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INTERVENTIONAL AND OTHER TECHNIQUES 263
tube into the stomach. This is now better done
endoscopically. 12
Indirect ultrasound guidance
Not infrequently drainage of fluid, for example
from the pleural cavity, may be performed away
from the ultrasound department in the ward or
clinic. Although ideally this is done under guidance
with a portable scanner, in practice excellent results
are obtained for larger, non-loculated collections,
particularly pleural effusions, by marking the skin
surface with a felt-tip marker in the main scanning
department to enable drainage to be safely carried
out on the ward.
The mark should be made with the patient in
the position in which drainage is to be attempted,
for example sitting or decubitus right side raised,
LT
A
B
C
Figure 11.11 (A) Longitudinal ultrasound image of the left kidney. There is clear evidence of hydronephrosis.
(B) Similar image during a nephrostomy procedure. The electronic ultrasound guide path can be easily visualized. The
guide wire (arrow) can also be seen within the renal pelvis and collecting system. (C) Longitudinal ultrasound scan of
the left kidney immediately following nephrostomy. The collecting system remains dilated due to injected contrast. The
echogenic tips of the drainage cathether (arrow) can be visualized within the renal pelvis.