Chapter 24 - Ultrasound-Guided Transthoracic Procedures
Video 24-1. This video shows a pleural effusion above the diaphragm, the liver, the hepatorenal recess, and the kidney. The inexperienced scanner may identify the recess as the diaphragm and the liver as an echodense pleural effusion with inadvertent subdiaphragmatic device insertion. It is required to positively identify the kidney, the liver (or spleen), and the diaphragm when accessing a pleural effusion. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 9th intercostal space in the right mid-axillary line.
Video 24-2. This video shows a large pleural effusion, atelectatic lung, and a drainage catheter situated in the fluid. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 6th intercostal space in the right mid-axillary line.
Video 24-3. This video shows a lung mass adjacent to the chest wall that is suitable for ultrasound guided aspiration or biopsy. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 6th intercostal space in the right posterior axillary line.
Video 24-4. This video shows a lingular lung mass adjacent to the chest wall and heart that is suitable for ultrasound-guided aspiration or biopsy. Determination of safe needle trajectory must take into account adjacent anatomic structures, as indicated in this image. The 3.5 MHz transducer is in an oblique orientation and placed perpendicular to the chest wall to scan through the 5th intercostal space in the left anterior axillary line.
Video 24-5. This video shows a pericardial effusion from a subcostal window with the liver interposed between the heart and the abdominal wall. This would contraindicate needle insertion at this site. The 3.5 MHz transducer is in a subxiphoid position to obtain a long-axis subcostal view of the heart.
Video 24-6. This video shows a pericardial effusion from an apical window with sufficient fluid to permit safe pericardiocentesis. The 3.5 MHz transducer is in an apical position to obtain an apical four chamber view of the heart.
Video 24-7. This video shows a pericardial effusion from parasternal sort-axis window with sufficient fluid to permit safe pericardiocentesis. The 3.5 MHz transducer is in a parasternal position to obtain a parasternal short-axis view of the heart.
Video 24-8. This video shows a pericardial effusion from a subcostal window with insufficient fluid depth for safe pericardiocentesis. This would contraindicate needle insertion at this site. The 3.5 MHz transducer is in a subxiphoid position to obtain a long-axis subcostal view of the heart.
Video 24-9. This video shows a pericardial effusion from a subcostal window with adequate fluid depth for safe pericardiocentesis. The 3.5 MHz transducer is in a subxiphoid position to obtain a long-axis subcostal view of the heart.
Video 24-10. This video shows an acute hemopericardium that resulted from an attempt to perform pericardiocentesis from the subcostal position as indicated in Figure 24-8 and Video 24-8. This image emphasizes the need to have an adequate depth of fluid to permit safe needle insertion into the pericardial fluid. The 3.5 MHz transducer is in a subxiphoid position to obtain a long-axis subcostal view of the heart.
Video 24-11. This video shows a pericardial effusion from an apical window with sufficient fluid to permit safe pericardiocentesis. The 3.5 MHz transducer is in an apical position to obtain an apical four chamber view of the heart.
Video 24-12. This video shows agitated saline injection into a pericardial catheter following successful pericardiocentesis. This confirms appropriate device position. The 3.5 MHz transducer is in a subxiphoid position to obtain a long-axis subcostal view of the heart.