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Relatório de estágio em ultrassonografia vascular
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Introdução: A ultrassonografia vascular é um exame de imagem não invasivo que utiliza ondas de ultrassom para a avaliação da estrutura vascular e hemodinâmica do fluxo sanguíneo em tempo real. Quando aplicada à neurologia, permite tanto o diagnóstico, acompanhamento e estratificação de risco de doenças cerebrovasculares.
Objetivo: Consolidar competências técnicas em ultrassonografia vascular, com foco em EcoDoppler Triplex cerebrovascular, bem como discutir dois relevantes casos clínicos, entre os exames realizados no Hospital de Santa Maria (Lisboa).
Resultados: Relativamente à casuística do estágio a amostra é constituída por 244 doentes. Foram recolhidos os dados referentes aos achados ultrassonográficos de 216 EcoDoppler dos grandes vasos do pescoço mais transcraniano, 9 EcoDoppler transcraniano mais Sinais Microembólicos, 7 EcoDoppler das artérias temporais, 7 EcoDoppler das artérias oftálmicas e 5 EcoDoppler transcraniano. Deste conjunto, observaram-se ainda, na sala de EcoDoppler cerebrovascular, 3 exames de ultrassonografia vascular dos membros inferiores em doentes com pesquisa positiva de microêmbolos sistémicos, identificados com utilização do Doppler trancraniano e soro agitado.
Foram ainda analisados 2 casos clínicos com utilização do EcoDoppler como meio complementar de diagnóstico e como técnica de apoio na monitorização do tratamento e seguimento: uma mulher de 34 anos de idade com quadro de Acidente Isquémico Transitório em território vertebro-basilar por dissecção vertebral; uma mulher de 76 anos de idade com Acidente Vascular Cerebral isquémico no território da artéria cerebral média.
Conclusão: O EcoDoppler constitui atualmente uma ferramenta indispensável na avaliação hemodinâmica cerebral e na prevenção do acidente vascular cerebral. A experiência adquirida durante o estágio permitiu consolidar competências técnicas relevantes e compreender o contributo clínico do EcoDoppler no diagnóstico e no seguimento das doenças cerebrovasculares, tal como demonstrado nos dois casos clínicos apresentados.
Introduction: Vascular ultrasonography is a non-invasive imaging modality that uses ultrasound waves to assess vascular structure and blood flow haemodynamics in real time. When applied to neurology, it enables the diagnosis, follow-up, and risk stratification of cerebrovascular diseases. Objective: To consolidate technical skills in vascular ultrasonography, with a focus on cerebrovascular Triplex Doppler ultrasound, as well as to discuss two relevant clinical cases among the examinations performed at Hospital de Santa Maria (Lisbon). Results: Regarding the case series from the clinical internship, the sample consisted of 244 patients. Data were collected from the ultrasonographic findings of 216 extracranial carotid and vertebral Doppler ultrasound examinations combined with transcranial Doppler, 9 transcranial Doppler examinations with microembolic signal detection, 7 temporal artery Doppler ultrasound examinations, 7 ophthalmic artery Doppler ultrasound examinations, and 5 transcranial Doppler examinations. In addition, within the cerebrovascular Doppler ultrasound unit, 3 vascular ultrasonography examinations of the lower limbs were observed in patients with positive systemic microembolic signal detection, identified using transcranial Doppler and agitated saline. Furthermore, two clinical cases were analysed in which Doppler ultrasound was used both as a complementary diagnostic tool and as a monitoring technique during treatment and follow-up: a 34-year-old woman presenting with a transient ischaemic attack in the vertebrobasilar territory caused by vertebral artery dissection; and a 76-year-old woman with an ischaemic stroke in the middle cerebral artery territory. Conclusion: Doppler ultrasound currently represents an indispensable tool in the assessment of cerebral haemodynamics and in stroke prevention. The experience acquired during the clinical internship enabled the consolidation of relevant technical skills and provided a deeper understanding of the clinical contribution of Doppler ultrasound in the diagnosis and follow-up of cerebrovascular diseases, as demonstrated in the two clinical cases presented.
Introduction: Vascular ultrasonography is a non-invasive imaging modality that uses ultrasound waves to assess vascular structure and blood flow haemodynamics in real time. When applied to neurology, it enables the diagnosis, follow-up, and risk stratification of cerebrovascular diseases. Objective: To consolidate technical skills in vascular ultrasonography, with a focus on cerebrovascular Triplex Doppler ultrasound, as well as to discuss two relevant clinical cases among the examinations performed at Hospital de Santa Maria (Lisbon). Results: Regarding the case series from the clinical internship, the sample consisted of 244 patients. Data were collected from the ultrasonographic findings of 216 extracranial carotid and vertebral Doppler ultrasound examinations combined with transcranial Doppler, 9 transcranial Doppler examinations with microembolic signal detection, 7 temporal artery Doppler ultrasound examinations, 7 ophthalmic artery Doppler ultrasound examinations, and 5 transcranial Doppler examinations. In addition, within the cerebrovascular Doppler ultrasound unit, 3 vascular ultrasonography examinations of the lower limbs were observed in patients with positive systemic microembolic signal detection, identified using transcranial Doppler and agitated saline. Furthermore, two clinical cases were analysed in which Doppler ultrasound was used both as a complementary diagnostic tool and as a monitoring technique during treatment and follow-up: a 34-year-old woman presenting with a transient ischaemic attack in the vertebrobasilar territory caused by vertebral artery dissection; and a 76-year-old woman with an ischaemic stroke in the middle cerebral artery territory. Conclusion: Doppler ultrasound currently represents an indispensable tool in the assessment of cerebral haemodynamics and in stroke prevention. The experience acquired during the clinical internship enabled the consolidation of relevant technical skills and provided a deeper understanding of the clinical contribution of Doppler ultrasound in the diagnosis and follow-up of cerebrovascular diseases, as demonstrated in the two clinical cases presented.
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Ultrassonografia vascular EcoDoppler Doenças cerebrovasculares Diagnóstico Vascular ultrasonography EchoDoppler Cerebrovascular diseases Diagnosis