Endocavitary Contrast Enhanced Ultrasound (CEUS) – Work in Progress

Abstract

The application of ultrasound contrast agents via drainage catheters provides substantial information on location and dimensions of drained fluid collections and their communication with surrounding organ structures. The biliary system can be visualised. Oral administration is feasible and provides important additional information.

Endocavitary contrast‐enhanced ultrasound: A technique whose time has come?

“…However, in our experience, the most important advantage of eCEUS compared with saline instillation alone is that it will dependably detect fistulae, both those occurring as complications and those indicating the origin of an abscess (Figure 2, Figure 3A-3D). 17 In some cases, this information will lead to important changes in management (eg, from antibiotic treatment and drainage to surgery).…”

“…If dislodgment occurs, it can be correctly diagnosed. 17 In gray-scale US, inadequate drainage can be suspected when septa are seen in a pleural effusion. eCEUS can prove loculation (Figure 4), and the patient's management can be changed.…”

“…The position of the drain tip can also be monitored during treatment (eg, if draining is interrupted) to elucidate the cause. 17,18,21 eCEUS-PTC may also be useful to confirm passage of a drain into the small bowel or patency of the cystic duct. In cases of concurrent aerobilia, it can be useful to destroy bubbles by means of a high-energy US impulse (bubble destruction) to distinguish refluxed air from USCM.…”

“…Proposed indications for eCEUS include locating tubes and drains in body cavities, abscesses, or collections 13,14 ; estimating the dimensions and detecting the communications of fluid collections 13,[15][16][17] ; percutaneous, transpapillary, or intraoperative visualization of the biliary system [16][17][18][19][20][21][22][23] ; demonstrating thoracoabdominal communication in cases of suspected hepatic hydrothorax [24][25][26] ; detecting and quantifying fistulae in various locations [27][28][29] digestive tract after oral or colonic administration of USCMs 17,[30][31][32][33][34] ; confirming correct placement of a percutaneous nephrostomy 35 ; and evaluating obstructive disease of the salivary glands. 36 Endocavitary administration of USCMs has recently been included in guidelines from the European Federation of Societies for Ultrasound in Medicine and Biology, which emphasize that no well-established indications exist at present but recommend considering the use of eCEUS if alternatives (eg, fluoroscopy, need to transport critically ill patients) may carry a higher risk for the patient.…”

“…In our US department we do more than 12,000 US examinations and around 600 USguided interventions per year and frequently perform eCEUS in various settings preliminarily described by Heinzmann et al, 17 in an attempt to gain information beyond that provided by gray-scale US or to reduce patient risk to less than that associated with fluoroscopic imaging or endoscopy.…”