Ultrasound or sonography

The ultrasound examination, also called sonography, echography or ultrasound for short, is a painless, imaging diagnostic method that uses the properties of ultrasound to analyze the soft tissue (muscles, tendons and bursa).

Quick and practical to use, tens of thousands of such examinations are carried out in Italy every day at low cost.
Since this procedure does not have any side effects, anyone can undergo sonography, unlike, for example, magnetic resonance , which is not possible for pregnant women and patients with a pacemaker .

A gel is applied to the patient’s skin, which is also used in ultrasound therapy and serves to guide the signal.


How is a sonography performed?

The body part to be examined is exposed, smeared with a gel and scanned with the ultrasound probe, which transmits and receives the signal.
The examining doctor looks for abnormalities such as effusions, hematomas, inflammation, and scars; if this is in an area between at least two muscle layers, he follows its course to the origin until he can identify it with certainty. You can for a comparison possibly open the limb examine the other side of the body to determine differences.

The doctor stops the transducer (probe) at the crucial point, saves the image on the computer and prints it out at the end of the examination. It is not easy to decipher an ultrasound image, you see a black and white chaos interspersed with different shades of grey; it needs an expert who can read the structures correctly and recognize changes and pathologies.
Even inexperienced doctors can make serious mistakes here; I’ve dealt with patients that the doctor has torn a musclehad diagnosed, although it was only about enlarged lymph nodes or simply an inflammation; or a simple muscle strain has been mistaken for a phlebitis.

Which body structures can be examined?

The limbs are well examined by skeletal muscle ultrasound; In the case of the knee and spine , however, this procedure is of little use; magnetic resonance is useful here. So-called full organs, ie those that do not contain any air, can be represented well; The lungs and intestines can therefore not be analyzed.
Shoulders, elbows, hands and feet are often examined from the joints, with the muscular apparatus mainly the thigh tissue: biceps and quadriceps, as well as calf muscles, upper arm biceps, upper and lower bone muscles, extensors and external rotators of the forearm.

Why is ultrasound used so often?

Sonography is extremely convenient because it does not require any preparation, such as with resonance, it is also easy to transport and gives a complete overview of the soft tissues and internal organs. With today’s equipment, the extent of muscle-tendon injuries , cysts or bruising after a bruise can be measured, and a thickened or inflamed tendon ( tendinitis ) can be identified.

Different parts of the body can be examined in one session, depending on where the transducer is placed. During the ultrasound , no dangerous rays are emitted and no contrast medium has to be injected. It is quick to carry out, the examination is completed in a quarter of an hour.

What preparation is necessary?

No special preparation is required for ultrasound examinations of muscles, tendons, ovaries, breasts and thyroid glands.

For an ultrasound of the organs in the lower abdomen, such as the bladder, prostate, pelvis, uterus, testicles, etc., at least one liter of non-carbonated water must be drunk up to 45 minutes before the examination. Carbonated drinks should be avoided because the vesicles appear as spots on sonography.

In the upper abdominal region, the digestive tract must not contain any solid or gaseous contents, so you must not eat anything more than 8 hours before the examination. Food such as vegetables, carbonated drinks, alcohol, bread, pasta, wholemeal products, legumes, milk and dairy products must be avoided two days beforehand, because the dietary fibers they contain cause increased gas formation in the intestines (bloating, meteorism). Meat, fish, fruit without the skin and a small amount of grain may be eaten.

In the case of an endorectal sonography, the same preparation is carried out as for the lower abdomen, in addition, a cleansing intestinal enema must be taken about three hours before the examination.

What does the ultrasound show?

With ultrasound, an image is displayed in different shades of gray (from white to black) that represent the different intensities of the signals received by the sonographer. The white areas indicate a “ hyperechoic ” or “ echoic” structure, such as a kidney stone. In muscles and tendons, hyperechoic zones can indicate calcium deposits or fibrous scar tissue that has formed after a muscle tear.

Further meaning of white areas:

  • stones _
  • fatty liver (hepatic steatosis),
  • fibroids (fibrous).

Black areas indicate a “ hypoechoic ” or “ hyperechoic” structure that is usually fluid because inflammation is present; but it can also be a malignant formation. In the case of muscles and tendons, an inhomogeneous, hypoechoic zone can indicate a muscle tear or a bruise.

Further meaning of black areas:

 How does the ultrasound device work?

In this method, ultrasonic waves are generated by the piezoelectric effect with crystals arranged in the probe. The doctor uses the ultrasound probe (also called the transducer), which looks like a barcode scanner used in the supermarket,
to examine the body .

The  sonographer’s transducer not only emits the ultrasound waves, but also receives the reflected echo. This device does not harm the examined area in any way, because it does not emit ionizing rays, but sound waves; therefore, this technique can also be used to monitor the development of a pregnancy.
The emitted sound wave penetrates the human body to a depth of several centimeters and can be reflected, refracted, scattered or dampened there.
The signal is fully reflected when it hits a bone; when it crosses a cyst or effusion, it remains unchanged and penetrates further into the deeper layers.

The signal received is transmitted from the probe to the computer, which displays the examined tissue on a monitor; Bones are shown in white, effusion in black.
Between these two extremes there are various shades of grey, corresponding to a different intensity of the reflected sound wave, a different color means a different organ: liver, thyroid, embryo, etc. Due to the thousandths of a second that elapse between the transmission of the signal and the
reception of the reflex, the depth can vary of the reflecting structure can be reconstructed.

Ultrasound examination during pregnancy

There are currently 4 ultrasound methods: 2D, 3D, 4D and Doppler. The most common application is 2D ultrasound, which displays a series of two-dimensional slice images.
The technologically advanced 3D form is used for prenatal diagnostics. The examined tissue is viewed from different angles, and the recorded data enable a three-dimensional representation.

The 4D ultrasound also makes movement visible and shows the most realistic images of fetus growth.
With the 3D and 4D method, anomalies can be detected that cannot be easily detected with the 2D technique.
While the ultrasound techniques described above show the internal structures and tissues, the Doppler method can be used to examine the blood vessels.

Usually three ultrasound examinations are carried out during pregnancy:

  • The first ultrasound, between the ninth and twelfth week of pregnancy, is designed to assess cardiac activity and detect any multiple pregnancies.
  • The second ultrasound checks the development of the organs and examines whether there are any malformations.
  • The third ultrasound serves to assess the child’s growth.

Benefits of ultrasound in pregnancy

  • Ultrasound has no embryo-toxic effect on the fetus. Also, there are diseases that affect the soft tissues and show up on the ultrasound but not on the x-ray.
  • Transvaginal ultrasound is an alternative when abdominal ultrasound does not provide clear images of the fetus, especially in the first trimester.
    It is also useful for detecting a pregnancy implanted outside the uterine cavity (ectopic pregnancy), a multiple pregnancy or a risk of miscarriage . If there is meteorism (excessive accumulation of gas in the digestive tract), an abdominal ultrasound may show blurry images, in which case a vaginal ultrasound would be preferable.
  • Abdominal ultrasound is a non-invasive procedure that does not cause infection or pain, making it a safe method for both mother and child.
  • Doubts arising from ultrasound can be confirmed by additional examinations such as chorionic villus sampling and amniocentesis.

Risks of an ultrasound examination during pregnancy

  • Transvaginal ultrasound may cause some discomfort because the probe is inserted into the vagina for the examination.
  • Insufficiently qualified staff or inappropriate equipment can be harmful to the child.
    Physician incompetence can result in an infant overdosing on sound waves, which could result in growth retardation or low birth weight.

2. Ultrasound examination

The second ultrasound examination of the prenatal care is often referred to as a large ultrasound, fine diagnostics or organ ultrasound, since the gynecologist takes a closer look at the embryo and its organs.
The child is measured from the head to the pelvis to determine the timely development of the organs.
The functionality and development of the vital organs is checked during this examination.
The sex of the child can also be determined in this second ultrasound.
The examination takes about 15-20 minutes.

When is the 2nd ultrasound examination carried out?

The second ultrasound examination takes place in the second trimester of pregnancy, between the 18th and 22nd week of pregnancy.
Every pregnant woman should have this second ultrasound performed, regardless of age or other illnesses.

Why is the 2nd ultrasound so important?

The second ultrasound scan is extremely important to determine if the fetus has any developmental or inherited disorders such as:

  • Down-Syndrom
  • Edwards-Syndrome (Trisomy 18)
  • Patau syndrome (trisomy 13)

The second ultrasound examination is recommended especially when the first ultrasound revealed abnormalities in the fetus.

How much does an ultrasound examination cost?

The cost depends on which part of the body is being examined, but an ultrasound of the shoulder costs less than an ultrasound of the entire abdomen.
As a rule, the costs are between 50 and 120 euros.

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