"Q": What is the echography?
"R":The echography is a diagnostic methodology that utilizes ultrasounds (and so not X rays)
"Q:" I have just done an echography few days ago; may I repeat it?
R: Surely. Ultrasounds, at the utilized diagnostic powers, are not, on the grounds of the actual medical knowledges, dangerous.
"Q": but my wife is pregnant...
"R": Also in pregnancy the ecography can be considered safe; some particularly sophisticated "ultrasound system", are furthermore able to low furthermore the emission power.
"Q": Which anatomical structures one can study with the echography?
"R":
1) The brain in newborn (almost until one year of life and further); in the adult age is possible carry out a transcranic doppler ecography, showing the flow in some cerebral vessels; not always the imagine quality is optimal because the ultrasonic bundle must cross bone that notoriously stops ultrasounds; for this reason, one need very low frequency probes.
2) the neck with its glands (Eg. thyroid, salivary glands lymph nodes), and its vessels.
Echography does not replaces but integrates the otolaryngology examination that allows to see directly laryngeal and pharyngal mucosa, and the vowels cords.
The echography also showing these structures, is not however able to evidence all their pathologies.
3) The heart (the ecography studies heart anatomy and also its function with the doppler-color doppler; the echography is however different from electrocardiogram, showing cardiac electric potentials; Echography and electrocardiogram integrate each other), the pleura (some portions of it), some superficial portions of lungs (obviously the ecography is not the ideal methodical to study the lungs; ultrasound only shows the pleural effusion and eventually lung superficial or pleural masses).
4) The liver, the gallbladder, biliary trees, the pancreas, the spleen, abdominal vessels, the peritoneum, the retroperitoneum, the kidneys, the bladder, the urinary tract, the uterus and the ovaries.
The echography is not generally useful to diagnose: gastric ulcers and gastritis and duodenitis,intestinal polyps (not always visible), intestinal diverticolum (not always visible).
The echography will be instead indicated in suspecting hiatal hernia (characterized from upward sliding of the stomach and often associated to gastric esophageal reflux ), some intestinal infections as the appendicitis, intestinal masses, intestinal expansions, intestinal twists (Eg volvolo), intussusception and some congenital anomalies.
5)The pregnancy and the fetus (see).
6)the limbs and their vessels, better if associated to the doppler (that shows as a graph the blood movements) or the color doppler (that shows as colors, blood movements)
7)The subcutaneous tissue and the skin (utilizing very high frequency probes).
8)The tendons, the muscle and sometime the articulations
9)The breast (see after)
10)The infant hips
11) The testicle and annexed structures (e.g epididymis
It need to specify that:
a)We all have in our body (neck, groin, armpits, abdomen etc) the lymphonodes; sometimes (depilations, cosmetics products, infections, infective diseases, sore throat, tumors), they can enlarge; the ecography studying the form, the sizes, the structure,and the lymphonode vascularization, helps to make a correct diagnosis.
b)The Echography as all other imaging medical methodical, can't make histological diagnosis, but can only to provide orientations on the nature of a picture.
It will be useful to perform other tests, as the fine needle echographic aspiration, TAC or the magnetic nuclear risonance. The last two methodical, as the ecography, can't do cyto-histological diagnosis and they so have integrative value; the first methodical (fine needle aspiration) provides instead, almost always a correct cytologic orientation (if correctly executed, with very thin needles,lower than 1mm, It is a trustworthy and safe methodical with very low contraindications: It is almost unache, and does not causes tumoral cells disseminations if not in exceptional cases).
c) eventually a light organ infection (Eg. infection of the liver or kidney, thyroid, fallopian tubes, ovaries, etc), can't cause macroscopiche anatomical alterations, and so to be invisible to the ecography
d)The ecographic "enemies "are abdomen air, the obesity, the bones (with exception of the neonatale age in which some pathologies can be well studied ecographically, as the post partum clavicle fracture or the evolution of callus in fractures).
In some people the visualization will be best, in other worst.
"Q": Which preparation does need to perform an echography?
"R": That Depends; for small parts (Eg. neck, thyroid, muscles) does not need any preparation.
Gallbladder, liver, biliary trees and stomach Ecography, needs be fasts from at least 8 hours (warning: diabetic subjects in insulin or oral antidiabetic therapy or patients with hypoglicemic tendency, have to consult their own physician before fasting).
For the kidneys, bladder, uterus and ovaries (sovrapubic examination)is necessary the full bladder;sometimes, also the emphy bladder (sovrapubic examination), will obtain a good visualization of gynaecological organs.
By transvaginal echograpy is not necessary the full bladder.
It Needs to specify that generally the excessive bladder filling is not indicated because often causes ultrasound artefacts and compresses the near structures.
It is good to obtain a middle bladder filling (Eg. don't urinate for about 3-4 hours; if 1 hour before examination one does not feel any stimulus, one will need gradually to drink not gased water (about 1/2 liter); if one hour before examination one feels stimulation, do not make anything; if one hour before examination one feels big stimulus, one try to void the bladder of that much for to remove the ache, but not the stimulus .
For all the other abdominal structures, is preferable to make an intestinal cleaning and to perform an antimeteoric treatment: avoid for some days before examination to exceed in fruits, legumes, vegetables, gased drinks,candy; eventually your physician will prescribe for some days befor echography, an antimeteoric preparation.
If there is constipation,it will be useful to take a bland laxtive two days before ecography, the choice will be between those do not facilitate the meteorism (ask for your own doctor).
"Q": Is better to perform a mammography or a breast ecography?
"R": The ecography and the mammography are complementary examinations.
The modern ultrasound systems consents to obtain very high resolutions and so many things will be visible with the ecography but not with the mammography (Eg. small cysts).
Anyway mammography better shows microcalcifications that sometimes can be the only marker of a cancer.
In the very dense breast (as those of young women), the ecography is the main test. After the 40 years or in particular conditions, It is however useful to associate the two methodical. Simplifying, an ecography carried out with a very high definition ultrasound system by a expert ultrasonogrpher, is a test extremely precise.
Generally, breast echography can be performed indifferently in any period of the menstrual cycle.
"Q":My child is just born; how the infant hips are better imagined? By echograpy or radiography? When is recomended their evaluation?
"R":Actually ecography has fully replaced the radiography of the hips, unless particular conditions.
One can carry out the echography just after birth and preferably within the first two months of life.
"Q": I would carry out an ecography of the uterus and ovaries; I have heard about transvaginal sonography, and sovrapubic echography; which do you recommend?.
'R':Transvaginal sonography allows an bigger image definition than sovrapubic methodical (It is not indicates in virgin patients); one inserts in vagina (known well: not in the uterus), an ultrasound probe about like a finger thick, that procures the eventual same discomfort than a gynaecological visit.
It is indispensable when the sobvrapubic echography for technical reasons does not obtains a good image quality.
Is however always advisable.
"Q":Does the gynaecological echography replace a gynaecological visit or a PAP TEST?
R: The gynaecological visit is formed from two moments: the first is the bimanual palpation, executed from physician with two fingers in vagina and a hand on the patient abdomen. This action would have the main scope to study the uterus and ovaries; really although the opinion of gynaecologist and gynaecological books, the reliability of this "medical act", Is clearly inferior to echography (mainly if transvaginal).
For studying the uterus and ovaries I can affirm that the ecography really replaces this phase of the visit.
The second part of the gynaecological visit is represented from vaginal speculum insertion and from observation of the vaginal part of uterine neck (portio) besides of the vagina and vulva.
Such part of gynaecological visit (that would be executed without doubt with the colposcopy and not with only eyes), not may be replaced from ecography. This is the same about the pap test.
"Q": When to do in pregnancy echography?
"R":Here advised periods (attention: unless particular conditions,It is advisable to execute transvaginal sonography that better allows than sovrapubic echography, an early diagnosis of many malformations (until the third month; later transvaginal sonography will be able to better to value the lower fetal parts (e.g. fetal head), and the conditions of the uterine neck and also of the uterine internal orifice and low sited palcenta.
6-7 weeks' gestation (in such period one will show the fetal heart; exists wide individual variability; transvaginal sonography allows to anticipate the visualization of the fetal heart and of the ovular chamber of one or two weeks: with transvaginal sonography: ovular chamber will be eventually visible to the 3 - 4 week: the fetale heart will be visible about to the 4-5 week; before echography can only imagine (but do not give the certainty), a pregnancy.
12-13 weeks' gestation
16-18 weeks' gestation
22 weeks' gestation
25-27 weeks' gestation
32-34 weeks' gestation
37 weeks' gestation
For calculating gestationale age (considering an ideal menstrual cycle of 28 days), we can count (transforming then days in weeks) from day first of the last menstruation.
"Q":Can sonography evidence all fetal malformations?
"R": All malformation surely no, but an carefully examination performedt in gestational ages previously advisited, with a good ultrasound system, with a patient that has good capacity to make her cross from ultrasounds, and with the fetus in favourable position, surely offers the best guaranties of absence of fetal damages. Unfortunately some malformations are visible only tardily or at the birth.
"Q": I feel often speak of morphologic echography; What is it?
"R": With this term one intends the ecography of the fifth month that allows a most easy visualization of the fetal structures. Really all the ecography should be morphologic, I.e. executed with the maximum attention to the fetal anatomy.
Attention: not all echography are equal; the majority of physicians executes a first level ecography valuing only the main anatomical structures. They exist second and third level ultrasonographer and echography that perform a detailed examination of all the fetal structures, as the color doppler of the fetal heart. Obviously, a third level echography is alwais advisable.
"Q":Can echography to suspect Down syndrome?
"R": theoretically yes, but not always.
If an cromosomic anomaly (as the Down syndrome) is associated to fetal malformations, It can be identified with the ecography; sometimes indipendently from the presence or less of malformations, one can precociously to evidence a double nucal contorn or an amniotic liquid alteration (both in excess and in defect).
Sometime the Down fetus has a spastic attitude and often has a growth retard or more shorter fingers or other minor alterations).
It is possible that a fetus with down syndrome has not somatic alterations showed by echography.
Q: when sonographically is the fetal sex visible?
R: fetal sex is anatomically evident from about 10 week.
By ultyrasound it will be shown about from 12 week (better with endovaginal ultrasound); Is important the fetal orientation and maternal structure. Sometimes the fetal sex will not be visible neither at the end of pregnancy.
Optimal gestational age: about 25 weeks.
Q: Can the echography be performed if the patients has a Pace Maker?
R: Yes ,generally, but It is better to inform the ultrasonographer.
Q: Must I to remove necklaces, bracelets etc?
Absolutely no. Only if their to cause mechanical impediment.
