UMEM Educational Pearls

Category: International EM

Title: Focused Assessment with Sonography for HIV/TB (FASH- Part 1)

Keywords: Infectious disease, ultrasound, HIV, TB (PubMed Search)

Posted: 9/29/2016 by Jon Mark Hirshon, MD, MPH, PhD (Emailed: 10/5/2016) (Updated: 10/5/2016)
Click here to contact Jon Mark Hirshon, MD, MPH, PhD


What is the FASH Exam?

  • Focused Assessment with Sonography for HIV/TB
  • A new exam suitable for rapid identification of extrapulmonary TB


Submitted by Dr. Laura Diegelmann



  • The majority of HIV-TB co-infection cases (78%) are reported in sub-Saharan Africa.
    • Extra-pulmonary TB risk increases as immune deficiency progresses.
    • Ultrasonography can be helpful in identifying extra-pulmonary TB-associated findings in the patient with HIV.
  • The FASH exam (Focused Assessment with Sonography for HIV/TB).
    • 20% of all TB is extrapulmonary TB (EPTB).
    • High percent of these patients have sputum negative smears for mycobacterium.
    • In the setting of advanced HIV the diagnosis of EPTB may be difficult do to atypical clinical presentations, undiagnosed HIV and infection at occult sights where sputum testing will be negative.
  • Rational for FAST exam-
    • Expedite diagnosis
    • Earlier initiation of TB treatment which improves M&M



  1. Heller T, Wallrauch C, Goblirsch S, Brunetti E. Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review.  Crit Ultrasound 2012;4:21
  2. Heller T, Wallrauch C, Lessells RJ, Goblirsch S, Brunetti E. Short report: Short course for Focused Assessment with Sonography for HIV/TB: Preliminary Results in a Rural Setting in South Africa with High Prevalence of HIV and TB. Am J Trop Med Hyg. 2010;82:512-5.