Importance Of Ultrasonography Research Articles

Clinical Impact of Fatty Pancreas and Its Correlation with Metabolic Disease: Focusing on the Cellular Mechanism and the Ultrasonographic Findings

Fatty pancreas is commonly observed on abdominal ultrasonography. However, there is a lack of knowledge regarding the clinical significance and the severity of fatty pancreas. This review article summarized previous studies describing the criteria for severity grading and diagnosis, the importance of ultrasonography as a diagnostic tool, and the clinical significance of the relationship between fatty pancreas and inflammation and cancer. Furthermore, the manuscript attempted to demonstrate the clinical, molecular, and cellular associations of fatty pancreas with metabolic diseases such as type 2 diabetes mellitus and metabolic syndrome.

Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension: The Importance of Ultrasound.

Fluid overload, a prevalent complication in patients with renal disease and hypertension, significantly impacts patient morbidity and mortality. The daily clinical challenges that clinicians face include how to identify fluid overload early enough in the course of the disease to prevent adverse outcomes and to guide and potentially reduce the intensity of the diuresis. Traditional methods for evaluating fluid status, such as pitting edema, pulmonary crackles, or chest radiography primarily assess extracellular fluid and do not accurately reflect intravascular volume status or venous congestion. This review explores the rationale, mechanism, and evidence behind more recent methods used to assess volume status, namely, lung ultrasound, inferior vena cava (IVC) ultrasound, venous excess ultrasound score, and basic and advanced cardiac echocardiographic techniques. These methods offer a more accurate and objective assessment of fluid status, providing real-time, non-invasive measures of intravascular volume and venous congestion. The methods we discuss are primarily used in inpatient settings, but, given the increased pervasiveness of ultrasound technology, some could soon expand to the outpatient setting.

The Importance of Ultrasonography in the Evaluation of Mammary Tumors in Bitches.

The high incidence of mammary tumors in small animals is concerning. Patient history, clinical examination, physical evaluation, and imaging studies are important for clinical staging. Ultrasonography is commonly applied to investigate the presence of abdominal metastasis. However, it has been shown to provide important information regarding mammary tumors' architecture and advanced sonographic techniques can provide information regarding neovascularization, stiffness, and perfusion. Different techniques have been investigated to determine accuracy to predict the lesions' histological classification. This paper reviews the information regarding each sonographic technique in the evaluation of mammary tumors, describing the most common findings and their potential to accurately assess and predict malignancy. Even though the gold standard for the diagnosis of mammary lesions is the histopathological examination, some ultrasonographic features described can predict the potential of a lesion being malignant. Among the different sonographic techniques, elastography can be considered the most reliable modality to accurately differentiate benign from malignant tumors when malignant lesions present increased stiffness. However, the combination of all sonographic techniques can provide important information that can lead to a better therapeutic approach and clinical staging. Furthermore, the potential of the sonographic study, especially CEUS to monitor therapeutic progression, demonstrate the need of further studies.

Testicular Dysfunction in 47,XXY Boys: When It All Begins. A Semilongitudinal Study.

Klinefelter syndrome is the most common chromosomal disorder in males and the most common cause of hypergonadotropic hypogonadism. We describe the natural history of testicular dysfunction in patients with Klinefelter syndrome through the integration of clinical, hormonal, and quantitative ultrasound data in a life-course perspective. Prospective semilongitudinal study. We included 155 subjects with 47,XXY karyotype (age range: 7 months-55 years) naïve to testosterone replacement therapy. Subjects were divided according to pubertal stage and age group (transition age and adults). Serial clinical, hormonal, and testicular ultrasound (US) assessments were performed. Testicular development progresses until Tanner stage 4, with subsequent regression, whereas Sertoli and germ cell impairment is not hormonally detected before Tanner stages 3-4, as reflected by normal inhibin B values until stage 4 and the fall in the inhibin B/follicle-stimulating hormone ratio thereafter. The testosterone/luteinizing hormone ratio peaks during Tanner stages 2-3 and declines from Tanner stage 4 onward, preceding the development of overt hypogonadism. US echotexture progressively worsens until transition age, reflecting ongoing gonadal compromise, whereas quantitative US echotexture measures and the presence of both hypoechoic lesions and microlithiasis independently and significantly predict a lower circulating testosterone level. The findings from this large prospective study contribute to our understanding of the natural history of testicular dysfunction in Klinefelter syndrome, underlining the importance of quantitative testicular US in infancy and childhood, as well as during pubertal development and transition age, for the optimal care of Klinefelter syndrome patients.

Adrenal haemorrhage in new born presenting as severe neonatal jaundice

Neonatal adrenal haemorrhage is a relatively uncommon. Most often associated with difficult labour, birth trauma, hypoxia, sepsis. Clinical manifestations may vary from asymptomatic to life threatening Addisonian crisis. We present a case of right subacute adrenal hematoma confirmed on MRI abdomen. Risk factor being birth asphyxia. He presented with neonatal jaundice and was managed successfully by conservative methods. Treatment depends on the clinical features and severity. Most of the cases are asymptomatic and managed conservatively. Infants with acute haemorrhage might need urgent blood transfusion. Laparotomy is indicated when haemorrhage seems to be continuing, especially when the exact site of haemorrhage is in doubt. Adrenal haemorrhage usually takes 3 weeks to 6 months to resolve completely. Our case was clinically and hemodynamically stable, so he was managed conservatively and discharged after a week. This case emphasizes the importance high degree of suspicion in evaluation of neonate presented with late onset jaundice and importance of ultrasonography in diagnosis and conservative management.

Insight into clinical, laboratory, and GIT ultrasound diagnostic findings of cystic fibrosis in pediatrics

BackgroundCystic fibrosis (CF) is a multisystem disorder. Gastrointestinal tract (GIT) involvement presently requires medical attention, and this improves the survival rate of patients with CF. GIT imaging has an essential role in the early detection of GIT affection. This study aimed to quantify the abdominal symptoms and their relationship to clinical findings, abdominal ultrasound scoring system, and laboratory parameters, correlating GIT manifestation with ultrasound diagnostic findings.MethodsThis was a cross-sectional study that included 60 patients diagnosed with CF based on clinical manifestations and confirmed by a positive sweat chloride test ≥ 60 mmol/L and/or genetic analysis (CFTR gene mutation; a copy from each parent) in the CF clinic in the Children’s Hospital, in a period of 12 months.ResultsRecurrent abdominal pain (RAP) was the most common GIT manifestation, followed by abdominal distension and steatorrhea. Ultrasonography (US) showed that the most frequent findings were pancreatic lipomatosis in 16 patients (26.7%), the next common finding was heterogeneous coarse hepatic parenchyma in 14 patients (23.3%), while the least finding was the thickened bowel walls in 2 patients (3.3%). Abdominal US scoring revealed that the highest burden of GIT symptoms was clearly associated with pancreatic lipomatosis and liver steatosis with the highest score (6/7) (p = 0.048), while bowel wall thickness (BWT) had the lowest score (3/7) (Table 4).ConclusionThis study reveals that abdominal US is a non-invasive investigation that helps in the early detection of GIT involvement in CF. RAP is a common GIT manifestation and may reflect a major pathology. Moreover, a significant relationship was detected between RAP and pancreatic cystosis and lipomatosis. Therefore, the study also highlights the importance of US as a routine non-invasive follow-up tool for patients with CF and suggests close monitoring of patients with CF by abdominal US performed every 6 to 12 months.

LİPÖDEMDE SUBKÜTAN YAĞ DOKUSU KALINLIĞI İLE ADİPOKİNLER ARASINDAKİ İLİŞKİ

Giriş ve Amaç: Adipokinler ve disfonksiyonel yağ dokusu arasındaki ilişkide subkutan yağ dokusundan ziyade viseral yağ dokusundaki değişikliklerin rolüne dikkat çekilmiştir. Özellikle cilt altı yağ dokusunun etkilendiği lipödemde adipokinler hakkında bilgi yetersizdir. Bu çalışmada lipödemli hastalarda adiponektin, ghrelin, resistin ve visfatin düzeylerinin ve bunların yağ doku kalınlığı ile ilişkisinin araştırılması amaçlandı. Bu amaçla cilt altı yağ dokusu kalınlığı ultrasonografi ile objektif olarak değerlendirildi.
 Gereç ve Yöntemler: Lipödem tanısı almış toplam 19 kadın hasta ve yaş farkı olmayan 15 sağlıklı kadın çalışmaya dahil edildi. Deri ve deri altı yağ dokusu kalınlıkları ultrasonografik olarak ölçüldü. Tüm deneklerin serum adiponektin, ghrein, resistin ve visfatin seviyeleri sandviç ELISA protokolü kullanılarak ölçüldü.
 Bulgular: Lipödemli hastalarda, uyluk ve baldırda subkutan subkutan doku kalınlığı ve toplam deri-subkutan kalınlığı kontrollere kıyasla, uyluktaki deri kalınlığı dışında önemli ölçüde arttı (P0.05). Lipödemli hastalarda ve kontrollerde ultrason ile adiponektin, ghrelin, resistin ve visfatin ile deri, deri altı ve toplam kalınlık ölçümleri arasında anlamlı bir ilişki bulunmadı (P>0.05). İstatistiksel olarak anlamlı olmasa da detaylı incelendiğinde adipokinler ve ultrason ölçümleri arasındaki ilişkide gruplar arasında pozitif veya negatif korelasyonlar gözlendi.
 Sonuç: Bulgularımıza göre, serum adipokin düzeyleri ile deri altı yağ dokusu kalınlığı arasında anlamlı bir ilişki bulunmamakla birlikte, tamamen ilgisiz oldukları tartışmalıdır. Daha geniş serilerde yapılacak çalışmalar adipokinlerin cilt altı doku kalınlığı ile ilişkisine ve ultrasonografinin önemine ışık tutacaktır.

The importance of ultrasonography in surgical treatment of vascular access for hemodialysis complications

Background. Most complications of vascular access for hemodialysis require surgical treatment and if ineffective lead to fistula loss and depletion of the vascular resource for the new fistula creation.Objective. To identify complications of permanent vascular access for hemodialysis which require surgical treatment and evaluate its results using duplex scanning.Design and methods. Ultrasonography, clinical and laboratory examinations were performed in 550 patients undergoing hemodialysis.Results. Complications of vascular access for hemodialysis were detected in 154 (28.0 %) patients, surgical treatment was performed in 96 (62.3 %) patients. The main indications for surgical treatment were: significant stenosis, occlusive thrombosis, non-occlusive thrombosis in combination with significant vein stenosis, aneurysm with increased access flow, ischemic steal syndrome of the hand and pulsating hematoma. The analysis of surgical interventions showed that the creation of a new access was more often performed (41.7 %) compared to other types of fistula reconstructions which leads to a decrease in the number of vessels in the upper extremities that can be used to create access in the future.Conclusion. Duplex ultrasound allows diagnosing vascular access for hemodialysis complications and evaluating the results of their surgical treatment.

Correlation between Quantitative Ultrasonography on Small Muscles of the Foot in Diabetic Peripheral Neuropathy and Electrodiagnostic Study

Abstract Background: DPN is worthy of study as it's a leading cause for disability due to foot ulceration and amputation, gait disturbance, and fall-related injury. That makes the early diagnosis of DPN invaluable. Aim of Study: To assess the correlation between quantita-tive muscle ultrasonography (US) findings and electrodiag-nostic study results in patients with diabetic peripheral neu-ropathy (DPN). The clinical importance of quantitative muscle US in DPN was also evaluated. Patients and Methods: Twenty-five patients with DPN and 25 healthy volunteers were recruited. All control and DPN subjects underwent a bilateral peroneal and tibial motor nerve conduction study (NCS) and quantitative muscle US. Ultrasound images of the abductor haullicis (AH) muscle and the extensor digitorum brevis (EDB) muscle were obtained to measure thickness, muscle cross-sectional area (CSA) and echo intensity (EI). Differences in muscle thickness, CSA, and EI between the control and DPN patients' groups were analyzed. Relationships between electrodiagnostic study results and quantitative US parameters were evaluated. Results: A close relations observed between US findings (EI, CSA and muscle thickness) and NCS neuro-physiological findings indicating that we can use both examinations to detect muscle atrophy, and that US can expect changes in neurophys-iologic parameters in diabetics (muscle thickness and CSA were decreased, and EI was increased). The findings in the peroneal nerve were more significant than those in tibial nerve. Comparison between cases and controls regarding quantitative muscle US revealed a statistically insignificant difference in most the parameters, but some parameters showed statistically significant difference. However, there was a clinical importance of the US examination despite the insig-nificant statistics. Conclusion: These findings suggest that quantitative muscle ultrasound may be useful for detecting muscle changes in DPN. Further studies are needed to confirm the findings in larger groups of diabetic patients and to evaluate peripheral muscles by using quantitative muscle US in other types of neuropathy and neuromuscular diseases.

Twelve tips for integrating ultrasound guided peripheral intravenous access clinical skills teaching into undergraduate medical education

Peripheral Intravenous access (PIV) is a procedure undertaken by Medical Practitioners and Non-Medical Practitioners. Traditional PIV uses a visual and tactile technique to locate blood vessels close to the surface of the skin. Chronic medical conditions, dehydration, obesity and recurrent intravenous access can make PIV challenging. Ultrasound (US) guided PIV is recommended to aid the identification of the arm arteries and veins and improve the success rate of needle placement in difficult cases. Medical and non-medical schools, and hospital organisations, are recognising the importance of US guided PIV education for undergraduate and postgraduate Medical and Non-Medical Practitioners. This to promote independence, efficiency and to improve patient safety. The aim of this 12 tips article is to highlight the considerations and practicalities of integrating and delivering, a practical based skills (PBS) session, on the use of US guided practice as an adjunct in difficult PIV, into the undergraduate medical education curricula.

Beliefs, attitude, and knowledge of the Iranian physiatrists towards neuromusculoskeletal ultrasound and common barriers in its application

BackgroundRegarding the increasing application of neuromusculoskeletal sonography among medical specialties, specifically physiatrists, this study aims to assess the knowledge and skill level of these specialists in neuromusculoskeletal sonography in Iran.MethodsThis descriptive, cross-sectional study was performed in 2018. The utilized questionnaire developed based on previous studies in collaboration with 6 university lecturers of Shaheed Beheshti, Iran, and Tabriz medical universities and a physiatrist from Hacettepe University (Turkey); it included questions entailing demographic data, knowledge, and performance levels. Its validity and reliability were evaluated through face validation, pilot study, and the Cronbach α calculated via SPSS. Data extraction and analysis were also performed by SPSS-25.ResultsOf 364 questionnaires distributed, 300 were properly filled and entered into the study, of which, 38% were filled by clinical residents, 10% university lecturers, and 52% other categories (e.g. private sector).The average number of musculoskeletal patient visits was 140.6 ± 119 and the mean number of musculoskeletal sonographies requested was 8.2 ± 5.2 per month (the three most common indications reported as the shoulder, carpal tunnel syndrome, and tendon injuries).95% of the participants considered the importance of sonography for physiatrists to be “very high” or “high”; with the most valuable applications “as a guide for procedures (90%), its diagnostic utility (68%), and follow up/evaluating the response to treatment (45%). 86% of physiatrists reported they had participated in musculoskeletal sonography courses, 60% during residency, and the rest through workshops.Also, the participants mentioned safety (83%), the possibility of performing simultaneous diagnosis and intervention procedures (70%), repeatability (58%), and dynamic imagery (52%) as the major advantages of musculoskeletal ultrasound.Conclusiona large number of doctors consider musculoskeletal sonography to be essential for physiatrists, though insufficient education on the subject and the low number of ultrasound devices are some of the obstacles in enhancing the use of this technology in PM&R setting. Presenting certified specific training courses during residency, provision of necessary rotations, using the capacities of the PM&R scientific committee, and the private sector for running workshops and professional training courses are suggested for enhancing the knowledge and skills of neuromusculoskeletal sonography.

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English

Investigation of ultrasound-assisted KOH and CaO catalyzed transesterification for biodiesel production from waste cotton-seed cooking oil: Process optimization and conversion rate evaluation

Development of Ultrasound (US)-assisted biodiesel production from Waste Cotton-seed Cooking Oil (WCCO) is gaining importance due to significantly lower reaction time and high energy-efficiency. In the present novel work, a comprehensive experimental study for KOH and CaO catalyzed transesterification process with detailed process optimization was performed. Kinetic modeling, scalability and energy analysis were performed to confirm the relative importance of US compared to Mechanical Stirring (MS). The optimized process parameters for KOH and CaO catalyst conditions were determined as methanol/oil molar proportion: 6.1:1 and 10.9:1, catalyst amount (w/w) %: 0.46 % and 0.96 %, reaction temperature: 53.2 °C and 48.3 °C, and the corresponding yield: 97.76 % ± 0.03 and 96.16 % ± 0.03 respectively. Box-Behnken model exhibits a significant correlation with experimental results in case of KOH (R2 = 0.98) and CaO (R2 = 0.97) catalyzed conditions. Triglyceride conversion follows pseudo-first-order reaction kinetics. The activation energy calculated for KOH and CaO catalyzed conditions was 21.36 and 33.83 kJ/mol respectively, which is 1.5 – 1.7 times lower as compared to MS process. Energy analysis showed that dissipated energy in US process is higher compared to MS. The scalability effect (with tenfold batch size), and ultrasonic duty cycle analysis showed that the continuous sonication is more effective in comparison to pulse mode. Physicochemical properties of produced biodiesel were observed in accordance with fuel specification as prescribed by ASTM D6751. Outcomes of this study are useful for development of energy-efficient US-assisted biodiesel production process on industrial scale.

Racial Diversity in Hepatocellular Carcinoma in a Predominately African-American Population at an Urban Medical Center.

Surveillance, treatment, and outcomes for African-American (AA) populations with hepatocellular carcinoma (HCC) remain under evaluated. This study evaluated demographics, surveillance, therapy, and outcomes for a predominately AA population. The electronic medical records of a large health-care provider were used to identify 274 patients with visits for HCC between 2010 and 2017. Tumor size at diagnosis was defined by imaging with ≤ 5 cm being defined as "small." Surveillance for HCC was defined based on ultrasound (US) assessments. Patients were primarily AA (78%) and male (76%) with an average age at diagnosis of 62 years. Hepatitis C virus (HCV) was more likely to be a risk factor for the development of HCC in AA as compared to non-AA (92% vs 67%; p < 0.005). Surveillance rates were low (16% for AA vs 7% for non-AA). An aspartate aminotransferase platelet ratio index (APRI) value > 0.7 within 2 years of tumor diagnosis was a strong predictor for the risk of the development of HCC (86% AA vs 79 % non-AA). In this study, race was not a factor in treatment or outcomes, and most patients received tumor ablative treatment. Given the low surveillance rates and the demonstrated increased survival for patients with small tumors, ways to increase surveillance must be initiated. The results of this study demonstrate the need for physician/patient education on the importance of surveillance US. Further, this study supports routine assessment of APRI in AA patients in an effort to identify patients in whom intensive surveillance will significantly improve earlier detection of tumors.

High rate of detection of ultrasound signs of prostatitis in patients with HPV-DNA persistence on semen: role of ultrasound in HPV-related male accessory gland infection.

Papillomavirus (HPV) often occurs in the semen of patients with male accessory gland infection (MAGI). Ultrasound (US) evaluation has been suggested as a promising diagnostic tool for patients with HPV-related MAGI. No data on the spontaneous clearance of HPV-DNA have been reported so far in HPV-related MAGI. The primary aim of the study was to assess the percentage of early HPV-DNA spontaneous clearance in patients with prostatitis. The secondary aim was to evaluate the frequency of spontaneous clearance of HPV-DNA among patients with prostatitis associated with the presence or absence of US abnormalities. Patients with inflammatory MAGI and at least one suspicious criterion for HPV infection underwent semen HPV-DNA detection and prostate US. The presence of HPV-DNA was further investigated after a 6-month-long follow-up. Eighty patients satisfied the inclusion criteria and were recruited in the study. 69% of patients (55/80) showed HPV-DNA persistence in the semen. Among them, 82% (45/55) was positive for US signs of prostatitis, while they occurred only in 12% (3/25) of those patients with no sign of HPV-DNA persistence (p < 0.001). All patients with persistent high-risk HPV genotype (n = 30) showed at least two US signs of prostatitis. In 73% of patients (22/30), E6 and E7 mRNAs were detected. US signs of prostatitis more frequently occurred in patients with evidence of HPV-DNA persistence on semen, especially in those with high-risk genotypes. This highlights the importance of US in the framework of HPV-related MAGI.

The Importance of Ultrasonography in Veterinary Medicine: Editorial

Desde que foi introduzida na Medicina Veterinária, por volta de 1940, a ultrassonografia vem revolucionando o segmento na produção de imagens em movimento das estruturas e órgãos do corpo animal em tempo real permitindo muitas aplicações por ser um dos melhores métodos de diagnóstico não invasivos já criados pelo homem. Desde então, milhares de animais vem sendo beneficiados por esta tecnologia, que pode ser aplicada em diferentes campos de atuação da Medicina Veterinária, sendo sua primeira aplicação ocorrida no ano de 1966 para detecção de gestação em ovinos. O método pode ser realizado em qualquer ambiente, sem a necessidade de segurança específica, sem efeitos biológicos nocivos e limitações tecnológicas ou experiência do operador e características particulares do animal. O objetivo desse editorial é atentarmos para uma ferramenta que vem sendo largamente utilizada na avaliação da condição corporal, na seleção genética, na produção animal que atenda ao mercado consumidor, além de ser de grande importância para o diagnóstico de doenças com planejamento e tratamentos, pois, quanto mais difundido o conhecimento das diferentes interfaces do ultrassom, maior será a eficácia diagnóstica. Ganham os médicos veterinários – e, claro, animais e tutores.

The importance of ultrasonography in the diagnosis and treatment of musculoskeletal problems of haemophilia A

Haemophilia A, defined by a deficiency of clotting factor VIII, can cause bleeding in various locations, especially on muscles and joints. For these patients, ultrasonography plays a very important role in the monitoring and shaping of the replacement treatment with factor VIII, by confirming the time when full clinical-imaging complete remission is obtained

Pseudothrombophlebitis syndrome in a rheumatoid arthritis patient with swollen calf and persistent itching: a case report

BackgroundBaker’s cyst is a benign lesion that results from degenerative or inflammatory diseases of the knee joint. When Baker’s cyst ruptures, it may simulate deep vein thrombosis known as Pseudothrombophlebitis syndrome with calf pain, swelling and redness. Pseudothrombophlebitis syndrome without thrombus in popliteal veins has distinct treatment choice than deep vein thrombus.Case presentationIn this report, we presented a 47 year-old male rheumatoid arthritis patient with complaints of redness, pain and swelling on his right calf. Pseudothrombophlebitis syndrome was diagnosed due to ruptured Baker’s cyst.ConclusionsWe used musculoskeletal ultrasound for both differential diagnosis and treatment of pseudothrombophlebitis syndrome. Ultrasonography revealed massive fluid collection within muscle layers. 280 cc inflammatory fluid was aspirated simultaneously. We also emphasized the importance of ultrasonography in diagnosis and treatment of Pseudothrombophlebitis syndrome with this report.

Diagnosing Pseudoaneurysm of the Extracranial Carotid Arteries Using Doppler Ultrasonography: A Case Report

Carotid artery pseudoaneurysms are a rare complication of carotid endarterectomy, with few recorded in the literature. We describe a case of a 56-year-old man who presented with symptoms of left hemispheric transient ischemic attack and subsequently underwent a carotid endarterectomy. The patient returned to Accident and Emergency department with an ipsilateral neck swelling found to be an extracranial pseudoaneurysm. Doppler ultrasound imaging was used throughout the management of this patient from preendarterectomy to postpseudoaneurysm bypass. This report discusses the importance of ultrasonography in the diagnosis and follow-up of carotid pseudoaneurysms.

Ultrasound for central vascular access. A safety concept that is renewed day by day

Background: Ultrasound (US)-guided central venous catheterization is intended to reduce complications, enhance success rates on the first attempt, and increase accuracy, thus becoming a standard in clinical practice. Objectives: To review the relevant literature on the importance of US as a guide to central venous access and to describe the benefits of this tool and the impact of its use on the safety of the procedure. Methods: A narrative review of various medical literature databases and recognized guidelines (National Guideline Clearinghouse, New Zealand Guidelines, National Institute for Clinical Excellence, Cochrane, and JAMA). Results: High-quality evidence recommends US-guided inter nal jugular vein access as the preferred approach in routine practice. However, different other anatomical sites may be necessary for vascular access depending on the clinical setting. Related complications associated with landmark-guided techni ques range between 0.3% and 18.8% and depend on multiple conditions such as patient characteristics and access site. US has been associated with a reduction in the relative risk of complica tions, failed attempts, and failed first attempt of 57%, 86%, and 41%, respectively. Conclusion: US should be used routinely in central vascular access. Current evidence supports this recommendation for the internal jugular vein approach, but no so for the other approaches, in cases of difficult or failed access using conventional approaches.