Portable ultrasound devices are surprisingly effective in the hands of experienced examiners. Imaging quality is predictably inferior to so-called high-end devices. Nearly all acute and therapeutically relevant diagnoses and findings were registered, even though nearly a quarter of the findings diagnosed with the high-end device were overlooked. These findings were mostly clinically irrelevant or very small in size. As could be expected, problems arose with pathological findings requiring high resolution, i.e., liver metastases, tiny gallstones, appendicitis, Crohn's disease etc. These form a clear indication for a high-end ultrasound examination.
An innovative, prospective, randomized multicenter study regarding the diagnosis of kidney stones with ultrasound and CT including more than 2700 patients was recently published in the highly respected New England Journal of Medicine 1. The study showed that in the case of clinical suspicion of nephrolithiasis the results of those primarily examined with ultrasound and those primarily examined with CT did not differ with respect to diagnoses, complications, pain, frequency of repeat presentation at the emergency room and hospitalization over 30 days, and not even with respect to missed diagnoses during a 6-month follow-up period. For the detection of kidney stones, there were as slightly lower sensitivity and a higher specificity for US compared to CT. As expected, the radiation exposure and costs in the ultrasound arm were lower. Approximately 40?% of the ultrasound patients underwent CT in the following 6 months. The study results are certainly surprising to many colleagues who saw unenhanced low-dose CT as the diagnostic gold standard in a strict method comparison 2 3. No wonder that the frequency of CT examinations for suspected kidney stones has increased in the USA tenfold from 1996???2007 4. However, in light of earlier ultrasound publications regarding kidney stone diagnosis, this result is not surprising. The importance of ultrasound for kidney stone diagnosis 5 6 and the equivalence of US and intravenous urography even for the detection of ureteral stones have long been known in Europe 7 8 9. We know even German publications cannot be widely read and even English publications require an accepted publication medium or they remain virtually unknown. A prospective study including 100 patients in the discontinued EJU publication from Elsevier showed equivalence of ultrasound and intravenous urography for kidney and ureteral stones and superiority of US over plain radiography of the kidneys 9. Today, numerous studies are available, primarily comparisons between US and CT with very different results. As in the past, the results primarily depend on the quality of the examination technique 10 11 12 13 14 15. The study by Smith-Bindman et al. 1 shows the high value of ultrasound diagnosis when used directly in the clinical setting. The concept of continuing the physical examination with technical means was introduced in Germany in 1976 16. The additional inclusion of the medical history was performed as part of ?clinical sonography? in Europe. This approach was named ?point of care ultrasound? in the USA and for approximately 15 years American colleagues in emergency units have been using the ultrasound probe with great success in this regard. In the USA this new development was based less on European experiences than on increasing economic pressure and the rapid development of US equipment. The discussion regarding CT-based increased radiation exposure and the possible increase in malignant diseases that was started by Brenner et al. 17 and is still ongoing may have also had an impact. This discussion has basic...
The soft tissues of the neck can be examined at the highest resolution with ultrasound probes of high frequencies due to their superficial position. There are many clinically important diagnostic issues concerning the thyroid gland, the parathyroid, lymph nodes, vessels of the neck, salivary glands and other structures of the field of ENT and even the nerves of this region. Numerous different medical departments therefore work in this field either together or I a parallel fashion. In addition to different sub-specialties of internal medical and surgical departments, radiologists, neurologists, ENT doctors, gnathologists and radio-oncologists are all active here. Even intensive care personnel and anaesthesiologists use ultrasound for sonographically guided punctures. It is therefore obvious that the cervical region is of special importance for an interdisciplinary journal, constituting a large part of publications. In the last 2 (1/2) years, we published two articles about cervical lymph nodes , eight concerning the topic of vessels , two articles about salivary glands and three dealing with the parathyroid glands . The present issue again contains three publications concerning this area, characteristically from three different medical specialties, each of great significance for various medical fields. An important article deals with deQuervain thyroiditis . Albeit this is not a common disease, any clinician working on the cervical region should be well aware of this entity, as the patients concerned often go through a medical "odyssey" with different specialists before the right diagnosis is made. An important addition to sonographical interventional techniques is percutaneous instillation therapy for focal autonomous adenomas of the thyroid : it is fast acting and effective, representing a genuine therapeutic alternative to surgery or radioactive iodine treatment in many cases. The case report on a - fortunately non-permanent - partial laryngeal necrosis resulting from the instillation of 96 % alcohol demonstrates the potential damage an established method can cause if applied without expertise. It is therefore mandatory to be aware of potential side effects and carry out the intervention proficiently, strictly keeping in mind the indication for therapy. A further case report demonstrates in an impressive way the importance of cervical sonography for the detection and landmarking of parathyroid adenomas. The fact that the author is a surgeon might serve as valid proof, as the surgery of parathyroid glands almost solely depended on the experience and the explorative skill of the surgeon until recently.
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