Normal findings: The left lobe of the liver will be visible in the upper parts of the image serving as an acoustic window. Commands asking the patient to inspire might help to displace the heart caudally and improve visualization. The patient should try to relax his abdominal muscles (arms placed beside the body) as an attempt is made to вЂscoopвЂ™ the transducer under the ribs. Probe position: The probe is placed transverse in the epigastric angle the transducer is then tilted cranially to get a view of the intra-thoracic organs and the heart. A chest X-ray showing cardiomegaly is frequently caused by pericardial effusion and should be further assessed by ultrasound.

Indication: Pericardial effusion should be considered in every HIV-positive individual with signs of breathlessness, retrosternal pain, and signs of progressive heart failure, tachycardia or hypotension. In a similar approach, a focused assessment with sonography for HIV-associated TB (FASH) protocol was developed, modeled on these protocols and experiences in emergency medicine. Short protocols have been successfully established in emergency medicine such as focused assessment with sonography for trauma for trauma victims. Specific protocols need to be provided for questions applicable in different settings and patient populations. In recent years, the introduction of point-of-care US performed by clinicians has been successfully implemented in a variety of settings. Ultrasound (US) can rapidly identify abnormal signs, which in high prevalence settings, will be highly suggestive of EPTB, but trained sonographers are scarce in resource-limited settings to detect these findings. Typical ultrasound (US) findings of abdominal TB include retroperitoneal and mesenteric lymphadenopathy with node diameter greater than 1.5 cm, multiple splenic hypoechoic nodules between 0.5 and 1 cm, and patterns of ascites. Pleural effusion, especially when unilateral and associated with HIV infection, is most likely to be caused by tuberculosis in countries with a high TB incidence. Cardiac tamponade is the most severe clinical presentation of TB pericarditis and constitutes a life threatening event that requires immediate medical intervention. Tuberculous pericarditis is consistently reported as the predominant cause of pericardial effusion in Southern Africa and is in most of the cases associated with HIV co-infection. Д¬ommon manifestations of EPTB include pericardial effusion, pleural effusion, and abdominal TB. Consequently, the diagnosis is usually based on clinical case definitions. Diagnosis is hampered by the difficulty to obtain material, poor sensitivity of microscopy, and the limited availability of culture techniques.

EPTB accounts for 15% to 20% of all TB cases reported by TB control programs in the African region. In sub-Saharan Africa, the convergence of human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics has led to a resurgence of extrapulmonary TB (EPTB).

Focused assessment