Filipiak-Strzecka Dominika, Lipiec Piotr, Kasprzak Jarosław D
Chair and Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Poland.
Adv Clin Exp Med. 2023 Mar;32(3):267-274. doi: 10.17219/acem/158555.
The advantages of ultrasonography do not need to be discussed. It is suitable for use in diverse clinical settings and environments by operators with different backgrounds. Recent technological advances have led not only to the enhancement of the diagnostic capabilities of stationary ultrasound systems but also to miniaturization, which in turn led to the introduction of smartphone-sized handheld ultrasound devices (HUDs), designed to be used at bedside to improve and extend the scope of physical examination. Although diagnostic capabilities of HUDs are expanding, according to guidelines, they cannot be perceived as a tool suitable for performing full echocardiographic examination. However, their ultraportability made them essential for the bedside assessment, with the particular emphasis on the bedside focus cardiac ultrasound (FoCUS)-goal-oriented, limited echocardiographic screening. Clinically relevant cardiological targets suggested for HUDs include the assessment of left ventricular (LV) systolic function and size, assessment of other cardiac chambers, identification of gross valvular abnormalities, and detection of the pathological masses within the heart cavities. Handheld ultrasound devices may be also helpful in identifying pleural effusion or subpleural consolidations; furthermore, brief ultrasonographic assessment of "lung comets" enables the estimation of the level of congestion. Ultrasound screening for certain vascular abnormalities also appears promising. The limitations of HUDs are rather obvious and caution is needed to distinguish the role of HUD-based bedside-limited scan from comprehensive stationary echocardiography. It appears that the right approach is to treat them as complementary tools proving their capabilities in diverse clinical scenarios.
超声检查的优势无需赘述。它适用于不同背景的操作人员在各种临床环境中使用。最近的技术进步不仅提高了固定式超声系统的诊断能力，还实现了小型化，进而催生了智能手机大小的手持式超声设备（HUD），其设计用于床边检查，以改进和扩展体格检查的范围。尽管HUD的诊断能力在不断扩展，但根据指南，它们不能被视为适合进行完整超声心动图检查的工具。然而，其超便携性使其成为床边评估的重要工具，尤其侧重于床边聚焦心脏超声（FoCUS）——目标导向的有限超声心动图筛查。针对HUD提出的临床相关心脏检查目标包括评估左心室（LV）收缩功能和大小、评估其他心腔、识别明显的瓣膜异常以及检测心腔内的病理性肿块。手持式超声设备在识别胸腔积液或胸膜下实变方面也可能有帮助；此外，对“肺彗星征”进行简短的超声评估有助于估计充血程度。对某些血管异常进行超声筛查似乎也很有前景。HUD的局限性相当明显，需要谨慎区分基于HUD的床边有限扫描与全面的固定式超声心动图的作用。正确的做法似乎是将它们视为在各种临床场景中证明其能力的补充工具。
