Sonographic Anatomy Research Articles

Best Practices for the Use of High-Frequency Ultrasound to Guide Aesthetic Filler Injections—Part 2: Middle Third of the Face, Nose, and Tear Troughs

The midface is a key area in facial aesthetics, highly susceptible to age-related changes such as fat pad absorption, bone resorption, and loss of skin elasticity. These changes lead to the formation of prominent folds, such as the nasolabial fold. In addition, critical vascular structures and non-vascular components, such as the facial artery, angular artery, and parotid gland, make this region prone to complications during filler injections. High-frequency ultrasound (HFUS) offers real-time, radiation-free visualization of facial anatomy, enabling injectors to accurately target the desired treatment planes and avoid critical structures. This article is the second in a series of articles on ultrasound-guided facial injections and focuses on the midface. It provides a detailed overview of the sonographic anatomy of key areas, including the nose, tear trough, nasolabial fold, zygomatic, and preauricular regions. Step-by-step techniques for ultrasound-guided filler injections are described, emphasizing the importance of scanning both before and during injections to ensure safe filler placement. By using ultrasound in this area, injectors can possibly minimize risks such as vascular occlusion and other complications, such as the Tyndall effect and intra-parotid injection. With ongoing advancements, ultrasound-guided injections are expected to become more refined, enhancing both aesthetic outcomes and patient safety.

Sonographic anatomy of surgically acquired abdominal pseudohernia—A guide to the documentation of anterolateral integument denervation with ultrasound

AbstractIncisional hernia is a common clinical diagnosis when a patient presents with a post‐surgical abdominal wall bulge. Herniation is a complication that can result from a disruption to the anterior abdominal wall, however other differentials need to be considered to account for a localized prominence of the abdominal integument. One such differential is a pseudohernia; a bulging of an intact abdominal integument without protrusion of abdominal contents. This can occur as a direct consequence of operative trauma and subsequent denervation injury to abdominal wall musculature. Although surgical techniques have been refined to reduce the potential of segmental neuropathy, atrophy of the abdominal wall can be a long term sequalae that clinically mimics that of a hernia. Such an outcome can result from surgical approaches with a particular location and orientation leaving little option to avoid damage to nerves inherent to the area. Damage to these nerves can not only result in abdominal wall laxity but also to the development of further complications that can affect a patient's quality of life. The aim of this article is to increase sonographer awareness of postsurgical pseudohernia of the anterolateral abdominal wall as a differential to incisional hernia, and as such provide guidance on how to demonstrate this anomaly. Considering that pseudohernia and incisional hernia have differing management techniques, the sonographer can play a pivotal role in influencing patient management, negating the need for surgical hernia repair and advocate for a conservative management pathway.

Three-dimensional Analysis of Lifting Effects after High-intensity Focused Ultrasound (Ultraformer-MPT) across Seven Facial Aesthetic Units Considering SonoAnatomy.

This investigation delves deep into the lifting degree for each area of noninvasive facial rejuvenation through high-intensity focused ultrasound (HIFU). The study meticulously examines the lifting effects of HIFU treatment across seven distinct facial aesthetic-units, using advanced three-dimensional scanner analysis. The study examined a cohort of 50 patients treated with HIFU. Pre- and immediate posttreatment evaluations were conducted using three-dimensional scanner analysis, allowing for precise quantification of lifting effects across seven aesthetic units. Treatment protocols were tailored to leverage five cartridges with micropulsed mode options, optimizing outcomes based on sonographic anatomy. The forehead was lifted by 1.24 mm; crow's feet, 2.25; malar region, 2.46; posterior cheek, 3.40; jowl, 2.90; mandible, 3.09; and neck, 3.53. The forehead showed a lift of 1.24 mm, attributed to the thin tissue requiring a cautious approach to avoid discomfort. A lift of 2.25 mm in the crow's feet area demonstrated the efficacy of HIFU in addressing fine lines and wrinkles. Significant lift of 2.47 mm in the malar region highlights HIFU's effectiveness in addressing mid-face laxity and restoring volume to the cheeks. The most substantial lift of 3.38 mm in the posterior cheek underscores targeted energy application for enhanced lifting and contouring. Notable lifting effect of 2.90 mm in the jowl area benefits sagging along the jawline, refining facial contour. Lift of 3.10 mm in the mandible shows improvement of lower facial laxity, defining the jawline. The highest lift of 3.55 mm in the neck region addresses laxity and sagging for a defined neck profile.

Simulation tools in ultrasound-guided regional anesthesia: developing a simple, inexpensive erector spinae plane (ESP) block teaching model.

The erector spinae plane (ESP) block is an increasingly utilized regional block in the emergency department, representing one effective alternative or adjunct to opioid analgesia in patients presenting with rib fractures. While there is growing interest, its widespread adoption faces hurdles, such as a lack of appropriate training resources. Gelatin-based phantoms to simulate human anatomy have been widely used to facilitate ultrasound-guided procedures, although no such model for the ESP block has yet been defined in the literature. To address this gap, we sought to design and assemble an inexpensive, simple to build, reusable phantom to simulate the sonographic anatomy of the posterior thoracic wall and serve as a task trainer for an ultrasound-guided ESP block. This novel phantom model reproduces an ultrasonographic fascial plane using a gelatin medium and 3D-printed thoracic spine with ribs allowing for needle guidance and hydrodissection.

Sonographic imaging of the genicular nerves of the knee

Introduction: The genicular nerves are sensory nerves around the knee. With the improvements in ultrasound imaging resolution, these nerves can be identified sonographically. Topic description: Due to their small size, genicular nerves are often underappreciated and overlooked during routine sonographic imaging. Chronic pain associated with knee osteoarthritis, or postsurgical knee pain can be relieved by ultrasound-guided radiofrequency ablations or nerve blockades targeting the genicular nerves. Discussion: To sonographically image these nerves, or guide nerve blocks or ablations, knowledge of the sonographic anatomy, technique and normal appearances of the genicular nerves and their surrounding structures is required and is unpacked in this pictorial essay. Conclusion: Enhanced knowledge of the anatomy and a systematic approach to sonographically image and assess the genicular nerves of the knee can enhance the diagnosis of pathology, nerve injury or entrapment, and sonographic guidance of interventional procedures for pain relief.

Ultrasound assessment of acute Achilles tendon rupture and measurement of the tendon gap.

Achilles tendon rupture is a common sports-related injury which can carry significant morbidity to patients. Ultrasound remains the workhorse of imaging as it can confirm and localise the extent of Achilles tendon injury. The sonographic anatomy, both normal and ruptured sonographic appearances, as well as sonographic technique must be appreciated to accurately image and report findings, critical to patient management. Particular attention should be applied to the measurement of the diastasis between acutely ruptured tendon ends as this information can assist with informing the decision of conservative vs. operative management. Further work is necessary to standardise the measurement technique including correlating the degree of plantarflexion of the foot with the sonographic tendon gap measures.

The ileocecal valve in transabdominal ultrasound Part 1: Sonographic anatomy and technique.

The ileocecal valve is a part of the gastrointestinal tract that separates two intestinal segments differing in both anatomy and function. Dysfunction or surgical removal of the valve usually results in the development of small intestinal bacterial overgrowth syndrome. The available literature lacks a broader discussion and ultrasound presentation of the ileocecal valve. The aim of this study is to present our experience in transabdominal ultrasound of the ileocecal valve in comparison with colonoscopic and computed tomography colonography data. In this part of the manuscript, we discuss the anatomical structures in the right iliac fossa that make up the ileocecal segment of the intestine. The ileocecal valve, which comes in two morphological forms: labial and papillary, is its central part. As shown in computed tomography colonography, the first type is more common, accounting for 76%, the second type accounts for 21%, whereas ileocecal valve lipomatosis is found in 3% of cases. Post-mortem studies have shown a significantly higher incidence of valve lipomatosis, which was found in up to 4 out of 5 cases. Our observations correspond with these findings. Ileocecal valve lipomatosis presents on ultrasound as a hyperechoic, well-circumscribed lesion, with no evident vascularity on color Doppler. This image should be differentiated especially from a lipoma, a relatively common large intestinal pathology. The paper presents two methods of preparation for an ultrasound scan (i.e. only on an empty stomach or after cleansing the intestine) and determines the optimal imaging methods for the ileocecal valve using transabdominal ultrasound. At the end of the ileocecal examination, it should be remembered to assess the lymph nodes in the right iliac fossa.

Development and Implementation of a Basic Veterinary Ultrasound Curriculum.

Diagnostic ultrasound is an important imaging modality in veterinary medicine. Surveys of veterinarians suggest that ultrasound is a desired clinical competence and that new graduates are expected to practice basic ultrasound skills. This report describes the development and implementation of a basic ultrasound training program in the core curriculum at Iowa State University College of Veterinary Medicine (ISU-CVM). A multidisciplinary team of ISU-CVM faculty created and delivered a basic ultrasound training program consisting of two lectures and two hands-on laboratories incorporated into a second-year core course, utilizing ballistic gel and silicone phantoms as well as live-dog scanning. The focus of training was on basic image acquisition, image optimization, and regional sonographic anatomy of the canine abdomen. Students were surveyed at 6-month intervals during program implementation. Survey data from graduating students, alumni, and employers were also analyzed. The program was successfully implemented and was well-received by all key stakeholders. Alumni and employer surveys reinforced the importance of basic ultrasound skills as a competency for new graduates. Student survey data revealed that satisfaction with ultrasound training increased after implementation of the program, as did students' perception of their skill level in individual ultrasound competencies. Student surveys also identified ways to enrich the program by providing additional opportunities for ultrasound practice in subsequent laboratory courses and clinical rotations. This report summarizes lessons learned during development of basic ultrasound training in the core curriculum at ISU-CVM and can serve as a reference for other institutions considering similar programs.

Sonographic anatomy and technique to image the plantar digital nerves and aid identification of a Morton's neuroma.

The anatomy of the forefoot is complex, and the sonographic assessment to image the plantar digital nerves and exclude, diagnose or discriminate between a Morton's neuroma and intermetatarsal bursitis can be challenging. A good appreciation of the sonographic anatomy, technique, normal and abnormal appearances is required to undertake a sonographic assessment of the forefoot and its interspaces, particularly the plantar digital nerves. This is unpacked in this paper with associated pictorial aids. Muscles, tendons, and ligaments of the interspaces and the nearby metatarsophalangeal joints and their associated soft-tissue structures are helpful sonographic landmarks to guide imaging and assessment of the common and proper plantar digital nerves and the intermetatarsal bursa. These need to be appreciated from both dorsal and plantar sonographic approaches, in both short- and long-axis imaging planes. Improved understanding of the anatomy and sonographic appearances of the interspace structures can enhance the sonographic assessment of the forefoot and improve diagnosis of a Morton's neuroma and/or intermetatarsal bursitis when present to guide patient management.

Boxer's knuckle: Sonographic anatomy and assessment of sagittal band tears of the dorsal hood.

Boxer's knuckle: Sonographic anatomy and assessment of sagittal band tears of the dorsal hood.

Development and evaluation of a point-of-care ocular ultrasound curriculum for medical students - a proof-of-concept study

BackgroundPoint-of-care Ocular Ultrasound (POCOUS) has gained importance in emergency medicine and intensive care in recent years. This work aimed to establish and evaluate a dedicated ultrasound education program for learning POCOUS-specific skills during medical studies at a university hospital.MethodsThe blended learning-based program (6 teaching units) based on recent scientific publications and recommendations was developed for students in the clinical part of their medical studies. Experts and trainers consisted of physicians from the Ear-Nose-Throat, radiology, ophthalmology and neurology specialties as well as university educational specialists. Lecture notes containing digital video links for preparation was produced as teaching material. In total, 33 students participated in the study. The education program, including the teaching materials, motivation and subjective gain in competency, was evaluated with the aid of a questionnaire (7-point Likert response format). Objective learning success was assessed on the basis of pre- and post-tests. These covered the skill areas: “anatomical basics”, “ultrasound basics”, “understanding of cross-sectional images”, “normal findings” and “pathology recognition”.ResultsIn the objective assessment of image interpretation, the participants improved significantly (p < 0.001) from pre- to post-test with a large effect size (Cohen’s d = 1.78, effect size r = 0.66). The evaluations revealed a high level of satisfaction with the course concept, teaching materials and the tutors. In addition, a high level of motivation was recorded in relation to continuing to study “ultrasound diagnostics” and “ophthalmologic diseases”. A significant (p < 0.01) positive gain was also achieved in terms of the subjective assessment of competency. This covers areas such as expertise, sonographic anatomy and performing a POCOUS examination as well as recognizing retinal detachment, globe perforation and increased optic nerve sheath diameter.ConclusionThe results of this feasibility study show that medical students accept and support a POCOUS-specific education program and are able to develop a higher objective and subjective level of competency. Future transfer to other sites and larger groups of participants seems feasible.

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta.

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography (CT) is the current gold standard to image the abdominal aorta, the process of obtaining a CT may be time-consuming, requires the use of intravenous contrast dye, and involves exposure to ionizing radiation. Point-of-care Ultrasound (POCUS) can be performed at the bedside and has excellent sensitivity and specificity for the diagnosis of abdominal aortic aneurysm and excellent specificity for the diagnosis of abdominal aortic dissection. Additionally, POCUS is non-invasive, cost-effective, lacks ionizing radiation, requires no intravenous contrast dye, and can be performed without taking the patient from a critical care area. Screening for abdominal aortic aneurysm (AAA) can be done in primary care settings as well. This article will review the approach to POCUS of the abdominal aorta to evaluate such critical pathology. In this paper, we will review the sonographic anatomy of the abdominal aorta as well as the choice of the ultrasound probe, description of POCUS image acquisition, and some pearls and pitfalls of using POCUS to aid in the diagnosis of potentially life-threatening abdominal aortic pathology.

Nephrologist-Led Simulation-Based Focused Cardiac Ultrasound Workshop for Medical Students: Insights and Implications

BackgroundPoint-of-care ultrasonography (POCUS) is being increasingly recognized as an adjunct to physical examination. However, limited availability of trained faculty in specialties other than emergency medicine and lack of universal training standards remain key barriers to its widespread integration into undergraduate and graduate medical curricula. In this study, we sought to explore the effectiveness of a short simulation-based workshop for medical students teaching basic cardiac ultrasound led by a nephrologist. MethodsWorkshops were conducted for 2 different groups of 4th-year medical students with a total of 25 attendees. The workshop consisted of a 1-hour lecture followed by 15 minutes of cardiac anatomy simulation and a 2- to 2.5-hour hands-on session in the simulation laboratory. An anonymous precourse questionnaire comprising 10 questions assessing the interpretation of common grayscale ultrasound findings encountered in patients with undifferentiated hypotension was performed. After the workshop, a postcourse exam and survey were conducted, retesting the same concepts and seeking the students’ feedback on the course. ResultsIn total, 23 and 20 students answered the pre- and postcourse surveys, respectively. The mean total score on the pretest was 63.8% ± 13.6%, which significantly increased to 91.5% ± 10.5% on the posttest (P < .001). About 90% of the respondents strongly agreed that the cardiac anatomy simulation improved their understanding of the cardiac sonographic anatomy; 75% strongly agreed that the hands-on simulation enhanced their confidence in image acquisition and interpretation; and 70% said they would choose nephrology elective if POCUS training was integrated with it. ConclusionsA nephrologist-led diagnostic POCUS workshop using simulation techniques is effective in improving the learners’ knowledge, understanding of the sonographic cardiac anatomy, and confidence in image acquisition. Integration of POCUS training may increase medical student interest in nephrology elective rotations.

Effects of a focused training on first-year osteopathic medical students' ability to incorporate point-of-care ultrasound in assessment of the anterior knee.

Patients frequently present to the outpatient clinic, urgent care, or emergency department with a painful, swollen knee. Differentiating the underlying etiology can be a challenge for both medical students and seasoned clinicians alike. Because this scenario can represent a time-sensitive emergency, developing skills to diagnose the underlying cause quickly and accurately is essential for proper management, whether the patient would benefit from osteopathic manipulation, prompt administration of antibiotics, or a more invasive procedure like joint aspiration or surgery. The objectives are to determine the effects of a focused ultrasound training on first-year osteopathic medical students' ability to identify normal sonographic anatomy of the anterior knee and to differentiate between three common pathologies: joint effusion, prepatellar bursitis, and cellulitis. First-year osteopathic medical students voluntarily participated in this cross-sectional study. The study protocol included a focused ultrasound training (online materials, brief didactic and single hands-on sessions) followed by a hands-on assessment. A written test and 5-point Likert scale questionnaire were administered before and after the focused training. Nine weeks later, students completed a follow-up written test. The proportion of students who correctly identified common pathologies on written tests before (pretest) and after (posttest) training and on the follow-up written test were compared utilizing the Fisher's exact test. A t test was utilized to compare data from the pretraining and posttraining questionnaires. Of 101 students completing the written pretest andpretraining questionnaire, 95 (94.1 %) completed the written posttest and posttraining questionnaire, and 84 (83.2 %) completed the follow-up written test. Students had limited previous experience with ultrasound; 90 (89.1 %) students had performed six or fewer ultrasound examinations before the focused ultrasound training. On written tests, students accurately identified joint effusion (22.8 % [23/101] pretest, 65.3 % [62/95] posttest, 33.3 % [28/84] follow-up test), prepatellar bursitis (14.9 % [15/101] pretest, 46.3 % [44/95] posttest, 36.9 % [31/84] follow-up test), and cellulitis (38.6 % [39/101] pretest, 90.5 % [86/95] posttest, 73.8 % [62/84] follow-up test). Differences were found between pretest andposttest for identification of all three pathologies (allp<0.001) and between the pretest and 9-week follow-up test for identification of prepatellar bursitis andcellulitis (both p≤0.001). For questionnaires, (where 1=strongly agree, 5=strongly disagree), the mean (standard deviation [SD]) confidence for correctly identifying normal sonographic anatomy of the anterior knee was 3.50 (1.01) at pretraining and 1.59 (0.72) at posttraining. Student confidence in the ability to differentiate joint effusion, prepatellar bursitis, and cellulitis utilizing ultrasound increased from 4.33 (0.78) at pretraining to 1.99 (0.78) at posttraining. For the hands-on assessment, 78.3 % (595 correct/760 aggregated responses) of the time students correctly identified specific sonographic landmarks of the anterior knee. When the evaluation combined real-time scanning with a prerecorded sonographic video clip of the anterior knee, 71.4 % (20/28) accurately identified joint effusion, 60.9 % (14/23) correctly diagnosed prepatellar bursitis, 93.3 % (28/30) recognized cellulitis, and 47.1 % (8/17) diagnosed the normal knee. Our focused training was effective at immediately increasing basic knowledge, as well as confidence of first-year osteopathic medical students when assessing the anterior knee with point-of-care ultrasound. However, spaced repetition and deliberate practice may be useful for learning retention.

Abdominal ultrasound in amazonian manatee (Trichechus inunguis) (Natterer, 1883).

Morphophysiological species researches are fundamental, and diagnostic imaging is an excellent technique, already used in wild animals, with great application, not invasive and provide real-time information of each body. Amazonian manatees are on the list of endangered animals classified in the vulnerable category and knowledge of the normal pattern of ultrasound anatomy of organs and tissues is important for the maintenance and well-being of captive specimens contributing to reintroduction actions. The objective of the study was to standardize the examination technique and describe the ultrasound findings of the liver, gallbladder, stomach, urinary bladder and the subcutaneous tissue of the abdominal region in Trichechus inunguis, in order to contribute with the anatomical and sonographic knowledge and assist in the diagnosis and prognosis diseases. The study used 18 animals to describe the normal sonographic anatomy in the abdominal cavity of the Amazonian manatee. During abdominal scan, it was possible to visualize the features of the liver, gallbladder, stomach, urinary bladder obtained satisfactory results in this study. Therefore, other structures were not primarily identified by the reduced time, lots of fat and gases in intestines of animals.

Normal Sonographic Anatomy of the Wrist and Hand

Normal Sonographic Anatomy of the Wrist and Hand

Sonographic anatomy and imaging of the dorsal supportive ligaments of the Chopart joint complex

AbstractAnkle sprains are common. Midfoot ligaments, particularly the dorsal ligaments of the Chopart joint complex, can be injured in combination with other ankle and foot injuries via an ankle sprain, but are clinically difficult to detect. The prevalence of injury to dorsal midfoot ligaments may be underreported as they can be overlooked, underappreciated, and underdiagnosed. Symptoms can include chronic pain, long‐term functional limitations, and physical disability due to lack of timely management. Sonographic assessment of the ankle and foot following an ankle sprain should include assessment of the dorsal midfoot ligaments. This paper will provide a description of the sonographic anatomy, appearances, and assessment of the dorsal ligaments of the Chopart joint complex. Early diagnosis of injury can allow for appropriate management and treatment.

Teaching Module on Ultrasound-Guided Venous Access Using a Homemade Gel Model for Fourth-Year Medical Students.

IntroductionEvidence supports an ultrasound-guided approach in patients with difficult vascular access. Prior research on teaching ultrasound-guided intravenous access has included only small groups of first- and second-year medical students.MethodsWe enrolled fourth-year medical students in our teaching module. The module featured a 6-minute prelearning narrated lecture and 5-minute orientation, followed by ultrasound-guided IV placement on homemade gel models. Facilitators were emergency medicine (EM) residents with a prespecified level of procedural ultrasound skills according to EM milestones. Students completed pre- and postmodule surveys. Facilitators completed the Directly Observed Procedural Skills Evaluation. Primary outcomes included global rating, proficiency on six procedural skills, and perceived learning.ResultsOur module was completed by 150 fourth-year medical students (94% of the class); 84% cannulated the vein in one attempt. We used a global rating scale to describe the students' cannulation abilities; 59% were trusted to perform this procedure with direct supervision and coaching, 29% with indirect supervision, and 8% without supervision. There was no association between a student's order of attempting IV access within the group and global rating (p = .41). Students reported increased understanding of indications, antecubital anatomy, sonographic anatomy, and procedural comfort (12%, 29%, 38%, and 65% improvement pre- vs. postmodule, respectively; p < .001).DiscussionOur module enabled more than one-third of fourth-year medical students to achieve an indirect supervision or better level of proficiency in ultrasound-guided IV access, with significant improvements in perceived knowledge. This module may be useful for other educators facilitating the transition to residency.

Atlas of Sonographic Anatomy of the Hand and Wrist.

Accurate knowledge of the technique of ultrasonographic (US) examination and of normal US appearance is a prerequisite for a successful US examination of the wrist and hand. In this article, we describe our standard US examination as well as the normal US findings of the hand and wrist.

Gross and sonographic anatomy of sciatic nerve in fecB Sheep

Fecb Sheep having high socio-economic importance and available in abundance with high vulnerability to general anesthesia, prompted gross anatomical and sonographic study of its peripheral nerves. Sciatic nerve being the largest peripheral nerve in the body received first preference. Two fresh sheep cadavers, free from any neuro and musculoskeletal pathology were dissected for the location and origin of sciatic nerve and associated blood vessels. Ultrasonographic scans of sciatic nerve were obtained from four fresh cadavers using linear array transducer of frequency 10–18 MHz. During this study, for exposure and identification of the sciatic nerve and its branches, only one skin incision was given in the pelvic region caudal to the sacrum and extended through the whole lateral aspect of limb, after putting the cadaver sheep in lateral recumbency. The skin was reflected laterally. The sciatic nerve was found emerging out through greater sciatic foramen. The nerve on lateral aspect of the limb terminated into two branches the tibial nerve and the common peroneal nerve. The sciatic nerve at the site of its emergence from the greater sciatic foramen appeared as a hyperechoic ellipsoid.