Ultrasound Fundamentals: An Evidence-Based Guide for Medical Practitioners

Description

Written by experts in the field, this concise and evidence-based ultrasound text includes key topics ranging from the head and neck to the upper and lower extremity, covering all the clinically relevant sonoanatomy. This 33-chapter book emphasizes the practical use of ultrasound for the diagnosis and treatment of a multitude of conditions in various specialty areas such as airway management, cardiovascular disease assessment, pulmonary status evaluation, orthopedics, gynecology and pediatrics.  The optimal techniques and the step-by-step interpretation of normal and pathologic sonoanatomy are discussed in detail. This text can be used as a starting point for the study of ultrasound guided diagnosis and treatment, a refresher manual for sonoanatomy on major organ systems, or a last-minute guide before a bedside procedure. There is a great breadth of material that is covered in a comprehensive manner, making it a great resource for board review and exam preparation for various medical, surgical and allied specialties. Unique and pragmatic, Ultrasound Fundamentals is a back to basics manual on normal and pathologic sonoanatomy of head and neck, upper and lower extremity, chest, abdomen and other major organ systems. Foreword Preface Contents Contributors Part I: Ultrasound Basics Ultrasound Physics & Overview 1 Introduction 2 What Is Ultrasound? 2.1 Wavelength & Frequency 2.2 Strength of a Wave 3 Ultrasound Image Generation 3.1 Intrinsic Features Influencing Ultrasound Studies 3.2 Ultrasound Modes 4 Resolution 5 Ultrasound Transducer 5.1 Types of Transducers 5.2 Transducer Position 6 Doppler Sonography 6.1 Pulsed Wave Doppler 6.2 Color Doppler 6.3 Power Doppler 7 Artifacts 7.1 Shadowing 7.2 Posterior Enhancement 7.3 Mirror Images 7.4 Reverberation 7.5 Ring Down 7.6 Comet Tail 7.7 Side Lobe 7.8 Anisotropy 7.9 Transducer Piezoelectric Crystal Failure 8 Aliasing 8.1 Tissue Vibration 8.2 Twinkle 9 Conclusion References Ultrasound Probe Selection, Knobology and Optimization of Image Quality 1 Introduction 2 Probe Selection 3 Knobology 4 Scanning Terminology 5 Probe Manipulation 6 Structure Visualization and Needle Orientation 7 Needle Visualization 8 Summary References Basic Ultrasound Needling Techniques 1 Introduction 2 In-Plane Vs out-of-Plane Approach 3 Proper Needle Handling Techniques 4 Needle Selection 5 Body Ergonomics 6 Conclusion References Practical US Guided Vascular Access 1 Introduction 2 Principles of US Guidance for Vascular Access 3 Vessel Identification 4 Vessel Abnormality Diagnosis 5 US Guidance Approaches 6 US Guided Internal Jugular Vein Cannulation 6.1 Pre-Procedure Checklist 6.2 US Screening 6.3 Step-by-Step US Guided IJV Cannulation (Fig. 10) 7 US Guided Subclavian Vein Cannulation 8 US Guided Femoral Vein Cannulation 9 US Guided Artery Cannulation 10 US Guided Peripheral Venous Cannulation 11 Troubleshooting for Guidewire Advancement 12 Conclusions References Part II: Head and Neck Ultrasound Ultrasound for Head Assessment: Diagnosis and Treatment 1 Introduction 2 Basic Anatomy Markers in Intracranial Ultrasound 2.1 Transabdominal and Transperineal Ultrasound 2.2 Cerebrovascular Function 2.3 Transcranial Ultrasonography of the Brain Parynchema 2.4 TCS for Post-Operative Localization of Brain Implants 2.5 Novel Screening for Zika Virus 3 Conclusion References Ultrasound-Guided Neck Assessment 1 Introduction 2 Hyoid Bone 2.1 Anatomy 2.2 Sonoanatomy 2.3 Pathology 3 Larynx 3.1 Anatomy 3.2 Sonoanatomy 3.3 Pathology 4 Vocal Cords 4.1 Anatomy 4.2 Sonoanatomy 4.3 Pathology 5 Cricoid Cartilage and Cricothyroid Membrane 5.1 Anatomy 5.2 Sonoanatomy 5.3 Pathology 6 Thyroid 6.1 Anatomy 6.2 Sonoanatomy 6.3 Pathology 7 Trachea 7.1 Anatomy 7.2 Sonoanatomy 7.3 Pathology 8 Clinical Applications References The Utility of Ultrasound in Airway Management 1 Introduction 2 Review of Basic Anatomy 3 Predicting Difficult Airway Management 4 Regional Anesthesia 5 Confirmation of Airway Placement 6 Utilization in Emergency Situations 7 Conclusion References Ultrasound Technique for Common Head and Neck Blocks 1 Introduction 2 Trigeminal Nerve Block 2.1 Anatomy 2.2 Sonoanatomy and Clinical Application 3 Supraorbital Nerve Block 3.1 Anatomy 3.2 Sonoanatomy and Clinical Application 4 Infraorbital Nerve Block 4.1 Anatomy 4.2 Sonoanatomy and Clinical Application 5 Mental Nerve Block 5.1 Anatomy 5.2 Sonoanatomy and Clinical Application 6 Greater Occipital Nerve Block 6.1 Anatomy 6.2 Sonoanatomy and Clinical Application 7 Lesser Occipital Nerve Block 7.1 Anatomy 7.2 Sonoanatomy and Clinical Application 8 Cervical Plexus Block 8.1 Anatomy 8.2 Sonoanatomy and Clinical Application 9 Brachial Plexus Blocks 9.1 General Brachial Plexus Anatomy 10 Interscalene Nerve Block 10.1 Anatomy 10.2 Sonoanatomy and Clinical Application 11 Supraclavicular Brachial Plexus Block 11.1 Anatomy 11.2 Sonoanatomy and Clinical Application 12 Stellate Ganglion Block 12.1 Anatomy 12.2 Sonoanatomy and Clinical Application References Part III: Upper and Lower Extremity Ultrasound The Techniques and Merit of Ultrasound in Orthopaedics 1 Introduction 2 Advantages 3 Disadvantages 4 Technical Considerations 5 Soft Tissue Masses and Fluid Collections 6 Foreign Bodies 7 Nerve Entrapment 8 Rotator Cuff Tears and Other Shoulder Pathology 9 Peroneal Tendon Instability 10 Pediatric Developmental Dysplasia of the Hip (DDH) 11 Injections References Shoulder Joint Sonoanatomy and Ultrasound-Guided Shoulder Joint Injection 1 Introduction 2 Anatomy 3 Patient Positioning and Sonographic Anatomy 3.1 Long Head Bicep Tendon 3.2 Subscapularis 3.3 Supraspinatus 3.4 Infraspinatus and Teres Minor 3.5 Acromioclavicular (AC) Joint and Subacromial Subdeltoid Bursa 4 Commonly Encountered Pathologies of the Shoulder 5 Interventional Techniques 6 Conclusion References Elbow Joint Sonoanatomy and Ultrasound-Guided Elbow Joint Injection 1 Introduction 2 Anatomy and US Technique 2.1 Anterior Elbow 2.2 Medial Elbow 2.3 Lateral Elbow 2.4 Posterior Elbow 3 Commonly Encountered Pathologies of the Elbow 3.1 Distal Bicep Tendon (DBT) Tear or Rupture 3.2 Tennis Elbow (Lateral Epicondylitis) (Common Extensor Tendinosis) 3.3 Golfers Elbow (Medial Epicondylitis) (Common Flexor Tendinosis) 3.4 Ulnar Collateral Ligament Injury 3.5 Lateral Collateral Ligament Complex Injury 3.6 Olecranon Bursitis 4 Interventional Procedures 4.1 Needle Fenestration 4.2 Epicondylitis Steroid Injection 4.3 Intra-articular Injection 4.4 Olecranon Bursitis 5 Conclusion References Wrist Joint Sonoanatomy and Ultrasound-Guided Wrist Joint Injection 1 Introduction 1.1 Osseous Structures 1.2 Flexor Compartment 1.3 Extensor Compartment 1.4 Nerves 1.4.1 Median Nerve 1.4.2 Ulnar Nerve 1.4.3 Radial Nerve 1.5 Intrinsic Wrist Ligaments 1.6 Rheumatoid Arthritis 1.7 Carpal Tunnel Injection 1.8 De Quervain’s Tenosynovitis Injection 1.9 First Carpometacarpal (Trapeziometacarpal) Joint Injection 1.10 Tendon Sheath Injection (Trigger Finger) References Ultrasound Guided Brachial Plexus Block 1 Anatomy 2 History 3 Indications 4 Absolute/Relative Contraindications 5 Techniques 5.1 Distal Upper Extremity Blocks 5.2 Supraclavicular Block 5.3 Infraclavicular Brachial Plexus Block 5.4 Axillary Brachial Plexus Block 5.5 Proximal Upper Extremity Block 5.6 Interscalene Block 6 Conclusions References Hip Joint Sonoanatomy and Ultrasound-Guided Hip Joint Injection Introduction 1 Anterior Hip Anatomy 2 Anterior Hip Pathology 2.1 Hip Osteoarthritis Injection 2.2 Snapping Hip Syndrome Diagnosis 2.3 Iliopsoas Tendinopathy/Bursitis Diagnosis and Injection 2.4 Rectus Femoris Tear Diagnosis 3 Medial Hip Anatomy 4 Medial Hip Pathology 4.1 Adductor Tear 5 Lateral Hip Anatomy 6 Lateral Hip Pathology 6.1 Greater Trochanteric Pain Syndrome 7 Posterior Hip Anatomy 8 Posterior Hip Pathology 8.1 Hamstrings Tendinopathy/Ischial Bursitis References Knee Joint Sonoanatomy and Ultrasound-Guided Knee Joint Injection Introduction 1 Anterior Knee Anatomy 2 Anterior Knee Pathology 2.1 Knee Osteoarthritis 2.2 Patellar Tendinopathy 2.3 ACL Tear 3 Posterior Knee Anatomy 4 Posterior Knee Pathology 4.1 Baker’s Cyst 5 Medial Knee Anatomy 6 Medial Knee Pathology 6.1 Medial Collateral Ligament Sprain 6.2 Pes Anserine Bursitis 6.3 Medial Meniscus Tear 7 Lateral Knee 8 Lateral Knee Pathology 8.1 Lateral Collateral Ligament Sprain 8.2 Lateral Meniscus Tear 8.3 Common Peroneal Nerve Entrapment References Ankle Sonoanatomy and US Guided Joint Blocks 1 Introduction 2 Ankle Sonoanatomy 2.1 Anterior Ankle 2.2 Medial Ankle 2.3 Lateral Ankle 2.4 Posterior Ankle 3 Ultrasound Guided Ankle Injections and Nerve Blocks 3.1 Tibiotalar and Subtalar Joint Injection 3.2 Ankle Blocks References Ultrasound Guided Nerve Blocks for Lower Extremity 1 Fascia Iliaca Nerve Block 1.1 Introduction 1.2 Patient Positioning and Landmarks 1.3 Ultrasound Anatomy 1.4 Nerve Distribution 1.5 Technique 2 Popliteal Nerve Block 2.1 Introduction 2.2 Patient Positioning and Landmarks 2.3 Ultrasound Anatomy 2.4 Nerve Distribution 2.5 Technique 3 Sciatic Nerve Block 3.1 Introduction 3.2 Patient Positioning and Landmarks 3.3 Ultrasound Anatomy 3.4 Nerve Distribution 3.5 Technique 4 Obturator Nerve Block 4.1 Introduction 4.2 Patient Positioning and Landmarks 4.3 Ultrasound Anatomy 4.4 Nerve Distribution 4.5 Technique 5 Femoral Nerve Block 5.1 Introduction 5.2 Patient Positioning and Landmarks 5.3 Ultrasound Anatomy 5.4 Nerve Distribution 5.5 Technique 6 Saphenous Nerve Block 6.1 Introduction 6.2 Patient Positioning and Landmarks 6.2.1 Transsartorial Approach (Adductor Canal) to Saphenous Nerve Block 6.2.2 Distal Saphenous Nerve Block 6.3 Ultrasound Anatomy 6.4 Nerve Distribution 6.5 Technique References Part IV: Chest and Abdomen Ultrasound The Role of Ultrasound in the Management of Cardiac Patients 1 Introduction 2 Goal-Directed Echocardiography 3 Intravenous Fluid Therapy Management 4 Cardiac Arrest 5 Emerging Roles of Ultrasound, Pulmonary Embolism 6 Valvular Pathology 7 Conclusion References Ultrasound for Chest: Heart and TTE 1 Introduction 1.1 Ultrasound Basics 1.2 Ultrasound Probes 2 TTE Anatomy and Windows 3 Applications. Clinical Indications 3.1 LV Systolic Function 3.2 Diastolic Dysfunction 3.3 Wall Motion Abnormalities 3.4 Heart Valves Assessment 3.5 Infective Endocarditis 3.6 Embolic Sources 3.7 Hypertrophic Cardiomyopathy 3.8 Volume Status 3.9 Measurement of Cardiac Output (CO) 4 Echocardiography Advantages 5 Limitations and Pitfalls 6 Conclusions References Ultrasound for Chest: Lung and Pleural Examination and Diagnosis 1 Probe Types 2 Image Acquisition 2.1 Patient Positions 2.2 Probe Manipulation 2.3 Examination Points 3 Normal Lines and Signs 3.1 Pleural Line 3.2 A-Line 3.3 Bat Sign 3.4 Lung Sliding 3.5 Seashore Sign 4 Pathological Lines and Signs 4.1 B-Line 4.2 Stratosphere Sign 4.3 Pleural Effusion 4.4 Quad and Sinusoid Sign 4.5 Lung Pulse 5 Normal and Pathological Indicators 5.1 Normal Lung 5.2 Pneumothorax 5.3 Atelectasis 5.4 Alveolar-Interstitial Syndrome 5.5 Pneumonia 6 Conclusion References Ultrasound-Guided Nerve Blocks for Chest 1 Introduction 2 Anatomy of Pectoral and Axillary Regions 2.1 Skin 2.2 Subcutaneous Fat Forms 2.3 Muscle 2.4 Cartilages and Bones 2.4.1 Ribs 2.4.2 Sternum 2.4.3 Sternoclavicular Joints 2.4.4 Scapula 2.4.5 Vascular Network of Chest Wall 2.4.6 Spinal Nerves of Thoracic Wall 2.4.7 Thoracic Lymph Nodes 2.4.8 Endothoracic Fascia and Parietal Pleura 3 Thoracic Wall Blocks 3.1 Pecs I and II Block 3.2 Serratus Anterior Block 3.3 Interpleural Block 3.4 Intercostal Nerve Block 3.5 Paravertebral Block 4 Analgesic Potential of Pecs Blocks 4.1 Chest Wall Pain Syndrome 4.2 Intercostal Neuralgia 4.3 Traumatic Rib Injury 4.4 Post-Operative Thoracotomy 4.5 Analgesic Techniques and Approaches- Ultrasound-Guided and Video-Assisted Intercostal Nerve Cryoablation 5 Clinical Applications of Pecs Block 5.1 Pecs Block for Breast Surgery 5.2 Pecs Block for Cardiothoracic Surgery 5.3 Other Clinical Applications of Pecs Blocks 6 Summary and Conclusion References Ultrasound Guided Nerve Blocks for Abdomen 1 Introduction 2 Anatomy of Abdomen 2.1 Transversus Abdominis Plane (TAP) 2.2 Transversalis Fascia Plane (TFP) 2.3 Structure of a Typical Thoracolumbar Spinal Nerve 2.4 Anatomy of Quadratus Lumborum Muscle (QL) and Thoracolumbar Fascia (TLF) 2.5 Lumbar Arteries 3 Abdominal Wall Blocks 3.1 TAP Block 3.2 Nomenclature 3.3 Lateral TAP Block 3.4 Posterior TAP Block 3.5 Subcostal TAP Block 3.6 Local Anesthetics and Complications 3.7 Quadratum Lumborum Block 3.8 Types of QLB and Technical Aspects 3.9 Local Anesthetics and Complications 3.10 Rectus Sheath Block 4 Indications of Abdominal Wall Blocks 5 Summary and Conclusion References Part V: Ultrasound in Specialty Care The Role of Ultrasound in the Critical Care Setting 1 The Role of Ultrasound in Regional Anesthesia in the Intensive Care Setting: An Overview 2 Peripheral Nerve Blocks Utilizing Ultrasound 3 Peripheral Nerve Blocks for the Lower Extremities 4 Regional Analgesic Techniques in the Critical Care Setting 5 Ultrasound for Cardiovascular/Volume Status in the Intensive Care Setting 6 Summary References Clinical Utilization of Ultrasound in Vascular Disease 1 Introduction 2 ABI and Duplex Ultrasound for Vascular Disease 2.1 Relevant Anatomy and Physiology 2.2 Body Position 2.3 Cuff 2.4 Doppler 3 Measurement Protocol for the Ankle-Brachial Index with the Doppler Method 3.1 Measuring the Brachial Pressure 3.2 Measuring the Ankle Pressure 3.3 Calculating the ABI 3.4 Sensitivity/Specificity 3.5 ABI Exercise 4 Duplex Ultrasound Examination 4.1 Sensitivity and Specificity 4.2 Clinical Pearls 5 Evaluation for Deep Venous Thrombosis 5.1 Body Position 5.2 Limitations 5.3 Equipment 6 DVT Ultrasound Scanning 6.1 Sensitivity and Specificity 6.2 Lower Extremity 6.3 Clinical Pearls 6.4 Upper Extremity 7 U/S Screening for Carotid Disease 7.1 Technique 8 Color and Pulsed Wave Doppler Ultrasonography 9 AAA Screening and Evaluation 10 U/S Screening in AKI Assessment: Resistive Index 10.1 Technique References Pediatric Ultrasound 1 Introduction 2 Cranial Ultrasound 2.1 Indications for Scanning 2.2 Technique of Imaging 2.3 Findings in Preterm Infants 2.4 Findings in Term Infants 2.5 Finding in Infants with Macrocephaly 3 Ultrasound of the spine 3.1 Ultrasound of the Spine 3.2 Technique and Normal Anatomy 3.3 Imaging Findings Bibliography Fundamentals of Gynecologic Ultrasound 1 Use of Pelvic Ultrasonography 2 Examination Positioning and Techniques 2.1 Transvaginal Ultrasound Probes 2.2 Patient Positioning 3 Imaging of the Female Pelvis and Reproductive Tract 3.1 Transabdominal 3.2 Transvaginal 4 Uterus & Cervix 5 Endometrial Stripe 6 Adnexal Structures: Fallopian Tubes and Ovaries 7 Cul-de-sac 8 Doppler Studies 9 Saline Infusion Sonography (SIS) 10 Three-Dimensional Ultrasonography 11 Pathology and Clinical Applications 11.1 Leiomyoma 11.2 Leiomyosarcoma 11.3 Adenomyosis 11.4 Structural Abnormalities 11.5 Congenital Abnormalities 11.5.1 Müllerian Duct and Related Anomalies 11.6 Endometrial Stripe 11.6.1 Endometrial Stripe Thickening 11.7 Endometrial Lesions 11.7.1 Endometrial Polyps 11.8 The Cervix 11.9 Fallopian Tubes 11.9.1 Hydrosalpinx 11.9.2 Pyosalpinx 11.10 Ovaries 11.10.1 Functional Cysts 11.10.2 Hemorrhagic Cyst 11.10.3 Benign Neoplastic Ovarian Cysts 11.10.4 Endometriomas 11.10.5 Dermoid Cyst 11.11 Ovarian Torsion 11.12 Pelvic Inflammatory Disease 11.13 Peritoneal Inclusion Cysts 12 Conclusion References Ultrasound for Spine and Nerve Blocks 1 Introduction 2 Anatomy 3 Sonoanatomy of the Thoracic Spine 4 Position and Technique for Performing Parasagittal Oblique Scan in the Mid Thoracic Region 5 Position and Technique for Performing Transverse Midline Scan in the Mid Thoracic Region 6 Indications for Thoracic Nerve Block 7 Sonoanatomy of the Lumbar Spine 8 Position and Technique for Performing a Parasagittal Transverse Process (PST) Scan in the Lumbar Region 9 Position and Technique for Performing a Parasagittal Articular (PSA) Scan in the Lumbar Region 10 Position and Technique for Performing a Parasagittal Oblique (PSO) Scan in the Lumbar Region 11 Position and Technique for Performing a Transverse Spinous Process Scan in the Lumbar Region 12 Position and Technique for Performing a Transverse Interlaminar Scan in the Lumbar Region 13 Indications for Lumbar Nerve Blocks 14 Ultrasound Guided Spinal 15 Basic Anatomy and Sonoanatomy 16 Positioning and Technique 17 Caudal Nerve Block 18 Sonoanatomy of the Caudal Epidural Space 19 Summary References Use of Ultrasound in Urology 1 Introduction 2 Brief History of Ultrasound in Urology 3 Basic Modes of Ultrasonography 3.1 Grey Scale B Mode Ultrasound 3.2 Doppler Sonography 3.3 Harmonic Scanning 3.4 Spatial Compounding 4 Documentation, Reporting and Image Management System 5 Patient Safety 6 Renal Sonography 6.1 Antenatal Ultrasound Findings 6.2 Technique in Children and Adults 6.3 Indications 6.4 Normal Ultrasound Findings 6.4.1 Neonate 6.4.2 Adult 6.4.3 Normal Doppler Waveform in Adult Renal Artery 6.4.4 Renal Transplant 6.4.5 Surgical Technique 6.4.6 Normal Grey Scale Ultrasound Feathers of Transplant Kidney 6.4.7 Doppler Features of Transplant Kidney 7 Ultrasound of Ureters 7.1 Technique 8 Urinary Bladder 8.1 Technique 8.2 Indications 8.3 Normal Ultrasound Features 9 Ultrasonography of the Scrotum 9.1 Technique 9.2 Indications 9.3 Normal Ultrasound of Tests 9.4 Normal Ultrasound of Epididymis 10 Ultrasonography of Prostate Seminal Vesicles and Vas Deference 10.1 Technique 10.1.1 Transabdominal Scan 10.1.2 Transrectal Ultrasound (TRUS) 10.2 Indications 10.3 Normal Ultrasound Features of Prostate, Seminal Vesicles and Vas Deference 10.3.1 Prostate Gland 10.3.2 Seminal Vesicle and Vas Deference 11 Ultrasound of Penis 11.1 Indications 11.2 Technique 11.3 Grey Scale Ultrasound 11.4 Colour and Spectral Doppler Examination 12 Ultrasound Anatomy of Penis 12.1 Normal Features on Colour and Spectral Doppler Evaluation 12.2 Sonourethrography 13 Ultrasound in Urological Intervention 13.1 Ultrasound Guided Per Cutaneous Renal Access 13.1.1 Indications 13.1.2 Prerequisites 13.1.3 Procedures 13.1.4 Advantages of Ultrasound Over Fluoroscopic Guidance 14 TRUS Guided Prostate Biopsy 14.1 Indications 14.2 Contraindications 14.3 Prerequisites 14.4 Procedure 14.5 Complications [23] 15 Intra-operative Urologic Ultrasound 15.1 Indications 15.2 Transducers 16 Sonoelastography 17 Endoluminal Ultrasonography 18 Contrast-Enhanced Ultrasound (CEUS) References Ultrasound Guided Interventions 1 Introduction 2 Tools 3 Tasks 4 Pearls and Pitfalls 5 Future Directions 6 Conclusion References Ultrasound Application in Dermatologic Conditions 1 Introduction 2 The Basics 2.1 Tools 2.2 Ultrasonography of the Normal Skin 2.3 Ultrasonography of the Nail 3 Malignant Cutaneous Neoplasms 3.1 Malignant Melanoma 3.2 Squamous Cell Carcinoma (SCC) 3.3 Basal Cell Carcinoma (BCC) 4 Benign Vascular Neoplasm 4.1 Infantile Hemangioma 4.2 Vascular Malformations 5 Benign Solid and Cystic Neoplasm 5.1 Epidermal and Trichilemmal Cyst 5.2 Pilomatrixoma 5.3 Neurofibroma 5.4 Wart 6 Benign Neoplasms Involving the Nail 6.1 Periungual Wart 6.2 Subungual and Periungual Pyogenic Granulomas 6.3 Glomus Tumor 6.4 Periungual Fibroma 6.5 Digital Myxoid, Synovial, and Mucoid Cyst 6.6 Subungual Exostosis 6.7 Nail Findings of Systemic Autoimmune Diseases 7 Cutaneous Inflammatory Processes 7.1 Hidradenitis Suppurativa, Pilonidal Cyst, Acne Conglobata, and Dissecting Cellulitis of the Scalp 7.2 Psoriasis 7.3 Scleroderma and Morphea 7.4 Other Inflammatory Diseases 7.5 Panniculitis 7.6 Mycetoma 7.7 Keloid 8 Miscellaneous Skin Conditions 8.1 Other Subcutaneous Nodules: Gouty Tophus, Rheumatoid Nodule, Xanthoma 8.2 Lipoma 8.3 Foreign Bodies 8.4 Cosmetic Fillers 8.5 Live Organisms 9 Other Uses of Ultrasound in Dermatology References Part VI: Emergency Ultrasound Fundamentals of Point of Care Ultrasound Applications in Perioperative Settings 1 Introduction 2 Gastric Ultrasound 2.1 Indications 2.2 Acquisition of Image and Sonoanatomy 2.3 Clinical or Pathological Interpretation and Medical Decision Making 3 Lung Ultrasound 3.1 Indications 3.2 Acquisition of Image and Sonoanatomy 3.3 Clinical or Pathological Interpretation and Medical Decision Making 4 Cardiac Ultrasound 4.1 Indications 4.2 Acquisition of Image and Sonoanatomy 4.3 Clinical or Pathological Interpretation and Medical Decision Making 5 Additional Point of Care Techniques: Airway Ultrasound and FAST Exams 5.1 Indications 5.2 Acquisition of Image and Sonoanatomy 5.3 Clinical or Pathological Interpretation and Medical Decision Making References Ultrasound for Abdomen and FAST: Evaluation and Diagnosis 1 Introduction 2 Sonographic Evaluation of the Aorta 2.1 Aortic Aneurysm 2.2 Ultrasound Diagnosis of Aortic Aneurysm 2.3 Aortic Dissection 2.4 Ultrasound Diagnosis of Aortic Dissection 2.5 Conclusion 3 Sonographic Evaluation of the Gallbldder 3.1 Using Ultrasound to Evaluate Gallbladder Disease 3.2 Technique for Gallbladder POCUS 3.3 Ultrasound Diagnosis of Biliary Pathology 3.4 Pitfalls in Sonographic Evaluation of Gallbladder Disease 4 Sonographic Evaluation of the Kidneys 4.1 Kidney Stone Disease 4.2 Technique for POCUS of Kidneys 4.3 Using Ultrasound to Evaluate Kidney Stone Disease 4.4 Pitfalls in Sonographic Evaluation of Kidney Stone Disease 5 The Fast Exam 5.1 Background 5.2 Ultrasound Accuracy in Hemoperitoneum 5.3 Ultrasound Accuracy in Hemopericardium 5.4 Ultrasound Accuracy in Pneumothorax 5.5 Ultrasound Accuracy in Hemothorax 5.6 EFAST Exam for Penetrating vs Blunt Thoracoabdominal Trauma 5.7 How to Perform the EFAST Exam 5.7.1 Evaluation of Hemoperitoneum 5.7.2 RUQ Evaluation 5.7.3 Pelvic Evaluation 5.7.4 LUQ Evaluation 5.7.5 Hemopericardium Assessment 5.7.6 Hemothorax Assessment 5.7.7 Pneumothorax Assessment 6 Summary References Practicality of Ultrasound in Emergency Medicine 1 Introduction 1.1 History 1.2 Differentiating the Undifferentiated 2 Equipment 3 Administrative Issues 3.1 Training & Credentialing 3.2 Quality Assurance 3.3 Billing & Reimbursement 4 Applications of Ultrasound 4.1 Core Applications of Ultrasound 4.2 Advanced Applications of Emergency Ultrasound 4.3 Future Directions 4.3.1 Pocket Carried Devices Vertical, Horizontal, & Longitudinal Integration References Introduction Administrative Issues Applications of Ultrasound Index