On this page
Referral and warning signs
When to refer
Refer patients for ultrasound based on clinical indications where findings will influence management.
Red flags
- Not applicable for the modality itself, but US findings can reveal red flags (e.g., ruptured ectopic, appendicitis, DVT, free fluid in trauma).
Signs and symptoms
- Not applicable - Guidance topic.
Risk factors
- Not applicable.
Diagnosis
Clinical assessment
Ultrasound requested based on clinical suspicion to visualize soft tissues, fluid, organs, and blood flow.
Investigations
- Ultrasound Scan (various probes/modes - B-mode, Doppler).
Diagnostic criteria
Clinical question that can be answered by visualizing relevant structures/pathology with ultrasound.
Management
Non-pharmacological management
- Advantages: Non-invasive, No ionizing radiation (safe in pregnancy/children), Relatively low cost, Portable (bedside possible - POCUS), Real-time imaging, Good soft tissue visualization, Doppler assesses blood flow.
- Limitations: Operator dependent, Difficult in obese patients, Bowel gas obscures deeper structures, Bone blocks visualization.
- Requesting Scan: Provide clear clinical question and relevant history to sonographer/radiologist.
- Common Indications (Based on UCG Table & General Practice):
- - Obstetrics: Confirm IUP, viability, gestational age, fetal number, anatomy scan, placental location, amniotic fluid volume, fetal well-being, guide procedures.
- - Gynaecology: Assess uterus (fibroids, endometrium), ovaries (cysts, masses), adnexa, detect PID complications (abscess, hydrosalpinx), IUD location.
- - Abdomen:
- - Hepatobiliary: Gallstones, cholecystitis, liver size/lesions, cirrhosis signs, ascites.
- - Renal/Urinary Tract: Hydronephrosis, kidney stones (limited), kidney size/cysts/masses, bladder assessment.
- - Spleen size.
- - Pancreas (often obscured by gas).
- - Aorta (aneurysm screening).
- - Appendicitis (especially children/thin adults).
- - Intussusception (children).
- - Ascites detection/guidance for paracentesis.
- - Trauma (FAST Scan): Detect free fluid (blood) in pericardium/peritoneum.
- - Small Parts: Thyroid nodules/goitre, Testicular masses/torsion, Breast lumps/cysts.
- - Musculoskeletal: Soft tissue masses, effusions, tendon/ligament tears (limited).
- - Vascular (Doppler): DVT assessment, Arterial stenosis assessment.
- - Procedural Guidance: Biopsy, Aspiration, Drain placement.
Pharmacological treatment
- Not applicable.
Monitoring
- Follow-up scans as clinically indicated to monitor condition/response.
Complications
- Generally very safe.
- Misdiagnosis if poor technique or interpretation.
- Findings may be non-specific.
Prevention
- Appropriate patient preparation (e.g., full bladder for pelvic scan).
- Clear clinical request.
Patient education
- Explanation of why the scan is needed.
- Basic description of the procedure (gel, transducer).
- Painless nature.
- Any necessary preparation (e.g., full bladder, fasting).
Uganda-specific notes
Ultrasound availability is increasing, common at HC4 and Hospital level. Operator skill varies. Key tool for Obstetrics, Gynaecology, and abdominal pathology assessment. FAST scan increasingly used in trauma.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 24, Section 24.2.1 (Includes Ultrasound indications)