How to write pediatric echo report?
Post on 03-Jun-2015
2148 Views
Preview:
DESCRIPTION
Transcript
LOGO
How to write Pediatric Echo Report
Pediatric Echocardiography Introductory Course
Dr. Ahmed AbdElSamad Elhewala
Lecturer of Pediatrics – Faculty of Medicine -Zagazig University
zagPediatrics@gmail.com
Understanding the Echocardiogram
New
M-Mode2D
PW
CW
Echocardiography
2D Echocardiography
M-Mode Echocardiography
The M-mode ( 1-Dimension ) a single beam of ultrasound is transmitted and structure along its path reflect sound back to transducer. It was the first ultrasound modality to record display moving echoes from the heart and thus the motion could be interpreted in terms of myocardial and valvular function even it can help in studying arrhythmias. The M-modes were originally recorded without access to 2-dimensional images.
M-Mode Echocardiography
PW & CW Echocardiography
Pulsed Wave ( PW ) has the ability to detect the velocity and direction of blood at a certain point ; sampled volume.
Continuous Wave ( CW ) has the ability to detect velocity and direction of blood detected along line of measuring ;multiple sample volume
Pulsed wave can only measure low velocities up to 1.5 m/sec , CW has range ambiguity
Pressure gradient can be calculated from measured velocity
P=4 (V) 2
PW & CW Echocardiography
Follow ASE Guidlines
How to write Pediatric Echo Report
1.Descritpion of cardiac lesion
2. Measurement of cardiac chambers & Vessels
3. Evaluation of valves & gradients
4.Evaluation of cardiac functions
6.Conclusion and Recommendation
5.Wall motion abnormalities ,Pericaridum & masses
1-Description of Cardiac lesion
Segmental Approach
Situs ( S or I or A)
Position of the Apex ( Dextrocardia or Dextroposition)
Position of the Ventricles( D or L)
Atrio-ventricular connection
Ventriculo-arterial connection
Relationship of the great vessels
Segmental Approach
Segmental Approach
Segmental Approach
Cardiac Position & Orientation Position of the heart in the chest with regard to itslocation, and the orientation of its apex. Location of the heart in the chest:1. Levoposition - to the left2. Mesoposition - central3. Dextroposition - to the right Cardiac orientation is the base to apex orientation of theheart:1. Levocardia - apex directed to the left of the midline2. Mesocardia - apex oriented inferiorly in the midline3. Dextrocardia - apex directed to the right of the midline
Segmental Approach
Segmental Approach
Atrial Morphology The right and left atria are identified morphologically bytheir respective atrial appendages and veins emptyinginto them. The RA receives IVC, SVC and coronary sinus. The LA receives all 4 pulmonary veins. The RA has a triangular, broad based, anteriorappendage while the LA has a narrow, fingerlikeposterior appendage. The septum secundum (limbus of the fossa ovale) lies onthe RA side. The septum primum (flap) lies on the LAside. The Crista Terminalis is in the RA. LA is smoothwith fewer trabeculations. Almost invariably 2 atria are present although sometimesthere may be a common atrium if the IAS is absent.
Segmental Approach
Identifying the right and left ventricle and its relationship to each other ( right and left hand rule)
Segmental Approach
Identifying the right and left ventricle and its relationship to each other ( right and left hand rule)
Segmental Approach
Concordant or DiscordantConnections Connection : refers to the sequence of anatomicstructures. Normally, RA is connected to RV by means ofTV. RV is then connected to the PA by means of the PV.Therefore, there are atrio-ventricular connections andVentriculo-arterial connections to identify. Concordance: describes the relationship between thevarious chambers, valves, and great vessels. In thenormal heart all the connections and relationships in theanatomic sequence are concordant. Discordance : describes abnormal relationships betweenthe various chambers and great vessels.
Segmental Approach
Segmental Approach
AV Connection/Alignment AV Concordance AV Discordance Tricuspid Atresia Mitral Atresia Common AV Valve Overriding AV Valve Straddling AV Valve Double Inlet Ventricle
Segmental Approach
Segmental Approach
Arterial Morphology The definition of an aortais an artery that gives riseto the coronary arteriesand the brachiocephalicvessels. In contrast the pulmonaryartery branches into twobut does not give rise toany vessels.
Segmental Approach
Ventriculo-Arterial ConnectionConcordant or Discordant When the aorta is connected to the LV and thepulmonary artery to the RV the connection is describedas concordant. If the aorta is connected to the RV and the pulmonaryartery to the LV then the connection is discordant. Thisis most commonly seen in transposition of the greatarteries (TGA)
Segmental Approach
Concordant or Discordant
Double outlet Ventricle
Single outlet
Segmental Approach
Segmental Approach
Segmental Approach
2.Measurement of cardiac chambers
Origin RPA= 0.5cmBSA=0.4m2
Z - score
Z score= -3.5
M-Mode Echocardiography
Measurement of Vessels
Aorta
3.Evaluation of valves & gradients
Every Valve should be evaluated by 2D echocardiographic examination , then by color then by pulsed and continuous wave doppler.
Tricuspid regurge maximal pressure gradient can help estimate pulmonary artery systolic pressure
Pressure gradient across shunts should be measured
Company Namewww.themegallery.com
4.Evaluation of cardiac functions
Can be qualitative , semiquantitative or quantitative
Evaluation of systolic and diastolic functions of right and left ventricles
5.Wall motion , pericardium ,masses
Any wall motion abnormality should be described if dyskinetic as in aneurysm or hypokinetic as in ischemia or akinetic as in cases with infarction
Pericardial effusion should be identified and if there is tamponade
Any cardiac mass should be descriped , its location, attachment , size and relation to valves and vessels , what due you suspect ? Is it thrombus , tumour or vegetations
6.Conclusion & Recommendation
Should be in clear words stating the diagnosis , determining different lines of management .
Does the case need admission ? Is there need for emergency treatment ;
medical as prostin or surgical ? If surgery is recommended , when you
expect the surgery will be done?All this should be also explained to the
parents.
Important Items (ASE)
Full name of the patient in clear words
Age of the patient
Date of the study
Imaging window visibility
Name of study performer and signature
Refering physician and reason of referral
LOGO
Dr. Ahmed AbdElSamad Elhewala
zagPediatrics@gmail.com
top related