5 Minute Sono - Central Venous Catheters

5 Minute Sono - ET tube placement

Clinical indications

Facial pain, swelling, erythema, trauma

probe selection

Linear Probe

Tips/Notes

• Thyroid

  • Benign vs malignant

    • Hypoechoic halo produced by pseudo-capsule of fibrous connective tissue = benign

    • Thyroid malignancy

      • Primary sonographic finding is Calcifications without posterior shadowing

      • Ill-defined or irregular margins

      • Blood flow visualized through mass

      • Multiple nodules

      • Absent or incomplete halo

      • Any of these findings warrants referral for comprehensive US and FNA/biopsy

  • Grave’s Disease

    • Thyroid appears hyperechoic with thyroid inferno pattern on color doppler due to increased vascularity

  • Thyroglossal duct cysts

    • Most common congenital neck mass

    • Fluid filled with acoustic enhancement (not shadowing)

    • Can have thick or thin walls

    • Mixed echotexture/debris with complex patterns

    • Need to monitor outpatient

• Parathyroid

  • Will sit on posterior surface of thyroid gland

  • If visible should be suspicious for pathology

  • Will be hypoechoic compared to echogenic thyroid (thyroid often appears homogenous like liver or testicle)

• Lymph Nodes

  • LN are found in the parenchyma, benign nodes are oval in shape and when visualized on a short axis view they are 5-6 mm with a/an homogenous hyperechoic hilum

  • Malignant nodes: round, irregular, boarder, loss of echogenic hilum

• Parotid

  • Warthin’s tumor: Heterotopic parotid tissue located within the parotid LN is indicative of this pathology

    • Will be oval, well defined, hypoechoic

    • Inhomogeneous with multiple irregular anechoic areas

    • Will have hyperechoic posterior acoustic enhancement

  • Will be retromandibular fossa anterior to the ears and SCM

  • Image salivary glands in 2 dimensions

  • Scan through neck to assess for LN’s

• PTA

  • Tonsillitis: diagnosed with enlarged homogenous/striated tonsils

  • PTA: heterogenous/cystic in appearance

  • Normal tonsils:

    • Small, homogenous

    • Oval/triangular shape

    • 10-20 mm in length

• Sjogrens Disease

  • Appears like small, scattered Inhomogeneity: hypoechoic or anechoic with increased flow d/t long term inflammation

• Nasal Bone Fractures

  • US >>> plain films; sensitivity 98%, spec 95%

  • Soft tissue swelling, cortical irregularity, interruption in continuity of bone

Neck Vasculature

• ICA Stenosis

  • > 70 % stenosis gets surgical consult

  • Normal ICA

    • ICA PSV < 125 cm/s

      • Stenotic lumen is narrow and will have increased PSV

    • End diastolic velocity < 40 cm/s

    • No plaque or intimal thickening

    • ICA/CCA PSV ratio < 2

  • Mild ICA stenosis ➡ ratio < 2

  • Moderate ICA stenosis ➡ 2-4

  • Severe ➡ 4

• Carotid Artery Plaque

  • appears as a focal hyperechoic structure within the arterial lumen thickening greater than 50% of the surrounding IMT or greater than 0.5 mm

  • will also have Carotid wall thickness > 1.5 mm thickness

  • Carotid intima-media thickness (IMT)

    • Distance between 2 echogenic lines rep intima and media and the distance between their respective hypoechoic lines = IMT

• Determining ECA vs ICA

  • ECA has high peripheral resistance flow

  • In Healthy individuals:

    • ICA: low resistance waveform with forward flow even in diastole

    • External carotid artery: high resistance waveform with retrograde flow during diastole

    • Valsalva can help distinguish

    • Atherosclerosis makes this unreliable

  • Internal will have diastolic notch on PWD

• Central Venous Access: IJ

  • Associated findings with clots/complications

    • Multiple venopuncture attempts

    • Positioning of the CVC in the proximal SVC

    • Larger circumference of the catheter

  • Day 3-6 was highest at risk time for clot formation

  • Left sided placement 3.5 x more likely to thrombose d/t L brachiocephalic vein length and sharp angle into SVC

• Lemierre’s syndrome: infectious IJ thrombophlebitis

  • Can be d/t internal PTA rupture, IVDA, bacteremia

  • Always compare to normal side

  • May see an echogenic clot