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Libreria medica internazionale
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LIBRERIA STUDIUM
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Ultrasonography in Vascular Diagnosis
Schäberle
Editore
Springer
Anno
2011
Pagine
520
ISBN
9783642025082
160,00 €
I prezzi indicati possono subire variazioni poiché soggetti all'oscillazione dei cambi delle valute e/o agli aggiornamenti effettuati dagli Editori.
  • A comprehensive and up-to-date account of vascular ultrasound
  • The main chapters include atlas sections that present pertinent case material for both common and rare vascular diseases
  • The role of ultrasound as compared with other modalities is evaluated in detail
  • Ultrasound findings are discussed in their clinical context
  • Useful for beginners as well as for experienced sonographers

This is the second edition of a well-received book that has been recommended for inclusion in any vascular library or vascular radiology suite. The first edition has been fully revised so as to provide a comprehensive, up-to-date account of vascular ultrasound that reflects recent exciting advances in this diagnostic modality.

The emphasis remains on the clinical aspects most relevant to angiologists and vascular surgeons. The main chapters are subdivided into a text section and an atlas section. The text part of each chapter documents the ultrasound anatomy of the vascular territory in question, explains the examination procedure, describes normal and pathological findings, specifies the indications for diagnostic ultrasound, and assesses the clinical impact of the ultrasound findings. The atlas part of each chapter presents a compilation of pertinent case material to illustrate the typical ultrasound findings for both the more common vascular diseases and rarer conditions that are nevertheless significant for the vascular surgeon and angiologist. Throughout, the ultrasound material is compared with the angiographic and intraoperative findings.

Beginners will find this a useful textbook that guides them from a sensible and efficient examination procedure to reliable interpretation of ultrasound findings on the basis of a thorough discussion of all relevant vascular diseases. Experienced sonographers will benefit from the comprehensive presentation of rare vascular diseases, the detailed evaluation of the role of ultrasound as compared with other modalities, and the discussion of the ultrasound findings in their clinical context.

 

Table of Contents

1 Fundamental Principles................................................................................................. 1
1.1 Technical Principles of Diagnostic Ultrasound....................................................... 1
1.1.1 Gray-Scale Ultrasonography (B-Mode)........................................................ 1
1.1.1.1 Historical Milestones....................................................................... 1
1.1.1.2 Sound Waves.................................................................................... 1
1.1.1.3 Generating Ultrasound Waves.......................................................... 2
1.1.1.4 Physical Factors Affecting the Ultrasound Scan.............................. 2
1.1.1.4.1 Reflection and Refraction................................................. 3
1.1.1.4.2 Scattering.......................................................................... 3
1.1.1.4.3 Interference....................................................................... 4
1.1.1.4.4 Diffraction........................................................................ 4
1.1.1.4.5 Attenuation and Absorption............................................. 4
1.1.1.5 Generating an Ultrasound Image..................................................... 4
1.1.1.5.1 Pulse-Echo Technique...................................................... 4
1.1.1.5.2 Time-Gain Compensation................................................ 4
1.1.1.5.3 A-Mode............................................................................ 5
1.1.1.5.4 B-Mode............................................................................ 5
1.1.1.5.5 M-Mode............................................................................ 5
1.1.1.6 Resolution........................................................................................ 6
1.1.1.7 Beam Focusing................................................................................. 6
1.1.1.8 Types of Transducers........................................................................ 7
1.1.1.8.1 Principle of Operation...................................................... 7
1.1.1.8.2 Linear Arrays................................................................... 7
1.1.1.8.3 Curved or Convex Arrays................................................. 8
1.1.1.8.4 Sector Scanners................................................................ 8
1.1.1.8.5 Phased Arrays................................................................... 8
1.1.1.8.6 Mechanical Sector Scanners............................................. 8
1.1.1.8.7 Annular Phased Arrays.................................................... 9
1.1.1.8.8 Disadvantages of Mechanical Transducers...................... 9
1.1.1.9 Ultrasound Artifacts......................................................................... 9
1.1.1.9.1 Posterior Shadowing........................................................ 9
1.1.1.9.2 Acoustic Enhancement..................................................... 9
1.1.1.9.3 Edge Effect....................................................................... 9
1.1.1.9.4 Side Lobes........................................................................ 10
1.1.1.9.5 Reverberation Artifact...................................................... 10
1.1.1.9.6 Geometric Distortion........................................................ 11
1.1.2 Basic Physics of Doppler Ultrasound............................................................ 11
1.1.2.1 Continuous Wave Doppler Ultrasound............................................. 12
1.1.2.2 Pulsed Wave Doppler Ultrasound/Duplex Ultrasound..................... 13
1.1.2.3 Frequency Processing....................................................................... 13
1.1.2.4 Blood Flow Measurement................................................................ 14
1.1.3 Physical Principles of Color-Coded Duplex Ultrasound............................... 18
1.1.3.1 Velocity Mode.................................................................................. 18
1.1.3.2 Power (Angio) Mode........................................................................ 20
1.1.3.3 B-Flow Mode (Brightness Flow)..................................................... 21
1.1.3.4 Intravascular Ultrasound.................................................................. 22
1.1.3.5 Three-Dimensional/Four-Dimensional Ultrasound.......................... 23
1.1.4 Factors Affecting (Color) Duplex Imaging – Pitfalls.................................... 23
1.1.4.1 Scattering, Acoustic Shadowing...................................................... 23
1.1.4.2 Mirror Artifact.................................................................................. 24
1.1.4.3 Maximum Flow Velocity Detectable – Pulse Repetition Frequency.... 24
1.1.4.4 Minimum Flow Velocity Detectable – Wall Filter, Frame Rate....... 27
1.1.4.5 Transmit and Receive Gain.............................................................. 28
1.1.4.6 Doppler Angle.................................................................................. 28
1.1.4.7 Physical Limitations of Color Duplex Ultrasound........................... 28
1.1.5 Ultrasound Contrast Agents.......................................................................... 30
1.1.6 Safety of Diagnostic Ultrasound................................................................... 32
1.1.6.1 Thermal Effects................................................................................ 32
1.1.6.2 Mechanical Effects........................................................................... 33
1.1.6.3 Specific Risks of Individual Ultrasound Techniques....................... 33
1.2 Hemodynamic Principles......................................................................................... 34
1.2.1 Laminar Flow................................................................................................ 34
1.2.2 Flow Profiles and Perfusion Regulation........................................................ 36
1.2.2.1 Low-Resistance Flow....................................................................... 36
1.2.2.2 High-Resistance Flow...................................................................... 36
1.2.2.3 Blood Flow Regulation.................................................................... 37
1.2.3 Determining the Degree of Stenosis.............................................................. 38
1.3 Machine Settings..................................................................................................... 42
2 Peripheral Arteries......................................................................................................... 45
2.1 Pelvic and Leg Arteries........................................................................................... 45
2.1.1 Vascular Anatomy......................................................................................... 45
2.1.1.1 Pelvic Arteries.................................................................................. 45
2.1.1.2 Leg Arteries...................................................................................... 45
2.1.2 Examination Protocol and Technique............................................................ 47
2.1.2.1 Pelvic Arteries.................................................................................. 47
2.1.2.2 Leg Arteries...................................................................................... 48
2.1.3 Specific Aspects of the Examination from the Perspective
of the Angiographer and Vascular Surgeon................................................... 49
2.1.4 Interpretation and Documentation................................................................. 55
2.1.5 Normal Duplex Ultrasound of Pelvic and Leg Arteries................................ 55
2.1.6 Abnormal Findings: Clinically Oriented Ultrasound Examination,
Ultrasound Findings and Measurement Parameters, Diagnostic Role.......... 56
2.1.6.1 Atherosclerotic Occlusive Disease................................................... 56
2.1.6.1.1 Pelvic Arteries.................................................................. 57
2.1.6.1.2 Leg Arteries...................................................................... 60
2.1.6.2 Arterial Embolism............................................................................ 71
2.1.6.3 Aneurysm......................................................................................... 72
2.1.6.4 Rare Stenosing Arterial Diseases of Nonatherosclerotic Origin...... 73
2.1.6.4.1 Adventitial Cystic Disease............................................... 75
2.1.6.4.2 Popliteal Entrapment Syndrome...................................... 76
2.1.6.4.3 Raynaud’s Disease........................................................... 77
2.1.6.4.4 Paraneoplastic Disturbance of Acral Perfusion................ 79
2.1.6.4.5 Buerger’s Disease............................................................. 79
2.1.6.4.6 Inflammatory Conditions................................................. 80
2.1.6.4.7 Chronic Recurrent Compartment Syndrome of the Calf.. 81
2.1.7 Follow-up After Surgical and Interventional Treatment............................... 81
2.1.7.1 Thromboendarterectomy.................................................................. 81
2.1.7.2 Percutaneous Transluminal Angioplasty and Stenting..................... 81
2.1.7.3 Bypass Graft Surveillance................................................................ 83
2.1.7.3.1 Methodological Considerations and Stenosis Criteria..... 83
2.1.7.3.2 Controversy About the Benefit of Duplex Bypass
Graft Surveillance Programs............................................ 86
2.1.7.4 Ultrasound Vein Mapping Prior to Peripheral Bypass Surgery....... 88
2.1.8 Role of (Color) Duplex Ultrasound Compared with Other Modalities:
Problems and Pitfalls..................................................................................... 89
2.2 Arm Arteries............................................................................................................ 92
2.2.1 Vascular Anatomy......................................................................................... 92
2.2.2 Examination Protocol and Technique............................................................ 93
2.2.3 Clinical Role of Duplex Ultrasound.............................................................. 94
2.2.3.1 Atherosclerosis................................................................................. 94
2.2.3.2 Compression Syndromes.................................................................. 94
2.2.4 Documentation.............................................................................................. 95
2.2.5 Normal Findings............................................................................................ 95
2.2.6 Abnormal Findings, Duplex Ultrasound Measurements,
and Clinical Role........................................................................................... 95
2.2.6.1 Atherosclerosis................................................................................. 95
2.2.6.2 Compression Syndromes.................................................................. 95
2.3 Atlas: Peripheral Arteries........................................................................................ 97
3 Peripheral Veins.............................................................................................................. 165
3.1 Pelvic and Leg Veins............................................................................................... 165
3.1.1 Vascular Anatomy......................................................................................... 165
3.1.2 Examination Protocol.................................................................................... 167
3.1.2.1 Thrombosis....................................................................................... 167
3.1.2.2 Chronic Venous Insufficiency and Varicosis.................................... 170
3.1.3 Normal Findings............................................................................................ 173
3.1.4 Documentation.............................................................................................. 174
3.1.4.1 Deep Vein Thrombosis of the Leg................................................... 174
3.1.4.2 Chronic Venous Insufficiency and Varicosis.................................... 174
3.1.5 Clinical Role of Duplex Ultrasound.............................................................. 174
3.1.5.1 Thrombosis and Postthrombotic Syndrome..................................... 174
3.1.5.2 Varicosis........................................................................................... 178
3.1.6 Duplex Ultrasound – Diagnostic Criteria, Indications, and Role.................. 181
3.1.6.1 Thrombosis....................................................................................... 181
3.1.6.2 Chronic Venous Insufficiency.......................................................... 192
3.1.6.3 Varicosis........................................................................................... 195
3.1.6.4 Varicophlebitis................................................................................. 198
3.1.7 Rare Venous Abnormalities........................................................................... 199
3.1.7.1 Venous Aneurysm............................................................................ 199
3.1.7.2 Tumors of the Venous Wall.............................................................. 201
3.1.7.3 Venous Compression........................................................................ 201
3.1.7.4 Adventitial Cystic Disease of Veins................................................. 201
3.1.7.5 Differential Diagnosis: Lymphedema, Lipedema............................ 201
3.1.8 Vein Mapping................................................................................................ 202
3.1.9 Diagnostic Role of Ultrasound...................................................................... 202
3.1.9.1 Thrombosis....................................................................................... 202
3.1.9.2 Chronic Venous Insufficiency.......................................................... 206
3.1.9.3 Varicosis........................................................................................... 208
3.2 Arm Veins and Jugular Vein.................................................................................... 209
3.2.1 Vascular Anatomy......................................................................................... 209
3.2.2 Examination Protocol and Technique............................................................ 209
3.2.3 Normal Findings............................................................................................ 209
3.2.4 Documentation.............................................................................................. 209
3.2.5 Clinical Role.................................................................................................. 210
3.2.6 Duplex Ultrasound Findings and Their Diagnostic Significance.................. 210
3.2.7 Diagnostic Role of Duplex Ultrasound Compared with Other Modalities... 211
3.3 Atlas: Peripheral Veins............................................................................................ 213
4 Shunts............................................................................................................................... 267
4.1 Clinical Role of Shunt Diagnosis............................................................................ 267
4.1.1 Background................................................................................................... 267
4.1.2 Diagnostic Tasks in Patients with Spontaneous and Therapeutic Shunts...... 267
4.2 Examination Protocol, Technique, and Diagnostic Role......................................... 269
4.2.1 Congenital and Acquired Fistulae................................................................. 269
4.2.2 Dialysis Access............................................................................................. 269
4.3 Typical Shunt-Related Changes in the Doppler Waveform..................................... 271
4.4 Shunt Maturation and Flow Volume Measurement................................................. 271
4.5 Documentation......................................................................................................... 272
4.6 Vascular Mapping Prior to AV Fistula Creation...................................................... 272
4.7 Abnormal Findings (Inadequate Dialysis)............................................................... 273
4.7.1 Shunt Stenosis...................................................................................................273
4.7.2 Peripheral Ischemia....................................................................................... 275
4.7.3 Shunt Aneurysm............................................................................................ 275
4.7.4 Abnormal Shunt Flow................................................................................... 276
4.8 Diagnostic Role of Duplex Ultrasound Compared with Other Modalities.............. 276
4.9 Atlas: Shunts............................................................................................................ 278
5 Extracranial Cerebral Arteries..................................................................................... 291
5.1 Normal Vascular Anatomy and Important Variants................................................. 291
5.2 Examination Technique and Protocol...................................................................... 294
5.2.1 Carotid Arteries............................................................................................. 294
5.2.2 Vertebral Arteries.......................................................................................... 297
5.3 Documentation......................................................................................................... 299
5.4 Normal Findings...................................................................................................... 299
5.4.1 Carotid Arteries............................................................................................. 299
5.4.2 Vertebral Arteries.......................................................................................... 299
5.5 Clinical Role of Duplex Ultrasound........................................................................ 299
5.5.1 Carotid Arteries............................................................................................. 299
5.5.1.1 Defining the Degree of Stenosis....................................................... 301
5.5.1.2 Plaque Morphology.......................................................................... 305
5.5.2 Vertebral Arteries.......................................................................................... 306
5.6 Ultrasound Criteria, Measurement Parameters, and Diagnostic Role..................... 306
5.6.1 Carotid Arteries............................................................................................. 306
5.6.1.1 Plaque Evaluation and Morphology................................................. 306
5.6.1.2 Stenosis Quantification/Stenosis Grading........................................ 314
5.6.1.3 Occlusion......................................................................................... 324
5.6.1.4 Postoperative Follow-Up.................................................................. 326
5.6.2 Vertebral Arteries.......................................................................................... 330
5.6.2.1 Stenosis............................................................................................ 330
5.6.2.2 Occlusion......................................................................................... 330
Contents xix
5.6.2.3 Dissection......................................................................................... 330
5.6.2.4 Subclavian Steal Syndrome.............................................................. 331
5.7 Diagnosis of Brain Death......................................................................................... 332
5.8 Rare (Nonatherosclerotic) Vascular Diseases of the Carotid Territory.................... 332
5.8.1 Dissection...................................................................................................... 332
5.8.2 Inflammatory Vascular Diseases (Takayasu’s Arteritis)................................ 334
5.8.3 Fibromuscular Dysplasia............................................................................... 335
5.8.4 Aneurysm...................................................................................................... 335
5.8.5 Arteriovenous Fistula.................................................................................... 336
5.8.6 Idiopathic Carotidynia................................................................................... 336
5.8.7 Vasospasm..................................................................................................... 336
5.8.8 Compression by Tumor, Carotid Body Tumor.............................................. 337
5.9 Diagnostic Role of Duplex Ultrasound in Evaluating the Extracranial
Cerebral Arteries...................................................................................................... 337
5.10 Atlas: Extracranial Cerebral Arteries....................................................................... 341
6 Visceral and Retroperitoneal Vessels............................................................................ 377
6.1 Abdominal Aorta, Visceral and Renal Arteries....................................................... 377
6.1.1 Vascular Anatomy......................................................................................... 377
6.1.1.1 Aorta................................................................................................. 377
6.1.1.2 Visceral Arteries............................................................................... 377
6.1.1.3 Renal Arteries.................................................................................. 378
6.1.2 Examination Protocol and Technique............................................................ 378
6.1.2.1 Aorta................................................................................................. 378
6.1.2.2 Visceral Arteries............................................................................... 378
6.1.2.3 Renal Arteries.................................................................................. 380
6.1.3 Normal Findings............................................................................................ 380
6.1.3.1 Aorta................................................................................................. 380
6.1.3.2 Visceral Arteries............................................................................... 380
6.1.3.3 Renal Arteries.................................................................................. 382
6.1.4 Interpretation and Documentation................................................................. 383
6.1.5 Clinical Role of Duplex Ultrasound.............................................................. 383
6.1.5.1 Aorta................................................................................................. 383
6.1.5.2 Visceral Arteries............................................................................... 385
6.1.5.3 Renal Arteries.................................................................................. 386
6.1.6 Measurement Parameters, Diagnostic Criteria, and Role of Ultrasound...... 387
6.1.6.1 Renal Arteries.................................................................................. 387
6.1.6.1.1 Renal Artery Occlusion.................................................... 392
6.1.6.1.2 Transplant Kidney............................................................ 392
6.1.6.2 Visceral Arteries............................................................................... 394
6.1.6.3 Aorta................................................................................................. 399
6.2 Visceral and Retroperitoneal Veins.......................................................................... 404
6.2.1 Vascular Anatomy......................................................................................... 404
6.2.1.1 Vena Cava......................................................................................... 404
6.2.1.2 Renal Veins...................................................................................... 404
6.2.1.3 Portal Venous System and Hepatic Veins........................................ 405
6.2.2 Examination Technique................................................................................. 405
6.2.2.1 Vena Cava......................................................................................... 405
6.2.2.2 Renal Veins...................................................................................... 406
6.2.2.3 Portal Vein and Superior Mesenteric Vein....................................... 406
6.2.3 Clinical Role of Duplex Ultrasound.............................................................. 407
6.2.3.1 Renal Veins...................................................................................... 407
6.2.3.2 Portal Venous System....................................................................... 407
6.2.4 Normal Findings............................................................................................ 408
xx Contents
6.2.4.1 Vena Cava and Renal Veins.............................................................. 408
6.2.4.2 Portal Venous System....................................................................... 408
6.2.5 Documentation.............................................................................................. 408
6.2.6 Abnormal Ultrasound Findings, Measurement Parameters,
and Diagnostic Role...................................................................................... 408
6.2.6.1 Vena Cava......................................................................................... 408
6.2.6.2 Renal Veins...................................................................................... 409
6.2.6.3 Superior Mesenteric Vein................................................................. 410
6.2.6.4 Portal and Hepatic Veins.................................................................. 411
6.3 Atlas: Visceral and Retroperitoneal Vessels............................................................ 415
7 Penile and Scrotal Vessels............................................................................................... 473
7.1 Vascular Anatomy.................................................................................................... 473
7.1.1 Penile Vessels................................................................................................ 473
7.1.2 Scrotal Vessels............................................................................................... 473
7.2 Examination Technique........................................................................................... 474
7.2.1 Erectile Dysfunction...................................................................................... 474
7.2.2 Scrotal Vessels............................................................................................... 475
7.3 Normal Findings...................................................................................................... 475
7.3.1 Penile Vessels................................................................................................ 475
7.3.2 Scrotal Vessels............................................................................................... 475
7.4 Documentation......................................................................................................... 475
7.5 Clinical Role of Duplex Ultrasound........................................................................ 476
7.5.1 Erectile Dysfunction...................................................................................... 476
7.5.2 Acute Scrotum............................................................................................... 476
7.5.3 Varicocele...................................................................................................... 477
7.6 Abnormal Findings: Role of Duplex Ultrasound Parameters.................................. 477
7.6.1 Erectile Dysfunction...................................................................................... 477
7.6.2 Acute Scrotum...................................................................................................478
7.6.3 Varicocele...................................................................................................... 479
7.7 Atlas: Penile and Scrotal Vessels............................................................................. 480
References.............................................................................................................................. 485
Subject Index......................................................................................................................... 513

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