Ultrasound Of Gastrointestinal Tract

:- Foreword :-

Two to three decades ago only very few radiologists, such as F. Weill and other pioneers
in the fi eld, believed in the diagnostic potential of ultrasound for the study of the gastrointestinal tract. The main applications of ultrasound were confi ned to the study of
solid visceral organs, the female pelvis and obstetrics. Rapid progress in computer technology
and in transducer design has opened totally new horizons for ultrasound, for
instance in musculoskeletal pathology, as well as in the gastrointestinal tract in children
and adults.
Today ultrasound plays a major role as the primary imaging procedure in acute
abdominal conditions involving the gastrointestinal tract. The indications for surgery
in patients suspected of acute appendicitis have dramatically improved due to the widespread
application of ultrasound.
I am very much indebted to the editors of this book, Prof. G. Maconi and Prof. G. Bianchi
Porro, both internationally recognized experts in abdominal ultrasound. They developed
the concept of this volume and have been very successful in involving several other distinguished
ultrasound experts from both Europe and the Far East.
I would like to congratulate the editors and the authors most sincerely on this outstanding
volume which provides a comprehensive overview of the use of ultrasound in
acute and chronic diseases of the gastrointestinal tract.
This book will be of great value, not only for radiologists, but also for gastroenterologists,
abdominal surgeons, pediatricians and oncologists. They will fi nd it a very helpful
guide in their daily clinical practice.
I am confi dent that it will meet with the same success among readers as previous
volumes published in this series.
Leuven Albert L. Baert

Manual Of Emergency & Critical Care Ultrasound

Manual of Emergency and Critical Care Ultrasound
The use of ultrasound has revolutionized the way many acute injuries and
conditions are managed in emergency departments (ED) and critical care units,
with several accrediting agenciesmandating that physicians become proficient
in the applications and interpretation of ultrasound. Today, EDs and critical
care units nationwide are outfittedwith ultrasound equipment, allowing acute
conditions such as ectopic pregnancy or abdominal aortic aneurysm rupture
to be diagnosed within critical seconds.
This book is a practical and concise introduction to bedside emergency ultrasound.
It covers the full spectrum of conditions diagnosed via this modality
and gives useful instruction for using ultrasound to guide commonly performed
invasive procedures. It introduces the major applications for emergency
ultrasound by using focused diagnostic questions and teaching the
image acquisition skills needed to answer these questions. Images of positive
and negative findings for each application (FAST, echocardiography, etc.) are
presented, as well as scanning tips for improved image quality. Each section
also contains a review of the literature supporting each application.
Dr. Vicki E. Noble is the director for emergency ultrasound at Massachusetts
General Hospital in Boston, MA. She received her MD from the University of
Pennsylvania in 1999 and completed a fellowship in emergency ultrasound at
St. Luke’s–Roosevelt Hospital in New York. She is a Fellow of the American
College of Emergency Physicians and is the Ultrasound Section subcommittee
chair for education and practice standards. She is also a member of the
American Institute of Ultrasound in Medicine and has been a member of
the American Registry of Diagnostic Medical Sonographers since 2004. She
has been awarded the Society for Academic Emergency Medicine Excellence
Award and 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.
Dr. Bret Nelson is director of emergency ultrasound for the Department of
Emergency Medicine at Mount Sinai School of Medicine in New York. He is
a member of the American College of Emergency Physicians, the American
Institute of Ultrasound in Medicine, and the American Registry of Diagnostic
Medical Sonographers. He has taught courses on ultrasound throughout
Europe and the United States and received the Excellence in Teaching Award
at Mount Sinai.
Dr. A. Nicholas Sutingco is the director of emergency ultrasound for the
Departments of Emergency Medicine at the INOVA Fair Oaks Hospital in
northern Virginia. He received his MD from the George Washington University
School of Medicine and completed his emergency medicine residency
training at the Massachusetts General Hospital/Brigham and Women’s Hospital.
He is a member of the American College of Emergency Physicians and
is active in teaching courses in ultrasound in northern Virginia.

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Diagnostic Ultrasound Imaging

Perface :-
Thomas L. Szabo
Newburyport, Massachusetts
May 2004


The purpose of this book is to provide both an introduction and a state-of-the-art
review of the essential physics and signal processing principles of diagnostic ultrasound
in a single reference volume with a unified approach. This book draws together
many of the ideas from seminal papers, the author’s research, and other sources in a
single narrative and point of view. Unlike texts that present only the theory of acoustic
fundamentals, this book relates topics to each other in the context of ultrasound
imaging and practical application. It is the author’s hope that this work will contribute
to the overall development of ultrasound diagnostic imaging by serving as a focus
for discussion, an information source for newcomers, and a foundation for further
inquiry.
This text is intended for a graduate level course in diagnostic ultrasound imaging
and as a reference for practicing engineers in the field, medical physicists, clinicians,
researchers, design teams, and those who are beginning in medical ultrasound, as well
as those who would like to learn more about a particular aspect of the imaging
process. This book is an introduction to the basic physical processes and signal
processing of imaging systems, and as a guide to corresponding literature and terminology.
Parts of the book can be read on several levels, depending on the intent and
background of the reader. While this book provides sufficient equations for a scientific
foundation, there are also many parts of the book that go on for long stretches
without any equations. Equations can be thought of as a more precise description of
the variables involved and provide the means of simulation and deeper analysis.
This work is based in part on my nearly 20 years of research and development
experience at Hewlett Packard, later Agilent Technologies. Since my departure, the
healthcare group where I worked for nearly 20 years has become, by acquisition, part
of Philips Medical Ultrasound. I am indebted to my former colleagues for our many
collaborations over the years and for providing many requested images and material
for this book. Even though many of the images and system descriptions are from
Philips, readers can take some of this material to represent typical imaging systems.
Diagnostic ultrasound has been in use for over 50 years, yet it continues to evolve
at a surprisingly rapid rate. In this fragmented world of specialization, there is information
in abundance, but it is difficult to assimilate without order and emphasis. This
book strives to consolidate, organize, and communicate major ideas concisely, even
though this has been a challenging process. In addition, many essential pieces of
information and assumptions, known to those experienced in the field and not
available in journals and books, are included.
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Chest Sonography

Preface
The scope of application of chest sonography has been
significantly widened in the last few years. Portable ultrasound
systems are being used to an increasing extent in
preclinical sonography, at the site of trauma, in the ambulance
of the emergency physician or in ambulance
helicopters. In the emergency room, at the intensive care
unit and in clinical routine, chest sonography has proved
its worth as a strategic instrument to be used directly
after the clinical investigation. It helps the investigator to
decide—very rapidly—whether a traumatized patient is
suffering such severe internal hemorrhage that he needs
to be transported to the operating room immediately or
whether there still is time for further investigations like
CT. Several diagnoses such as pneumothorax, pneumonia
or pulmonary embolism can be established immediately.
Numerous recent publications have significantly
deepened our knowledge of chest sonography: the sonomorphology
of the normal pleura has been described
more accurately on cadavers and in histological sections.
The sonoanatomy of the upper aperture of the thorax has
been extended to include imaging of the brachial plexus,
which allows more precise administration of regional anesthesia
and the application of a smaller quantity of the
anesthetic. Monumental studies on lymph node staging
in the presence of bronchial carcinoma have been presented.
Here sonography is markedly superior to CT. The
high value of endoluminal accesses has been explained in
greater detail and with greater precision.
The present new issue has been extended to include
two subjects. Contrast sonography is currently at the
threshold of being introduced for the differentiation of
subpleural lung lesions—in some instances the sonomorphology
of the B-mode image and color-Doppler sonography
are still ambiguous. The second new section is an
elucidation of clinical sonography from symptoms to diagnosis.
I am most deeply indebted to the team of authors for
their creative cooperation and timely submissions. I also
thank Springer-Verlag for their close collaboration and
careful production of the book.
The purpose of this pictorial atlas is to help colleagues
serve their patients better. It will hopefully enable clinicians
to establish diagnoses rapidly at the patient’s bedside
with greater accuracy and efficiency, and to initiate
appropriate therapeutic measures on time.

Rankweil, August 2007
Gebhard Mathis

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BREAST ULTRASOUND

Preface

Gary J. Whitman, MD
Guest Editor
Gary J. Whitman, MD
Department of Diagnostic Radiology
The University of Texas M. D. Anderson Cancer Center
P.O. Box 301439, Unit 1350
Houston, TX 77230, USA
E-mail address:
gwhitman@di.mdacc.tmc.edu

Breast sonography is indispensable. Most breast lesions, other than small clusters of calcifications, can and may be evaluated with ultrasound. In the last decade and a half, we have witnessed tremendous
progress in breast ultrasound. The days of
using breast ultrasound solely to differentiate cysts
from solid masses are gone forever. Breast sonography
is commonlyused to evaluatemammographic
and palpable abnormalities, and ultrasound is often
used to evaluate findings initially noted on magnetic
resonance imaging (MRI). Sonography also plays
a role in screening for breast cancer and in evaluating
the extent of disease in the breast and the regional
lymph nodes.
Nearly all breast masses are sampled with
ultrasound-guided biopsy. Core biopsies, vacuumassisted
biopsies, and fine-needle aspirations are
commonly performed with sonographic guidance,
often followed by ultrasound-guided marker placement.
In addition, sonography can be used to help
guide catheters to drain abscesses or deliver
radiation therapy. In some centers, ultrasound is
guiding cryoablation and radiofrequency ablation
of breast lesions.
Breast ultrasound can be performed just about
anywhere. Although most ultrasound machines are
housed in sonography rooms, breast ultrasound
can be and has been performed in mammography
rooms, operating rooms, surgical holding areas,
emergency rooms, examination rooms, patient
hospital rooms, and intensive care units. Breast
ultrasound plays a major role in the daily management
of women with breast diseases.
In this issue of Ultrasound Clinics,we explore some
of the common uses of breast sonography. Drs. Berg
and Woel cover mammographic-sonographic correlation
in a comprehensive manner, and Dr. Dogan
and I provide an update on MRI-sonographic
correlation. Dr. Dogan, Dr. Yang, Joella Wilson,
Parul Patel, and Dr. Krishnamurthy assisted me on
an article on ultrasound-guided biopsies. Dr.
Cardenosa covers cysts, cystic lesions, and papillary
lesions with a practical approach, and Dr. Hashimoto
provides an update on sonography of ductal
carcinoma in situ. Dr. Huynh, Parul Patel, Joella
Wilson, Angelica Cantu, and Dr. Krishnamurthy
assisted me on an article on sonography of invasive
lobular carcinoma. Finally, Dr. Yang covers sonography
of unusual breast neoplasms. All of the
authors did a great job, and I thank them for taking
time away from other pursuits to work on Ultrasound
Clinics.

Color Atlas Of Ultrasound Anatomy

Important note: Medicine is an ever-changing science undergoing continual development.Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers mayrest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production
of the book.Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosageschedule or every form of application used is
entirely at the user’s own risk and responsibility.The authors and publishers request
every user to report to the publishers any discrepancies or inaccuracies noticed.
Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore,the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.This book, including all parts thereof, is legally protected by copyright. Any use, exploitation,or commercialization outside the narrow limits set by copyright legislation, without
the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing,preparation of microfilms, and electronic data processing and storage.

Ankle Ultrasound

This booklet consists of directions by the European Society Musculoskeletal Radiology.

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