Ultrasound Q&A - Dr. Weekes

Soft tissue Ultrasound:

• Cobble stoning appearance - Cellulitis
• Abscess: irregular edges , sonofluctuance, varied echogenicity
• Fournier’s Gangrene -Echogenic spots (artifacts from tiny air pockets), irregularly arranged, moveable and not organized like a foreign body e.g. glass, needle 

NERD alert! : Artifacts do NOT actually represent objects but suggest intense US reflection as it encounters sharply contrasting tissue density (examples include bone, stone or air) after traversing soft tissue medium (e.g. muscle, liver).

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Echocardiography Tips:

Eyeball qualitative LV systolic function assessment:
     -mitral annulus movement along the long/major axis
     -LV wall movement inward along minor axis
     -thickening of LV wall during systole
     -proximity of anterior leaflet of MV and septal wall

Eyeball qualitative RV assessment:
     - RV tends to dilate before it goes bad (with acute pulmonary embolism physiology)
     - RV shape and function more complex
     - Most significant movements of RV are along long/major axis [NERD alert!: TAPSE (tricuspid annular planar systolic excursion)]

Image Acquisition Tips:
     - Focused RV assessment:
         - Apical window: angle medially toward RV to get better view of RV apex, free wall and annulus
         - Use subcostal window… must view RV apex
         - Parasternal long: angle anteriorly and you’ll see both RV & RA
     - Looking for RV enlargement (RVE):
          - Look for RVE Apex enlargement + widened RV base
          - Subcostal and apical views to get a good look at the apex 
          - Parasternal short axis view
          - Normal contour of RV semilunar/croissant next to donut (LV)
          - RVE might show as ‘helmet’ rather than ‘croissant’

Tips to Avoid Trips

• Rotate slightly on A4 view to optimize view/cuts of RV (to avoid underestimating)
• Step 1: Make sure apex at center and no foreshortening (to avoid overestimating RV size)
• Step 2: Adjust view of A4 for better view of RV free wall and annulus
• Step 3: see if Subcostal 4 chamber view agrees with Step 1 and step 2 assessments