Emerging applications of clinical ultrasonography

Abstract

In this work, we introduce the numerous emerging areas and frontiers in the use of point-of-care ultrasonography. Of these, we review the following three: 1) the use of clinical ultrasonography in infectious and tropical diseases (we address its usefulness in the diagnosis and follow-up of the main syndromes, in tropical diseases, and in areas with scarce resources); 2) the usefulness of clinical ultrasonography in the assessment of response to volume infusion in severely ill patients (we review basic concepts and the main static and dynamic variables used for this evaluation); and 3) the use of clinical ultrasonography in the assessment of muscle mass in elderly patients with primary sarcopenia (we review the main muscles and measurements used for it).

Resumen

En el documento actual introduciremos las áreas más emergentes y frontera del uso de la ecografía clínica a la cabecera del paciente, que son numerosas. De entre todas ellas se revisarán 3: 1) la ecografía clínica en las enfermedades infecciosas y patología tropical (se abordará su utilidad en el diagnóstico y seguimiento de los principales síndromes, así como los usos para patología tropical y en áreas con escasos recursos); 2) la utilidad de la ecografía clínica para la evaluación de la respuesta a la infusión de volumen en pacientes graves (se revisarán conceptos básicos, así como las principales variables estáticas y dinámicas utilizadas para realizar esta evaluación); y por último, 3) se abordará la utilización de la ecografía clínica para la valoración de la masa muscular en la sarcopenia primaria de las personas ancianas (se repasarán los principales músculos y medidas que se utilizan para ello).

Introduction

In recent years, the development of clinical ultrasonography is undeniable in different fields and specialties such as community and family medicine, emergency departments, internal medicine, intensive care, cardiology, anesthesiology, rheumatology, nephrology, gastroenterology, and many more.

The advantage that ultrasonography offers over other diagnostic methods is its simplicity of its use, which is at the point of care; the speed at which it can be learned; and the increasing portability of ultrasound equipment without a loss of resolution. The equipment competes to be the most suitable for daily use, the cheapest, and even to be compatible with other devices such as tablets or smartphones.¹ Its usefulness has also been demonstrated in telemedicine in the transmission of images obtained in remote areas or adverse conditions which can then be interpreted by specialists.² The fact that learning ultrasonography has become quite extensive is likely a response to a greater demand for efficacy and safety in medical care. It has become widespread not only in the field of healthcare, but also in residency programs and on the medical student or even non-medical personnel level.3, 4, 5

In this series of articles on clinical ultrasonography, we discuss the main clinical applications and most established modalities as well as the main scenarios in which clinical ultrasonography is useful.

In this work, we will introduce the numerous emerging areas and frontiers in the use of this technology which include, among others: intestinal ultrasonography, thyroid ultrasonography, and ultrasonography in caring for cardiac arrest. Among the areas of future clinical ultrasonography development, three stand out: infectious and tropical diseases, its use in evaluating the response to volume infusions in severely ill patients, and evaluation of muscle mass in primary sarcopenia in the elderly. Below, we list the most interesting and relevant clinical aspects of each.