Ultrasound and Physical Examinations for Obese Patients

To the Editor: The article by Drs Silk and McTigue on the physical examination in obese patients¹ did not discuss the use of portable, handheld ultrasound as an adjunct. Small, portable, handheld ultrasound units are now available. In 1988, Filly,² in an editorial, called ultrasound the stethoscope of the future but was concerned about its use in untrained hands. In 2002, Dodd³ encouraged teaching the technique of ultrasound usage to medical students beginning in the gross anatomy laboratory and ending in ward rounds and senior electives. In 2003, Greenbaum⁴ projected that in the near future “medical students will also be buying a ‘sonoscope’” in addition to a stethoscope. He envisioned the sonoscope as enhancing the physical examination of all patients. With the advent of smaller, better-quality, and less-expensive machines, and medical schools beginning to provide technical training for their students, the use of point-of-care ultrasound is increasing, with applications in physical diagnosis, screening, and guiding procedures.⁵ Small, portable, handheld ultrasound units are now inexpensive enough for this to be a reasonable addition to a clinician's everyday armamentarium. Little, however, has been written about use of this technology in obese patients or about the upper limits of its usefulness. Because ultrasound penetrates fluid and solid organs well, it may be useful in the physical examination of the obese patient.