[Sonoanatomy of the muscles and fascia spaces of the pectoral regions]. / Die Sonoanatomie der Muskeln und Faszienräume der Regio pectoralis.

BACKGROUND: Aim of the study was to work out a reliable method for the ultrasonographic evaluation of the pectoral region. METHODS: The study was performed in 20 cadaver specimens and 20 healthy volunteers as well as in 10 patients with disorders of the pectoral region. RESULTS: For examination of the pectoralis major muscle, the landmark for the positioning of the ultrasound transducer was found to be the lateral border of the anterior axillary fold in the direction of the tip of the coracoid process. Tilting the probe medially, the fibres of the pectoralis major muscle become visible in longitudinal alignment. The main part of the clavicular portion of the pectoralis major muscle can be visualised by moving the probe parallel to this position. Tilting the probe downwards, both the internal part of the clavicular portion, the sterno-costal and the abdominal portion are evaluated. For examination of the pectoralis minor muscle, the probe is positioned between the tip of the coracoid process and the sternal angle. Thus the whole muscle can be examined with a single sweep of the transducer. In all the specimens, probands and patients of our group, both muscle, fascias and pathological lesions could be clearly depicted. SUMMARY: Based on the introduction of standard examination planes, the pectoral region can be evaluated in detail using ultrasonography. Lesions and pathologic changes can be reliably appointed to individual anatomical structures.

[Ultrasound imaging and localization of metal implants. A clinical study]. / Sonographische Darstellung und Lokalisation von Metallimplantaten. Eine klinische Studie.

In a first experimental study we investigated the visualisation of metal implants in reference to dimension, shape, material (titanium, steel, biodegradable screws) and surface structures and an eventual change of the echo pattern in correlation to the surrounding structures, the vicinity to bone and the change of the sound angle. For this purpose ultrasound investigation was performed in artificial and cadaver bones and in cadaver limbs after implantation of screws, plates, K-wires and cerclage wires. We found that metal implants of a certain dimension can be localised by typical artefacts (resonance artefact, comet tile artefact). In the following clinical study we investigated the value of ultrasound in finding and localisation of implants after osteosynthesis. In patients with 25 locking femur nailing, 30 locking tibia nailing, 30 osteosynthesis done by screws and plating, metal was easily localised by typical artefacts. Ultrasound examination gave the possibility to define the number of screws, the localisation to surrounding tissue, loosening of screws and eventual as sociated inflammatory tissue swelling (bursitis, tendovaginitis).