WO2023095973A1

WO2023095973A1 - Method for obtaining ultrasound image of individual having subcutaneous emphysema

Info

Publication number: WO2023095973A1
Application number: PCT/KR2021/017716
Authority: WO
Inventors: 배성일
Original assignee: 경상국립대학교병원
Priority date: 2021-11-29
Filing date: 2021-11-29
Publication date: 2023-06-01

Abstract

The present invention relates to a method for obtaining an ultrasonic image of an individual having subcutaneous emphysema, the method comprising the steps of: emitting ultrasonic waves to a first region of the skin surface of an object to obtain a first ultrasonic image; and applying pressure to the first region to move subcutaneous air existing below the first region and then emitting ultrasonic waves to the first region to obtain a second ultrasonic image, wherein an ultrasonic image in which a body structure (for example, tissues, organs, etc.) is clearly displayed can be obtained even from an individual having subcutaneous air in the body, and an ultrasound-guided procedure or examination can be performed more safely and accurately.

Description

Ultrasound image acquisition method of subcutaneous emphysema

The present invention relates to a method for obtaining an ultrasound image.

The use of ultrasound for diagnosis and treatment is increasing. This has the advantage of reaching a diagnosis through ultrasound examination and visually explaining it to the patient. In addition, there is an advantage in that immediate consultation with the patient is possible and immediate treatment can be applied while performing the ultrasound examination. Procedures that can be performed under ultrasound guidance include injection, aspiration, needling, barbotage, nerve block, tumor biopsy, and foreign body removal.

On the other hand, subcutaneous emphysema (subcutaneous emphysema) means a state in which air comes out into the subcutaneous tissue when there is damage to the trachea, bronchi, and lungs along with chest or neck trauma. Subcutaneous emphysema may occur primarily at a young age or may occur secondary to oral or cervical and thoracic surgery, pneumothorax and mediastinum infection. In the case of hypodermic patients, obscure ultrasound images are obtained due to the air present under the skin. Specifically, there is a problem in that subcutaneous air present in the body of patients with subcutaneous emphysema reflects ultrasound signals to obstruct image formation of the corresponding structure, and it is impossible to clearly identify the corresponding anatomical structure with ultrasound. Therefore, it is not easy to perform an ultrasound-guided procedure or examination on patients with subcutaneous air, and it is required to obtain clear ultrasound images in patients with subcutaneous air.

An object of the present invention is to provide an ultrasound-guided central venous catheterization method in patients with subcutaneous cervical emphysema.

1. Obtaining a first ultrasound image by radiating ultrasound to a first area of a skin surface of an object; and

Applying pressure to the first region to move the subcutaneous air existing below the first region, and then irradiating the first region with ultrasonic waves to acquire a second ultrasound image; Ultrasound image acquisition method of.

2. The method according to 1 above, wherein the movement is a movement from a first body region where subcutaneous air is located to a second body region different from the first body region before applying the pressure. .

3. The method according to 1 above, wherein the object is an animal.

4. The method according to 1 above, wherein the pressure is applied with an ultrasound probe, a finger, or a palm.

5. Obtaining a first ultrasound image by radiating ultrasound to a first area of the skin surface of the object; and

Applying pressure to the first region to move the subcutaneous air existing below the first region, and then irradiating the first region with ultrasonic waves to acquire a second ultrasound image; In ultrasound-guided procedure method.

6. The method according to 5 above, wherein the ultrasound-guided procedure is ultrasound-guided catheterization, ultrasound-guided foreign body removal, ultrasound-guided pain treatment, or ultrasound-guided injection.

7. The method according to 5 above, wherein the ultrasound-guided procedure is ultrasound-guided catheter insertion, and the method further comprises inserting a catheter through the blood vessel of the subject.

8. The method according to 7 above, wherein the blood vessel is a central vein.

9. Obtaining a first ultrasound image by radiating ultrasound to a first area of the skin surface of the object; and

Applying pressure to the first region to move the subcutaneous air existing below the first region, and then irradiating the first region with ultrasonic waves to acquire a second ultrasound image; In ultrasound-guided examination method.

10. The method of 9 above, wherein the ultrasound-guided examination is an ultrasound-guided tissue biopsy.

By using the ultrasound image acquisition method of the present invention, an ultrasound image in which body structures (eg, tissues, organs, etc.) are clearly and clearly displayed can be obtained even in an object having subcutaneous air in the body.

In addition, by using the ultrasound image acquisition method of the present invention, an ultrasound-guided procedure or examination can be performed more safely and accurately in an object having subcutaneous air in the body.

1 shows an ultrasound image of the neck of a patient with subcutaneous emphysema. Figure 1 (A) is an ultrasound image of a subcutaneous emphysema in the right neck, Figure 1 (B) is an ultrasound image in which the right internal jugular vein (arrow) appears clearly after moving the subcutaneous air in the right neck to the side. 1(C) is an ultrasound image confirming that hyperechoic dots (arrows) appear in the right internal jugular vein after central venous catheterization was performed through the right internal jugular vein. Figure 1(D) is an ultrasound image showing subcutaneous emphysema of the left neck compared to the right neck after central venous catheterization. 1(E) is an ultrasound image confirming that the left internal jugular vein and common carotid artery appear clearly after moving the subcutaneous air of the left neck to the side.

Hereinafter, the present invention will be described in detail.

The present invention provides a method for acquiring an ultrasound image of an individual with hypodermic emphysema.

Subcutaneous emphysema (subcutaneous emphysema) refers to a condition in which air escapes into the subcutaneous tissue when trauma to the chest or neck is accompanied by damage to the trachea, bronchi, or lungs.

Subcutaneous pneumothorax objects are objects in which subcutaneous air exists in the body. For example, hypodermic pneumothorax objects may have subcutaneous air located on the neck, arms, legs, shoulders or chest, but the area where subcutaneous air can be located is not limited. don't

In the case of a subject with subcutaneous emphysema, when an ultrasound image is acquired, the subcutaneous air present in the body reflects the ultrasound signal, interfering with the formation of an image of the corresponding structure, and it is impossible to clearly identify the corresponding anatomical structure with ultrasound. The ultrasound image acquisition method of the present invention is a method capable of solving the above problems.

The method for acquiring an ultrasound image of an individual with hypodermic hypoplasia of the present invention may include moving subcutaneous air present in the body by applying pressure to the skin surface of the subject.

Specifically, the method for acquiring an ultrasound image of a hypodermic pneumothorax subject of the present invention

obtaining a first ultrasound image by radiating ultrasound to a first area of a skin surface of an object; and

The method may include applying pressure to the first region to move subcutaneous air existing below the first region, and then irradiating the first region with ultrasonic waves to obtain a second ultrasound image.

The pressure is sufficient as long as it is applied to the skin surface of the subject, and the method of applying the pressure is not limited. For example, the pressure may be applied with an ultrasound probe, a finger, or a palm, but is not limited thereto.

The subject may be an animal, for example, at least one selected from the group consisting of humans, non-human mammals, birds, reptiles, amphibians, and fish, but is not limited thereto.

The movement may be a movement from a first body region where subcutaneous air is located to a second body region different from the first body region before applying the pressure. The movement is sufficient if it is a different area based on the area where the subcutaneous air is located before applying the pressure, and the direction is not limited.

According to one embodiment, the movement may be a movement to the side based on the area where the subcutaneous air is located before applying the pressure.

The method of acquiring an ultrasound image of an individual with hypodermic emphysema of the present invention may be performed by a machine or device as well as a person.

The method for obtaining an ultrasound image of an individual with hypodermic hypoplasia of the present invention can obtain a second ultrasound image in which the body structure is more clearly and clearly displayed than the first ultrasound image by moving the position of the subcutaneous air by applying pressure. The ultrasound image acquisition method of the present invention can be extended and applied to ultrasound-guided procedures or examinations in hypodermic patients. For example, ultrasound-guided pain treatment (eg, arm, leg, or shoulder pain treatment) in subcutaneous emphysema patients by applying the ultrasound image acquisition method of hypodermic emphysema of the present invention, or ultrasound-guided examination (eg, mass, It can be applied to tests for muscle damage or ligament damage), etc.

The present invention provides a surgical method under ultrasound guidance in hypodermic patients.

The ultrasound-guided procedure method in hypodermic pneumothorax subjects of the present invention

The ultrasound-guided procedure may be a known ultrasound-guided procedure, such as ultrasound-guided catheter insertion, ultrasound-guided foreign body removal, ultrasound-guided pain treatment, or ultrasound-guided injection, but is not limited thereto.

For example, the ultrasound-guided procedure is ultrasound-guided catheterization, and the method may further include inserting a catheter through a blood vessel of the subject.

When the region into which the catheter is to be inserted is not clearly visualized by subcutaneous air in the acquiring of the first ultrasound image, pressure is applied to the body of the subject to move subcutaneous air existing around the region into which the catheter is to be inserted, thereby providing a catheter It is possible to obtain a second ultrasound image in which the area to be inserted is clearly and clearly indicated, and safe and accurate catheter insertion can be performed.

Specifically, the ultrasound-guided treatment method for a hypodermic subject of the present invention comprises the steps of obtaining a first ultrasound image by irradiating ultrasound to a first area of the skin surface of the subject;

obtaining a second ultrasound image by applying pressure to the first region to move subcutaneous air existing below the first region and then irradiating the first region with ultrasonic waves; and

It may include inserting a catheter through the blood vessel of the subject.

In this case, the object may be an object that requires catheter insertion, and may be an object that is not easy to insert the catheter because subcutaneous air exists in the body and the area where the catheter is to be inserted is blocked in the ultrasound image.

In this case, the first region may be an upper skin surface region of a blood vessel into which a catheter is to be inserted.

In this case, the second ultrasound image is an ultrasound image in which the blood vessel into which the catheter is to be inserted is clearly displayed, and the location where the catheter is to be inserted can be determined based on the second ultrasound image acquired in the step of obtaining the second ultrasound image. .

Insertion of the catheter can be performed by a known method. For example, after puncturing a blood vessel with a syringe, a guide line may be inserted into the injection needle to secure a passage through which the catheter can enter, and the catheter may be inserted through the guide line, but is not limited thereto.

According to one embodiment, the ultrasound-guided procedure method in a hypodermic emphysema is an ultrasound-guided central venous catheter insertion method in a hypodermic emphysema, and the blood vessel may be a central vein. In this case, applying the pressure may be applying pressure with an ultrasound probe to the skin surface around the puncture site. In this case, moving the subcutaneous air may be to move the subcutaneous air by pushing a subcutaneous bubble around the neck puncture site in a lateral direction with the ultrasound probe.

The central vein may be, but is not limited to, the subclavian vein, the external jugular vein, the internal jugular vein, or the femoral vein.

The ultrasound-guided procedure method in the subject of hypodermic hypoplasia of the present invention may be performed by a machine or device as well as a person.

The term “catheterization” refers to the insertion of a plastic medical device or catheter into a hole or blood vessel in the body. “Central venous catheterization” is the insertion of a tube into a central vein. A central vein refers to a large vein that connects to the body and enters the heart, unlike small peripheral veins located in the hands or feet. Since the central vein is not visible on the surface of the skin, a method through image guidance such as ultrasound or human fluoroscopy can be used to perform it more safely. “Ultrasound-guided central venous catheterization” is a method of performing central venous catheterization by guiding in-body images using ultrasound on the skin surface around the area where the catheter is inserted. Ultrasound-guided central venous catheterization is known to be safer than traditional central venous catheterization.

The present invention provides an ultrasound-guided examination method in hypodermic patients.

The ultrasound-guided examination method in hypodermic pneumothorax subjects of the present invention

The ultrasound-guided examination may be an ultrasound-guided tissue biopsy, for example, an ultrasound-guided examination of a mass, muscle damage, or ligament damage, but is not limited thereto.

The ultrasound-guided examination method for hypodermic patients of the present invention may be performed by a machine or device as well as a person.

Hereinafter, examples will be described in detail to explain the present invention in detail.

실시예Example

The patient to undergo central venous catheterization was a 61-year-old male (height 163 cm, weight 65 kg) and had no specific medical history other than hypertension and diabetes. During a regular health examination in 2011, a mass was found in the right upper chest on a chest radiograph, but there were no related symptoms. The patient underwent regular chest radiography every year from 2011 to 2019 in a private outpatient clinic. In 2019, a chest radiograph showed a larger chest mass, but the patient still had no symptoms related to the mass. He was transferred from a private hospital to Gyeongsang National University Hospital for further clinical evaluation and examination by a doctor. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed at Gyeongsang National University Hospital. On chest CT and thoracic spine MRI, a 7.4 cm mass was observed in the posterior mediastinum, and a large intensified mass (size: 7 cm) was observed in the right intervertebral foramen and paraspinal area at the T2-T3 level. Therefore, he decided to remove two neurogenic tumors located in the right upper lobe of the lung and the second thoracic vertebrae at Gyeongsang National University Hospital.

First, the patient underwent video-assisted thoracoscopic surgery to remove a neurogenic tumor in the right upper lung. Cervical subcutaneous emphysema was observed after removal of the chest tube 6 days after surgery. Subcutaneous emphysema was mild and the patient was observed.

Two days after the subcutaneous emphysema was observed, a second thoracic hemisection was performed to remove the neurogenic tumor located in the thoracic spine.

A central venous catheter had to be inserted for blood transfusion and drug infusion before surgery. An assistantd operator was prepared for central venous catheter insertion through the internal jugular vein, and the patient was placed in the Trendelenburg position. For ultrasound-guided catheter placement, an appropriate amount of gel was applied to the linear ultrasound probe, all air between the linear ultrasound probe and the skin was removed, and the structure around the right neck was examined. However, the right internal jugular vein could not be found due to the shadow of ultrasound (Fig. 1A). The right internal jugular vein around Sedillot's triangle, a traditional skin puncture site for catheterization, was found, but the structure was difficult to ascertain. Doppler images were also not clearly observed. Since subcutaneous air bubbles are known to interfere with ultrasound transmission, we thought that moving the bubble around the neck would make the image clearer. Therefore, the subcutaneous bubble around the puncture site on the right neck was pushed laterally using a linear ultrasound probe. Through this, it was possible to clearly visualize the anatomical structure including the right internal jugular vein in the ultrasound image (Fig. 1B). Central venous catheterization through the right internal jugular vein could be safely performed using a 7-French double lumen central venous catheter (Bioline next, Ewha Group) according to an ultrasound-guided protocol using an out-of-plane method (Fig. 1C). .

Then, to confirm the effectiveness of this method, an ultrasound image of Sedillot's triangle in the left neck, which was not used for a central venous catheter, was checked. A subcutaneous bubble was observed on the ultrasound image of the left neck (Fig. 1D), but after applying pressure with a linear ultrasound probe to move the subcutaneous bubble laterally, clear images of all structures including the left internal jugular vein were obtained (Fig. 1E).

General anesthesia for gastric surgery was maintained using targeted controlled infusions of propofol and remifentanil. The operation took 3 hours and went smoothly. The patient was discharged 6 days after surgery. After 3 weeks, chest radiograph showed no special findings. Currently, the patient is healthy and has no complications. Applicants obtained informed consent for this case report from the patient. It was approved by the Institutional Review Board of Gyeongsang National University Hospital (GNUH 2020-05-017).

Claims

obtaining a first ultrasound image by radiating ultrasound to a first area of a skin surface of an object; and

Applying pressure to the first region to move the subcutaneous air existing below the first region, and then irradiating the first region with ultrasonic waves to acquire a second ultrasound image; Ultrasound image acquisition method of.
The method of claim 1, wherein the movement is a movement from a first body region where subcutaneous air is located to a second body region different from the first body region before applying the pressure.
The method according to claim 1, wherein the object is an animal.
The method according to claim 1, wherein the pressure is applied with an ultrasound probe, a finger, or a palm.
obtaining a first ultrasound image by radiating ultrasound to a first area of a skin surface of an object; and

Applying pressure to the first region to move the subcutaneous air existing below the first region, and then irradiating the first region with ultrasonic waves to acquire a second ultrasound image; In ultrasound-guided procedure method.
The method according to claim 5, wherein the ultrasound-guided procedure is ultrasound-guided catheter insertion, ultrasound-guided foreign body removal, ultrasound-guided pain treatment, or ultrasound-guided injection.
The method according to claim 5, wherein the ultrasound-guided procedure is ultrasound-guided catheter insertion, and the method further comprises inserting a catheter through a blood vessel of the subject.
The method of claim 7 , wherein the blood vessel is a central vein.
obtaining a first ultrasound image by radiating ultrasound to a first area of a skin surface of an object; and

Applying pressure to the first region to move the subcutaneous air existing below the first region, and then irradiating the first region with ultrasonic waves to acquire a second ultrasound image; In ultrasound-guided examination method.
10. The method of claim 9, wherein the ultrasound-guided examination is an ultrasound-guided tissue biopsy.