Neck Ultrasound. Faculty Info: Amy Kule, MD
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1 Neck Ultrasound Date: Friday, October 19, 2018 Time: 11:00 AM Location: SMALL GROUP LABORATORY SSOM L71 Watch: Ø Neck Ultrasound Scanning Protocol (4:00): Faculty Info: LEARNING OBJECTIVES Ø Correlate anatomic structures identified during live-dissection with findings on ultrasound Ø Demonstrate the ability to describe and identify normal ultrasound anatomy in the neck Ø Select the appropriate transducer and optimizing image capture by adjusting function keys HANDS-ON OBJECTIVES Ø Identify structures in the Neck o Thyroid cartilage o Thyroid gland (isthmus, right and left lobes) o Trachea and Tracheal rings o Esophagus o Common carotid artery o Internal carotid artery o External carotid artery o Subclavian artery o Internal jugular vein o Sternocleidomastoid muscle
2 Gross Anatomy NECK ULTRASOUND Credit: SHB Neck lecture, Slide 56
3 Ultrasound Anatomy Neck Ultrasound Scanning Protocol: Probe Selection: Ø Linear Patient Positioning and Preparation: Ø Supine for scan of anterior neck Ø Patient s head turned to the contralateral (opposite) side to evaluate the lateral neck structures Credit: 1. Technique: Ø Transverse (axial) plane Ø Place linear probe midline and survey the neck superiorly and inferiorly. Note the thyroid cartilage and its triangular shape. Ø Take note of how the shape of the thyroid cartilage changes as you sweep the probe along the anterior aspect of the neck. Structure to Identify: Ø Thyroid cartilage
4 2. Technique: Ø Transverse (axial) plane Ø Sweep the probe inferiorly (caudally) to see the tracheal rings, the isthmus and the right and left lobes of the thyroid gland. Ø Note the relationship and difference of appearance between the thyroid gland and the trachea. Ø A collapsed esophagus will lay to the left and inferior to the trachea. To better visualize the esophagus, scan as your patient takes a drink, and you should see the lumen of the esophagus distend as the anechoic fluid moves through the esophagus. Structures to Identify: Ø Thyroid gland (Isthmus, Lobes) Ø Trachea and tracheal rings Ø Esophagus 3. Technique: Part 1: Ø Slide the probe slightly to the patient s right, off midline to interrogate the right lobe of the thyroid. The probe will remain in transverse orientation. Ø The carotid artery is just lateral to the thyroid gland, and the internal jugular vein is usually anterolateral to the carotid artery. Have the patient valsalva (attempted exhalation against a closed airway or bearing down, like having a bowel movement ) in order to distend the internal jugular vein (IJ). Ø Further differentiate the carotid artery from the IJ by noticing the compressibility and ovoid shape of the IJ and the pulsatility of the carotid artery. Sometimes the IJ may appear to pulse, however, the pulsation is originating from the carotid artery underneath it. Ø Anterior to the vessels you will find the sternocleidomastoid muscle. Muscle will have a striated appearance.
5 Structure of the Human Body (2018/2019) Part 2: Ø Sweep the probe cranially along the right common carotid artery to identify its branches (internal and external carotid arteries). The common carotid artery will branch near the angle of the mandible. Ø Sweep the probe caudally along the right common carotid artery to identify the subclavian artery at the level of the clavicle. As the subclavian artery runs medial to lateral, the vessel will appear in long axis (running horizontally along the screen). Structures to Identify: Ø Common carotid artery Ø Internal jugular vein Ø Sternocleidomastoid muscle Ø Internal carotid artery Ø External carotid artery Ø Subclavian artery (Is isthmus of thyroid lobe; SCM = sternocleidomastoid muscle; C carotid artery; JV internal jugular vein) Credit:
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