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Aspiration
Drainage
Biopsy
Aspirations
Cysts aspiration Paracentesis (Ascites)
Cysts aspiration: Cysts are very common. Usually be diagnosed accurately with ultrasound.
Causing significant tenderness The diagnosis of a cyst remains in question following the ultrasound
POSITION
The skin is cleaned , numbed with topical anesthesia. Using ultrasound guidance, a small needle is advanced into the cyst and suction is applied to draw the fluid out, causing the lump
to collapse.
The lump (arrow) in this patients right breast was thought to be a cyst, but some features are not characteristic and aspiration was necessary.
Using ultrasound guidance, a fine needle (white line) is placed so that its tip (double arrow) is in the center of the lump (single arrow). Aspiration is applied by using a syringe attached to the needle. If this is a cyst, fluid is drawn into the syringe as the lesion collapses.
After the aspiration, the needle (white line) and its tip (double arrow) are seen, but the lump is gone.
If is very helpful to get an ultrasound scan of the ascites before the procedure. The radiologist will mark the spot for paracentesis. Two things are important: What is the distance from the skin to the fluid? Usually 1 cm. What is distance to the midpoint of the collection? Usually 3 cm.
Here we clearly see free fluid in Morrison's pouch that extends superiorly around the liver
See the needle entering the peritoneal cavity obliquely from just beneath the indicator marker.
The diaphragm and liver or spleen should be identified first. The probe can then be moved towards the head
The probe is then rotated 180 degrees to visualize the pleural fluid between the ribs to ensure that there is only fluid visualized ie. no lung, diaphragm, or liver or spleen.
Procedure allow collections which would otherwise require open surgery to be drained via a skin incision only a few mm in size.
Localized abscess related to ovary (tubo-ovarian) Abscess collection after surgery Hepatic abscess (amebic or post-op) Renal abscess or retro-peritoneal abscess. Splenic abscess
Abscess is first delineated &a safe route from skin to the abscess cavity is identified by ultrasound.
The catheter is introduced into the abscess cavity, either directly using a trocar catheter (as used for chest intubation (or by modified
Maneuvering of the trocar or guide-wire within the abdominal cavity should be done strictly under ultrasound surveillance
Drainage is recorded daily ,response to the treatment is assessed by clinical parameters & u/s.
Indications
Icterus/liver enzyme elevation/elevated bile
acids
Focal nodules or masses anywhere Renal disease sometimes (i.e. renal dysplasia, renal masses, lymphosarcoma suspects) Prostatomegaly Free abdominal fluid Cysts
Lymphadenopathy
Adrenal glands Transitional cell carcinoma suspect masses Chronic renal failure, glomerulonephritis
Probe orientation
Reference marker corresponds to left side of screen (see Screen Orientation
Probe Skin
Rock and/or slide the probe to line up the lesion to a reachable position
Superficial lesion can be toward the edge or in the center of the beam
Angle to use for a superficial lesion: Aim needle more perpendicular to beam
Take biopsy
Percutaneous needle biopsy of the breast provides reliable diagnosis of both benign and malignant disease and is a proven alternative
Ultrasound guidance is an accurate and reliable biopsy guidance technique and is the method of choice and suitable for all breast lesions
visible on ultrasound
CNB & FNAB are effective methods for the diagnosis of most breast lesions
Although CNB has higher sensitivity & positive predictive value for abnormalities like microcalcifications & distortions of architecture.
Architectural distortion
Micro-calcifications
Cyst aspiration
PROCEDURE: The long axis of the needle, should be visible along the long axis of the transducer.
Occasionally, during an FNA biopsy or cyst aspiration, the transducer can be rotated 90 degrees to visualize the echogenic dot of the needle within the lesion.
Liver biopsies are performed for both focal and nonfocal lesions.
When imaging guidance is employed, it can take one of two forms: US-guided "marking" in which a mark is made upon the skin during US examination for a biopsy to be performed later without imaging guidance or real-time US guidance.
The patient is positioned supine, with the hands comfortably resting behind the head
The preliminary scan also ensures that no major vessels, dilated biliary channels or gall bladder are in the path of the biopsy needle.
Before the procedure is started, breathing instructions are practiced with the patient.
The skin site is prepped and draped to ensure asepsis The local area is anesthetized with a local anesthetic.
Indications: Biopsy of a focal solid lesion /suspicious cystic lesion for diagnosis.
No radiation & is therefore well suited for most nonfocal renal biopsies in thin pts and in biopsies
The patient is placed in the prone position and the biopsy is typically taken from the lower pole of the kidney if there are no specific locations of interest.
The biopsy needle is guided using ultrasound to ensure visualization of the needle as it
Care is taken not to enter the collecting system (as it would result in haematuria) or to go near
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