Medical Mondays #1: Ultrasonography 101

Initially I thought I would do a case presentation each Monday, but there just hasn't been enough time to put together a quality SOAP note.  Instead, (and as advance warning for future Mondays that might contain more photographs of items less interesting to the medically-less-inclined and more graphic) here I'll ease in with a note about one of the technical skills I'm learning here.

Our clinic has certain capabilities.  We can do a variety of tests: rapid malaria, rapid HIV, blood sugar, wet mounts, PPD, etc.  However, a wonderful tool without the accessibility of an immediate x-ray or CT scan is the ultrasound.  In a primary care setting in Africa, we see loads of patients with vague pain in the chest, breast, abdomin, and pelvis.  Beyond doing a FAST ultrasound in the ED or ob/gyn ultrasounds, I was previously clueless as to the multiple uses of this amazing tool.

Ultrasound liver/major vessels/lymphadenopathy

Take for instance the snapshot I grabbed on the right.  For my 29 year old extremely cachetic HIV+ patient - this clued us in to extreme lymphadenopathy in the paraortic lymph nodes.  In the left part of the image is the liver the two large dark spots in the center-bottom the SVC and aorta.  The milieu just northeast of them is a confluence of nodes that told us that our patient likely has abdominal Tuberculosis.  She was one of two patients with abdominal TB in the clinic this week so far.

X-ray of fibrocavitary/cavitary/infilitrates

The x-ray on the right also is a patient with TB - though with the classically more apparent pulmonary presentation.   This 9 year old HIV+ cachectic patient had a productive cough and so we sent him for an x-ray.  Right apex, left upper lobe possibly have cavitary markings and middle left has possible infiltrate.

Some of the numbers so far:
HIV 24
TB 14 + 3 extrapulm
Malaria 13
pioderma 12
sore throat/cough 19
DUB 2
STDs 7
angina 1
pneumonia 8
pregnancy 17
hypertension 14
hep A 1
bells palsy 2
......
loads of others (URI, musculoskeletal, anemia)... I have gotten lazy with tallying them all.

Most interesting differentials (as in these made me think a little harder) for me have included: unilateral periorbital edema, fever with cardiomyopathy on echo, jaundice