Interventional Ultrasound A Practical Guide and Atlas PDF

Preface xix
Acknowledgments . xx
Contributors xxi
Abbreviations. xxiii
General Aspects of Interventional Ultrasound
1 Interventional Ultrasound: Introduction and Historical Background . 2
H. Lutz
1.1 The Vienna Congress . 2
1.2 The Introduction of Ultrasound into
Routine Clinical Use 3
1.2.1 The Evolution of Ultrasound Imaging
Techniques . 3
1.2.2 Technical Evolution of Ultrasound-Guided
Biopsies. . 4
1.2.3 Clinical Application 7
1.2.4 Risks of Interventional Ultrasound . 9
1.3 Later Developments: Ultrasound-
Guided Therapeutic Interventional
Procedures 10
1.4 Outlook . 10
References . 11
2 Interventional Materials and Equipment 13
2.1 General Considerations on
Interventional Procedures 13
U. Gottschalk, C. F. Dietrich
2.1.1 Brief Historical Introduction 13
2.1.2 Biopsy Principles and Techniques. . 13
2.1.3 Needle Systems . 15
2.2 Therapeutic Interventions 20
2.2.1 Introduction. . 20
2.2.2 Brief Historical Review . 20
2.2.3 Patient Preparation 21
2.2.4 Access Routes . 21
2.2.5 Indications and Contraindications . 21
2.2.6 Complications 22
2.2.7 Needle Techniques 23
2.2.8 Special Needle Types. 23
2.2.9 Trocar Technique. . 23
2.2.10 Seldinger Technique . 24
2.2.11 Peel-Away Sheath . 24
2.2.12 Anchor Systems, Suture Techniques. . 25
2.2.13 Guidewires . 26
2.2.14 Dilators 27
2.2.15 Drainage Catheters 27
2.2.16 Other Drainage Systems 29
2.2.17 Accessories . 29
References . 31
3 Informed Consent 32
D. Nuernberg, A. Jung
3.1 What Should Be Disclosed? . 32
3.1.1 Indication 32
3.1.2 Explaining the Procedure. 32
3.1.3 Risks and Complications. . 32
3.2 Means of Disclosure. . 32
3.2.1 Consent Form. 32
3.2.2 Informed Consent Discussion . 32
3.2.3 Delegating Informed Consent . 33
v
3.3 Documentation 33
3.4 Timing of the Consent Process 33
3.5 Special Situations 33
3.5.1 Implied Consent 33
3.5.2 Patients Lacking the Capacity
to Consent . 33
3.5.3 Minors. 33
3.5.4 Language Barriers . 34
3.5.5 Waiving of Informed Consent . 34
References . 34
4 Medications, Equipment, and Setup Requirements 35
D. Nuernberg, A. Jung
4.1 Medications . 35
4.1.1 Premedication 35
4.1.2 Analgesia. 35
4.1.3 Coagulation 36
4.1.4 Local Anesthesia 36
4.2 Equipment and Setup Requirements 37
4.2.1 Biopsy Equipment . 37
4.2.2 Interventional Materials. . 37
4.2.3 Positioning, Preprocedure Examination,
and Marking. . 37
4.2.4 Monitoring During the Procedure. . 37
4.2.5 Postprocedure Monitoring. . 37
4.2.6 Facilities (Procedure Room) . 37
4.2.7 Functional and Design Requirements. 38
4.2.8 Operational and Organizational
Requirements. 38
References . 38
5 Pathology and Cytology . 40
A. Tannapfel, C. F. Dietrich
5.1 Pathology . 40
5.2 Biopsies . 40
5.2.1 Types of Biopsy Procedure 40
5.3 Histology or Cytology? . 40
5.3.1 Sources of Error . 41
5.4 Typing, Grading, and Staging . 41
5.4.1 Classification (Typing). . 41
5.4.2 Grading 43
5.5 Specific Analysis . 43
5.5.1 Lymph Nodes . 43
5.5.2 Lymphomas 45
5.6 Hormone Growth Factor Receptor
Analysis . 47
References . 48
6 Fine Needle Aspiration Cytology. . 49
C. Jenssen, T. Beyer
6.1 Specimen Collection . 49
6.1.1 Ultrasound-Guided Biopsy . 49
6.1.2 Needle Movement and Aspiration . 49
6.2 Specimen Preparation 49
6.2.1 Fluid Aspirates 49
6.2.2 Centrifuging Effusions . 49
6.2.3 Aspirates from Solid Lesions 50
6.3 Fixation and Staining . 55
6.3.1 Basic Principles . 55
6.3.2 Air Drying and Romanowsky Stains 55
6.3.3 Wet Fixation and Papanicolaou Staining 55
6.3.4 Ancillary Tests 56
6.4 Cytomorphologic Evaluation. . 58
6.4.1 Rapid On-Site Evaluation . 58
6.4.2 Final Cytologic Diagnosis . 63
6.5 Conclusions . 64
References . 64
Contents
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7 Infections and Diagnostic Microbiology . 68
T. Glueck, H. J. Linde, C. F. Dietrich
7.1 General Principles of Microbiological
Testing 68
7.1.1 Microbiological Specimens . 68
7.1.2 Prerequisites for Microbiological Testing. . 68
7.2 Microbiological Techniques. 69
7.2.1 Stains. . 69
7.2.2 Culture Techniques 71
7.2.3 Nucleic Acid Amplification Techniques . 71
7.2.4 Serology . 71
7.2.5 When Are Microbiological Test Results
Available? 72
7.2.6 Limitations of Microbiological Methods 72
7.2.7 Specimen Receipt during Off-hours
(Nights,Weekends, Holidays) . 72
7.3 Specific Guidelines for Microbiological
Testing and Differential Diagnosis by
Organ Systems and Syndromes . 73
7.3.1 Investigation of Enlarged Lymph Nodes. 73
7.3.2 Microbiological Testing and Antimicrobial
Therapy for Suspected Tuberculosis 76
7.3.3 Liver Mass Suspicious for an Abscess
(Including Amebic Abscess) . 77
References . 81
8 Hygiene Management . 82
H. Martiny, D. Nuernberg
8.1 General Hygienic Requirements . 82
8.1.1 Personal Protective Equipment and
Coverings 82
8.1.2 Disposable Probe Covers . 83
8.1.3 Ultrasound Gel. . 83
8.2 Hand Antisepsis and Skin
Preparation. . 83
8.3 Ultrasound Probe and Accessories. 84
8.3.1 Decontamination of the Ultrasound
Probe 84
8.3.2 Decontamination of Ultrasound
Accessories . 85
References . 85
9 Contraindications, Complications, and Complication Management 86
C. Jenssen, C. F. Dietrich
9.1 Interventional Risk . 86
9.1.1 Complication Rates and Mortality . 86
9.1.2 Factors that Influence Interventional
Risk . 86
9.2 Frequent Complications and Their Risk
Factors 86
9.2.1 Pain and Vasovagal Reactions . 86
9.2.2 Bleeding Complications 87
9.2.3 Needle Tract Seeding 88
9.2.4 Specific Complications . 89
9.3 Prevention of Complications 89
9.3.1 Risk Assessment and Patient
Selection. 89
9.3.2 Modification of Risk Factors. 90
9.3.3 Risk Reduction Techniques . 92
9.3.4 Local Anesthesia and Intravenous
Sedation . 92
9.3.5 Prevention of Infection . 93
9.3.6 Optimal Approach and Alternatives 93
9.4 Contraindications 93
9.4.1 Coagulopathies . 93
9.4.2 Procoagulant Therapy and Antiplatelet
Drugs. . 94
9.4.3 “Risky” Lesions and Access Routes . 94
9.5 Management of Complications . 95
9.5.1 Postinterventional Care and Detection of
Complications 95
9.5.2 Treatment of Complications. 95
9.6 Specific Biopsy Sites. . 95
9.6.1 Liver Biopsy 95
9.6.2 Renal Biopsy. . 99
9.6.3 Pancreatic Biopsy . 99
9.6.4 Splenic Biopsy 100
Contents
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9.6.5 Biopsy of Gastrointestinal Hollow Organs
and Mesenteric Masses. 100
9.6.6 Adrenal Biopsy. . 100
9.6.7 Lungs, Pleura, and Mediastinum. 101
9.7 Specific Interventions 101
9.7.1 EUS-FNA, EUS-TCB, EBUS-TBNA . 101
9.7.2 EUS-Guided Therapeutic Interventions . 101
9.7.3 Transrectal Prostatic Biopsy. 102
9.7.4 Ultrasound-Guided Drainage (of Cysts,
Pseudocysts, Abscesses, Cholecystitis) 102
9.7.5 Ultrasound-Guided PTCD and
Cholecystotomy. 103
9.7.6 Ultrasound-guided Tumor Ablation
Therapy. . 103
References . 104
10 Assistance in Ultrasound Interventions 109
U. Gottschalk, C. F. Dietrich
10.1 Basic Principles 109
10.2 Duties of Assisting Personnel . 109
10.3 Diagnostic Ultrasound. . 110
10.4 Diagnostic Interventions . 110
10.5 Therapeutic Interventions 111
10.6 Sedation 111
10.7 Drain Placement . 111
10.8 Endosonography. 113
References . 113
11 Sedation in Interventions . 114
U. Gottschalk, C. F. Dietrich
11.1 Introduction . 114
11.2 Medications . 114
11.3 Personnel Requirements. . 114
11.4 Monitoring Requirements 115
11.5 Postprocedure Care 115
11.6 Complications . 115
11.7 Summary. . 115
References . 115
Specific Ultrasound-Guided Procedures: Abdomen
12 Indications for Diagnostic Interventions in the Abdomen and Thorax
(Liver, Pancreas, Spleen, Kidneys, Lung, Other Sites). 120
H. Kinkel, D. Nuernberg
12.1 Liver 120
12.1.1 Diffuse Liver Diseases 120
12.1.2 Focal Liver Lesions. 121
12.2 Pancreas 123
12.3 Spleen 123
12.4 Kidneys . 124
12.5 Lung 125
12.6 Adrenal Gland . 125
12.7 Lymph Nodes 125
12.8 Other Lesions 126
References . 126
Contents
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13 Diagnostic and Therapeutic Paracentesis of Free Abdominal Fluid. . 128
D. Nuernberg
13.1 Peritoneal Cavity. 128
13.2 Sites of Predilection for
Intra-abdominal Fluid 128
13.3 Pathogenesis and Differential
Diagnosis of Ascites 129
13.4 Specific Indications. 129
13.4.1 Transudate . 129
13.4.2 Exudate. . 129
13.4.3 Cirrhosis . 130
13.4.4 Heart Failure . 130
13.4.5 Hypoalbuminemia. 130
13.4.6 Peritonitis 130
13.4.7 Peritoneal Carcinomatosis 130
13.4.8 Hemoperitoneum . 130
13.4.9 Pancreatitis. 131
13.4.10 Other Rare Abdominal Fluid Collections 131
13.5 Differentiating a Localized Fluid
Collection from Ascites . 133
13.6 Practical Issues: How and Where to
Aspirate? 133
13.7 Diagnostic Paracentesis: Laboratory
Tests 134
13.8 Indications for Therapeutic
Paracentesis . 134
13.8.1 Treatment of Ascites in Hepatic Cirrhosis:
Paracentesis for Symptom Relief in
Hepatic Cirrhosis (and Pancreatitis) 134
13.8.2 Palliative Paracentesis for Peritoneal
Carcinomatosis . 135
13.8.3 Cytostatic Therapy of Peritoneal
Carcinomatosis (Intraperitoneal
Chemotherapy) . 135
13.8.4 Drainage (with Irrigation) for Bile Leakage
(For Example in a Palliative Setting) 135
13.9 Materials 136
13.10 Contraindications, Complications, and
Postprocedure Care 136
References . 137
14 Fine Needle Aspiration Biopsy and Core Needle Biopsy 138
J.-C. Kaemmer, D. Nuernberg
14.1 Historical Background. . 138
14.2 Description of Biopsy Techniques . 138
14.2.1 What Type of Needle Should Be Used? . 138
14.3 Biopsy Technique for Specific Needle
Types . 141
14.3.1 Biopsy with the Chiba Needle . 142
14.3.2 Cutting Biopsy with an Otto or Franseen
Needle. 142
14.3.3 Autovac and BioPince Biopsy Systems 142
14.3.4 Biomol Biopsy System. . 143
14.3.5 Trucut Needles. . 143
14.4 Summary. . 143
References . 143
15 Abscess Drainage. 144
C. F. Dietrich, A. Ignee, U. Gottschalk
15.1 Historical Considerations . 144
15.2 Preliminary Remarks, Etiology 144
15.3 Selection of Imaging Modality 144
15.3.1 Ultrasound . 144
15.3.2 Conventional Radiographic Drainage. 146
15.3.3 Computed Tomography 146
15.3.4 Magnetic Resonance Imaging . 146
15.4 Devices. . 146
15.4.1 Drainage Catheters 146
15.5 Indications 147
15.6 Contraindications 147
Contents
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15.7 Patient Preparation 147
15.8 Treatment Options . 148
15.8.1 General 148
15.8.2 Medical Treatment Options . 148
15.8.3 Surgical Treatment Options . 148
15.9 Technique of Percutaneous Abscess
Drainage 148
15.9.1 Preparation. 148
15.9.2 Initial Needle Insertion. 149
15.9.3 Trocar Technique. . 151
15.9.4 Irrigation. 154
15.9.5 Drain Removal 154
15.9.6 Specimen Processing. 154
15.10 Postprocedure Care 154
15.11 Specific Diseases . 154
15.11.1 Pyogenic Liver Abscess . 154
15.11.2 Abscesses in Appendicitis,
Peridiverticulitis 155
15.11.3 Liver Abscess in Biliary Disease 155
15.11.4 Abscess in Pancreatitis . 156
15.11.5 Liver Abscess in Amebiasis. . 156
15.11.6 Protozoan Infections with Liver
Involvement 157
15.11.7 Septic (Pyogenic) Abscess with Associated
Diseases (Sepsis, Coagulopathies,
Ascites) 157
15.11.8 Infection of Necrotic Tumor
Components. . 158
15.11.9 Liver Abscess after Liver
Transplantation . 158
15.12 Complications . 158
15.13 Irrigation 159
15.14 Sequelae 159
15.15 Ultrasound-Guided Gallbladder
Drainage and Other Indications . 159
References . 160
16 Percutaneous Sclerotherapy of Cysts 163
C. F. Dietrich, B. Braden
16.1 Percutaneous Sclerotherapy of Liver
Cysts 163
16.1.1 Epidemiology and Etiology . 163
16.1.2 Symptoms. . 163
16.1.3 Indications . 163
16.1.4 Contraindications . 163
16.1.5 Interventional Materials and Equipment. . 163
16.1.6 Sclerosing Agents . 163
16.1.7 Treatment Options 163
16.1.8 Technique for Percutaneous Sclerotherapy
of a Liver Cyst. 163
16.2 Sclerotherapy Technique . 164
16.2.1 Follow-up Care . 164
16.2.2 Prognosis 164
16.3 Percutaneous Sclerotherapy of
Renal Cysts 164
16.3.1 Summary of the Literature. . 164
16.3.2 Epidemiology, Differential Diagnosis,
and Classification . 165
16.3.3 Technique. . 166
16.3.4 Sclerosing Agents . 166
16.4 Alternative Procedures . 167
16.5 Special Issues Relating to
Splenic Cysts 167
16.6 Special Issues Relating to Pancreatic
Cysts 167
References . 167
17 Interventional Treatment of Echinococcosis. 168
C. F. Dietrich, M. Hocke
17.1 Echinococci: Types and Epidemiology. . 168
17.1.1 Echinococcus granulosus. . 168
17.1.2 Echinococcus multilocularis . 169
17.2 Clinical Manifestations . 169
17.3 Diagnosis. . 169
17.3.1 Three Main Diagnostic Criteria 169
Contents
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17.3.2 Laboratory Parameters . 169
17.3.3 Serologic and Molecular Biologic Tests . 169
17.4 Imaging Studies, Staging of Disease . 169
17.4.1 Historical Background . 169
17.4.2 Morphologic and Functional Classification
Systems. . 171
17.4.3 WHO Classification 171
17.5 Treatment . 173
17.5.1 Surgical Treatment Options . 174
17.5.2 Drug Treatment Options. . 174
17.5.3 Local Ablative Procedures: PAIR . 175
17.5.4 Endoscopic Retrograde
Cholangiography 177
References . 177
18 Local Ablative Procedures; Percutaneous Ethanol and Acetic
Acid Injection . 179
C. F. Dietrich, B. Braden, M. Hocke
18.1 Basic Considerations . 179
18.1.1 What Tumors Are Suitable for Local
Ablative Procedures?. 179
18.1.2 Radiofrequency Ablation or
Percutaneous Ethanol Injection? 179
18.1.3 Ethanol or Acetic Acid Injection? 179
18.1.4 Single or Multiple Sessions? 179
18.2 Indications 179
18.2.1 Considerations on Hepatocellular
Carcinoma . 180
18.3 Contraindications 180
18.4 Practical Aspects. 180
18.4.1 Materials and Equipment. 180
18.4.2 Preparations. . 180
18.4.3 Technique. . 180
18.5 Follow-up Care, Complications, and
Prognosis . 182
18.5.1 Follow-up Care . 182
18.5.2 Complications 182
18.5.3 Monitoring of Treatment Response 182
18.5.4 Factors That Determine Prognosis . 183
18.6 Summary. . 183
References . 183
19 Local Ablative Procedures for Liver Tumors, Radiofrequency Ablation . 185
C. F. Dietrich, T. Albrecht, T. Bernatik, A. Ignee
19.1 Concepts (Curative, Palliative,
Multimodal) . 185
19.1.1 Hepatocellular Carcinoma 185
19.1.2 Colorectal Carcinoma 185
19.2 Selection of Imaging Modality
(Ultrasound, CT, MRI) 186
19.3 Indications 186
19.3.1 Number of Tumors 186
19.3.2 Tumor Size . 186
19.3.3 Tumor Location . 186
19.4 Contraindications 187
19.5 Preparations. 187
19.5.1 Antibiotic Prophylaxis . 187
19.5.2 Local Anesthesia, Sedation, Sedation/
Analgesia, and General Anesthesia . 187
19.5.3 Treatment Planning. . 187
19.6 Materials 187
19.6.1 Standard Materials 187
19.6.2 Basic Principle 188
19.6.3 Monopolar versus Bipolar and Multipolar
Systems. . 188
19.6.4 Needle Applicators 189
19.6.5 Control and Temperature
Measurement. 189
19.6.6 Flow Rate of Needle Perfusion. 189
19.7 Technique . 189
19.7.1 Patient Positioning 189
19.7.2 (Local) Anesthesia . 190
19.7.3 Probe Insertion . 190
19.7.4 Techniques for Specific Systems . 191
Contents
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19.8 Assessing the Efficacy of Treatment . 192
19.9 Complications and Aftercare. . 193
19.9.1 Complications 193
19.9.2 Postinterventional Care 196
19.9.3 Clinical Aftercare and Follow-up. 196
References . 196
20 Percutaneous Transhepatic Cholangiodrainage. 198
C. F. Dietrich, B. Braden, X. W. Cui, A. Ignee
20.1 Basic Principles 198
20.2 Indications 198
20.2.1 Endoscopic Retrograde or Percutaneous
Approach 199
20.2.2 Rendezvous Technique. 199
20.3 Contraindications 199
20.4 Materials and Equipment . 200
20.4.1 Description of Materials 200
20.5 Technique . 201
20.5.1 Patient Positioning 202
20.5.2 Needle Insertion and Drainage 202
20.5.3 Procedure Time . 207
20.6 Success Rate. 207
20.6.1 Results with Plastic Endoprostheses . 207
20.6.2 Results with Metal Endoprostheses 208
20.7 Complications . 208
20.7.1 Incidence 208
20.7.2 Management of Complications 208
20.8 Aftercare 208
20.9 Use of Intracavitary Ultrasound
Contrast Agents . 209
20.10 Analysis of the Literature . 210
20.10.1 Present Authors’Data 210
20.10.2 Comparison of Endoprostheses. . 210
References . 212
21 Percutaneous Gastrostomy . 215
A. Ignee, G. Schuessler, C. F. Dietrich
21.1 Indications 215
21.2 Contraindications 215
21.3 Materials and Equipment . 215
21.4 Types of Gastrostomy 215
21.4.1 Percutaneous Endoscopic
Gastrostomy. . 215
21.4.2 Percutaneous Sonographic Gastrostomy 216
21.5 Advantages and Disadvantages of
Different Methods . 216
21.6 Success Rates of Different Gastrostomy
Techniques 216
21.7 Complication Rates of Different
Gastrostomy Techniques . 216
21.8 Role of Ultrasonography. . 217
21.8.1 General 217
21.8.2 Ultrasound-Assisted PEG . 218
21.8.3 Technique of Percutaneous Sonographic
Gastrostomy. . 219
21.9 Questions Relevant to Percutaneous
Sonographic Gastrostomy 220
21.9.1 Use of a Spasmolytic Agent . 220
21.9.2 Prophylactic Antibiotics 220
21.9.3 Use of a Guidewire 220
21.9.4 Need for Gastropexy . 220
21.9.5 Type of Drainage 221
21.10 Summary. . 222
References . 223
Contents
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22 Interventional Endosonography 224
C. F. Dietrich, M. Hocke, C. Jenssen
22.1 Cost–Benefit Analysis 224
22.2 Historical Introduction . 224
22.3 Materials and Equipment . 224
22.3.1 Requirements of the Endoscopy Unit . 224
22.3.2 Which Endosonography Systems Have
Become Established? 225
22.3.3 Which Biopsy Needles and Techniques
Have Become Established?. . 225
22.3.4 Guidewires . 227
22.3.5 Fixed-Diameter Dilators 228
22.3.6 Balloon Dilators . 229
22.3.7 Plastic Stents (Pigtail) 230
22.3.8 Metal Stents 231
22.3.9 Diathermy Devices, Cystotome 232
22.3.10 Retrievers 233
22.3.11 Supplementary Techniques in EUS-guided
Biopsy . 234
22.4 Procedure . 234
22.4.1 Sedation . 234
22.4.2 Other Medications. 234
22.4.3 Orientation. 234
22.4.4 General Rules for Needle Insertion . 234
22.4.5 Biopsy Technique . 235
22.4.6 Suction 235
22.4.7 Specimen Processing. 235
22.5 Diagnostic Interventions . 236
22.5.1 Indications . 236
22.5.2 Risk of Complications 237
22.5.3 Contraindications . 238
22.6 Therapeutic Interventions, General
Aspects . 238
22.6.1 Therapeutic EUS-Guided Interventions . 238
22.6.2 Endoscopes and Needle Types. 238
22.6.3 General Rules for Needle and Wire
Handling . 239
22.6.4 Indications . 239
22.6.5 Contraindications . 239
22.7 Drainage of Peripancreatic Fluid
Collections 239
22.7.1 History 239
22.7.2 Basic Anatomical Considerations 239
22.7.3 Pathophysiologic Considerations 239
22.7.4 DiagnosticWorkup 239
22.7.5 Indications . 240
22.7.6 Timing of the EUS Intervention. . 240
22.7.7 Selection of Procedure . 240
22.7.8 Technique. . 240
22.7.9 One-Step Systems . 240
22.7.10 Treatment of Nonpancreatic Fluid
Collections . 242
22.7.11 Surgical Options 243
22.8 EUS-Guided Cholangiodrainage . 243
22.8.1 Introduction. . 243
22.8.2 Indications and Treatment Goals 244
22.8.3 Equipment . 244
22.8.4 Preparatory Measures. . 244
22.8.5 Technique. . 244
22.8.6 Assessing the Result, Postinterventional
Care, Complications . 246
22.9 EUS-Guided Pancreatic Duct
Drainage 246
22.9.1 Indications and Treatment Goals 246
22.9.2 Technique. . 246
22.9.3 Assessing the Result, Postinterventional
Care, Complications . 246
22.10 Celiac Plexus Neurolysis and Celiac
Plexus Blockade. . 246
22.10.1 Indications and Treatment Goals 246
22.10.2 Materials. 247
22.10.3 Technique. . 247
22.10.4 Assessing the Result, Postinterventional
Care, Complications . 247
22.11 Tumor Ablation with Alcohol . 247
22.12 EUS-Guided Vascular Interventions 248
22.12.1 Indications and Treatment Goals 248
22.12.2 Materials. 248
22.12.3 Technique. . 248
22.12.4 Assessing the Result, Postinterventional
Care, Complications . 248
22.13 Complications . 249
22.14 Postinterventional Care 250
References . 251
Contents
xiii
23 Special Issues Regarding Interventions in the Spleen 254
C. F. Dietrich
23.1 Diffuse Splenic Changes 254
23.2 Specific Disorders 254
23.2.1 Splenic Rupture . 254
23.2.2 Splenic Infarction . 254
23.2.3 Focal Splenic Changes. . 255
23.3 Procedures 255
23.3.1 Clinical Scenarios. . 255
23.3.2 Anatomical Considerations in Splenic
Interventions . 255
23.3.3 Procedures for Specific Applications . 256
23.4 Abscess Drainage 256
23.5 Indications 256
23.6 Contraindications 256
23.7 Indications for Splenic Biopsy Drawn
from Case Data 256
23.8 Postinterventional Care 257
23.9 Complications . 257
23.10 Preinterventional Vaccinations. . 257
References . 257
Specific Ultrasound-Guided Procedures: Thorax
24 Thoracic Interventions. 260
W. Blank, A. Heinzmann
24.1 Advantages of Ultrasound-Guided
Interventions 260
24.2 Indications 261
24.3 Contraindications 261
24.4 Selection of Materials 261
24.4.1 Ultrasound Technology 261
24.4.2 Biopsy Devices 262
24.5 Preparations. 263
24.6 Technique . 264
24.6.1 ChestWall Lesions 264
24.6.2 Pleural Space . 264
24.6.3 Subpleural Lung Lesions. . 265
24.6.4 Pulmonary Abscesses 268
24.6.5 Mediastinum . 268
24.7 Steps in the Procedure . 269
24.7.1 Preparations. . 269
24.7.2 Technique. . 269
24.7.3 Postprocedure Care. . 269
24.8 Problems and Complications. . 269
24.8.1 Postbiopsy Pneumothorax. . 269
24.9 Postprocedure Care and Follow-Up. . 270
References . 271
Specific Ultrasound-Guided Procedures: Urogenital System
25 Percutaneous Renal Biopsy. . 274
U. Goettmann, B. K. Kraemer
25.1 Indications 274
25.2 Contraindications 274
25.3 Materials and Equipment . 275
25.4 Preparations. 275
25.5 Procedure . 276
25.5.1 Native Renal Biopsy. . 276
25.5.2 Review of the Procedure Steps 277
25.5.3 Biopsy of a Renal Allograft 277
25.6 Complications . 277
Contents
xiv
25.7 Postbiopsy Care. . 278
25.8 List of Materials and Equipment. 278
References . 278
26 Interventional Urology 280
D. Brix, A. Ignee, C. F. Dietrich
26.1 Transrectal Ultrasonography of the
Prostate . 280
26.1.1 Introduction. . 280
26.1.2 Equipment Requirements 280
26.2 Diseases of the Prostate 280
26.2.1 Prostate Cancer . 280
26.2.2 Prostatic Abscess 281
26.3 Prostate Biopsy 281
26.3.1 Introduction. . 281
26.3.2 Indications . 281
26.3.3 Informed Consent and Preparation 281
26.3.4 Complications and Their Management . 281
26.3.5 Transperineal Biopsy. 282
26.4 Percutaneous Nephrostomy 282
26.4.1 Introduction. . 282
26.4.2 Indications . 282
26.4.3 Relative Contraindications 282
26.4.4 Complications 282
26.4.5 Preparations. . 282
26.4.6 Materials and Equipment. 282
26.4.7 Technique. . 282
26.4.8 Anesthesia . 283
26.4.9 Procedure 283
26.4.10 Postoperative Care 284
References . 285
Specific Ultrasound-Guided Procedures: Other Organ Systems
27 Interventional Thyroid Ultrasound . 288
B. Braun, T. Mueller
27.1 Diagnostic Interventions . 288
27.1.1 Indications . 288
27.1.2 Contraindications . 288
27.1.3 Methods . 288
27.1.4 Complications 290
27.1.5 Materials and Equipment. 290
27.1.6 Preparation. 291
27.1.7 Procedure 292
27.1.8 Problems. 293
27.1.9 Pitfalls in Thyroid Biopsy . 294
27.2 Therapeutic Interventions 295
27.2.1 Evacuation Procedures . 296
27.2.2 Ablative Procedures . 296
References . 301
28 Musculoskeletal Interventions. . 304
W. Hartung, T. Weigand
28.1 Indications and Contraindications . 304
28.1.1 Indications . 304
28.1.2 Contraindications . 304
28.2 Materials and Equipment . 304
28.3 Procedure . 305
28.3.1 Preparations. . 305
28.3.2 Overview of Technique. 306
28.3.3 Details of Technique . 306
28.3.4 Rotator Cuff (Supraspinatus Muscle) . 309
28.4 Pitfalls and Complications 312
28.5 Postprocedure Care 313
References . 313
Contents
xv
29 Neurologic Interventions, Ultrasound-Guided Regional Anesthesia 315
H. H. Wilckens, A. Ignee, M. Kaeppler, H. Boehrer, C. F. Dietrich
29.1 History and Development 315
29.2 Indications 315
29.3 Contraindications 315
29.3.1 Patient Refusal 315
29.3.2 Clinically Overt Coagulopathy and
Anticoagulant Medication 315
29.3.3 Infections at the Puncture Site 316
29.3.4 Neurologic Deficit . 316
29.4 Needle Insertion Techniques 316
29.4.1 Out-of-Plane versus In-Plane
Technique. . 316
29.5 Ultrasound Imaging of Nerves and
Muscles . 316
29.5.1 Nerves. 316
29.5.2 Muscles 317
29.6 Materials and Equipment . 317
29.6.1 Ultrasound Machines 317
29.6.2 Anesthesia Needles and Catheters . 317
29.7 Regional Anesthesia at Specific Sites:
Upper Limb. . 318
29.7.1 Brachial Plexus. . 318
29.7.2 Infraclavicular Brachial Plexus Block . 320
29.7.3 Axillary Brachial Plexus Block . 321
29.8 Regional Anesthesia at Specific Sites:
Lower Limb. . 322
29.8.1 Lumbosacral Plexus. . 322
29.8.2 Femoral Nerve Block. 323
29.8.3 Obturator Nerve Block . 323
29.8.4 Sciatic Nerve Block 325
29.8.5 Saphenous Nerve Block 326
29.8.6 Lateral Femoral Cutaneous
Nerve Block 326
29.9 Summary. . 327
References . 328
30 Ultrasound-Guided Emergency and Vascular Interventions . 330
T. Mueller, C. Jenssen
30.1 Emergency Interventions . 330
30.1.1 Indications . 330
30.1.2 Contraindications . 331
30.1.3 Materials and Equipment. 331
30.1.4 Antisepsis 332
30.1.5 Problems and Complications 332
30.1.6 Intra-abdominal Free Fluid . 332
30.1.7 Intrathoracic Free Fluid 333
30.1.8 Pneumothorax. . 333
30.1.9 Pericardial Fluid. 334
30.2 Percutaneous Vascular
Interventions 335
30.2.1 Vascular Access . 335
30.2.2 Ultrasound-Guided Treatment of
Pseudoaneurysms . 341
30.3 Endosonographically Guided Vascular
Interventions 345
30.3.1 Indications and Treatment Goals 345
References . 348
Specific Ultrasound-Guided Procedures: Other Applications of Interventional
Ultrasound
31 Extravascular Use of Ultrasound Contrast Agents 354
A. Ignee, G. Schuessler, C. F Dietrich
31.1 Approved Indications. 354 31.2 Contraindications and
Complications . 354
Contents
xvi
31.3 Technique . 354
31.4 Use of Ultrasound Contrast Agents in
Physiologic Body Cavities. 355
31.4.1 Voiding Sonography for the Detection of
Vesicoureteral Reflux 355
31.4.2 Contrast-Enhanced Ultrasound for
Evaluating Tubal Patency . 355
31.4.3 Imaging the Peritoneal Cavity with UCAs
(for Detection of Ascites) . 355
31.4.4 Biliary Tract 356
31.4.5 UCAs in Enterography . 356
31.4.6 CEUS Gastrography—Percutaneous
Injection of UCA into the Stomach
to Assess Gastrostomy Placement. . 356
31.5 Use of Ultrasound Contrast Agents in
Nonphysiologic Body Cavities . 356
31.5.1 Ultrasound Fistulography 356
31.5.2 Percutaneous Injection of UCAs for
Abscess Imaging 357
31.5.3 UCAs for Demonstrating
Pancreatitis-Associated Cystic Lesions
after EUS-Guided Biopsy . 357
31.6 Summary. . 357
References . 358
32 Volume Navigation. 359
C. F Dietrich, A. Ignee, M. Hoepfner
32.1 How Tracking Works . 359
32.2 Position Marking. 359
32.3 Fusion with CT, MRI, or PET Volume
Data Sets 359
32.4 Fusion with Archived Ultrasound
Volume Data 362
32.5 Magnetic Field–Assisted Needle
Tracking and Guidance . 362
32.6 Illustrative Images and Case
Reports . 362
32.6.1 Case Report 1 . 362
32.6.2 Case Report 2 . 362
References . 363
33 Palliative Interventions and the Role of Ultrasonography in Palliative Care. . 364
D. Nuernberg
33.1 Content and Goals of Palliative Care . 364
33.2 Ultrasound in Palliative Staging,
Follow-Up, and Palliative Treatment
Monitoring 364
33.3 Ultrasound-Guided Palliative
Interventions 365
33.3.1 Palliative Diagnostic Interventions . 365
33.3.2 Specific Palliative Therapeutic
Interventions . 366
33.4 Portable Ultrasound in Specialized
Ambulatory Palliative Care . 367
33.5 Palliative Ultrasound in Caring
Medicine 367
33.6 Conclusions . 368
References . 368
Index 369
Interventional Ultrasound A Practical Guide and Atlas PDF Ebook

Christoph F. Dietrich, MD
Professor and Head Physician
Medical Clinic 2
Caritas Hospital Bad Mergentheim gGmbH
Bad Mergentheim, Germany

Dieter Nuernberg, MD
Professor and Head Physician
Medical Clinic B
Ruppiner Hospitals GmbH
Neuruppin, Germany