ADVANCED TOPICS

These ultrasounds are for those of you who want to push the limits.

Topics included & plannned:

• Intussusception
• Bowel Obstruction
• Tendon Injuries
• Eye Ultrasound

Want to submit your own? Contact SafetyDoc@gmail.com.

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Intussusception with “Target” sign

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Small Bowel Obstruction (bowel lumen is black)

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Normal Tendon: Flexor Pollicis Longus (Courtesy Teresa Wu, MD)

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Lacerated Tendon: (Courtesy Teresa Wu, MD)

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Tips and Tricks for How to Evaluate Tendons Via Ultrasound,
by Teresa Wu, MD

• A careful history and physical exam will usually reveal whether tendon injury or disruption has occurred. Remember that normal function can be seen on physical exam with 90% tendon disruption.
• Ultrasound can be used to augment clinical findings and help expedite the diagnosis.
• Complete tears are usually easy to diagnose. Partial or small tears can be assessed via bedside ultrasonography.
• Use the 7.5 to 10 MHz linear array transducer.
• Superficial structures (like flexor and extensor hand tendons) are difficult to visualize due to echo reverberations from the transducer. Even with high-frequency transducers, better visualization might be achieved with a standoff pad or liquid interface to provide a better acoustic window.
• Skeletal muscle will appear hypoechoic with interwoven echogenic striations and hyperechoic fascial planes. Adjacent tendons will appear brightly hyperechoic with visible linear fibers on long-axis scanning.
• Any hypoechoic or anechoic interruption in the hyperechoic tendon fibers should raise the suspicion of a tendon disruption. The hypoechoic or anechoic area may represent blood or granulation tissue where the tendon fibers have torn apart.
• Subtle tendon damage may display an increase in the tendon cross-sectional area due to localized edema in the absence of actual tearing of the tendon fibers. Compare the area of interest to adjacent segments.
• If the ultrasound beam is not aimed directly parallel to the tendon fibers, a false hypoechogenicity artifact may be noted (anisotropy).

Normal Tendon: Flexor Pollicis Longus (Courtesy Teresa Wu, MD)

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Do you want a pocket reference that has essential material on ED Ultrasound as well as other imaging, labs, EKGs, procedures, risk management and more?

Then get Cornucopia: Emergency Medicine

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