Diagnosic applications

■ Biliary disease - gallstones (see Fig. 7.3), bile duct obstruction (see Fig. 7.4), cholecystitis.

Fig. 7.1 Pleural effusion. The collapsed lung can be seen within the pleural fluid. Fluid is readily identified using ultrasound whether in the pleural space or within the abdomen.

Fig. 7.1 Pleural effusion. The collapsed lung can be seen within the pleural fluid. Fluid is readily identified using ultrasound whether in the pleural space or within the abdomen.

Fig. 7.2 Pleural effusion drainage - pigtail catheter. The insertion of pigtail catheters on intensive care units is performed most safely using ultrasound guidance.
Fig. 7.3 Gallstones. Multiple echogenic stones are present which cast an acoustic shadow posteriorly. The demonstration of gallstones on intensive care units can be important in cases of obstructive jaundice, cholecystitis and pancreatitis.

Pancreatic disease and its complications, e.g. pancreatitis and pseudocysts (see Fig. 7.5).

Renal disease - stones, hydronephrosis (see Fig. 7.6), parenchymal thickness, etc.

Bowel pathology - appendicitis (see Figs 7.7 and 7.8).

Abdominal trauma - solid organ injury with free fluid (Fig. 7.9), ascites (Fig. 7.10).

Fig. 7.4 Dilated bile duct. The diameter of the duct can be accurately measured with ultrasound and in cases of obstruction, the cause may be identified such as this gallstone. Duct size increases with age or following cholecystectomy.

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Fig. 7.5 Pancreatic pseudocyst. This is one of the complications of pancreatitis which is readily diagnosed on ultrasound. If the collections become infected, then ultrasound-guided drainage is appropriate. Sterile collections do not usually require drainage.

Fig. 7.6 Hydronephrosis. The pelvicalyceal system is dilated. Proximal causes of obstruction such as proximal calculi can be diagnosed on ultrasound; the ureters are, however, poorly seen except the distal few centimetres at the vesicoureteric junction.

Fig. 7.7 Appendicitis. Ultrasound has poor sensitivity but high specificity in the diagnosis of appendicitis. Features include a 'lith', (arrow) a blind ending, non-compressible loop of bowel 6 mm or greater in diameter and surrounding fluid.

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Fig. 7.8 Appendicitis. Images in transverse section demonstrating failure of compression of the appendix.

I Fig. 7.9 Free fluid from splenic trauma. Ultrasound is extremely sensitive in the identification of free fluid. In the setting of trauma, the absence of free fluid is very useful in excluding intra-peritoneal haemorrhage. It has largely replaced diagnostic peritoneal lavage (DPL).

Therapeutic applications

■ Gall bladder drainage.

■ Pseudocyst/ascitic drainage.

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Fig. 7.12 Drainage of abdominal abscess. Ultrasound is the imaging modality of choice for the drainage of suitable abdominal abscesses. Real-time visualisation is possible for the insertion of pigtail drains - which are well seen on ultrasound. This is a portable technique which can be used on intensive care units.

Fig. 7.12 Drainage of abdominal abscess. Ultrasound is the imaging modality of choice for the drainage of suitable abdominal abscesses. Real-time visualisation is possible for the insertion of pigtail drains - which are well seen on ultrasound. This is a portable technique which can be used on intensive care units.

Fig. 7.13 DVT. A combination of grey scale ultrasound and Doppler ultrasound is used in the diagnosis of deep vein thrombosis. A normal vein can be compressed, it demonstrates phasic flow in time with respiration and squeezing on the limb augments blood flow. Deep vein thrombosis interrupts flow and prevents complete compression of the vein. The clot is frequently directly visualised. The technique is eminently suitable for patients on intensive care units, many of whom are at high risk of DVT.

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