15 blehar dj gaspari rj montoya a calderon r

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15. Blehar DJ, Gaspari RJ, Montoya A, Calderon R. Correlation of visual axis and coronal axis measurements of optic nerve sheath diameter. J Ultrasound Med 2008; 2 : 407–11. 16. Ballantyne SA, O’Neill G, Hamilton R, Hollman AS. Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 2002; 15 : 145–9. Diagnostic ultrasound 211 Ocular ultrasound
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11 Soft tissue and musculoskeletal ultrasound Introduction Interest in soft tissue and musculoskeletal ultrasound has grown rapidly over the past five years – not just among emergency physicians but among rheumatologists, orthopedists, primary care physicians, podiatrists, and many others as well. Clinicians have taken notice as evidence mounts of the ability of ultrasound to improve their diagnostic capabilities, not only by making anatomy plain at the bedside but also, more importantly, by evaluat- ing function dynamically. This chapter will provide a brief overview of soft tissue and musculoskeletal ultrasound, but for those who are interested entire courses and textboooks dedicated to this topic are available. As pressure to decrease the use of expensive diagnostic imaging such as magnetic resonance imaging (MRI) increases, the use of diagnostic ultrasound for musculo- skeletal complaints will likely continue to grow. Soft tissue While the differentiation between abscess and cellulitis would seem to be clinically apparent, research has shown that clinicians are not as accurate in making this distinction as they think using clinical exam parameters alone [ 1 , 2 ]. Ultrasound is readily able to make this distinction. In this way, painful drainage procedures can be avoided in those who have no drainable collec- tion, and return visits can be avoided in those who were not adequately treated with incision and drainage. In addition, ultrasound can highlight sonographic features that should make a clinician more suspicious of aggres- sive infectious processes such as necrotizing fasciitis and Fournier’s gangrene [ 3 , 4 ]. These include layering fluid along the fascial plane and “dirty shadows” or white shadows indicating the presence of air within the area of inflammation. Finally, once an abscess is identified, ultrasound can make the drainage procedure more accurate and identify surrounding vessels and nerves so that complications can be avoided. Procedural guidance will be discussed further in Chapter 16 . Bone and tendons Although long bone fractures are often detected clinically, the sensitivity of the physical exam is insufficient to exclude pathology. In addition, the man- agement of fractures varies considerably, based on characteristics undetect- able by physical exam alone (displacement, angulation, comminution). Thus, Diagnostic ultrasound 213 Soft tissue and musculoskeletal ultrasound
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clinicians often rely on plain x-ray (as well as CT and MRI) to characterize fractures in patients with extremity trauma. In addition, identifying ortho- pedic injuries that involve tendon injuries versus those where tendon func- tion is intact is essential but can be difficult in the setting of an acute injury.
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