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Methods of ultrasound of the upper limb
Last reviewed: 23.04.2024
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The survey procedure and the data obtained
When examining the veins of the upper limb, the patient lies on the back, the upper end of the body is slightly elevated. Put the patient's hand on his knees and hold it in the desired position with your left hand. Start the examination from the supraclavicular level with a medium or high frequency sensor (5-10 MHz). The sensor surface should be less than 4 cm wide to facilitate penetration into the supraclavicular fossa. Obtain a color image of the proximal part of the subclavian vein. Then trace the inner jugular vein upward in the cross section from the place of its fusion with the subclavian vein, using variable compression, as high toward the head as possible. If the results are normal, B-mode is sufficient. Then continue the research down the collarbone. When scanning through the pectoral muscle window, the veins are deep, so a sensor with a low frequency should be used. Start scanning immediately below the clavicle, tracing the vessels to the front axillary arch. Then scan from the armpit access, making sure that there is overlap of the axillary images with the thoracic to avoid passage of the axillary vein. When examining distal to the level of the armpit, lower your arm down to improve visualization of the veins. If desired, you can try to visualize the brachiocephalic vein from the supraclavicular access with the help of a high-frequency sensor Usually a vein vein examination is not required.
Ultrasound anatomy
Examination of the veins of the upper limb is complicated by the fact that the subclavian vein is "hidden" behind the clavicle. The supraclavicular part of the vein is anterior to the subclavian artery. Since the sensor is inclined to the collarbone, the vein is usually visualized only in the longitudinal section. At the subclavian level, the sensor is perpendicular, its upper end touching the clavicle. He moves along the bone to visualize the subclavian vessels in the medial and middle thirds of the clavicle. Vienna goes anterior to the artery, merging with the axillary vein at the lateral edge of the first rib. Shoulder veins and anterior humeral veins have a narrower caliber and less clinical significance.
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