Objectives
- Understand the proper technique and probe selection when scanning structures in the head/neck
- Describe the approaches to evaluating the salivary glands (parotid and submandibular)
- Describe the setup for assessing for peritonsillar abscesses (both intraoral and subcutaneous approaches)
- Name the sonographic features of acute sinusitis on ultrasound
- Recognize the appearance of blood vessels (jugular vein, carotid artery), and lymph nodes by ultrasound
Introduction to Head and Neck POCUS (presented by Dana Resop, MD)
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Which probe should be used when evaluating the structures in the head and neck?
The linear or endocavitary probe. Both are high frequency and great for seeing superficial structures
Describe the appearance of salivary glands (parotid and submandibular) on ultrasound
Salivary glands appear as homogenous, isoechoic tissue
May sometimes visualize a small duct (Wharton’s duct in the submandibular gland)
May also see lymph nodes near the salivary ducts
Describe the appearance of abnormal/inflamed salivary glands on ultrasound
Typically these appear more heterogenous (almost like cellulitis) and enlarged compared to the contralateral side
The ducts are more commonly enlarged (as this is most commonly cause by sialolithiasis
Stones may also be visualized as hyperechoic structures with a posterior shadow within the salivary glands
Describe the approach for utilizing ultrasound to evaluate a patient for sinusitis
Sit patient upright. Obtain views in the transverse and the sagittal views
Take measurements from the anterior to the posterior sinus wall
Name the sonographic features of acute sinusitis on ultrasound
- Thickening of the sinus space >3.5cm (measured from the anterior wall to the posterior wall of the sinus)
- The sinuses appear to be ‘fluid filled’ (anechoic in nature), whereas normal sinuses should have air reverberation artifact (A-lines)
Describe the setup and approach when evaluating a patient for a peritonsillar abscess using the intraoral approach
Sit the patient upright. Provide topical anesthetic (4% lidocaine atomized to the back of the throat)
Provide the patient with a suction catheter and an approach to hold the tongue down (bottom portion of speculum or a Mac 3 blade)
Place a probe cover on the endocavitary probe. Evaluate the tonsil of concern in the transverse plane
Can be done as:
- Static guidance: identifying abscess, then removing the probe and performing needle aspiration/I&D
- Dynamic guidance: identifying abscess, and visualizing a needle under ultrasound guidance into the fluid pocket in real time
Describe the transcutaneous approach to evaluating for a peritonsillar abscess
Place the high frequency probe under the angle of the jaw, increase depth
Fan the probe backwards/posterior to evaluate for peritonsillar abscess
Consider this approach in patients with significant trismus!
Describe the approach to estimating the JVP using ultrasound
Sit the patient upright at about 30 degrees
Using ultrasound, find the internal jugular vein; follow this superior
Identify the spot where vein begins to “collapse down”
Measure from the location identified under ultrasound to the sternal notch and add 5cm. This is your JVP
What do lymph nodes look like when visualized under ultrasound?
Ellipsoid (ovals) that appear to have a hypoechoic cortex and an echogenic/hyperechoic hilum
Evaluate the middle of the lymph node for the stalk (lymphatic vessel, artery, and vein)