Transthoracic Ultrasonography Research Articles

Diagnostic value of ultrasound guided transthoracic tru-cut biopsy in thorax malignancies

AIM: To investigate the diagnostic value of ultrasound (US) guided transthoracic fine needle aspiration biopsy (TTFNA) and US guided transthoracic tru-cut biopsy (TTTCB) in malignant thorax lesions. MATERIALS AND METHODS: Patients who underwent US guided transthoracic biopsies between April 2014 and May 2017 were retrospectively evaluated. Patients who were diagnosed as thoracic malignancy and both TTTCB and TTFNA performed for the same lesion were included in the study. The diagnostic accuracy of TTTCB, TTFNA and their combination were analyzed. The diagnostic accurracy of methods were statistically compared by McNemar Test. RESULTS: Thirty two patients were included in the study. Ultrasound guided TTFNA and/or TTTCB were diagnostic in 30 (93.8%) of them. TTFNA was diagnostic in 23 (%71.8), TTTCB were diagnostic in 26 (%81.2) of these pateints. Seven (77.7%) of 9 patients in which TTFNA was not diagnostic, TTTCB was diagnostic. The diagnostic accuracy was 71.8% and 81.2% for TTFNA and TTTCB, respectively. When TTTCB and TTFNA were performed consecutively in the same procedure, the overall diagnostic accuracy was 93.7%. There was no difference between the diagnostic accuracy of US-guided TTFNA and TTTCB (P=0.508). The diagnostic accuracy of combination of TTFNA and TTTCB was significantly higher than that of TTFNA alone (P=0.016). During the procedures, pneumothorax which did not require chest tube insertion was detected as complication in 1 case (3.1%). CONCLUSION: Diagnostic accuracy of US-guided TTFNA and TTTCB is high and has no superiority to each other. Combining both procedures under the quidence of US increases the diagnostic accuracy statistically significantly.

One-Lung Flooding Enables Ultrasound-Guided Transthoracic Needle Biopsy of Pulmonary Nodules with High Sensitivity

Ultrasound-guided transthoracic needle biopsy (USgTTNB) can only be used for peripheral tumours that contact the pleura. Sonographic accessibility of the entire lung can be achieved using one-lung flooding. In this study, feasibility, sensitivity and complication rate of USgTTNB of lung nodules after one-lung flooding in an ex vivo and in vivo lung tumour model were assessed. USgTTNB was performed ex vivo after one-lung flooding in 10 resected human lung lobes containing carcinoma or metastasis. USgTTNB after one-lung flooding and simulation of a lung nodule was conducted in vivo in 5 animals. Transthoracic sonography and chest X-ray were obtained 30 min after reventilation. The lungs were examined macroscopically and histopathologically. The pathologic diagnosis was confirmed in 85.7% and 100% of tumours after first and second puncture attempts, respectively. The successful puncture rate in vivo was 90%. Neither pneumothorax nor bleeding was observed. One-lung flooding enables USgTTNB of lung nodules with a high sensitivity and minimal risk of complications in a pre-clinical model.

Comparative study in left heart failure patients with or without pulmonary edema by integrative cardiopulmonary ultrasound

Objective To compare the clinical and echocardiographic parameters in left heart failure patients with or without pulmonary edema by cardiopulmonary ultrasound. Methods All patients underwent transthoracic lung ultrasonography and echocardiography examination. The following echocardiographic parameters were determined: left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD), left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV), left ventricular ejection fraction (LVEF), left atrial volume index (LAVindex), systolic pulmonary artery pressure (SPAP) and the degree of mitral regurgitation, the peak Doppler velocities of early (E) and late (A) diastolic flow, early (e′) diastolic velocity of the mitral annulus, and the average E/e′ ratio was calculated. The NYHA functional classification and N-terminal pro B-type natriuretic peptide (NT-proBNP) were also recorded. Results A total of 113 heart failure patients, included 72 patients (63.7%) combined with pulmonary edema revealed by lung ultrasonography. Compared with patients without pulmonary edema, those with pulmonary edema were with higher plasma concentrations of NT-proBNP, NYHA functional class, left ventricular diastolic function classification, SPAP and E/e′, larger LVEDD and the diameter of right ventricle, more severe mitral regurgitation, and lower LVEF(all P<0.05). By multivariate logistic regression analysis, E/e′, SPAP and NT-proBNP were independent echocardiographic predictors of pulmonary edema in patients with heart failure. Conclusions Cardiopulmonary ultrasound can evaluate heart and pulmonary condition in patients with heart failure. Left ventricular diastolic function is an important determinant of pulmonary edema in patients with left heart failure. Key words: Ultrasonography; Heart failure; Pulmonary edema

Cardiovascular Imaging Techniques in Systemic Rheumatic Diseases

The risk of cardiovascular (CV) events and mortality is significantly higher in patients with systemic rheumatic diseases than in the general population. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. Various types of assessments are employed for the evaluation of CV risk such as transthoracic or transesophageal echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. The diameter of coronary arteries can be assessed using invasive quantitative coronarography or intravascular ultrasound, and coronary flow reserve can be assessed using non-invasive transesophageal or transthoracic ultrasonography (US), MRI, CT, or positron emission tomography (PET) after endothelium-dependent vasodilation. Finally, peripheral circulation can be measured invasively using strain-gauge plethysmography in an arm after the arterial infusion of an endothelium-dependent vasodilator or non-invasively by means of US or MRI measurements of flow-mediated vasodilation of the brachial artery. All of the above are reliable methods of investigating CV involvement, but more recently, introduced use of speckle tracking echocardiography and 3-dimensional US are diagnostically more accurate.

Assessment of severe dyspnea in critically ill patients by transthoracic sonography: Fayoum experience of the Bedside Lung Ultrasonography in Emergency protocol

BackgroundManagement of critically ill patients requires imaging tools, which are important for optimizing diagnostic and therapeutic actions. Both bedside chest radiography and thoracic computed tomography have limitations that constrain their utility. The aim of our work is to explore the value of transthoracic ultrasound (TUS) using the Bedside Lung Ultrasonography in Emergency (BLUE) protocol in critical ill patients with severe dyspnea.Patients and methodsThis study included 109 ICU patients with acute dyspnea at Fayoum University Hospital. The judgments of chest ultrasound using the BLUE protocol were compared with the final diagnoses; rare diagnoses and uncertain diagnoses were excluded.ResultsBy application of the BLUE protocol, TUS was absolutely sensitive, specific, and accurate for the diagnosis of pneumothorax. For pneumonia, the sensitivity, specificity, and diagnostic accuracy were 93.8, 95.7, and 95.8%, respectively, whereas these parameters for pulmonary edema were 100, 96.8, and 99%, respectively. TUS was absolutely sensitive in the diagnosis of chronic obstructive pulmonary disease, asthma, or diffuse parenchymal lung disease, whereas the specificity and diagnostic accuracy were 88.9 and 88.9%, respectively, for chronic obstructive pulmonary disease and asthma and 96.8 and 100%, respectively, for diffuse parenchymal lung disease.

Sonographic features of idiopathic pulmonary fibrosis

Background Idiopathic pulmonary fibrosis (IPF) is a specific form of idiopathic interstitial pneumonia (IIP) that occurs primarily in the elderly and is confined to the lungs. With the use of transthoracic ultrasound (TUS), diffuse parenchymal lung disease should be considered if multiple comet-tail artifacts distributed over the whole surface of the lung together with a thickened and irregular, fragmented pleural line are visible. Objective The aim of this study was to evaluate lung ultrasound usefulness in the diagnosis of IPF. Patients and methods This study was carried out on 40 patients diagnosed as having IPF. All cases were subjected to a full assessment of history, clinical examination, laboratory investigations, arterial blood gases, pulmonary function test, plain chest radiography, high-resolution computed tomography, and TUS. Results Our results showed that B-lines in combination with thickened and irregular pleura are the TUS features of IPF. There was a statistically significant correlation among B-lines distance (mm), pleural line thickness (mm), pleural line irregularity, abolished lung sliding found by TUS, and severity of the disease. Conclusion TUS is a useful tool in the diagnosis and assessment of the severity of IPF and can be used as a complementary method beside high-resolution computed tomography. The distance between two adjacent lines in combination with thickened and irregular pleura is a good feature in the follow-up of disease progression.

Association between coronary artery disease and responsiveness of aortic stiffness and pulsatile diameter change to nitroglycerin

Aim: This study aimed to evaluate the difference between the effect of nitroglycerin on the aortic stiffness measured by transthoracic M-mode ultrasonography in patients with and without coronary artery disease (CAD).Material and Methods: This study was conducted on one hundredpatients with a presume diagnosis of CAD. The patients who had a SYNTAX score (SS) ≥1 according to the results of coronary angiography constituted the CAD group (n:60), while patients who had a SS=0 constituted the control group (n:40).The stiffness of the ascending aorta and arterial blood pressure were measured before and 10 minutes after the sublingual administration of 800 mcg nitroglycerin. A comparison of each parameter before and after nitroglycerin was evaluated for statistical significance using paired sample t-test.Results: In the control group, after nitroglycerin administration, there was a statistically significant reduction in the pulsatile diameter change (from 2.30±0.79 to 1.74±0.91) and significant increase in stiffness index (from 6.24±2.41 to 9.07±5.88). In the CAD group, after nitroglycerin administration, there wasno statistically significant difference in terms of pulsatile diameter change (from 1.42±0.88 to 1.28±0.68) and stiffness index (from 13.52±7.64 to 13.10±7.85).Conclusion: The effect of nitroglycerin on the aortic stiffness measured by transthoracic M-mode ultrasonography differs in the CAD and control groups. Our findings warrant further studies with a larger population to describe the practicability of this method for the CAD diagnosis.Keywords: Aorta; Coronary Artery Disease; Stiffness; Nitroglycerin.

Mediastinal masses-transthoracic ultrasonography aspects.

Mediastinal masses are usually assessed by computer tomography (CT) and magnetic resonance imaging (MRI). Transthoracic ultrasonography (TUS) can also provide useful information concerning prevascular and posterior mediastinal masses abutting the thoracic wall, but is underused for mediastinal pathology. Moreover, it provides a valuable and safe method for guiding interventional procedures in those areas, even in cases when other approaches are difficult or impossible. Considering TUS a very useful imagistic method for diagnosing mediastinal masses, we present a pictorial essay of various mediastinal diseases which can be assessed by this method.

Validity of Ultrasound Lung Comets for Assessment of the Severity of Interstitial Pneumonia

Ultrasound (US) lung comets are often observed in patients with interstitial lung disease or congestive heart failure, but few studies have explored the clinical importance of US lung comets in patients with the former condition. We explored whether the US lung comet number could be used to assess the severity of interstitial pneumonia. Forty stable patients with interstitial pneumonia were examined. Lung comets evident on transthoracic US imaging in 12 selected regions of the posterior chest wall were analyzed. We defined lung comets accompanied by thickened and irregular pleural lines as interstitial US lung comets; these predominated in patients with interstitial pneumonia. The total number of interstitial US lung comets was correlated with the data from chest high-resolution computed tomography, pulmonary function tests, serologic tests, and the 6-minute walk test. The 40 patients included 16 with idiopathic pulmonary fibrosis and 24 with nonspecific interstitial pneumonia. Thirty-four patients had interstitial US lung comets, which were more common in the lower than the upper lung area. Good correlations were evident between the lung comet number and the extent of the reticular pattern on chest high-resolution computed tomography (r = 0.710; P < .01), predicted forced vital capacity (r = -0.614; P < .01), and lung diffusion capacity for carbon monoxide (r = -0.577; P < .01). Notably, the lung comet number had a strong negative correlation with the percutaneous oxygen saturation level after the 6-minute walk test (r = -0.751; P < .01). The number of interstitial US lung comets evident on transthoracic US imaging may be a valuable marker of disease severity in patients with interstitial pneumonia.

Type B Aortic Dissection Diagnosed by Left-Sided Transthoracic Ultrasonography in a Woman With Preeclampsia.

Type B Aortic Dissection Diagnosed by Left-Sided Transthoracic Ultrasonography in a Woman With Preeclampsia.

Implication of Transthoracic Sonography in Assessment of Circulatory Failure: Fayoum Experience With Falls Protocol

SESSION TITLE: Rapid Session: Bedside Imaging SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 07:30 AM - 08:30 AM PURPOSE: Acute circulatory failure is one of the most familiar concerns of the Intensivists. The assessment of acute circulatory failure is a challenge in absence of solid gold standard. It is suggested that artifacts generated by lung ultrasound can be of help. The aim of this study was to evaluate the efficiency of transthoracic ultrasound (TUS) in hemodynamic assessment of shock. METHODS: This study included 63 ICU patients with circulatory shock at Fayoum university hospital.All patients were studied with TUS using FALLS protocol (Fluid Administration Limited by Lung Sonography). The FALLS-protocol followed Weil’s classification of shocks. TUS artifacts and outcomes were compared with definite final diagnosis according to history, clinical examination, laboratory investigations, chest x- ray, echocardiography, CT pulmonary angiography or other diagnostic tools. RESULTS: Obstructive shock was the presentation in 18 patients. TUS using FALLS protocol detected this category of shock in 4 patients with pericardial tamponade, 8 cases of tension pneumothorax and 3 cases of pulmonary embolism with a sensitivity and specificity of 83% and 100% respectively. Cardiogenic shock was demonstration in 15 patients. Using B profile; TUS was absolutely sensitive and specific for diagnosis of this entity of shock. Hypovolemic shock was detected in 20 patients. A profile by TUS with response to fluid therapy was demonstrated in 18 patients with a sensitivity and specificity of 90% each. On the other hand, A profile converting to B profile by fluid therapy was observed in 8 patients out of 10 presenting with septic shock giving a sensitivity of 80% and a specificity of 85%. CONCLUSIONS: TUS utilizing FALLS protocol is a simple, bedside, noninvasive, cheap, and rapid effective tool in sequential diagnosis of obstructive, cardiogenic, hypovolemic, and septic shock. CLINICAL IMPLICATIONS: TUS is a fast, inexpensive, widely available bed-side diagnostic tool that should be applied in rapid hemodynamic assessment of circulatory failure in intensive care units. DISCLOSURE: The following authors have nothing to disclose: Gamal Agmy, Randa Ahmed, Alliaa Mohamed, Sherif Hamed, Mohamed Saad No Product/Research Disclosure Information

Assessment of Severe Dyspnea in Critical Ill Patients by Transthoracic Sonography: Fayoum Experience With Blue Protocol

Assessment of Severe Dyspnea in Critical Ill Patients by Transthoracic Sonography: Fayoum Experience With Blue Protocol

Impact of chronic obstructive pulmonary disease severity on diaphragm muscle thickness

BackgroundSonographic assessment of the diaphragm muscle thickness for disease progression in chronic obstructive pulmonary disease (COPD) patients was poorly evaluated. AimTo assess the impact of COPD severity on diaphragm muscle thickness measured by transthoracic ultrasound (TUS). MethodsCase-control study was conducted on 100 clinically stable male COPD patients and100 age-matched healthy subjects. Thickness of the diaphragm (TD) was measured by B- mode TUS. Measurements were taken on three different images to find the average static TD at residual volume (RV) and at total lung capacity (TLC). A thickness fraction (TF) was derived by subtracting the average thickness of the diaphragm at RV from the average thickness of the diaphragm at TLC/average thickness of the diaphragm at RV [TD at TLC-TD at RV/TD at RV]. COPD severity was measured by spirometry. Moreover, partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were measured. ResultsThe right and left TF were significantly lower in COPD group than control group. All static right and left TD indices didn't shows any significant difference between COPD group and control group (p>0.05). The right and left TF were significantly decreased through progression of COPD (mild, moderate, severe and very-severe grades) (p=0.020, 0.002 respectively). TD at RV bilaterally were negatively correlated with the smoking index, also the left TD at TLC was negatively correlated with the smoking index and forced vital capacity (FVC%). The right and left TF were positively correlated with body mass index (BMI), forced expiratory volume in first second (FEV1%), FEV1/FVC ratio, and PaO2, while it was negatively correlated with PaCO2. ConclusionThe static TD measured at RV and at TLC are preserved in COPD. The TF bilaterally was significantly decreased in COPD group and is decreased with increasing severity of COPD. The negative correlation of TF and PaCO2 indicates that the diaphragm dysfunction is the main contributor to neuromuscular respiratory failure in COPD patients.

Transthoracic ultrasonographic features of diffuse parenchymal lung diseases

ObjectivesThe value of transthoracic ultrasonography (TTUS) in diffuse parenchymal lung disease (DPLD) has not been established yet. This prospective study was conducted to assess pleural and parenchymal alterations in patients with DPLD by TTUS and to compare the results with chest high-resolution computed tomography (HRCT). The results of TTUS were compared with some arterial blood gas (ABG) parameters and 6-min walk test (6MWT).Patients and methodsThis study was conducted on 50 patients. All patients underwent HRCT, resting ABGs, and 6MWT, in addition to TTUS to evaluate (a) the presence and number of B-line and distance between them, (b) pleural effusion, (c) pleural thickening, (d) an irregular, fragmented pleural line, and (e) subpleural alterations.ResultsThe studied group showed female predominance, wide range of age, and most of them were nonsmokers. All patients had diffuse bilateral B-lines. B-line numbers were inversely correlated with severity of pulmonary fibrosis detected by HRCT modified Warrick score; however, distance between B-lines was directly correlated with severity of pulmonary fibrosis. Some ABGs (resting PaO2, resting SpO2%, AaDO2) and 6MWT parameters were correlated with B-line number and distance between them. As detected by TTUS, the majority of patients (82%) had irregular thickened pleural line, whereas 44% of them had absent lung sliding.ConclusionTTUS can play a complementary role in the diagnosis and monitoring of DPLD patients. Multiple B-lines distributed over the entire lung surface in combination with a thickened, irregular, and fragmented pleural line are strongly suggestive of the presence of DPLD. TTUS gives an idea about diffuse or limited, early, or advanced DPLD.

Interstitial Syndrome And Alveolar Consolidation: Sonographic Markers of Hemodynamic Pulmonary Edema In Infants

With the purpose of evaluating the possibility of describing hemodynamic pulmonary edema in infants with congenital heart disease using the previously suggested sonographic phenomena “alveolar consolidation” and “interstitial syndrome” in adults, 131 children of both genders were examined at the age of 1-246 days. Of these infants, 47 had congenital heart anomalies, 51 had chronic somatic pathology and patent foramen ovale, and 33 had a somatic pathology associated with either congenital heart disease or small heart abnormalities. The duration of observation and the number of sessions of ultrasound scanning were determined by the health status dynamics of the infants. All infants were described in terms of 179 characteristics of physical examination and laboratory and instrumental findings obtained through standard procedures. Echocardiography and ultrasound lung scans were performed with LOGIQ E (General Electric) and HD11 (Philips) using linear, convex, and sector transducers (7-12, 3-5, and 1.7-4.0 МHz respectively). In addition to standard protocols of heart and lung description, we also registered the square of consolidated parcels summarized for all lung segments, the number of B-lines summarized for all lung segments, and the swing of diaphragm and lung movement and calculated the diaphragm and lung swing ratio. An attempt to describe the differences between pulmonary circulation in terms of ultrasound sonography for heart defects associated and not associated with blood filling in the lungs was successful. The total area of air-free/consolidated subpleural parcels of lungs and the extent of interstitial lung syndrome were the most informative sonographic characteristics. It was concluded that interstitial edema and alveolar consolidation, described in terms of transthoracic ultrasound sonography, are recommended for use as markers of the disorders of pulmonary circulation associated with congenital heart malformations in infants.

Possibilities of using ultrasound for diagnosis of invasive pulmonary mucormycosis – A case study

IntroductionMucormycosis is a rare but highly lethal fungal infection, usually affecting immunocompromised patients.AimTo present and analyze the diagnostic capabilities of transthoracic ultrasonography in invasive pulmonary mucormycosis.Case studyWe present a case involving a 41-year-old female patient with pneumonia complicated by multisystem organ failure, who was diagnosed with invasive pulmonary mucormycosis.Results and discussionTransthoracic ultrasonography (TUS) revealed a consolidation area of heterogeneous echostructure with an abnormal air bronchogram, possibly suggestive of an invasive pulmonary fungal disorder. The presence of lesions observed with TUS was confirmed by computed tomography (CT). The final diagnosis of mucormycosis was possible after Mucor species fungi were detected in bronchoalveolar lavage culture.Conclusions(1) TUS is a widely available and inexpensive diagnostic method that is characterized by the absence of adverse effects, and its applicability in the diagnosis of pulmonary disorders other than invasive fungal infections is well documented. (2) Ultrasonographic analysis of lesions facilitates differentiation between bacterial and fungal pneumonia, and the high sensitivity and specificity of the procedure compared to CT scans as a reference method supports the reliability of ultrasound scans in the diagnosis of invasive pulmonary aspergillosis (IPA). (3) The use of TUS in the diagnosis of invasive pulmonary mucormycosis appears warranted, particularly in cases when it is impossible to obtain a proven diagnosis. (4) Ultrasonographic diagnosis of invasive lung disorders, including mucormycosis, requires further studies.

The role of transthoracic ultrasonography in predicting the outcome of community-acquired pneumonia in hospitalized children.

Transthoracic ultrasound (TUS) has recently become a valuable tool in the diagnosis of community-acquired pneumonia (CAP). This study assessed the association between TUS findings and clinical outcome in children with CAP. The medical records of pediatric patients hospitalized with CAP who underwent transthoracic ultrasonography within 48 hours of admission were retrospectively reviewed. Associations between the TUS findings and patient outcome were analyzed, including intensive care unit (ICU) admission, length of hospital stay, and tube thoracotomy. The study enrolled 142 patients (median age, 60 months): 28 (19.7%) required ICU admission, 14 (9.89%) underwent tube thoracotomy, and 26 (18.3%) had a hospital stay > 9 days. Multifocal involvement seen by TUS were independently associated with ICU admission, a prolonged hospital stay, and tube thoracotomy (p = 0.0027, p = 0.02, and p = 0.0262, respectively). A pleural effusion and fluid bronchogram were independent predictors of a longer hospital stay (p = 0.003 and p = 0.006, respectively). In addition, a fluid bronchogram was an independent predictor of tube thoracotomy (p = 0.0262).ConclusionTUS findings of fluid bronchogram, multifocal involvement, and pleural effusion were associated with adverse outcomes, including longer hospital stay, ICU admission, and tube thoracotomy in hospitalized CAP children. Therefore, TUS is a novel tool for prognostic stratifications of CAP in hospitalized children.

Effects of Progressive Hypoventilation on Left Ventricular Appearance: An Alternative Etiology of Acute Sonographic Short-Axis D-Shaping.

The purpose of this study was to evaluate the effects of progressive hypoventilation on echocardiographic measures of the left ventricular (LV) appearance in a porcine model. Ten piglets were included in the experimental group, and 5 served as controls. The experimental group underwent 3 interventions of progressive hypoventilation (baseline: tidal volume, 240 mL; respiratory frequency, 16 minutes-1 ; first intervention: tidal volume, 240 mL; respiratory frequency, 8 minutes-1; second intervention: tidal volume, 240 mL; respiratory frequency, 4 minutes-1 ; and third intervention: tidal volume, 120 mL; respiratory frequency, 4 minutes-1 ). Respiratory resuscitation was initiated if the MAP decreased to 50% of the baseline level or at the end of the third intervention. Transthoracic sonography and invasive measurements were obtained throughout. The primary end point was the LV end-diastolic eccentricity index, a measure of LV D-shaping. The median LV end-diastolic eccentricity index increased from 1.1 (interquartile range, 1.0-1.1) at baseline to 1.4 (1.3-1.4) 3 minutes after the third intervention (P < .001) and returned to baseline after resuscitation (P = .093). The MAP declined from 87 mm Hg (81-92 mm Hg) to 50 mmHg (33-66 mm Hg) after initiation of the third intervention (P < .001). The mean pulmonary arterial pressure increased from 20 mm Hg (15-21 mm Hg) to 39 mm Hg (38-40 mm Hg) during the second intervention (P < .001). Progressive hypoventilation led to a marked D-configuration of the LV and a sharp decrease in systemic blood pressure. After respiratory resuscitation, sonographic measures normalized. These findings were explainable by the pressure changes observed within the left and right ventricles.

Effectiveness of a Perioperative Transthoracic Ultrasound Training Program for Students and Residents

Focused ultrasound (US) is being incorporated across all levels of medical education. Although many comprehensive US courses exist, their scope is broad, requiring expert instructors, access to simulation, and extensive time commitment by the learner. We aim to compare learning across levels of training and specialties using a goal-directed, web-based course without live skills training. A prospective observational study of students and residents from medicine, surgery, and anesthesiology. Analysis compared pretests and posttests assessing 3 competencies. Individual mean score improvement (MSI) was compared by paired-sample t-tests and MSI among cohorts by analysis of variance, with significance set at p ≤ 0.05. McNemar test compared those who agreed or strongly agreed with survey items with those who did not before and after intervention. Jackson Memorial Hospital, Miami, FL residency training programs in Medicine, Surgery, and Anesthesiology. A total of 180 trainees participated. A significant MSI was noted in each of 3 competencies in all 3 cohorts. Students' (S) MSI was significantly higher than residents' (R) and interns' (I) in US "knobology" and window recognition [S = 2.28 ± 1.29/5 vs R = 1.63 ± 1.21/5 (p = 0.014); vs I = 1.59 ± 1.12/5 (p = 0.032)]; students' total score MSI was significantly higher than residents [7.60 ± 3.43/20 vs 5.78 ± 3.08/20 (p < 0.008)]. All cohorts reported improved comfort in using transthoracic US and improved ability to recognize indications for use. More than 81% of all participants reported improved confidence in performing transthoracic US; more than 91% reported interest in additional training; and more than 88% believed course length was appropriate. Learners across levels of medical training and specialties can benefit from a brief, goal-directed, web-based training with early incorporation producing maximal yield.

Contribution of Myocardial Perfusion’s Tomoscintigraphy in the Management of Coronarian Disease in Senegal: About 42 Cases

The aim of the study was to evaluate the contribution to moscintigraphy of myocardial perfusion (TSMP) with 99mTc-sestamibi in the management of suspected or known coronary patients’s population. It included 42 patients with an average age of 57.02 ± 9.77 years with extremes ranging from 36 to 77 years. The pre-test probability in 38 patients was high in 7 patients (18.42%), intermediate in 29 patients (76.31%) and low in 2 patients (5.26%). Patients with a high pre-test probability had a positive scintigraphy. Among the 26 patients who underwent transthoracic ultrasound (TTU), 10 with normal kinetics on trans-thoracic ultrasound (TTU) had positive scintigraphy. For 16 patients with TTU abnormalities, 6 had negative scintigraphy and 10 had positive scintigraphy. The TSMP was positive for 28 patients (66.66%). Among these patients, 16 had pure ischemia, 57.14% (16/28), 7 pure necrosis (25%), and 5 both necrosis and ischemia. Myocardial perfusion scintigraphy remains a very contributory consideration in the management of coronary disease. This is synchronized with the electrocardiogram (ECG) and is an important diagnostic and prognostic tool for coronary artery disease. It also provides a good indication of coronary angiography.