For those patients with small aneurysms, observation may be recommended, and the aneurysm’s size followed over time by repeated tests.
• Veins can also be evaluated by ultrasound. It is a standard test to assess whether swelling in a leg is due to a blood clot, deep vein thrombosis (DVT), or another cause.

Abdominal structures
Aside from its use in obstetrics, ultrasound can evaluate most of the solid structures in the abdominal cavity. This includes the liver, gallbladder, pancreas, kidneys, bladder, prostate, testicles, uterus, and ovaries.
• Ultrasound is the preferred technique to test for gallstones or an infected gallbladder. The ultrasound can reveal the stones and signs of infection, including thickening of the gallbladder wall and fluid surrounding the gallbladder. The ultrasound may find a blockage in the bile ducts.
• For those patients where the radiation of a CT scan (computerized tomography) is a potential risk (pregnant patients or children), ultrasound may be used to look for diseases like appendicitis or kidney stones.
• Ultrasound is the test of choice to diagnose testicular torsion.
• Pelvic ultrasound is used in gynecology to help assess non-pregnancy related issues like lower abdominal pain, ovarian cysts, uterine fibroids, uterine growths, and endometriosis.

The neck
The thyroid gland can be imaged using ultrasound, looking for nodules, growths, or tumors.

Knee joint
Ultrasound can be used to detect bulging of fluid from a swollen knee joint into the back of the knee, called a Baker’s cyst.

Screenings
Ultrasound may be used to screen for blood vessel diseases by measuring blood flow and blockage in the carotid arteries. Similarly, by measuring the aorta’s diameter in the abdomen, ultrasound can screen for an aneurysm (abnormal dilatation) and the risk of rupture. These tests may be indicated for an individual patient, or they may be offered as a community wide health screening assessment.

Screenings

Ultrasound may be used to screen for blood vessel diseases by measuring blood flow and blockage in the carotid arteries. Similarly, by measuring the aorta’s diameter in the abdomen, ultrasound can screen for an aneurysm (abnormal dilatation) and the risk of rupture. These tests may be indicated for an individual patient, or they may be offered as a community wide health screening assessment.

Therapeutic uses for Ultrasound

Ultrasound may be used to help physicians guide needles into the body.
When an intravenous line is required, but it is difficult to find a vein, ultrasound guidance may be used to identify larger veins in the neck, chest wall, or groin.

Ultrasound may be used to guide a needle into a cavity that needs to be drained (for example, an abscess) or a mass that needs to be biopsied, where a small bit of tissue is removed for analysis.

Risks of Ultrasound

There are no known risks to ultrasound. As technology has improved, the machines have become smaller, portable, and available for use at the patient’s bedside.

Preparing for an Ultrasound

Preparation for ultrasound is minimal. Generally, suppose internal organs such as the gallbladder are to be examined. In that case, patients are requested to avoid eating and drinking except for water for six to eight hours before the examination. This is because food causes gallbladder contraction, minimizing the size visible during the ultrasound.

In preparation for examining the baby and womb during pregnancy, it is sometimes recommended that mothers drink at least four to six glasses of water approximately one to two hours before the examination to fill the bladder. This helps improve the images captured during the exam.

Results

A technician generally performs the ultrasound. The technician will notice preliminary structures and may point out several of these structures during the examination. The official reading of the ultrasound is done by a radiologist, a physician who is an expert at interpreting ultrasound images. The radiologist records the interpretation and transmits it to the practitioner requesting the test. Occasionally, during the ultrasound test, the radiologist will ask the patient questions and or examine to define further the purpose for which the test is ordered or to clarify preliminary findings.

Plain x-rays might be ordered to evaluate early findings further.
A summary of all of the above results is reported to the health care practitioner who requested the ultrasound. They are then discussed with the patient in the context of the patient’s overall health status.

MEDICAL DISCLAIMER:

By reading this website, you acknowledge that you are responsible for your own health decisions. The information throughout this medical website is not intended to be taken as medical advice. The information provided is intended for general information regarding our Pulmonology services. If you are interested in finding out more, please contact our office for a personal consultation. Avoid worrisome self-diagnosis; the best pulmonology doctors will properly diagnose your problem and refer you to a specialist if necessary. No information on this site should be used to diagnose, treat, prevent, or cure any disease or condition.