Description:

The X-Minus 7 approach is an intercostal window. Find the xiphoid process and move laterally to the right approximately 7 centimeter. Place the probe perpendicular to the skin between the ribs. In most cases, the gallbladder will be found posterior to the liver parenchyma immediately beneath the probe. In the few instances where the gallbladder is not identified, move the probe laterally, sweeping through the liver

Duration: 00:00:15 / Uploaded: 2011-10-11 11:52:11

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Real time transverse imaging of an AAA bifurcating into the iliacs.

Duration: 00:00:04 / Uploaded: 2011-10-06 09:35:34

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Full of stones: This gallbladder is full of stones. Many echogenic foci with shadowing are seen within the lumen of the gallbladder.

Duration: 00:00:06 / Uploaded: 2011-10-11 12:33:17

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WES sign: The Wall-Echo-Shadow sign can make it very difficult to identify and evaluate the gallbladder. There is a very strong echo at the rim of the stone and wall of the gallbladder. The shadow is very thick and clean and extends through the liver.

Duration: 00:00:22 / Uploaded: 2011-10-11 12:33:17

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Parasternal short axis (PSAX) window: dilated high pressure RV pushes LV = 'D' sign (cf 'O' sign seen in PSAX window in normal heart)

Duration: 00:00:02 / Uploaded: 2011-11-02 06:25:08

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Measuring the CBD: This video demonstrates the porta hepatis in the long-axis with power flow Doppler. The CBD lies in the long-axis just anterior to the portal vein. The Doppler is not absolutely necessary, but it is helpful as the hepatic artery is sometimes visualized instead. This CBD is not measured in the video, but is of normal caliber.

Duration: 00:00:05 / Uploaded: 2011-10-11 12:33:17

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Real time transverse imaging of an AAA with an intramural thrombus.

Duration: 00:00:04 / Uploaded: 2011-10-06 09:34:04

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Lung rockets [multiple B lines] plus pleural effusion in patient with congestive cardiac failure.

Duration: 00:00:07 / Uploaded: 2011-11-02 06:32:28

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Have you ever had a patient with chest pain and a non-diagnostic EKG, but you were sure they were having an MI?? Did you know 80-90% of those patients may have a wall motion abnormality? Wouldn’t it be cool if you could diagnose those and get ‘em to cath lab IMMEDIATELY? Of course it would! Well if you want to learn how, here’s our podcast on how to do just that.

Duration: 00:14:31 / Uploaded: 2011-10-12 13:11:30

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Abdominal aorta dissection flap seen in long axis of aorta

Duration: 00:00:05 / Uploaded: 2011-11-01 02:32:19

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Real time scanning of a normal abdominal aorta in the transverse view.

Duration: 00:00:12 / Uploaded: 2011-10-06 08:49:41

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after draining about 1000 ml of effusion - significant clinical improvement as confirmed by improved heart chamber size and higher EF

Duration: 00:00:09 / Uploaded: 2011-10-21 04:00:08

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On ultrasound, pyelonephritis usually appears as an apparently normal kidney. Occasionally it can be so severe that the normal renal architecture is lost, as in this case with perinephric fluid.

Duration: 00:00:05 / Uploaded: 2011-11-02 05:02:22

Description:

Dr. Vicki E. Noble practices emergency medicine at Massachusetts General Hospital, where she is the division director for Emergency Ultrasound. Dr. Noble received her medical degree from the University of Pennsylvania in Philadelphia, and completed a fellowship in emergency ultrasound at St.Luke’s-Roosevelt Hospital in New York. Dr. Noble is certified as a registered diagnostic medical sonographer, a fellow of the Amercian College of Emergency Physicians (ACEP), and the chair councilor for the ultrasound section within ACEP. She has been nominated for the Harvard University Medical School Teaching Award and the Brian McGovern Award for Clinical Excellence at Massachusetts General Hospital. She has taught extensively in emergency ultrasound both in the United States and internationally. We get the inside scoop as Dr. Noble talks extensively about the upcoming happenings in the ultrasound section of ACEP including exciting online changes as well as an October meeting. One of our favorite things to ask folks during interviews is what ultrasound techniques they get excited about. Vicki speaks about a recent use of ultrasound to locate a hernia. Sooooo, as a bonus, we’ve added some extra info on using ultrasound to diagnose hernias. This is definitely a podcast you don’t want to miss. Heck, we’ve even slapped some bloopers onto the end. Every second of this one is chock full of yummy ultrasound goodness. So watch it, download it, give us some feedback, and use the knowledge to go farther in your practice.

Duration: 00:12:29 / Uploaded: 2011-10-19 23:42:01

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Aortic dissection flap transverse view

Duration: 00:00:05 / Uploaded: 2011-11-02 04:22:39

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Partial PTX identified with lung point on high resolution ultrasound with linear probe

Duration: 00:00:06 / Uploaded: 2011-10-21 03:43:53

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ultrasound-guided ulnar nerve block video with in-line technique

Duration: 00:00:47 / Uploaded: 2011-10-21 12:08:13

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patient with worsening SOB and CP over several days, PMH of lung cancer
now unable to lie flat... low blood pressure

Duration: 00:00:11 / Uploaded: 2011-10-21 03:53:25

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sonographic air bronchogram on ultrasound

Duration: 00:00:15 / Uploaded: 2011-10-28 22:55:05

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activated saline is injected to confirm needle placement before a pig tail catheter is introduced

Duration: 00:00:20 / Uploaded: 2011-10-21 03:57:44

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The “subscostal sweep” , the “X minus 7” and the "flattening the probe" approach. The subcostal sweep is generally the most effective window and is usually attempted first. Start the scan with the probe in longitudinal orientation and the probe-indicator oriented toward the patient’s head and instruct the patient to take a deep breath. Sweep the probe inferiorly and laterally along the subcostal margin.

Duration: 00:00:26 / Uploaded: 2011-10-10 18:53:52

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patient with fall and shortness and breath. Chest wall tenderness with presumed rib fracture and suspicion for pneumothorax

Duration: 00:00:06 / Uploaded: 2011-10-21 04:14:29

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now in short axis view, a pericardiocentesis needle is introduced under ultrasound guidance (right upper corner of image)

Duration: 00:00:19 / Uploaded: 2011-10-21 03:55:10

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Ultrasound appearance of lobar pneumonia with sonographic airbronchogram and consolidation.

Duration: 00:00:15 / Uploaded: 2011-10-28 22:59:50

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Duodenum mimicking gallbladder filled with stones: The duodenum adjoins the posterior aspect of the liver. At times, it may appear as the gallbladder filled with stones. The air in the duodenum appears as

Duration: 00:00:15 / Uploaded: 2011-10-11 12:33:17

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Multiple B lines = 'lung rockets' in acute cardiogenic pulmonary oedema (edema for the Yanks). Linear probe.

Duration: 00:00:06 / Uploaded: 2011-11-01 05:31:23

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Contracted gallbladder wall: This image demonstrated the classic appearance of the contracted gallbladder wall. Note the three distinct layers of the wall. The wall is thickened, but pathologic thickening will not demonstrate the three layers of the wall.

Duration: 00:00:11 / Uploaded: 2011-10-11 12:33:17

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Multiple gallstones: Three or more gallstones lie within the gallbladder with shadowing.

Duration: 00:00:08 / Uploaded: 2011-10-11 12:33:17

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Scanning bones? What? Who’s ever heard of such! Mainly anyone who’s been reading the literature lately, that’s who. Some pretty sweet lit has been published lately regarding MSK ultrasound and it’s time to get on board. The scaphoid is a little crazy, though, right. A non-long bone, and in the hand. Crazy, you may say, but…… what if you could avoid the CT, MRI or a long wait in an unnecessary thumb SPICA. Well, maybe you can. Take a listen to our expert guest presenter, look up the literature, start practicing, and decide for yourself.

Duration: 00:11:45 / Uploaded: 2011-10-19 21:49:34

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Real time scanning of a proximal or high normal aorta in the sagittal view.

Duration: 00:00:04 / Uploaded: 2011-10-06 09:32:14

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Measuring the gallbladder wall: To properly measure the gallbladder wall, view the organ in the short-axis and freeze the image on the narrowest portion of the wall.

Duration: 00:00:12 / Uploaded: 2011-10-11 12:33:17

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Mickey Mouse sign: The video shows an enlarged view of the portal triad in the short-axis. The CBD and hepatic artery form the ears of the Mickey Mouse sign. When power flow Doppler is added, the portal vein (large circle) and the hepatic artery (Mickey

Duration: 00:00:05 / Uploaded: 2011-10-11 12:33:17

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Thick wall: This patient

Duration: 00:00:04 / Uploaded: 2011-10-11 12:33:17

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Gallbladder short axis: The video demonstrates fanning through the short axis of the gallbladder from the neck to the fundus.

Duration: 00:00:10 / Uploaded: 2011-10-11 12:33:17

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Very small stone: This video shows a very small stone that we missed in our department on first pass. Can you find it?

Duration: 00:00:28 / Uploaded: 2011-10-11 12:33:17

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Dilated CBD: This patient

Duration: 00:00:35 / Uploaded: 2011-10-11 12:33:17

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Gallbladder long axis: Note the main hepatic fissure extending from the tapered end of the gallbladder to the cross-section of the portal vein. The entire complex resembles an exclamation point.

Duration: 00:00:09 / Uploaded: 2011-10-11 12:33:17

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Multiple gallstones: Multiple echogenic foci within the gallbladder lumen with shadowing behind.

Duration: 00:00:10 / Uploaded: 2011-10-11 12:33:17

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Air in the GB wall: There are comet-tail artifacts extending down from this gallbladder wall indicating air due to emphysematous cholecystitis.

Duration: 00:00:38 / Uploaded: 2011-10-11 12:33:17

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Layer of stones: Notice the very bright line of stones at the lower left aspect of the gallbladder with shadowing behind.

Duration: 00:00:08 / Uploaded: 2011-10-11 12:33:17

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SIN sign: This gallstone lies in the neck of the gallbladder. The so-called SIN (Stone In the Neck) sign may be more indicative of cholecystitis in the correct clinical scenario.

Duration: 00:00:06 / Uploaded: 2011-10-11 12:33:17

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Sludge: This gallbladder is full of sludge. Several small gallstones are also found toward the neck of the organ.

Duration: 00:00:15 / Uploaded: 2011-10-11 12:33:17

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Gallstone vs. Duodenum: The duodenum sits very close to the gallbladder. So close that the thickness of the ultrasound beam may pick up parts of both, superimposing the duodenum onto the gallbladder in the image. This can cause problems because the duodenum may shadow due to air leading the sonographer to believe there is a gallstone within the gallbladder.

Duration: 00:00:05 / Uploaded: 2011-10-11 12:33:17

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SubcostalSweepVideo

Duration: 00:00:26 / Uploaded: 2011-10-11 12:33:17

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Video clip showing the

Duration: 00:00:30 / Uploaded: 2011-10-11 12:33:17

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Polyp: This patient has multiple gallbladder polyps adhering to the wall. The position of polyps in the gallbladder is important as they may cause acute cholecystitis if they lodge in the neck of the gallbladder.

Duration: 00:00:17 / Uploaded: 2011-10-11 12:33:17

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This video shows a normal CBD. The clip has three sections: first, three important structures are demonstrated in regular B-Mode: The long, black structure closest to the bottom of the image is the inferior vena cava (IVC) coursing beneath the liver. Above that is the portal vein. The portal vein is tortuous in this video and the black circular structure at the end of the portal vein to the left is the continuance of the portal vein. Finally, above the portal vein is the narrow CBD. In the second part flow is demonstrated using power Doppler. Note the flow through the IVC and several sections of the portal vein. In the third part of the clip, magnification (Zoom function) is applied in B-Mode and the CBD is measured.

Duration: 00:00:53 / Uploaded: 2011-10-11 12:33:17

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Pericholecystic Fluid (PCCF): This patient has a thick gallbladder wall and a small wedge of free fluid to the left of that thickened wall. It is subtle, but note the dark area next to the gallbladder.

Duration: 00:00:15 / Uploaded: 2011-10-11 12:33:17

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Gallbladder long axis: Note the main hepatic fissure extending from the tapered end of the gallbladder to the cross-section of the portal vein. The entire complex resembles an exclamation point.

Duration: 00:00:09 / Uploaded: 2011-10-11 12:33:17

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Large gallstone: The video shows a large gallstone within the lumen of the gallbladder. The gallstone reflects virtually all of the sound waves. Therefore, the edge of the stone is very bright on the screen and the tissues behind the stone are obscured by shadows because no sound waves make it past the stone.

Duration: 00:00:22 / Uploaded: 2011-10-11 12:33:17

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Large CBD: A massively dilated CBD may be very disorienting. Watch how these sonographers use power Doppler ultrasound to differentiate the biliary tract from the vasculature in the liver.

Duration: 00:00:28 / Uploaded: 2011-10-11 12:33:17

Description:

Rotating the probe

Duration: 00:00:39 / Uploaded: 2011-10-11 12:33:17