Subcostal view, large chronic pericardial effusion without signs of tamponade.
Subcostal view of a moderate pericardial effusion with signs of RV and RA collapse. Patient presented with tachycardia, hypotension and had a dilated, non-responsive IVC. Emergent bedside pericardiocentis was performed and she stabilized.
PLAX loop of a heart of a patient with acute pulmonary embolism shows severe right ventricle dilation with no contraction except apically. This is known as McConnell sign.
PSAX loop of a normal heart. The left ventricle contracts and expands symmetrically and the Right ventricle is crescent shaped and small.
PSAX loop of a heart with chronic severe right heart strain. The left ventricle contracts into a D-Shape and the right ventricle is grossly dilated and circular.
A normal intercostal space with an A-line pattern and lung sliding.
An abnormal intercostal space with a B-line pattern. This represents a single positive zone.
An intercostal space using a pocket-sized ultrasound. Note the presence of both A-lines in the top portion of the screen and numerous B-lines. This should be considered a positive zone.
Thickened diaphragm. This example is from a patient with a malignant pleural effusion. The diaphragm can be seen as a thickened echogenic line traversing the middle of the image.
PE, pleural effusion. Note the multiple lattice-like septations in this complex pleural effusion. Because of this, the patient went for VATS (video-assisted thoracoscopic surgery) instead of having a bedside thoracentesis.
A normal intercostal space with an A-line pattern and normal lung sliding with curvilinear high-frequency probe.
A normal intercostal space with an A-line pattern and normal lung sliding a linear high-frequency probe.
Although an A-line pattern is seen, there is no sliding, which suggests PTX.
B-lines are laser-like vertical artifacts that arise at the pleural line and move with respiration. The presence of B-lines rules out PTX at this position.
A lung point is diagnostic of PTX. Note the dynamic transition point as normal sliding along the pleural line varies with respiration.
Consolidation with air bronchograms. Note the moving, hyperechoic lines which are dynamic air bronchograms and the similar appearing non-moving lines which are static air bronchograms. Dynamic air bronchograms are specific for pneumonia while static air bronchograms can be caused by pneumonia or atelectasis.This video contains dynamic and static air bronchograms. Courtesy of David Schrift, MD.
Image depicting alternating hyper- and hypoechoic lines and peristalsis of normal bowel.
Video representing to-and-fro movement of bowel contents consistent with a small bowel obstruction.
Video representing significantly decreased to absent peristalsis, a late finding in small bowel obstruction.
Free fluid between loops of small bowel, a late finding in small bowel obstruction (Image and video). Still Image courtesy of Claire Abramoff.
Gastric contents in pyloric channel.
Image of the fetus. M-mode is used to display a dynamic wave form of the fetal heart. M-mode can be used to document static images of cardiac activity.
This video demonstrates active fetal breathing. Notice the diaphragm moving rapidly and the ribs expanding and contracting.
A pedunculated fibroid in the right adnexa. The fibroid is noted to be continuous with the myometrium and separate from the ovary. The fibroid is seen first followed by the ovary as the probe is swept through the right adnexa in the transverse plane.
In this image there is a copper IUD located in the cervical canal. Note the echogenic focus and posterior shadowing. There is also an incidental adnexal mass.
Normal dynamic impingement examination. Note the bird’s beak appearance of the supraspinatus tendon and how it smoothly moves deep to the acromion as the shoulder is slowly abducted.
Pathologic dynamic impingement examination. Note the bird’s beak appearance of the supraspinatus tendon. The tendon is much thicker, more disorganized, and nonfibular in appearance compared to the normal tendon as seen in the normal dynamic impingement examination video. As the shoulder abducts, the tendon passes deep to the acromion in an unsmooth manner in which it catches and bunches along the acromion indicating impingement.
Note how the median nerve dives deep while the tendons maintain their depth in this transverse wrist scan, as the transducer is moved proximally along the forearm.
Swirling pus as an abscess is compressed. Courtesy of Dr. Ben Smith.
This is a video of the same patient from Figure 41.13 who has necrotising fasciitis and gas in the fascial plane. Courtesy of Dr. Adrian Goudie.
Note the alternating hyperechoic and anechoic layers and the hyperechoic shadowing air inside portions of it. Also note the peristalsing movements.
The testicle is visualized on the right. As the patient performs the Valsalva maneuver, fat can be seen herniating into the scrotum.
Full compression of a normal common femoral vein at the saphenous vein junction.
Non-compression of a DVT in the common femoral extending into the saphenous vein junction. The clot can also be visualized directly and is seen as hyperechoic filling of the affected veins.
Maximum diameter is <2.1cm and IVCCI is >50%. In these images the abdominal convention is being used—the probe marker is to the left which corresponds with the cranial end of the patient.
Plethoric IVC with poor collapsibility. Maximum diameter is clearly >2.1 cm and IVCCI is <50%. In these images the abdominal convention is being used—the probe marker is to the left which corresponds with the cranial end of the patient.
Full scan, transverse. This video demonstrates the full scan in the transverse plane from the celiac artery to the iliac bifurcation.
This video demonstrates the full scan in the longitudinal plane from the proximal landmarks to the distal landmarks.
Bowel gas is seen as a hyperechoic with grey shadowing at the top left of the screen. It is initially obscuring view of the aorta and IVC. As graded pressure is applied to the probe, the aorta and IVC can be seen moving to the top of the screen as the bowel gas is pushed out of view.
Left atrial enlargement sign. Parasternal long-axis view of the heart demonstrating a left atrium with a diameter larger than that of the aorta during the entire cardiac cycle.
Subxiphoid view of the heart with pleural effusion. Note the collapse of the right ventricle in diastole which is also known as the “trampoline sign” and is associated with cardiac tamponade. Courtesy of Thomas Cook, MD and Jacob Schoeneck, MD.
Subxiphoid view of the heart with pleural effusion. Note the collapse of the right ventricle in diastole that is also known as the “trampoline sign” and is associated with cardiac tamponade. Courtesy of Thomas Cook ,MD and Jacob Schoeneck, MD.
In this subcostal four chamber view, normal catheter position is confirmed by visualization of echogenic bubbles in the right atrium and ventricle. From Ablordeppey EA, Drewry AM, Beyer AB, et al. Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: A systematic review and meta-analysis. Crit Care Med. 2017 Apr; 45(4): 715–724.
Parasternal long axis view of the heart demonstrating reduced excursion of anterior mitral valve leaflet suggestive of depressed systolic function.
Parasternal long axis view of heart demonstrating normal excursion of anterior mitral valve leaflet consistent with normal systolic function.
The ultrasound transducer is placed in the third intercostal space along the mid-clavicular line of the patient’s anterior chest wall in the sagittal orientation and B-lines are noted.
The transducer is placed in the posterolateral axillary line at the costophrenic angle in a coronal position and no anechoic fluid collection is noted between the lung and diaphragm.
With the transducer in the subxiphoid position and a subcostal 4-chamber view of the heart is obtained. The area of the RV is clearly greater than the area of the LV.
The transducer is placed in the subxiphoid position and a subcostal 4-chamber view of the heart is obtained. The area of the RV is noted to be less than the area of the LV.
From the subxiphoid 4-chamber cardiac view, the probe is rotated from 9 o’clock to 12 o’clock in order to visualize the intrahepatic IVC. The IVC is dilated and demonstrates respiratory variation of less than 50%.
From the subxiphoid 4-chamber cardiac view, the probe is rotated from 9 o’clock to 12 o’clock in order the visualize the intrahepatic IVC. The IVC is not dilated and demonstrates respiratory variation greater than 50%.
Peripheral intravenous (PIV) catheters: Catheter inserted through skin in out-of-plane orientation.
The short-axis method is demonstrated. The needle-tip is seen intermittently as a bright dot. Once seen the provider moves the transducer distally until it disappears. The catheter is then advanced in small increments until the needle-tip is seen again. This process will repeat until the catheter is inserted into the middle of the vein. This process ensures the needle-tip is being visualized and not mistaken for the shaft of the catheter.
The long-axis method is demonstrated. The majority of the catheter and the needle-tip are very visible during the entire cannulation process. The provider occasional moves the transducer laterally to ensure the catheter is lined up with the middle of the vessel. If the catheter is lateral to the middle of the vessel small corrections are made to re-align it.
Notice only the lumen of the vein expands. The surrounding tissue is not expanded. A partial intravenous thrombus can also be seen surrounding the catheter.
Notice the catheter is not clearly within an identifiable lumen and the surrounding tissue is expanded with the flush.
Cine clip of the endometrial polyp using color Doppler.
PLAX view of a heart with normal ejection fraction. Note how the anterior leaflet comes close to striking the interventricular septum.
PLAX view of a heart with moderately reduced ejection fraction. Note how the anterior leaflet stays remote from the interventricular septum and the contractility is reduced but still present.
PLAX view of a heart with severely reduced ejection fraction. Note the near absence of contractility and poor excursion of the mitral valve.
PSAX view of a heart with normal ejection fraction.
PSAX view of a heart with moderately reduced ejection fraction.
PSAX view of a heart with severely reduced ejection fraction.