Although considered a relatively rare occurrence, penile fracture is nonetheless a urological emergency. The importance of correctly identifying this pathology is essential when the long‐term sequelae of a delayed or misdiagnosis are considered. Due to the stigma attached to this entity, it is assumed that its true incidence remains underreported, and as such, literature on the sonographic evaluation of penile fracture is rendered to be relatively scarce. The consequence of such an unusual referral means that there is a gap in knowledge when it comes to attaining an accurate ultrasound diagnosis. This article will review the anatomy of the penis, the pathophysiology contributing to penile fracture, and how an inherent understanding of both is vital to the accurate sonographic grading of different fracture types. Although penile fracture is still considered a clinical diagnosis, ultrasound provides critical information in atypical or equivocal cases whereby multiple differential diagnoses cannot be excluded. The possibility of an incorrect diagnosis based on inconclusive historical and clinical findings therefore highlights not only the important role of ultrasound in the facilitation of prompt surgical intervention but also its contribution to a favourable patient outcome by way of correct management.

Although splenic artery aneurysm (SAA) rupture in the pregnant patient is considered a rare occurrence, its consequences can be catastrophic for both mother and fetus. The mortality rate from this entity in pregnancy is disproportionately high when compared with that of the general population, with multiparity thought to be a contributing factor. Potential reasons for this may be explained by its non‐specific abdominal symptoms often misdiagnosed as common obstetric differentials, combined with a rapid deterioration of patient condition post rupture. For these reasons, SAA rupture should have a high index of suspicion when a pregnant women presents with an acute abdomen, as a favourable outcome is dependent on prompt diagnosis and appropriate medical intervention. This article reviews the incidence of SAA rupture in pregnancy, outlines the pathophysiological processes that contribute to this entity being more prevalent in the gravid population, and displays the pivotal role ultrasound can play in expediting this diagnosis. In the emergency situation, ultrasound examination of a pregnant patient should be extended from a focussed pelvic study to encompass the entire abdominal cavity. Its portability combined with its nonionising nature makes ultrasound the modality of choice to reduce the time to diagnosis and thus influence treatment pathways.

Rib fracture is reported to be the most commonly encountered aetiology following blunt chest trauma, 1,2 but despite this, it is frequently regarded as insignificant. Unfortunately, this ideology is compounded when the limitations of conventional imaging modalities are evaluated. In the acute setting, plain radiography can render rib fractures undetected in 50% of cases, 3 and although computer tomography (CT) is deemed to have a higher sensitivity than plain film, its limitations can include a lower specificity in the setting of higher radiation doses. 4,5 Regarded as being a sentinel injury, a rib fracture can act as an external marker to more serious pathologies 5-7 which can in turn compromise the normal breathing mechanism and/or the status of the thoraco-abdominal organs. As delayed diagnosis can result in increased patient morbidity and mortality, resulting from both primary and secondary complications, the detection of rib fracture is imperative in not only predicting patient outcomes but in the development of appropriate management pathways. 2,8 The aim of this case study is therefore twofold-it evaluates the sequelae that can result from rib fracture irrespective of how trivial the injury may seemand in doing so acknowledges the importance of correctly identifying this pathology in the acute setting. Secondly, it highlights a case where ultrasound detected rib fractures not seen on original plain radiographs, but suspected on magnetic resonance imaging (MRI) in a setting where CT of the chest was not performed. | CASE DESCRIPTIONA 37-year-old female presented to the emergency department following a high-speed motor vehicle accident (MVA) in which she was the front seat passenger. Suspicion was raised as to the presence of a retro-peritoneal bleed or hollow organ perforation upon sighting extensive thoraco-abdominal swelling and haematoma in conjunction with a tachycardic heart rhythm of 110 to 130 beats per minute. The initial chest radiograph was deemed unremarkable with normal cardio-mediastinal contours and clear lung fields. No evidence of pneumothorax or displaced rib injury was detected despite the patient complaining of slight chest discomfort on inspiration.As this woman was of child-bearing age and a radiation worker, doctors were hesitant to perform a CT scan initially, and as such intravenous fluids were hung and a period of observation undertaken in the hope that the tachycardia would subside. An ECG eight hours post MVA continued to demonstrate a tachycardic rhythm, and so it was decided to perform an abdominal ultrasound to exclude any intraperitoneal bleeding. No free fluid or solid organ lacerations were detected on the ultrasound scan. As mesenteric shearing could not be excluded by ultrasound, a CT was requested of the abdomen and pelvis. The results were again unremarkable, and the patient was observed overnight in case any pathology developed in the critical hours post trauma. Nine hours later, the patient's heart rate had dropped below 100 beats per minute, her chest sounds were cle...

A request for an ultrasound of the eye can be a relatively infrequent occurrence for a sonographer, but ultrasound can play a pivotal role in the detection of vision threatening conditions. In those instances where sonographers are required to perform the occasional ocular ultrasound, a sound knowledge of normal anatomy, scanning techniques, technical parameters and pitfalls is pertinent to ensure pathology is not overlooked. Ultrasound of the eye is commonly performed following trauma or visual disturbance. As such it is a useful diagnostic tool when fundoscopic examination of the eye is limited. The fact that it lacks the use of ionizing radiation, is non‐invasive and readily accessible are just some of its many advantages. However, the greatest advantage is its ability to provide a dynamic assessment of the eye. Ocular structures have a higher sensitivity to ultrasound exposure, which necessitates the correct use of technical parameters so as to not induce any vision affecting biological effects. The purpose of this article is to introduce sonographers to normal ocular anatomy, optimal scanning techniques for enhanced pathology detection, and most importantly the safe use of physical parameters to minimize damage to sensitive ocular structures.