Interventional Ultrasound: A Practical Guide and Atlas

406 Pages·2014·23.96 MB·English

by  Christoph Frank Dietrich

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Interventional Ultrasound
A Practical Guide and Atlas
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
380 illustrations
Thieme
Stuttgart (cid:129) New York (cid:129) Delhi (cid:129) Rio
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Interventional ultrasound : a practicalguide and atlas / experience are continually expanding our knowledge, in
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Contents
Foreword................................................................................ xviii
Preface.................................................................................. xix
Acknowledgments..................................................................... xx
Contributors............................................................................ xxi
Abbreviations........................................................................... xxiii
GeneralAspectsofInterventionalUltrasound
1 InterventionalUltrasound:IntroductionandHistoricalBackground ............. 2
H.Lutz
1.1 TheViennaCongress................. 2 1.2.4 RisksofInterventionalUltrasound....... 9
1.2 TheIntroductionofUltrasoundinto 1.3 LaterDevelopments:Ultrasound-
RoutineClinicalUse.................. 3 GuidedTherapeuticInterventional
Procedures.......................... 10
1.2.1 TheEvolutionofUltrasoundImaging
Techniques........................... 3 1.4 Outlook............................. 10
1.2.2 TechnicalEvolutionofUltrasound-Guided
Biopsies.............................. 4 References ........................... 11
1.2.3 ClinicalApplication.................... 7
2 InterventionalMaterialsandEquipment ............................................ 13
2.1 GeneralConsiderationson 2.2.6 Complications ........................ 22
InterventionalProcedures............ 13 2.2.7 NeedleTechniques .................... 23
U.Gottschalk,C.F.Dietrich 2.2.8 SpecialNeedleTypes................... 23
2.2.9 TrocarTechnique...................... 23
2.1.1 BriefHistoricalIntroduction............ 13 2.2.10 SeldingerTechnique................... 24
2.1.2 BiopsyPrinciplesandTechniques........ 13 2.2.11 Peel-AwaySheath..................... 24
2.1.3 NeedleSystems....................... 15 2.2.12 AnchorSystems,SutureTechniques...... 25
2.2.13 Guidewires........................... 26
2.2 TherapeuticInterventions............ 20 2.2.14 Dilators.............................. 27
2.2.15 DrainageCatheters.................... 27
2.2.1 Introduction.......................... 20 2.2.16 OtherDrainageSystems................ 29
2.2.2 BriefHistoricalReview................. 20 2.2.17 Accessories........................... 29
2.2.3 PatientPreparation.................... 21 References ........................... 31
2.2.4 AccessRoutes......................... 21
2.2.5 IndicationsandContraindications ....... 21
3 InformedConsent...................................................................... 32
D.Nuernberg,A.Jung
3.1 WhatShouldBeDisclosed?........... 32 3.2 MeansofDisclosure.................. 32
3.1.1 Indication............................ 32 3.2.1 ConsentForm......................... 32
3.1.2 ExplainingtheProcedure............... 32 3.2.2 InformedConsentDiscussion ........... 32
3.1.3 RisksandComplications................ 32 3.2.3 DelegatingInformedConsent........... 33
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Contents
3.3 Documentation...................... 33 3.5.2 PatientsLackingtheCapacity
toConsent ........................... 33
3.4 TimingoftheConsentProcess........ 33 3.5.3 Minors............................... 33
3.5.4 LanguageBarriers..................... 34
3.5 SpecialSituations.................... 33 3.5.5 WaivingofInformedConsent........... 34
References ........................... 34
3.5.1 ImpliedConsent ...................... 33
4 Medications,Equipment,andSetupRequirements ................................ 35
D.Nuernberg,A.Jung
4.1 Medications......................... 35 4.2.3 Positioning,PreprocedureExamination,
andMarking.......................... 37
4.1.1 Premedication........................ 35 4.2.4 MonitoringDuringtheProcedure........ 37
4.1.2 Analgesia............................. 35 4.2.5 PostprocedureMonitoring.............. 37
4.1.3 Coagulation .......................... 36 4.2.6 Facilities(ProcedureRoom)............. 37
4.1.4 LocalAnesthesia ...................... 36 4.2.7 FunctionalandDesignRequirements..... 38
4.2.8 OperationalandOrganizational
4.2 EquipmentandSetupRequirements .. 37 Requirements......................... 38
References ........................... 38
4.2.1 BiopsyEquipment..................... 37
4.2.2 InterventionalMaterials................ 37
5 PathologyandCytology............................................................... 40
A.Tannapfel,C.F.Dietrich
5.1 Pathology........................... 40 5.4.2 Grading.............................. 43
5.2 Biopsies............................. 40 5.5 SpecificAnalysis ..................... 43
5.2.1 TypesofBiopsyProcedure.............. 40 5.5.1 LymphNodes......................... 43
5.5.2 Lymphomas.......................... 45
5.3 HistologyorCytology?............... 40
5.6 HormoneGrowthFactorReceptor
5.3.1 SourcesofError....................... 41 Analysis............................. 47
5.4 Typing,Grading,andStaging ......... 41 References ........................... 48
5.4.1 Classification(Typing).................. 41
6 FineNeedleAspirationCytology...................................................... 49
C.Jenssen,T.Beyer
6.1 SpecimenCollection ................. 49 6.3.1 BasicPrinciples ....................... 55
6.3.2 AirDryingandRomanowskyStains...... 55
6.1.1 Ultrasound-GuidedBiopsy ............. 49
6.3.3 WetFixationandPapanicolaouStaining.. 55
6.1.2 NeedleMovementandAspiration ....... 49
6.3.4 AncillaryTests........................ 56
6.2 SpecimenPreparation................ 49 6.4 CytomorphologicEvaluation.......... 58
6.2.1 FluidAspirates........................ 49
6.4.1 RapidOn-SiteEvaluation............... 58
6.2.2 CentrifugingEffusions ................. 49
6.4.2 FinalCytologicDiagnosis............... 63
6.2.3 AspiratesfromSolidLesions............ 50
6.5 Conclusions ......................... 64
6.3 FixationandStaining................. 55
References ........................... 64
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Contents
7 InfectionsandDiagnosticMicrobiology ............................................. 68
T.Glueck,H.J.Linde,C.F.Dietrich
7.1 GeneralPrinciplesofMicrobiological 7.2.6 LimitationsofMicrobiologicalMethods .. 72
Testing.............................. 68 7.2.7 SpecimenReceiptduringOff-hours
(Nights,Weekends,Holidays)........... 72
7.1.1 MicrobiologicalSpecimens ............. 68
7.1.2 PrerequisitesforMicrobiologicalTesting.. 68 7.3 SpecificGuidelinesforMicrobiological
TestingandDifferentialDiagnosisby
7.2 MicrobiologicalTechniques........... 69 OrganSystemsandSyndromes ....... 73
7.2.1 Stains................................ 69 7.3.1 InvestigationofEnlargedLymphNodes... 73
7.2.2 CultureTechniques.................... 71 7.3.2 MicrobiologicalTestingandAntimicrobial
7.2.3 NucleicAcidAmplificationTechniques ... 71 TherapyforSuspectedTuberculosis...... 76
7.2.4 Serology............................. 71 7.3.3 LiverMassSuspiciousforanAbscess
7.2.5 WhenAreMicrobiologicalTestResults (IncludingAmebicAbscess)............. 77
Available?............................ 72 References ........................... 81
8 HygieneManagement................................................................. 82
H.Martiny,D.Nuernberg
8.1 GeneralHygienicRequirements....... 82 8.3 UltrasoundProbeandAccessories..... 84
8.1.1 PersonalProtectiveEquipmentand 8.3.1 DecontaminationoftheUltrasound
Coverings............................ 82 Probe................................ 84
8.1.2 DisposableProbeCovers ............... 83 8.3.2 DecontaminationofUltrasound
8.1.3 UltrasoundGel........................ 83 Accessories........................... 85
References ........................... 85
8.2 HandAntisepsisandSkin
Preparation.......................... 83
9 Contraindications,Complications,andComplicationManagement.............. 86
C.Jenssen,C.F.Dietrich
9.1 InterventionalRisk................... 86 9.3.5 PreventionofInfection................. 93
9.3.6 OptimalApproachandAlternatives...... 93
9.1.1 ComplicationRatesandMortality ....... 86
9.1.2 FactorsthatInfluenceInterventional 9.4 Contraindications.................... 93
Risk ................................. 86
9.4.1 Coagulopathies ....................... 93
9.2 FrequentComplicationsandTheirRisk 9.4.2 ProcoagulantTherapyandAntiplatelet
Factors.............................. 86 Drugs................................ 94
9.4.3 “Risky”LesionsandAccessRoutes....... 94
9.2.1 PainandVasovagalReactions ........... 86
9.2.2 BleedingComplications................ 87 9.5 ManagementofComplications ....... 95
9.2.3 NeedleTractSeeding .................. 88
9.2.4 SpecificComplications................. 89 9.5.1 PostinterventionalCareandDetectionof
Complications ........................ 95
9.3 PreventionofComplications.......... 89 9.5.2 TreatmentofComplications............. 95
9.3.1 RiskAssessmentandPatient 9.6 SpecificBiopsySites.................. 95
Selection............................. 89
9.3.2 ModificationofRiskFactors............. 90 9.6.1 LiverBiopsy .......................... 95
9.3.3 RiskReductionTechniques ............. 92 9.6.2 RenalBiopsy.......................... 99
9.3.4 LocalAnesthesiaandIntravenous 9.6.3 PancreaticBiopsy ..................... 99
Sedation............................. 92 9.6.4 SplenicBiopsy........................ 100
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Contents
9.6.5 BiopsyofGastrointestinalHollowOrgans 9.7.3 TransrectalProstaticBiopsy............. 102
andMesentericMasses................. 100 9.7.4 Ultrasound-GuidedDrainage(ofCysts,
9.6.6 AdrenalBiopsy........................ 100 Pseudocysts,Abscesses,Cholecystitis).... 102
9.6.7 Lungs,Pleura,andMediastinum......... 101 9.7.5 Ultrasound-GuidedPTCDand
Cholecystotomy....................... 103
9.7 SpecificInterventions................ 101 9.7.6 Ultrasound-guidedTumorAblation
Therapy.............................. 103
9.7.1 EUS-FNA,EUS-TCB,EBUS-TBNA ......... 101 References ........................... 104
9.7.2 EUS-GuidedTherapeuticInterventions... 101
10 AssistanceinUltrasoundInterventions.............................................. 109
U.Gottschalk,C.F.Dietrich
10.1 BasicPrinciples ...................... 109 10.6 Sedation ............................ 111
10.2 DutiesofAssistingPersonnel......... 109 10.7 DrainPlacement..................... 111
10.3 DiagnosticUltrasound................ 110 10.8 Endosonography..................... 113
10.4 DiagnosticInterventions ............. 110 References ........................... 113
10.5 TherapeuticInterventions............ 111
11 SedationinInterventions ............................................................. 114
U.Gottschalk,C.F.Dietrich
11.1 Introduction......................... 114 11.6 Complications ....................... 115
11.2 Medications......................... 114 11.7 Summary............................ 115
11.3 PersonnelRequirements.............. 114
References ........................... 115
11.4 MonitoringRequirements............ 115
11.5 PostprocedureCare.................. 115
SpecificUltrasound-GuidedProcedures:Abdomen
12 IndicationsforDiagnosticInterventionsintheAbdomenandThorax
(Liver,Pancreas,Spleen,Kidneys,Lung,OtherSites)............................... 120
H.Kinkel,D.Nuernberg
12.1 Liver ................................ 120 12.5 Lung................................ 125
12.1.1 DiffuseLiverDiseases.................. 120 12.6 AdrenalGland ....................... 125
12.1.2 FocalLiverLesions..................... 121
12.7 LymphNodes........................ 125
12.2 Pancreas ............................ 123
12.8 OtherLesions........................ 126
12.3 Spleen .............................. 123
References ........................... 126
12.4 Kidneys ............................. 124
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