Hi Craig,
I remember very distinctly. I was in our facility, in the exam room, scanning a patient. 
Sorry, I couldn't resist. 
Actually I saw them in the left common carotid artery.
Bill



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-------- Original message --------
From: Craig Hume <[log in to unmask]>
Date: 6/27/18 5:26 AM (GMT-05:00)
To: [log in to unmask]
Subject: Re: Microemboli Question

Sorry if its already answered but where where you when you saw thr HITS?

Sonographer formally known as Crash Bandicoot

On 27 Jun 2018 00:50, "Denise Levy" <[log in to unmask]> wrote:
Bery , very same thing right ??  Lol 

On Tue, Jun 26, 2018 at 7:48 AM Denise Levy <[log in to unmask]> wrote:
Hi Bill,
I just checked my phone and did not have a positive example of a grade 4-5 PFO. TCD I bet Colleen Douville at Swedish would have something or Brenda Rinsky at Mt Sinai, 
They are my hero’s for TCD and also scan carotids . You see I can still respond ,, good pick up Bill. They should do TCD monitoring at the same time with the echo ,, grading is bery precise ,  Denise Levy 

On Tue, Jun 26, 2018 at 7:04 AM Bill Schroedter <[log in to unmask]> wrote:
Thanks Patrick. Agree with you on all counts. I spent some time searching and could not find too much, therefore figured I would consult my learned colleagues.  This lady was a spry 80 y/o with no history of any heart disease save an occasional PVC.  The HITS I saw did not seem to correlate with the PVC's.  That's why I was thinking perhaps PFO.  I only noted on the left side and as mentioned, her carotids were normal.
Thanks, B

-----Original Message-----
From: UVM Flownet <[log in to unmask]> On Behalf Of Patrick DeMuth
Sent: Tuesday, June 26, 2018 9:58 AM
To: [log in to unmask]
Subject: Re: Microemboli Question

Bill,

You certainly can detect microemboli on an extracranial study. I don't think there is literature that discusses extracranial detection rate, etc. namely because embolic detection is dependent on the frequency of the transducer. The lower the frequency, the more emboli you will detect (if there is emboli present).

One interesting question would be if the patient had a valve replacement, as these are shown to shed air emboli, which produce a higher signal to noise ratio compared to particulate matter. If you found embolic signals on both sides that would confirm the central source.

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