Interventional Ultrasound: A Practical Guide and Atlas
Title Page
Copyright
Contents
Foreword
Preface
Acknowledgments
Contributors
Abbreviations
General Aspects of Interventional Ultrasound
1 Interventional Ultrasound: Introduction and Historical Background
1.1 The Vienna Congress
1.2 The Introduction of Ultrasound into Routine Clinical Use
1.2.1 The Evolution of Ultrasound Imaging Techniques
1.2.2 Technical Evolution of Ultrasound-Guided Biopsies
1.2.3 Clinical Application
1.2.4 Risks of Interventional Ultrasound
1.3 Later Developments: Ultrasound- Guided Therapeutic Interventional Procedures
1.4 Outlook
References
2 Interventional Materials and Equipment
2.1 General Considerations on Interventional Procedures
2.1.1 Brief Historical Introduction
2.1.2 Biopsy Principles and Techniques
2.1.3 Needle Systems
2.2 Therapeutic Interventions
2.2.1 Introduction
2.2.2 Brief Historical Review
2.2.3 Patient Preparation
2.2.4 Access Routes
2.2.5 Indications and Contraindications
2.2.6 Complications
2.2.7 Needle Techniques
2.2.8 Special Needle Types
2.2.9 Trocar Technique
2.2.10 Seldinger Technique
2.2.11 Peel-Away Sheath
2.2.12 Anchor Systems, Suture Techniques
2.2.13 Guidewires
2.2.14 Dilators
2.2.15 Drainage Catheters
2.2.16 Other Drainage Systems
2.2.17 Accessories
References
3 Informed Consent
3.1 What Should Be Disclosed?
3.1.1 Indication
3.1.2 Explaining the Procedure
3.1.3 Risks and Complications
3.2 Means of Disclosure
3.2.1 Consent Form
3.2.2 Informed Consent Discussion
3.2.3 Delegating Informed Consent
3.3 Documentation
3.4 Timing of the Consent Process
3.5 Special Situations
3.5.1 Implied Consent
3.5.2 Patients Lacking the Capacity to Consent
3.5.3 Minors
3.5.4 Language Barriers
3.5.5 Waiving of Informed Consent
References
4 Medications, Equipment, and Setup Requirements
4.1 Medications
4.1.1 Premedication
4.1.2 Analgesia
4.1.3 Coagulation
4.1.4 Local Anesthesia
4.2 Equipment and Setup Requirements
4.2.1 Biopsy Equipment
4.2.2 Interventional Materials
4.2.3 Positioning, Preprocedure Examination, and Marking
4.2.4 Monitoring During the Procedure
4.2.5 Postprocedure Monitoring
4.2.6 Facilities (Procedure Room)
4.2.7 Functional and Design Requirements
4.2.8 Operational and Organizational Requirements
References
5 Pathology and Cytology
5.1 Pathology
5.2 Biopsies
5.2.1 Types of Biopsy Procedure
5.3 Histology or Cytology?
5.3.1 Sources of Error
5.4 Typing, Grading, and Staging
5.4.1 Classification (Typing)
5.4.2 Grading
5.5 Specific Analysis
5.5.1 Lymph Nodes
5.5.2 Lymphomas
5.6 Hormone Growth Factor Receptor Analysis
References
6 Fine Needle Aspiration Cytology
6.1 Specimen Collection
6.1.1 Ultrasound-Guided Biopsy
6.1.2 Needle Movement and Aspiration
6.2 Specimen Preparation
6.2.1 Fluid Aspirates
6.2.2 Centrifuging Effusions
6.2.3 Aspirates from Solid Lesions
6.3 Fixation and Staining
6.3.1 Basic Principles
6.3.2 Air Drying and Romanowsky Stains
6.3.3 Wet Fixation and Papanicolaou Staining
6.3.4 Ancillary Tests
6.4 Cytomorphologic Evaluation
6.4.1 Rapid On-Site Evaluation
6.4.2 Final Cytologic Diagnosis
6.5 Conclusions
References
7 Infections and Diagnostic Microbiology
7.1 General Principles of Microbiological Testing
7.1.1 Microbiological Specimens
7.1.2 Prerequisites for Microbiological Testing
7.2 Microbiological Techniques
7.2.1 Stains
7.2.2 Culture Techniques
7.2.3 Nucleic Acid Amplification Techniques
7.2.4 Serology
7.2.5 When Are Microbiological Test Results Available?
7.2.6 Limitations of Microbiological Methods
7.2.7 Specimen Receipt during Off-hours (Nights,Weekends, Holidays)
7.3 Specific Guidelines for Microbiological Testing and Differential Diagnosis by Organ Systems and Syndromes
7.3.1 Investigation of Enlarged Lymph Nodes
7.3.2 Microbiological Testing and Antimicrobial Therapy for Suspected Tuberculosis
7.3.3 Liver Mass Suspicious for an Abscess (Including Amebic Abscess)
References
8 Hygiene Management
8.1 General Hygienic Requirements
8.1.1 Personal Protective Equipment and Coverings
8.1.2 Disposable Probe Covers
8.1.3 Ultrasound Gel
8.2 Hand Antisepsis and Skin Preparation.
8.3 Ultrasound Probe and Accessories
8.3.1 Decontamination of the Ultrasound Probe
8.3.2 Decontamination of Ultrasound Accessories
References
9 Contraindications, Complications, and Complication Management
9.1 Interventional Risk
9.1.1 Complication Rates and Mortality
9.1.2 Factors that Influence Interventional Risk
9.2 Frequent Complications and Their Risk Factors
9.2.1 Pain and Vasovagal Reactions
9.2.2 Bleeding Complications
9.2.3 Needle Tract Seeding
9.2.4 Specific Complications
9.3 Prevention of Complications
9.3.1 Risk Assessment and Patient Selection
9.3.2 Modification of Risk Factors
9.3.3 Risk Reduction Techniques
9.3.4 Local Anesthesia and Intravenous Sedation
9.3.5 Prevention of Infection
9.3.6 Optimal Approach and Alternatives
9.4 Contraindications
9.4.1 Coagulopathies
9.4.2 Procoagulant Therapy and Antiplatelet Drugs
9.4.3 βRiskyβ Lesions and Access Routes
9.5 Management of Complications
9.5.1 Postinterventional Care and Detection of Complications
9.5.2 Treatment of Complications
9.6 Specific Biopsy Sites
9.6.1 Liver Biopsy
9.6.2 Renal Biopsy
9.6.3 Pancreatic Biopsy
9.6.4 Splenic Biopsy
9.6.5 Biopsy of Gastrointestinal Hollow Organs and Mesenteric Masses
9.6.6 Adrenal Biopsy
9.6.7 Lungs, Pleura, and Mediastinum
9.7 Specific Interventions
9.7.1 EUS-FNA, EUS-TCB, EBUS-TBNA
9.7.2 EUS-Guided Therapeutic Interventions
9.7.3 Transrectal Prostatic Biopsy
9.7.4 Ultrasound-Guided Drainage (of Cysts, Pseudocysts, Abscesses, Cholecystitis)
9.7.5 Ultrasound-Guided PTCD and Cholecystotomy
9.7.6 Ultrasound-guided Tumor Ablation Therapy
References
10 Assistance in Ultrasound Interventions
10.1 Basic Principles
10.2 Duties of Assisting Personnel
10.3 Diagnostic Ultrasound
10.4 Diagnostic Interventions
10.5 Therapeutic Interventions
10.6 Sedation
10.7 Drain Placement
10.8 Endosonography
References
11 Sedation in Interventions
11.1 Introduction
11.2 Medications
11.3 Personnel Requirements
11.4 Monitoring Requirements
11.5 Postprocedure Care
11.6 Complications
11.7 Summary
References
Specific Ultrasound-Guided Procedures: Abdomen
12 Indications for Diagnostic Interventions in the Abdomen and Thorax (Liver, Pancreas, Spleen, Kidneys, Lung, Other Sites)
12.1 Liver
12.1.1 Diffuse Liver Diseases
12.1.2 Focal Liver Lesions
12.2 Pancreas
12.3 Spleen
12.4 Kidneys
12.5 Lung
12.6 Adrenal Gland
12.7 Lymph Nodes
12.8 Other Lesions
References
13 Diagnostic and Therapeutic Paracentesis of Free Abdominal Fluid
13.1 Peritoneal Cavity
13.2 Sites of Predilection for Intra-abdominal Fluid
13.3 Pathogenesis and Differential Diagnosis of Ascites
13.4 Specific Indications
13.4.1 Transudate
13.4.2 Exudate
13.4.3 Cirrhosis
13.4.4 Heart Failure
13.4.5 Hypoalbuminemia
13.4.6 Peritonitis
13.4.7 Peritoneal Carcinomatosis
13.4.8 Hemoperitoneum
13.4.9 Pancreatitis
13.4.10 Other Rare Abdominal Fluid Collections
13.5 Differentiating a Localized Fluid Collection from Ascites
13.6 Practical Issues: How and Where to Aspirate?
13.7 Diagnostic Paracentesis: Laboratory Tests
13.8 Indications for Therapeutic Paracentesis
13.8.1 Treatment of Ascites in Hepatic Cirrhosis: Paracentesis for Symptom Relief in Hepatic Cirrhosis (and Pancreatitis)
13.8.2 Palliative Paracentesis for Peritoneal Carcinomatosis
13.8.3 Cytostatic Therapy of Peritoneal Carcinomatosis (Intraperitoneal Chemotherapy)
13.8.4 Drainage (with Irrigation) for Bile Leakage (For Example in a Palliative Setting)
13.9 Materials
13.10 Contraindications, Complications, and Postprocedure Care
References
14 Fine Needle Aspiration Biopsy and Core Needle Biopsy
14.1 Historical Background
14.2 Description of Biopsy Techniques
14.2.1 What Type of Needle Should Be Used?
14.3 Biopsy Technique for Specific Needle Types
14.3.1 Biopsy with the Chiba Needle
14.3.2 Cutting Biopsy with an Otto or Franseen Needle
14.3.3 Autovac and BioPince Biopsy Systems
14.3.4 Biomol Biopsy System
14.3.5 Trucut Needles
14.4 Summary
References
15 Abscess Drainage
15.1 Historical Considerations
15.2 Preliminary Remarks, Etiology
15.3 Selection of Imaging Modality
15.3.1 Ultrasound
15.3.2 Conventional Radiographic Drainage
15.3.3 Computed Tomography
15.3.4 Magnetic Resonance Imaging
15.4 Devices
15.4.1 Drainage Catheters
15.5 Indications
15.6 Contraindications
15.7 Patient Preparation
15.8 Treatment Options
15.8.1 General
15.8.2 Medical Treatment Options
15.8.3 Surgical Treatment Options
15.9 Technique of Percutaneous Abscess Drainage
15.9.1 Preparation
15.9.2 Initial Needle Insertion
15.9.3 Trocar Technique
15.9.4 Irrigation
15.9.5 Drain Removal
15.9.6 Specimen Processing
15.10 Postprocedure Care
15.11 Specific Diseases
15.11.1 Pyogenic Liver Abscess
15.11.2 Abscesses in Appendicitis, Peridiverticulitis
15.11.3 Liver Abscess in Biliary Disease
15.11.4 Abscess in Pancreatitis
15.11.5 Liver Abscess in Amebiasis
15.11.6 Protozoan Infections with Liver Involvement
15.11.7 Septic (Pyogenic) Abscess with Associated Diseases (Sepsis, Coagulopathies, Ascites)
15.11.8 Infection of Necrotic Tumor Components
15.11.9 Liver Abscess after Liver Transplantation
15.12 Complications
15.13 Irrigation
15.14 Sequelae
15.15 Ultrasound-Guided Gallbladder Drainage and Other Indications
References
16 Percutaneous Sclerotherapy of Cysts
16.1 Percutaneous Sclerotherapy of Liver Cysts
16.1.1 Epidemiology and Etiology
16.1.2 Symptoms
16.1.3 Indications
16.1.4 Contraindications
16.1.5 Interventional Materials and Equipment
16.1.6 Sclerosing Agents
16.1.7 Treatment Options
16.1.8 Technique for Percutaneous Sclerotherapy of a Liver Cyst
16.2 Sclerotherapy Technique
16.2.1 Follow-up Care
16.2.2 Prognosis
16.3 Percutaneous Sclerotherapy of Renal Cysts
16.3.1 Summary of the Literature
16.3.2 Epidemiology, Differential Diagnosis, and Classification
16.3.3 Technique
16.3.4 Sclerosing Agents
16.4 Alternative Procedures
16.5 Special Issues Relating to Splenic Cysts
16.6 Special Issues Relating to Pancreatic Cysts
References
17 Interventional Treatment of Echinococcosis
17.1 Echinococci: Types and Epidemiology
17.1.1 Echinococcus granulosus
17.1.2 Echinococcus multilocularis
17.2 Clinical Manifestations
17.3 Diagnosis
17.3.1 Three Main Diagnostic Criteria
17.3.2 Laboratory Parameters
17.3.3 Serologic and Molecular Biologic Tests
17.4 Imaging Studies, Staging of Disease
17.4.1 Historical Background
17.4.2 Morphologic and Functional Classification Systems
17.4.3 WHO Classification
17.5 Treatment
17.5.1 Surgical Treatment Options
17.5.2 Drug Treatment Options
17.5.3 Local Ablative Procedures: PAIR
17.5.4 Endoscopic Retrograde Cholangiography
References
18 Local Ablative Procedures Percutaneous Ethanol and Acetic Acid Injection
18.1 Basic Considerations
18.1.1 What Tumors Are Suitable for Local Ablative Procedures?
18.1.2 Radiofrequency Ablation or Percutaneous Ethanol Injection?
18.1.3 Ethanol or Acetic Acid Injection?
18.1.4 Single or Multiple Sessions?
18.2 Indications
18.2.1 Considerations on Hepatocellular Carcinoma
18.3 Contraindications
18.4 Practical Aspects
18.4.1 Materials and Equipment
18.4.2 Preparations
18.4.3 Technique
18.5 Follow-up Care, Complications, and Prognosis
18.5.1 Follow-up Care
18.5.2 Complications
18.5.3 Monitoring of Treatment Response
18.5.4 Factors That Determine Prognosis
18.6 Summary
References
19 Local Ablative Procedures for Liver Tumors, Radiofrequency Ablation
19.1 Concepts (Curative, Palliative, Multimodal)
19.1.1 Hepatocellular Carcinoma
19.1.2 Colorectal Carcinoma
19.2 Selection of Imaging Modality (Ultrasound, CT, MRI)
19.3 Indications
19.3.1 Number of Tumors
19.3.2 Tumor Size
19.3.3 Tumor Location
19.4 Contraindications
19.5 Preparations
19.5.1 Antibiotic Prophylaxis
19.5.2 Local Anesthesia, Sedation, Sedation/ Analgesia, and General Anesthesia
19.5.3 Treatment Planning
19.6 Materials
19.6.1 Standard Materials
19.6.2 Basic Principle
19.6.3 Monopolar versus Bipolar and Multipolar Systems
19.6.4 Needle Applicators
19.6.5 Control and Temperature Measurement
19.6.6 Flow Rate of Needle Perfusion
19.7 Technique
19.7.1 Patient Positioning
19.7.2 (Local) Anesthesia
19.7.3 Probe Insertion
19.7.4 Techniques for Specific Systems
19.8 Assessing the Efficacy of Treatment
19.9 Complications and Aftercare
19.9.1 Complications
19.9.2 Postinterventional Care
19.9.3 Clinical Aftercare and Follow-up
References
20 Percutaneous Transhepatic Cholangiodrainage
20.1 Basic Principles
20.2 Indications
20.2.1 Endoscopic Retrograde or Percutaneous Approach
20.2.2 Rendezvous Technique
20.3 Contraindications
20.4 Materials and Equipment
20.4.1 Description of Materials
20.5 Technique
20.5.1 Patient Positioning
20.5.2 Needle Insertion and Drainage
20.5.3 Procedure Time
20.6 Success Rate
20.6.1 Results with Plastic Endoprostheses
20.6.2 Results with Metal Endoprostheses
20.7 Complications
20.7.1 Incidence
20.7.2 Management of Complications
20.8 Aftercare
20.9 Use of Intracavitary Ultrasound Contrast Agents
20.10 Analysis of the Literature
20.10.1 Present Authorsβ Data
20.10.2 Comparison of Endoprostheses
References
21 Percutaneous Gastrostomy
21.1 Indications
21.2 Contraindications
21.3 Materials and Equipment
21.4 Types of Gastrostomy
21.4.1 Percutaneous Endoscopic Gastrostomy
21.4.2 Percutaneous Sonographic Gastrostomy
21.5 Advantages and Disadvantages of Different Methods
21.6 Success Rates of Different Gastrostomy Techniques
21.7 Complication Rates of Different Gastrostomy Techniques
21.8 Role of Ultrasonography
21.8.1 General
21.8.2 Ultrasound-Assisted PEG
21.8.3 Technique of Percutaneous Sonographic Gastrostomy
21.9 Questions Relevant to Percutaneous Sonographic Gastrostomy
21.9.1 Use of a Spasmolytic Agent
21.9.2 Prophylactic Antibiotics
21.9.3 Use of a Guidewire
21.9.4 Need for Gastropexy
21.9.5 Type of Drainage
21.10 Summary
References
22 Interventional Endosonography
22.1 CostβBenefit Analysis
22.2 Historical Introduction
22.3 Materials and Equipment
22.3.1 Requirements of the Endoscopy Unit
22.3.2 Which Endosonography Systems Have Become Established?
22.3.3 Which Biopsy Needles and Techniques Have Become Established?
22.3.4 Guidewires
22.3.5 Fixed-Diameter Dilators
22.3.6 Balloon Dilators
22.3.7 Plastic Stents (Pigtail)
22.3.8 Metal Stents
22.3.9 Diathermy Devices, Cystotome
22.3.10 Retrievers
22.3.11 Supplementary Techniques in EUS-guided Biopsy
22.4 Procedure
22.4.1 Sedation
22.4.2 Other Medications
22.4.3 Orientation
22.4.4 General Rules for Needle Insertion
22.4.5 Biopsy Technique
22.4.6 Suction
22.4.7 Specimen Processing
22.5 Diagnostic Interventions
22.5.1 Indications
22.5.2 Risk of Complications
22.5.3 Contraindications
22.6 Therapeutic Interventions, General Aspects
22.6.1 Therapeutic EUS-Guided Interventions
22.6.2 Endoscopes and Needle Types
22.6.3 General Rules for Needle and Wire Handling
22.6.4 Indications
22.6.5 Contraindications
22.7 Drainage of Peripancreatic Fluid Collections
22.7.1 History
22.7.2 Basic Anatomical Considerations
22.7.3 Pathophysiologic Considerations
22.7.4 DiagnosticWorkup
22.7.5 Indications
22.7.6 Timing of the EUS Intervention
22.7.7 Selection of Procedure
22.7.8 Technique
22.7.9 One-Step Systems
22.7.10 Treatment of Nonpancreatic Fluid Collections
22.7.11 Surgical Options
22.8 EUS-Guided Cholangiodrainage
22.8.1 Introduction
22.8.2 Indications and Treatment Goals
22.8.3 Equipment
22.8.4 Preparatory Measures
22.8.5 Technique
22.8.6 Assessing the Result, Postinterventional Care, Complications
22.9 EUS-Guided Pancreatic Duct Drainage
22.9.1 Indications and Treatment Goals
22.9.2 Technique
22.9.3 Assessing the Result, Postinterventional Care, Complications
22.10 Celiac Plexus Neurolysis and Celiac Plexus Blockade
22.10.1 Indications and Treatment Goals
22.10.2 Materials
22.10.3 Technique
22.10.4 Assessing the Result, Postinterventional Care, Complications
22.11 Tumor Ablation with Alcohol
22.12 EUS-Guided Vascular Interventions
22.12.1 Indications and Treatment Goals
22.12.2 Materials
22.12.3 Technique
22.12.4 Assessing the Result, Postinterventional Care, Complications
22.13 Complications
22.14 Postinterventional Care
References
23 Special Issues Regarding Interventions in the Spleen
23.1 Diffuse Splenic Changes
23.2 Specific Disorders
23.2.1 Splenic Rupture
23.2.2 Splenic Infarction
23.2.3 Focal Splenic Changes
23.3 Procedures
23.3.1 Clinical Scenarios
23.3.2 Anatomical Considerations in Splenic Interventions
23.3.3 Procedures for Specific Applications
23.4 Abscess Drainage
23.5 Indications
23.6 Contraindications
23.7 Indications for Splenic Biopsy Drawn from Case Data
23.8 Postinterventional Care
23.9 Complications
23.10 Preinterventional Vaccinations
References
Specific Ultrasound-Guided Procedures: Thorax
24 Thoracic Interventions
24.1 Advantages of Ultrasound-Guided Interventions
24.2 Indications
24.3 Contraindications
24.4 Selection of Materials
24.4.1 Ultrasound Technology
24.4.2 Biopsy Devices
24.5 Preparations
24.6 Technique
24.6.1 Chest Wall Lesions
24.6.2 Pleural Space
24.6.3 Subpleural Lung Lesions
24.6.4 Pulmonary Abscesses
24.6.5 Mediastinum
24.7 Steps in the Procedure
24.7.1 Preparations
24.7.2 Technique
24.7.3 Postprocedure Care
24.8 Problems and Complications
24.8.1 Postbiopsy Pneumothorax
24.9 Postprocedure Care and Follow-Up
References
Specific Ultrasound-Guided Procedures: Urogenital System
25 Percutaneous Renal Biopsy
25.1 Indications
25.2 Contraindications
25.3 Materials and Equipment
25.4 Preparations
25.5 Procedure
25.5.1 Native Renal Biopsy
25.5.2 Review of the Procedure Steps
25.5.3 Biopsy of a Renal Allograft
25.6 Complications
25.7 Postbiopsy Care
25.8 List of Materials and Equipment
References
26 Interventional Urology
26.1 Transrectal Ultrasonography of the Prostate
26.1.1 Introduction.
26.1.2 Equipment Requirements
26.2 Diseases of the Prostate
26.2.1 Prostate Cancer
26.2.2 Prostatic Abscess
26.3 Prostate Biopsy
26.3.1 Introduction
26.3.2 Indications
26.3.3 Informed Consent and Preparation
26.3.4 Complications and Their Management
26.3.5 Transperineal Biopsy
26.4 Percutaneous Nephrostomy
26.4.1 Introduction
26.4.2 Indications
26.4.3 Relative Contraindications
26.4.4 Complications
26.4.5 Preparations
26.4.6 Materials and Equipment
26.4.7 Technique
26.4.8 Anesthesia
26.4.9 Procedure
26.4.10 Postoperative Care
References
Specific Ultrasound-Guided Procedures: Other Organ Systems
27 Interventional Thyroid Ultrasound
27.1 Diagnostic Interventions
27.1.1 Indications
27.1.2 Contraindications
27.1.3 Methods
27.1.4 Complications
27.1.5 Materials and Equipment
27.1.6 Preparation
27.1.7 Procedure
27.1.8 Problems
27.1.9 Pitfalls in Thyroid Biopsy
27.2 Therapeutic Interventions
27.2.1 Evacuation Procedures
27.2.2 Ablative Procedures
References
28 Musculoskeletal Interventions
28.1 Indications and Contraindications
28.1.1 Indications
28.1.2 Contraindications
28.2 Materials and Equipment
28.3 Procedure
28.3.1 Preparations
28.3.2 Overview of Technique
28.3.3 Details of Technique
28.3.4 Rotator Cuff (Supraspinatus Muscle)
28.4 Pitfalls and Complications
28.5 Postprocedure Care
References
29 Neurologic Interventions, Ultrasound-Guided Regional Anesthesia
29.1 History and Development
29.2 Indications
29.3 Contraindications
29.3.1 Patient Refusal
29.3.2 Clinically Overt Coagulopathy and Anticoagulant Medication
29.3.3 Infections at the Puncture Site
29.3.4 Neurologic Deficit
29.4 Needle Insertion Techniques
29.4.1 Out-of-Plane versus In-Plane Technique
29.5 Ultrasound Imaging of Nerves and Muscles
29.5.1 Nerves
29.5.2 Muscles
29.6 Materials and Equipment
29.6.1 Ultrasound Machines
29.6.2 Anesthesia Needles and Catheters
29.7 Regional Anesthesia at Specific Sites: Upper Limb
29.7.1 Brachial Plexus
29.7.2 Infraclavicular Brachial Plexus Block
29.7.3 Axillary Brachial Plexus Block
29.8 Regional Anesthesia at Specific Sites: Lower Limb
29.8.1 Lumbosacral Plexus
29.8.2 Femoral Nerve Block
29.8.3 Obturator Nerve Block
29.8.4 Sciatic Nerve Block
29.8.5 Saphenous Nerve Block
29.8.6 Lateral Femoral Cutaneous Nerve Block
29.9 Summary
References
30 Ultrasound-Guided Emergency and Vascular Interventions
30.1 Emergency Interventions
30.1.1 Indications
30.1.2 Contraindications
30.1.3 Materials and Equipment
30.1.4 Antisepsis
30.1.5 Problems and Complications
30.1.6 Intra-abdominal Free Fluid
30.1.7 Intrathoracic Free Fluid
30.1.8 Pneumothorax
30.1.9 Pericardial Fluid
30.2 Percutaneous Vascular Interventions
30.2.1 Vascular Access
30.2.2 Ultrasound-Guided Treatment of Pseudoaneurysms
30.3 Endosonographically Guided Vascular Interventions
30.3.1 Indications and Treatment Goals
References
Specific Ultrasound-Guided Procedures: Other Applications of Interventional Ultrasound
31 Extravascular Use of Ultrasound Contrast Agents
31.1 Approved Indications
31.2 Contraindications and Complications
31.3 Technique
31.4 Use of Ultrasound Contrast Agents in Physiologic Body Cavities
31.4.1 Voiding Sonography for the Detection of Vesicoureteral Reflux
31.4.2 Contrast-Enhanced Ultrasound for Evaluating Tubal Patency
31.4.3 Imaging the Peritoneal Cavity with UCAs (for Detection of Ascites)
31.4.4 Biliary Tract
31.4.5 UCAs in Enterography
31.4.6 CEUS GastrographyβPercutaneous Injection of UCA into the Stomach to Assess Gastrostomy Placement
31.5 Use of Ultrasound Contrast Agents in Nonphysiologic Body Cavities
31.5.1 Ultrasound Fistulography
31.5.2 Percutaneous Injection of UCAs for Abscess Imaging
31.5.3 UCAs for Demonstrating Pancreatitis-Associated Cystic Lesions after EUS-Guided Biopsy
31.6 Summary
References
32 Volume Navigation.
32.1 How Tracking Works
32.2 Position Marking
32.3 Fusion with CT, MRI, or PET Volume Data Sets
32.4 Fusion with Archived Ultrasound Volume Data
32.5 Magnetic FieldβAssisted Needle Tracking and Guidance
32.6 Illustrative Images and Case Reports
32.6.1 Case Report 1
32.6.2 Case Report 2
References
33 Palliative Interventions and the Role of Ultrasonography in Palliative Care
33.1 Content and Goals of Palliative Care
33.2 Ultrasound in Palliative Staging, Follow-Up, and Palliative Treatment Monitoring
33.3 Ultrasound-Guided Palliative Interventions
33.3.1 Palliative Diagnostic Interventions
33.3.2 Specific Palliative Therapeutic Interventions
33.4 Portable Ultrasound in Specialized Ambulatory Palliative Care
33.5 Palliative Ultrasound in Caring Medicine
33.6 Conclusions
References
Index