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Awali M, Middleton WD, Daggumati L, Phillips CH, Caserta MP, Fetzer DT, Dahiya N, Chong WK, Wasnik AP, Burgan CM, Morgan T, Itani M. Ultrasound of palpable lesions: a pictorial review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04249-0. [PMID: 38763936 DOI: 10.1007/s00261-024-04249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 05/21/2024]
Abstract
Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.
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Affiliation(s)
- Mohamed Awali
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Lasya Daggumati
- University of Missouri Kansas City School of Medicine, 2411 Holmes St, Kansas City, MO, 64108, USA
| | - Catherine H Phillips
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Melanie P Caserta
- Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - David T Fetzer
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Nirvikar Dahiya
- Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Wui K Chong
- University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Ashish P Wasnik
- University of Michigan-Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Constantine M Burgan
- University of Alabama at Birmingham, 625 19 Street South JT N338A, Birmingham, AL, 35233, USA
| | - Tara Morgan
- Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA.
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Nti BK, Benzoni N, Starr R, Hays M, Vish D, End B, Russell F. Serial Trauma Abdominal Ultrasound in Children (STAUNCH): A Pilot Study. Pediatr Emerg Care 2024:00006565-990000000-00430. [PMID: 38587011 DOI: 10.1097/pec.0000000000003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. METHODS We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations. Examinations from pediatric patients (18 years or younger) who presented to an emergency department with blunt abdominal trauma were eligible for inclusion as long as the period between the first and second FAST was at least 30 minutes but no more than 24 hours. Demographic data and patient and outcomes were collected. RESULTS Data collected from 3 institutions found a total of 38 sFAST performed between July 2017 and September 2021 on eligible patients. Of these, there were 6 (15.4%) FAST examinations that were positive after an initial negative or indeterminate interpretation. The overall sensitivity and specificity of sFAST were 66.7% (95% confidence interval 22.3-95.7%) and 93.8% (79.2-99.3%), respectively. CONCLUSIONS This pilot study found that sFAST can enhance blunt trauma evaluation and improve sensitivity and diagnostic accuracy. More data are needed to determine how sFAST can be utilized in pediatric patients with blunt abdominal trauma.
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Affiliation(s)
- Benjamin K Nti
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Nicole Benzoni
- Franciscan Critical Care Medicine at St. Michael, Silverdale, WA
| | - Rebecca Starr
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Matthew Hays
- Department of Biostatistics and Health Science Data, Indiana University School of Medicine, Indianapolis, IN
| | - Dylan Vish
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Bradley End
- Department of Emergency Medicine, West Virginia University, Morgantown, WV
| | - Frances Russell
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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Shaahinfar A, Ghazi-Askar ZM. Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine. Emerg Med Clin North Am 2021; 39:529-554. [PMID: 34215401 DOI: 10.1016/j.emc.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central line placement), and critical care (endotracheal tube placement, pericardiocentesis, thoracentesis, and paracentesis). By incorporating ultrasound, emergency physicians caring for pediatric patients have the potential to enhance their procedural scope, confidence, safety, and success.
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Affiliation(s)
- Ashkon Shaahinfar
- Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Trailer 3, 747 52nd Street, Oakland, CA 94609, USA; Department of Emergency Medicine, UCSF School of Medicine, 550 16th Street, MH5552, San Francisco, CA, USA.
| | - Zahra M Ghazi-Askar
- Department of Emergency Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room M121, Alway Building MC 5768, Stanford, CA 94305, USA
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Gottlieb M, Sundaram T, Kim DJ, Olszynski P. Just the facts: point-of-care ultrasound for skin and soft-tissue abscesses. CAN J EMERG MED 2021; 23:597-600. [PMID: 33886108 DOI: 10.1007/s43678-021-00132-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, 1750 West Harrison Street, Suite 108 Kellogg, Chicago, IL, 60612, USA.
| | - Tina Sundaram
- Department of Emergency Medicine, Rush University Medical Center, 1750 West Harrison Street, Suite 108 Kellogg, Chicago, IL, 60612, USA
| | - Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Menegas S, Moayedi S, Torres M. Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians. J Emerg Med 2020; 60:310-320. [PMID: 33298356 DOI: 10.1016/j.jemermed.2020.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/02/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses. OBJECTIVE This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department. DISCUSSION Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative. CONCLUSIONS This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.
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Affiliation(s)
- Samantha Menegas
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Siamak Moayedi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mercedes Torres
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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