Diagnositic Ultrasound
The following situations can benefit from an ultrasound examination:
Abdominal pain, abdominal masses.
TIA or "blackouts" , loss of consciousness.
Dizziness.
Blood in the urine
swollen or painful calves for blood clots ( called DVT)
pain in legs when doing exercise or walking.
Swallowing problems ( neck masses)
Abnormal vaginal bleeding
Pregnancy diagnosis, bleeding, feral growth and other problems .
shoulder pain, knee swelling of pain. Elbow or ankle pain.
Breast nodules, follow up of cysts or fibroadenoma.
Lymphglands
Hernias.
What is diagnostic ultrasound?
- We use inaudible sound (frequencies between 2-18MHz) to scan organs, joints and blood vessels.
- A transducer or probe is used to scan an organ, limb or joint.
- We use higher frequencies for more superficial organs and lower for deeper organs.
- A sound wave of known frequency is sent into an organ, the tissue (depending on density) changes the wavelength and sends it back to the probe. The ultrasound machine then uses the altered wave length to produce a live picture on the machine screen.
- The denser the tissue, the whiter the image and the less dense tissues produce a grey image. Clear fluid produces a black image which helps with the delineation of anatomy and pathology.
Our next very useful tool is Doppler .
Directional Doppler is used to measure velocity and direction of flow, useful in heart and blood vessel examinations.
Types of Doppler:
1 .Directional: PW / CW/ AngioDoppler
2. Colour: Colour Doppler is superimposed on the 2D picture to indicate direction of flow turbulence, laminar flow , incompetence, short circuits etc.
3 .Angio Doppler: Non directional, but pick up very low and slow flow and perfusion.
Doppler is essential to measure flow in the :
heart and pick up valves that leak or does not open properly due to pathology. We also pick up openings in the septums of the hearts of babies or children that are born with short circuits like (ASD, VSD, open foramen ovale, PDA etc.)
4. CW Doppler is used for higher flow in one plane.
To evaluate blood vessels doppler is also essential. The important relevant vessels we examine are the following:
1 Leg veins (for deep vein thrombosis) after long flights or immobility;
2 Leg arteries: when arteries narrow that supplies the muscles and feet of blood – these patients develop pain when they walk or climb stairs, but pain disappear in rest.
3 Abdominal Aorta: Some develop a widening of their biggest arterie in their abdomen called AAA.
Abdominal aorta Aneurism:
When the main blood vessel wall weakens for any reason, mainly due to atherosclerosis the vessel starts dilating.
When it dilates above 3 cm in diameter in patients, we follow it up yearly to monitor the growth.
We refer our patients to vascular surgeons when it dilates more than 4,5 cm to be considered for a stent.
Neck vessels: Carotid duplex studies:
When patents get a “blackout”, dizzy spells, strokes, or lose consciousness temporarily, we study the arteries (called the carotid arteries), we look at the 2D image for calsifications, plaque, norrowing or thickening of the lining of the vessels to assess if the flow is disturbed and becomes turbulent , which then will cause embolism of inner artery wall deposits, leading to strokes.
We can also look at the intima, inner lining of the common carotid, and measure the IMT, intimate media thickness that can predict a patient’s risk for cardio vascular disease. It's means we measure the inner layer of the CCA (biggest neck artery).
There are normal valve tablets available to predict if a patient is at high risk for Cardiovascular disease.
Other examinations done are:
Heart , called echocardiograms
Abdominal scans
Pelvic- for female and male organs
Thyroid
Breasts in woman and men
Lymph glands
Joints: shoulders , knees, elbows, ankles and achilles tendons
Brain scans in childen, with open ventricles.
Afrikaans explanation:
Die ander ondersoeke is:
1 Buik sonars;
2 Bekken sonars;
3 Skildklier sonars;
4 Brein in babatjies;
5 Borste (mama sonars);
6 Kliere – tasbare limf kliere;
7 Gewrigte: Skouer beserings, enkels, achilles tendon beserings, elmboë en knieë.
8 Hart sonars
Om te verduidelik wat ons kan sien by elke ondersoek:
-Buik sonars: Die volgende toestande kan met ultraklank gediagnoseer word:
• Galstene, galblaas, verkalkings,
• Lewer Vergroting, tumour, vervettings, kiste
• Pankreas kiste, massas en vergrotings;
• Milt: grootte, bloedings, kliere in die hilus;
• Vog in die buik;
• Niere: Grootte, posisie, stene, vog in nier kelke , genoem hidronefrose , as ook kiste en tumore;
• Blaas :Wand dikte, volume, poliepe, stene, massas ens.
Cancer: Can be detected in any solid or fluid containing organ.
in bowel and lungs, due to gas, we cannot detect tumours.
I will now proceed to discuss the basics visible in each examination.
Abdominal examination :
Liver size and pathology
Gallbladder: stones, wall calcification, or wall thickening, gall gravel and stones Stones can be detected obstructing the gall ducts.
Pancreas size, density, tumors or cysts.
Spleen size and shape.
Ascites, fluid in the abdomen or in lung or heart sac, called effusions.
Bladder size, wall thickness and stones .
Prostate size and cysts ot nodules.
Other superficial organs that can be examined and visualized well:
• Thyroid: “goitre” – size consistency, nodules, cysts, tumours, gland around the thyroid and around the carotid and jugular vessels;
Salivary glands:
• Parotid; submandibulary
• Glands in the neck, axilla, groins, in abdomen around blood vessels;
Hernias:
• Femoral (groin) Inguinal, abdominal wall umbilical
Pelvis:
• Male: Prostate: size, nodules, cysts, tumours (cancer) calcifications etc.
• Female: Uterus and ovaries:
• Uterus: size, position, endometrial lining for menstrual problems.
• Ovaries: cysts, tumours endometriosis.
Testis (Skrotums):
• We examine the testis for masses, fluid, blood supply (torsion), after trauma to the scrotum, to check for tears, bleeding etc. Epididimus cysts, varicocoel stones, inflammation.
Mammae (Breasts):
• Tumours, cysts and fibroadenona of glandular tissue in women and men.
• Routine for families prone to breast Ca.
• Cysts, fibroadenosis, tumours
• Mastitis, abscesses.
Any mass that one can feel can be examined with ultrasound to see if it is possibly a cancer and a biopsy or fine needle aspiration can be done to send cells to the laboratory to see if there are any cancer cells.
Musculoskeletal ultrasound:
• Joints area ideal for examining with ultrasound, tendons, ligaments, muscles and joint spaces can be well visualised.
• Knees: Effusions “water in the joints ”, ligament tears, tendonitis (inflammation) or tears of tendons. Bakers cysts (mass behind the knee) that can rupture and cause a severe pain behind the knee that spreads down the back of the calve.
• Ankle: Ligament tears after ankle injury to see if and which ligaments might be torn. Achilles problems can also be diagnosed.
Tendonitis or tendon tears:
• Achilles tendon tears or inflammation.
• Shoulder: Rotator cuff tears, impringement, inozan shoulder, bursitis, joint effusion, biceps, tendon effusion or tears. Also infiltration of corticosteroids into tendon or bursae for treatment of tendonitis and lursitus.
• Elbow: Golfers or Tennis elbow – effusions, tendonitis.
• Fingers: Osteo arthritis, rheumatoid arthritis, tendon effusions, neuromas, ganglions etc.
Pregnancies:
Diagnosis of pregnancy:
• 5 weeks gestational age
• 6 weeks heart beat visable;
• 12-13 weeks nuchal translucency for chromosomal defects;
• 19-20 weeks: Anomaly scan and soft markers
• Doppler for flow monitoring of placental flow for placental function.
• Heart defects; other organs;
• Sex from 12- 16 weeks if well positioned.
