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It is important to obtain images of both hips because comparison views of the
unaffected side can be helpful in identifying true pathology versus an anatomical
variant.
As with all musculoskeletal ultrasound, it is important that the probe be held
perpendicular to the skin and as parallel to the femoral neck as possible; a slightly
oblique angle may cause the synovial space to appear falsely hypoechoic (an
artifact known as anisotropy). Finally, these authors have found that the accepted
criteria for the diagnosis of hip effusion may be misleading in some patients. A
patient with small bilateral effusions (less than 5 mm) may not meet official
criteria by measurements, but if the joint space appears convex with anechoic
fluid within it, an effusion is likely present.

FIGURE 131.14 Probe position for hip ultrasound.

GENITOURINARY ULTRASOUND
First Trimester Ultrasound
Abdominal pain in the pregnant adolescent female is a common presenting
complaint. The differential diagnosis is broad, ranging from benign self-limited
conditions to a spectrum of life-threatening and organ-threatening conditions.
Ectopic pregnancy must be identified and treated rapidly. It is the leading cause of
maternal mortality in the United States and has a reported prevalence as high as
8% for a pregnant patient presenting to the ED.