CNS Tuberculosis can manifest as meningitis, arachnoiditis and a tuberculoma. The rupture of a tubercle into the subarachnoid space leads to Tuberculosis Meningitis (TBME); the resulting hypersensitivity reaction can lead to an elevation of the intracranial pressure and hydrocephalus. While bedside optic nerve sheath diameter (ONSD) ultrasonography (USG) can be a sensitive screening test for elevated intracranial pressure in adult head injury, little is known regarding ONSD measurements in Tuberculosis Meningitis.Objectives:The aim of this study was to determine whether patients with TBME had dilation of the optic nerve sheath, as detected by ocular USG performed in the emergency department (ED).Materials and Methods:We conducted a prospective, observational study on adult ED patients with suspected TBME. Patients underwent USG measurements of the optic nerve followed by MRI. The ONSD was measured 3 mm behind the globe in each eye. MRI evidence of basilar meningeal enhancement and any degree of hydrocephalus was suggestive of TBME. Those patients without evidence of hydrocephalus subsequently underwent a lumbar puncture to confirm the diagnosis. Exclusion criteria were age less than 18 and obvious ocular pathology. In total, the optic nerve sheath diameters of 25 adults with confirmed TBME were measured. These measurements were compared with 120 control patients.Results:The upper limit of normal ONSD was 4.37 mm in control group. Those patients with TBME had a mean ONSD of 5.81 mm (SD 0.42). These results confirm that patients with tuberculosis meningitis have an ONSD in excess of the control data (P < 0.001).Conclusion:The evaluation of the ONSD is a simple non-invasive and potentially useful tool in the assessment of adults suspected of having TBME.

Objective:The objective of this study is to determine the accuracy of the bedside lung ultrasound in emergency (BLUE) protocol in giving a correct diagnosis in patients presenting with acute respiratory distress in emergency department.Materials and Methods:Patients with acute respiratory distress were evaluated. Ultrasound findings such as artifacts (A line, B line), lung sliding, alveolar consolidation or pleural effusion, and venous analysis were recorded. Ultrasonography findings were correlated with final diagnosis made by the treating unit. Sensitivity and specificity were calculated.Results:A total 50 patients were evaluated. The A profile (predominant A line with lung sliding) indicated chronic obstructive pulmonary disease/asthma (n = 14) with 85.17% sensitivity and 88.88% specificity. B profile (predominant B + lines with lung sliding) indicated pulmonary edema (n = 13) with 92.30% sensitivity and 100% specificity. The A/B profile (A line on one side and B + line on other side) and the C profile (anterior consolidation) and the A profile plus posterolateral alveolar and/or pleural syndrome indicated pneumonia (n = 17) with 94.11 sensitivity and 93.93% specificity. The A profile plus venous thrombosis indicated pulmonary embolism (n = 1) with 100% sensitivity and specificity. A’ profile (predominant A line without lung sliding) with lung point indicated pneumothorax (n = 5) with 80% sensitivity and 100% specificity.Conclusion:BLUE protocol was successful in average 90.316% cases. BLUE performed in emergency department is equivalent to computed tomography scan. BLUE protocol aids in making diagnosis and saves time and cost; avoids the side effects related to radiation.

Background: In developing country like India, central venous catheter is still inserted using anatomical landmark guidance with success rate up to 97.6% and complications up to 15%. Aims & Objective: This study was aimed to determine the anatomical variations of the internal jugular vein (IJV) in relation with carotid artery (CA) with the help of 2-D ultrasound. Material and Methods: This prospective randomized study was conducted in a teaching and tertiary care hospital on 100 young healthy volunteers of either sex, aged 20 years to 40 years. Each volunteer was placed supine with 15˚ down trendlenberg position with 45˚ neck rotation on contra-lateral side. Linear array probe with 7.5 M Hz of "Sonosite Micromaxx" ultrasound machine was placed perpendicular to the apex of the triangle formed by two heads of sternocleidomastoid muscle and clavicle. Vessels were visualized in transverse section in 2-D ultrasound. Exact location of IJV was identified in relation to the CA on ultrasound and recorded as lateral, antero-lateral, anterior, medial, and posterior. The diameter of IJV and CA, distance from skin to IJV were recorded on both sides of neck for each volunteer. Anterior position of IJV in relation to CA was defined as dangerous position. Small sized IJV was defined as diameter ≤7 mm. Data were analyzed using Graphpad prism software version 5.1. P value < 0.05 was taken as significant. Results: The mean diameter of IJV was 13.23 (2.52) mm in right and 10.25(2.29) mm in left side of neck (p=0.0001). Small sized IJV was in 1% in right and 8% in left side (p=0.0349). 15% and 28% of volunteers had dangerous position of IJV in relation to CA on right and left side of neck respectively (p=0.0381). Conclusion: Significant number of healthy young volunteers had anatomical variations in terms of size and position of IJV (left side > right side) in relation of CA by ultrasound screening. Thus, anatomical landmarks are not sufficient, alternative measures like ultrasound scanning should be implemented prior to catheterization to identify the individual with potentially difficult catheterization.

Context:The scope of ultrasound is emerging in medical science, particularly outside traditional areas of radiology practice.Aims:We designed this study to evaluate feasibility of bedside sonography as a tool for airway assessment and to describe sonographic anatomy of airway.Settings and Design:A prospective, clinical study.Materials and Methods:We included 100 adult, healthy volunteers of either sex to undergo airway imaging systemically starting from floor of the mouth to the sternal notch in anterior aspect of neck by sonography.Results:We could visualize mandible and hyoid bone as a bright hyperechoic structure with hypoechoic acoustic shadow underneath. Epiglottis, thyroid cartilage, cricoid cartilage, and tracheal rings appeared hypoechoic. Vocal cords were visualized through thyroid cartilage. Interface between air and mucosa lining the airway produced a bright hyperechoic linear appearance. Artifacts created by intraluminal air prevented visualization of posterior pharynx, posterior commissure, and posterior wall of trachea.Conclusions:Ultrasound is safe, quick, noninvasive, repeatable, and bedside tool to assess the airway and can provide real-time dynamic images relevant for several aspects of airway management.

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