Palpable Masses

N Principal signs and symptoms palpable, enlarged lymph nodes, painful or painless (see also p. 107) palpable masses of indeterminate nature. Enlarged lymph nodes may reflect a distant disease process (tumor, infection). The lymphatic pathways shown in Fig. 131 are helpful in locating the source of an infection. n The differential diagnosis is reviewed in Table 15, where the possible diagnoses are listed in order of their frequency in the general hospital setting. Table 15 Differential...

Scan Planes

Sa n Longitudinal and transverse planes l, Ma n Sonographic anatomy (Fig. 634) The largest of the major salivary glands, the parotid gland is located anteroinferior to the ear and posterolateral to the ramus of the mandible. Its excretory duct leaves the gland anterosuperior to the buccal mucosa. Generally the duct cannot be defined with ultrasound unless it is enlarged as a result of obstruction. Fig. 634 Topographic anatomy of the parotid gland Fig. 634 Topographic anatomy of the parotid...

N Alcohol instillation

Indications Malignant tumors (e.g., malignant primary or secondary hepatic tumors), thyroid adenoma. Prerequisites Good visualization, solitary lesion, tumor < 5 cm. n Suprapubic bladder catheter Indication Incontinence that necessitates long-term urinary diversion. Possible causes include outflow obstruction due to inoperable prostatic carcinoma. In principle, suprapubic aspiration of a full bladder can be carried out after clinical palpation and percussion. Ultrasound-guided aspiration is...

Endo130

N Clinical manifestations significant general malaise n Diagnosis Known history of valvular heart disease. Do not overlook this diagnosis, especially in patients with artificial valves. Repeated blood cultures echocardiography TEE n Sonographic findings Transthoracic echocardiography (TTE) valvular incompetence thickened, echogenic valves, possibly with mobile vegetations (difficult to detect by TTE because they are on the side away from the transducer) Transesophageal echocardiography (TEE)...

N Crohn disease of the terminal ileum

Crohn Stenosis

- Clinicalfeatures diarrhea, pain in the right lower quadrant of the abdomen, elevated ESR possible iron deficiency anemia, steatorrhea, vitamin B12 deficiency, bile acid loss syndrome with chologenic diarrhea - Fistula formation Fistulae may be enterocutaneous, enterovesical, entero-mesenteric, or enterouterine Caution Fistulae may also occur with intestinal tumors. - Hypoechoic inflammatory mesenteric reaction Sonographic findings (Figs. 532-534) - Thickening of the terminal ileal wall to >...

Residual Urine Determination

Sagittal Depth

N Indications Determination of residual urine. n Measurement Calculate bladder volume using the formula for an ellipsoid Have the patient empty the bladder completely. Measure the residual urine volume sonographically using the formula (Fig. 69) volume (mL) width (cm) x depth (cm) x length (cm) x 0.5. Fig. 69a, b a Measurement in transverse section. W width, D depth. b Measurement in sagittal section. L length Fig. 69a, b a Measurement in transverse section. W width, D depth. b Measurement in...

Overview Table

ital Table 68 Abnormal findings in the male genital organs P Benign prostatic hyperplasia (BPH, p. 390) Chronic prostatitis, prostatic calcifications (p. 391) Orchitis, abscess, hematoma (p. 392) n Changes in the seminal vesicles (Fig. 577) Focal echogenic areas calcifications (Fig. 577a) Hypoechoic swelling purulent vesiculitis (Fig. 577b). Must be differentiated from invasion by prostatic carcinoma. Fig. 577a, b Abnormalities of the seminal vesicles. a Calcifications of the seminal vesicles...

N Ureter

Ova Sustava

A ureter affected by outflow obstruction can be imaged at the three levels shown in Fig. 552. Fig. 552 Ultrasound examination of the ureter 1 ureteropelvic junction area, 2 preiliac segment of the ureter, 3 supravesical segment of the ureter The upper part of the ureter at the ureteropelvic junction can be identified in the posterior part of the flank scan and in the transverse renal scan. It lies posterior to the renal vein and artery and is directed anteriorly and medially (Fig. 553).

N Specific scan planes

Transthoracic with intercostal transducer placement Supraclavicular and suprasternal High right and left flank scans n Because ultrasound cannot penetrate aerated lung or the bony thorax, it can only demonstrate lesions that are in direct contact with the pleura or chest wall (see Figs. 605-608, p. 408, 409). n Interpretive criteria (Table 70) Fig. 596a, b a Subcostal scan The liver serves as an acoustic window for the transducer. b Intercostal scan. The transducer is oriented parallel to the...

N Fat necrosis of an epiploic appendix

Biconvex, incompressible mass of high echogenicity Surrounding rim of low echogenicity Fig. 104a, b Epiploic appendagitis. a Inflammatory matting and necrosis of the epiploic appendix (arrows) on the peritoneum (P). b Endoscopic appearance Fig. 104a, b Epiploic appendagitis. a Inflammatory matting and necrosis of the epiploic appendix (arrows) on the peritoneum (P). b Endoscopic appearance n Clinical manifestations Pain is localized to the hernia site and is constant if the hernia has become...

Principal Signs and Symptoms

Hodgkin Diasease Stage Iiib

Table 78 Clinical manifestations of tumors 1 Abnormal laboratory values (anemia, lymphocytosis, thrombocytosis, hemoblastosis, hypercalcemia, elevated ESR) n Definition unexplained loss of 10 of the body weight in 6 months, often caused by complex processes associated with a previously unknown neoplasm (metabolism, mass effects, obstructive stenosis, malnutrition, tumor metabolic products) n Occurrence Esophageal, gastric and duodenal tumors weight loss due to eating difficulties or impaired...

Diffuse Abdominal Pain

Differential diagnosis of diffuse abdominal pain Table 11 . Differential diagnosis of diffuse abdominal pain Accentuated bowel walls, increased intraintestinal fluid, possible small hypoechoic mesenteric lymph nodes Distended colon loops with tense, air-filled haustra Bidirectional peristalsis, dilated bowel loops containing Absence of peristalsis, dilated bowel loops Thickened peritoneum, dilated bowel without wall swelling, Long segmental thickening of bowel walls, acute luminal...

N Suspected pancreatic tumor

Sonography reliable sonographic evaluation with a sensitivity of 72 (only about 32 for tumors J 2 cm, comparable to CT) Endosonography Maximum accuracy, 100 ERP diagnostic accuracy of approximately 70 , because pancreatic tumors almost always arise from the ductal epithelium. Fine-needle aspiration cytology and histology high accuracy rate, > 90 . FNAB is not indicated for operable tumors, however, because of possible false-negative findings and the risk of seeding malignant cells along the...

N Procedure for percutaneous drainage Seldinger technique

Define the target lesion and puncture route, and measure as for a diagnostic aspiration (Figs 78, 79a). Make a stab incision with a scalpel blade. Insert the needle, remove the stylet, and check the position of the needle tip echo (may be necessary to aspirate and instill saline solution). Introduce the guidewire and remove the puncture needle. Dilate the tract with graded dila- Fig. 78a-c Diagnostic and therapeutic aspiration. a B-mode image shows an anechoic pancreatic pseudocyst anterior to...

G n Carcinoid

Primary tumor usually cannot be detected Metastases increased vascularity found by CDS n Malignant lymphoma (Fig. 551) involves a long bowel segment but rarely affects the large intestine Marked wall thickening anatomical wall layers frequently still defined Fig. 551a, b Malignant lymphoma of the ascending colon. a Hypoechoic, scalloped area of tumor infiltration in the bowel wall. b Diagram corresponding to the ultrasound image Fig. 551a, b Malignant lymphoma of the ascending colon. a...

Hepatosplenomegaly

Gaucher Syndrom Ultrasound Liver

N Principal signs and symptoms abdominal tenderness in the right and left upper quadrants, palpable organ enlargement Table 26 Differential diagnosis of hepatosplenomegaly Table 26 Differential diagnosis of hepatosplenomegaly Enlarged, echogenic, homogeneous liver with rarefied hepatic veins Hepatic tumor or metastasis (p. 150) Hypoechoic or echogenic masses, enlarged liver and spleen, biliary stasis High-grade lymphoma, lympho-granulomatous infiltrates in Hodgkin disease (p. 150) Enlarged...

Stomach

Table 62 Abnormal findings in the stomach (lesions difficult to detect with ultrasound are shown in parentheses) IS Wall thickening Luminal widening or narrowing O Wall edema (p. 355) Pyloric stenosis (p. 357) Impaired gastric emptying Chronic type B gastritis (Pyloric stenosis, p. 357) Cicatricial stricture or (p. 356) inflammatory stenosis (p. 359) M n trier disease (p. 356) Varices (p. 357) Tumor-related stenosis (p. 359) Infiltrating carcinoma Gastric ulcer, ulcerated Malignant gastric...

N Occurrence

Plasmacytoma Ultrasound

Superficial and deep (lower-extremity) venous thrombosis (Figs. 663 and 664) Portal vein thrombosis (see Fig. 370, p. 261) Vena cava or renal vein thrombosis (see Fig. 101, p. 74) Fig. 663a, b Deep vein thrombosis in paraneoplastic syndrome. a CDS thrombosis (TH). b Cause local metas-tased carcinoma of the sigmoid colon. The patient had a 3-week history of recurrent pneumonia and fever, initially diagnosed as postinfarction pneumonia. The tumor was not diagnosed until deep venous thrombosis...

N Vascularization patterns in benign tumors

Hepatic adenoma hypervascular (see Fig. 349, p. 248) Focal nodular hyperplasia hypervascular with a typical spoked-wheel pattern (see Fig. 348, p. 248) Leiomyomas, GIST tumors no detectable intratumoral vessels (Fig. 670) Fig. 670 Tumor of the gastric wall (T) benign malignant CDS shows no peripheral or intratumoral vessels. FNAB and histology leiomyoma. L liver n Vascularization patterns in malignant tumors depend on the tumor type and affected organ. There are no patterns of vascularity that...

Ultrasound

Ultrasound Mhz Depth Penetration

Formerly Evangelisches Krankenhaus Kredenbach Kreuztal, Germany B. Beuscher-Willems, L. Br gmann, C. G rg, T. Grebe, L. Greiner 1091 illustrations Georg Thieme Verlag Stuttgart New York Schmidt, Ultrasound 2007 Thieme All rights reserved. Usage subject to terms and conditions of license. Library of Congress Cataloging-in-Publication Data is available from the publisher. This book is an authorized and revised translation of the 3rd German edition published and copyrighted 2005 by Georg Thieme...

C n Procedure

Cu Measure the transverse diameter of the central echo complex at the widest point (Fig. 71). Administer 20 mg of furosemide by i.v. bolus. Repeat the measurement at 5 min and 15 min. n Findings In a normal examination, the separation of the central echo complex measured at 15 min is less than the separation measured at 5 min. If the separation increases or shows no change, an obstructive subpelvic stenosis should be suspected. Fig. 70 Measurement of the separation of the renal sinus echo...

Perirenal Masses and Adrenal Tumors

Perirenal Cysts

N Perirenal abscess or hematoma complex mass. An abscess may contain gas bubbles. n Perirenal cyst (Fig. 284, p. 209) anechoic mass n Adrenal tumors Hypoechoic mass Adrenal adenoma (incidentaloma) Pheochromocytoma (may also show a diffuse pattern) Fig. 422a-d Perirenal mass. a Perirenal fat (F). Arrows Gerota fascia enclosing the perirenal fat capsule, K kidney. b Incidentaloma of the right adrenal gland (arrows), detected incidentally as a complex mass. DD pheochromocytoma, metastasis, primary...

Examination

Diaphragmatic Surface Liver

N Upper abdominal transverse scan (to demonstrate the left lobe of the liver, see p. 22) n Right subcostal oblique scan (see p. 22) n High and extended right intercostal scans (see pp. 33 and 24) n Paramedian upper abdominal longitudinal scans (see p. 24) n The liver exhibits a diaphragmatic surface and a visceral surface. n Both surfaces meet anteroinferiorly at the sharp inferior hepatic border and posterosuperiorly at the fixed part of the diaphragm. n The liver is divided anatomically into...

N Regressive changes

Kidney Hemangioma

Liquefaction Foci of liquefaction may occur in benign and malignant tumors such as colorectal metastases (see Fig. 665a), atypical hemangiomas, and metastases from breast carcinoma. Carcinoid metastases can even be identified by their extensive central anechoic zones and hyperechoic rim (see Fig. 662, p. 440). - Microcalcifications may form in older hepatic metastases (Fig. 666 see also Fig. 665a) and in testicular and prostatic carcinomas (see Fig. 581, p. 391, and Fig. 585, p. 393). -...

Iif5

Fig. 636a, b Epidemic parotitis. a B-mode image enlargement of the gland. b CDS inflammatory hypervascularity Fig. 637a, b Inflammation of the submandibular gland hypoechoic swelling with anechoic streaks (edema) 427 Fig. 637a, b Inflammation of the submandibular gland hypoechoic swelling with anechoic streaks (edema) 427 C Recurrent swelling of the gland Essentially normal echo pattern n Sialadenosis (Fig. 638) Hamster cheeks, nonneoplastic. Common in alcoholics, seen occasionally in diabetics...

Abnormal Findings

Carotid Bulb

N Soft plaques (Fig. 305) luminal narrowing without an acoustic shadow Fig. 305 Small, soft plaque (arrow) in the CCA faint, smoothly curved area of luminal narrowing without an acoustic shadow Calcifications, sometimes with acoustic shadows (Fig. 307) Fig. 306a, b Luminal narrowing by hard plaques. a Calcified plaque in the carotid bulb. Luminal narrowing by plaque with an irregular surface is associated with a higher risk of thromboembolism. b Luminal narrowing by hard plaque with zones of...

Normal Anterior Ankle Joint Space Ultrasound

Nonhomogeneous Examples

N The patient is examined in the supine position. The prone position is used for posterior scanning. The ankle joint should be unconstrained, to allow passive movement. n Ankle joint Anterior and posterior longitudinal and transverse scans (Fig. 62). Fig. 62a, b Sonography of the ankle joint anterior longitudinal scan. a Scan plane, b normal findings. 1 Extensor digitorum longus, 2 ankle joint space Fig. 62a, b Sonography of the ankle joint anterior longitudinal scan. a Scan plane, b normal...

GB gallbladder with sludge

Abnormal Abdominal Appendix Children

N Accuracy of sonographic diagnosis With adequate visualization, there is no need for additional imaging modalities. Duplex sonography (e.g., in power mode) can distinguish a true thrombosis from venous occlusion by an infiltrating tumor and can detect vascularity in the tumor nodule. Angiography, venography, or CT may rarely be necessary in doubtful cases. n Principal signs and symptoms See p. 62 a. n Differential diagnosis See Table 10 ji Table 10 Differential diagnosis of lower abdominal...

N Sonographic findings

Signs of mechanical bowel obstruction (see p. 82). Gap in the peritoneal line (detectable with a 5 MHz or 7 MHz transducer). Bowel loops with thickened walls or omentum can be detected in the hernial sac. The contents are easier to identify if peristalsis is still present. Indirect hernia hernial sac that is lateral to the epigastric vessels and passes obliquely through the abdominal wall. Direct hernia medial hernial sac that passes directly through the abdominal wall. n Clinical...

Diffuse Changes

Sonographic Images Ivc Carcinomas

Table 41 Diffuse changes in hepatic echogenicity or contours Subtle Pronounced Alimentary or diabetic fatty liver (p. 234) Acute hepatitis (p. 235) Chronic hepatitis (p. 235) Fibrosis (p. 235) Congestive cirrhosis (p. 236) Incipient hepatic cirrhosis (p. 236) Diffuse metastasis, systemic hematologic disease (p. 239) Micronodular abscesses, metastases (p. 237) Toxic fatty liver, chronic toxic liver disease (p. 237) Severe chronic hepatitis, hepatic cirrhosis (p. 238) Diffuse metastasis,...

Extrahepatic Ductal Changes

Common Bile Duct Obstruction

Table 56 Extrahepatic duct changes Anechoic or hypoechoic DD vascular calcification (p. 332) Pneumobilia (p. 332) Ductal dilatation due to obstructive cholestasis (p. 330) Papillomatosis (p. 331) Ascariasis (p. 331) Sludge or pus (p. 331) n Anechoic ductal dilatation in obstructive cholestasis (Figs. 483 and 484) Diffuse, anechoic intraductal area > 7 mm Detectable obstructing lesion (tumor, stone) With sclerosing cholangitis segmental ductal dilatation, string-of-beads luminal irregularities...

Pancreas 111 Examination

Transverse Gallbladder Display

N Upper abdominal transverse scan (see p. 22). n Upper abdominal longitudinal scan (see p. 29). Sonographic Anatomy and Normal Findings Fig. 423 Topographic anatomy of the pancreas Fig. 424a, b Upper abdominal transverse scan displays the pancreas as a hypoechoic organ arching over the spinal column, aorta, and inferior vena cava and containing a double-walled echogenic duct. AO aorta, GB gallbladder, IVC inferior vena cava, L liver, P pancreas, U uncinate process, SV splenic vein. PD...

Vena Cava and Peripheral Veins

Positive Venous Reflux Images

,< u Table 34 Venous changes detectable by ultrasound ,< u Table 34 Venous changes detectable by ultrasound n Congestion (Figs. 283 and 284) e.g., vena cava-hepatic venous congestion systemic venous congestion Clinical signs unexplained dyspnea or lower-extremity edema. In this case a simple evaluation of the vena cava can quickly furnish a diagnosis or exclude heart failure. Severe vena caval congestion due to right-sided heart failure is characterized by pulsatile reflux into the hepatic...

Axillary Recess

Bad Blood Taylor Swift Outfit

Fig. 49a, b Sonography of the shoulder posterior longitudinal scan. a Scan plane, b normal findings. 1 Supraspinatus muscle, 2 infraspinatus muscle, 3 teres major Fig. 50a, b Sonography of the shoulder posterior transverse scan. a Scan plane, b normal findings. The humerus appears on the right side of the image. To the left of it is the scapular border, and above that is the infraspinatus. The deltoid muscle is visible above the humerus Fig. 50a, b Sonography of the shoulder posterior...

N Abnormal accumulations of fluid

Small Bowel Carcinamatosis

Pleural effusion (pleural metastases, see Fig. 659, p. 439) - Generalized with peritoneal carcinomatosis, hepatic metastases - Circumscribed with advanced gallbladder tumors, urogenital tumors, or intestinal tumors Differentiation of benign and malignant ascites see Figs. 675 and 676, Table 81 Fig. 676a, b Benign and malignant ascites. a Benign ascites smooth peritoneum and free-floating small bowel loops (sea anemone sign) in a patient with decompensated hepatic cirrhosis. b Malignant ascites...

Intrahepatic Ductal Changes

Intrahepatic Duct Branches

Table 55 Intrahepatic duct changes Anechoic or hypoechoic Biliary cysts, Caroli syndrome (p. 326) Sclerosing cholangitis (p. 327) Parasites (p. 328) Papillomatosis, papillomatous carcinoma (p. 328) Intrahepatic bile duct carcinoma (p. 328) Compression or infiltration by metastases (p. 329) Duct stones (p. 330) Pneumobilia (p. 330) n Ductal dilatation The dilated duct and associated portal vein branch appear as anechoic tramlines. Generally the bile duct lies anterior and the portal vein branch...

N Further studies

Gastric Carcinoma Ultrasound

In cases with a typical clinical presentation, it is sufficient to provide sonographic follow-up and treatment as needed. Asymptomatic cases that do not regress and show rapid growth p lymphade-nectomy. There are no definite ultrasound criteria for benign-malignant differentiation. n Most frequent causes see Table 18, p. 110. n Clinical manifestations frequently suggest the correct diagnosis. Lymph node enlargement has major prognostic implications for tumor staging (TNM), especially in terms...

Jaundice

Graphic Small Bowel Obstruction

Cholestasis with elevated liver values (AP, y-glutamate transferase GGT , bill- o rubin, etc.) Yellowish discoloration of the skin (jaundice when bilirubin > 3 mg dL), pruri- io tus, pale stool, dark urine, fatigue ij n Note Painless jaundice has a malignant etiology in more than 95 of cases. to n Sonographic findings. Particular attention is given to the following aspects 5 Size and configuration of the liver - Smooth or nodular surface C - Truncation or displacement of portal vessels -...

Postoperative Ultrasound 201 Normal Postoperative Changes

Post Operative Seroma

N The prior history (anamnesis) and follow-up history (catamnesis) can account for almost all postoperative findings. n Therefore, always ask about previous operations, especially involving the abdomen (it is easy to overlook scars in the darkened ultrasound room). n The absence of organs should be noted and documented (e.g., previous cholecys-tectomy, Figs. 643 and 644). It is also easy to miss an aortic prosthesis and other implant materials (Fig. 645). Fig. 643a, b Status...

JE Table 17 Differential diagnosis of enlarged lymph nodes

Sonographic Images Lymphangioma

Inflamed lymph nodes p. 110 Variable size, L W ratio j 2, prominent echogenic hilum Lymph node metastases p. 112 Variable size, L W ratio lt 2, absent hilar sign, aberrant vessels Malignant lymphoma p. 113 Variable size, L W ratio often lt 2, absent hilar sign, variable pattern of involvement, variable echogenicity, increased vascularity on CDS 8 T Porta hepatis Visceral 4 Superior and inferior mesenteric group Para-aortic group 0 Parietal Iliac group lymph nodes Fig. 143 Localization abdominal...

Fine Needle Aspiration Biopsy FNAB

Percutaneous Needle Biopsy

N Setup Fig. 72 The supplies include sterile drapes and gloves. n Prerequisites . Adequate coagulation Quick PT gt 70 , platelets gt 100 000 mm3. Factor analysis e.g., factor XIII may be indicated in patients with a hematologic systemic disease. Confirm a safe puncture route. Fig. 72 Materials for fine-needle aspiration biopsy 1 Syringe, needle, razor, local anesthesia. 3 Angiomed core needles. Otto needles 0.8 mm, 0.95 mm, 1.2 mm, or 4 glass slides with a formalin-filled Eppendorf tube Fig. 72...

Crohn Disease

N See also Small Intestine, p. 363, and Large Intestine, p. 366. n Clinical manifestations diarrhea, occasionally bloody abdominal pain over the site of maximum inflammation fever and malaise, malabsorption syndrome. n Diagnosis Physical examination palpable mass matted bowel loops due to transmural inflammation in Crohn disease a fistula is often detectable High colonoscopy with ileoscopy and tissue sampling from all bowel segments Crohn disease does not always produce grossly visible changes...

Intraluminal Changes

Gallbladder Stones With Noo Shadowing

Table 59 Intraluminal changes in the gallbladder Empyema, hydrops p. 347 Cholesterol polyp p. 347 Adenoma p. 347 Carcinoma p. 348 Gallbladder carcinoma with a stone p. 349 Empyema with a stone p. 349 Phlegmon p. 350 n Sludge Fig. 505 formation of bilirubin and cholesterol crystals floating, polypoid, or tumor-like, depending on specific gravity , common in patients on parenteral nutrition. It results in stone formation. Rounded, fungoid or flat layer of sediment that shows sluggish movement...

Ss 141 Examination

Gallbladder Enhancement Ultrasound

N Right subcostal oblique scan see p. 22 n Intercostal scan, extended intercostal scan see p. 23 n The gallbladder nestles in the gallbladder fossa on the visceral surface of the liver, with only its fundus projecting past the inferior hepatic surface. n The gallbladder is bounded on the right side by the right lobe of the liver, on the left side by the quadrate lobe, and posteriorly by the antrum or duodenal bulb Fig. 474a, p. 323, and Fig. 474b, p. 323 . n Although many variants may be...

N Urinary bladder

Distended Bladder Women

Lower abdominal transverse scan see Fig. 39, p. 30 Lower abdominal longitudinal scan see Fig. 40, p. 31 n Genital organs Lower abdominal transverse scan see Fig. 39, p. 30 Lower abdominal longitudinal scan see Fig. 40, p. 31 Special scan planes for the penis and testis Fig. 553 Topographic anatomy of the renal artery, renal vein, and ureter n Ureter The normal-sized ureter cannot be visualized with ultrasound. n Urinary bladder The normal bladder has a round, oval, or approximately triangular...

Ultrasound Scanning Planes

Intra Abdominal Structures

Fig. 15 Schematic representation of typical reverberations R occurring between strongly reflective interfaces I . T transducer Fig. 16 Reverberations Longitudinal scan of the uterus and bladder B with __ superimposed parallel lines caused by 14 abdominal wall structures. Arrows IUD n Significance Reverberations are consistently present in cystic organs but may also occur in solid structures. They are always troublesome and rarely helpful. They can be eliminated by changing the direction of the...

Sonographic Findings Leg Thrombophlebitis

Sonographic Leg Edema

N Principal signs and symptoms swollen extremities, dyspnea with pulmonary edema, possible pleural effusion, ascites, and anasarca. n Differential diagnosis Table 20 lists the possible diagnoses in order of their frequency in the general hospital setting. Table 2Q Differential diagnosis of edema Anechoic congested veins, echocardiography dilatative areas of Diagnosed by exclusion normal-appearing venous system, no Table 20 Differential diagnosis of edema - continued Enlarged kidneys, echogenic...

G69 Renal Insufficiency and Acute Renal Failure

Sonographic Finding Pain Abdomen

C n Principal signs and symptoms decrease or absence of urinary excretion, O increased solute retention in the blood, possible edema n Classification Renal failure is classified as prerenal, due to diminished renal blood I flow intrinsic renal , caused by renal parenchymal damage and postrenal, due to 5 Renal glomerulonephritis Tables 21 and 22 or interstitial nephritis Table 23 Postrenal Can be positively confirmed or excluded by sonography C Acquired Table 21 Classification of...

N Regressive fibrotic changes in the thyroid gland Fig 620

Clinical features may occur in a long-standing diffuse goiter or an irradiated 416 goiter. Fine, isoechoic nodules can be differentiated by their hypoechoic halo. Fig. 620a, b Regressive changes in the thyroid gland. a Hyperechoic fibrotic changes in the thyroid gland TG following irradiation primary tumor palatal carcinoma . TR trachea, JV jugular vein. b Predominantly hyperechoic thyroid gland with a nodular goiter and regressive fibrotic changes Fig. 620a, b Regressive changes in the...

Functional Disorders

Functional Bowel Obstruction

Increased intraluminal bowel contents, may be anechoic to echogenic depending on the contents Fig. 528a, b Functional disorders of the small intestine. a Acute enteritis fluid-filled bowel loops B . b Sprue the washing machine sign Fig. 528a, b Functional disorders of the small intestine. a Acute enteritis fluid-filled bowel loops B . b Sprue the washing machine sign Hypoechoic wall thickening edema Distention of the fluid-filled lumen Real-time ultrasound washing machine sign n Diabetic...

Female Cenital Tract

Does Paraovarian Cyst

Table 69 Abnormal findings in the female genital organs Oi 8 Submucous polypoid mass projecting into the uterine cavity Subserous bulge in the uterine contour Intramural hypoechoic mass in the uterine wall All frequent regressive changes cystic areas, calcifications Fig. 588a, b Uterine myoma. a Subserous uterine myoma arrow isoechoic or slightly hypoechoic mass causing a bulge in the uterine contour. b Intramural uterine myoma T with an anechoic center due to regressive liquefaction. UT...

Ascites

Primary Hepatic Carcinoma

N Principal signs and symptoms possible abdominal distention with prominent flanks, slender extremities, free fluid in the abdominal cavity as little as 30 mL can be detected sonographically feeling of tension and fullness, possible dyspnea and tachycardia n Differential diagnoses These are listed in Table 27 according to their frequency in the general hospital setting. Table 27 Differential diagnosis of ascites Diagnosis Sonographic signs Enlargement of the caudate lobe, wavy surface contours...

Wall Changes

Table 58 Changes in the gallbladder wall Wall thickening hepatic or pancreatic disease, Wall edema ascites, right heart failure, p. 341 Wall infiltration by carcinoma p. 341 Lymphoma, metastasis, abscess p. 341 Duplicated gallbladder p. 342 Flexion creases, true septa p. 342 Cholesterosis p. 343 Adenomyomatosis p. 343 Xanthogranulomatous cholecystitis p. 344 Chronic cholecystitis p. 344 Porcelain gallbladder p. 344 Emphysematous cholecystitis p. 345 n Acute cholecystitis Figs. 492 and 493 The...

Ss 131 Examination

Biliary Tract Anatomy

N intercostal scan, extended right intercostal scan, porta hepatis scan see p. 33 n Subcostal oblique scan on the right side see p. 22 . n With careful scrutiny, the intrahepatic bile ducts can be identified as fine anechoic bands running anterior to the portal venous branches except the left anterior segmental branch . The hepatic artery runs between or posterior to the intrahepatic ducts. n The right and left hepatic ducts unite at the porta hepatis to form the common hepatic duct. n The...

Hyperechoic Medulla

Medullary Nephrocalcinosis Differential

J 1 Upper abdominal transverse scan see p. 22 .C Lateral upper abdominal longitudinal scan see p. 24 n Sonographic anatomy and normal findings Figs. 372 and 373 The kidneys are located in the retroperitoneum on the iliopsoas muscles. Their longitudinal axes point laterally downward at a divergent angle. They are tilted laterally, and their lower poles are directed forward. An imaginary line joining the bases of the medullary pyramids separates the cortical substance of the kidney from the...

Evaluation and Further Testing

Renal Artery Stenosis Doppler Ultrasound

al n Diffuse changes e.g., renal failure, undetermined renal disease. Ultrasound is jj usually the primary imaging modality for evaluating these cases. Generally the -q process can immediately be classified as interstitial, glomerular, or atrophic on A the basis of sonographic findings. nd n Circumscribed changes These changes are often detected incidentally in routine O examinations. Table 50 reviews the various changes that may be found and the confidence with which they can be identified...

Circumscribed Changes

Focal Fatty Infiltration The Liver

Table 44 Circumscribed hepatic changes Focal sparing in fatty infiltration p. 245 Hypoechoic transformation of the caudate lobe p. 246 Regenerative nodule in hepatic cirrhosis p. 246 Metastases p. 250 Systemic hematologic diseases p. 250 Isoechoic metastases p. 251 Focal nodular hyperplasia p. 248 Echogenic portal tracts starry sky p. 253 Hemangioma p. 253 Lesions in porphyria p. 254 Metastasis colon carcinoma, carcinoid, p. 254 Intraductal stones p. 254 Pneumobilia p. 254 J n Liver cysts Figs....

High Grade Lymphoma Lymphogranulomatous Hodgkin Disease Figs 132 and 133

Ultrasound Parotid Swellings

N See Enlarged Lymph Nodes, p. 107 Hepatosplenomegaly, p. 148. n Note Malignant lymphoma is typically characterized by multifocal involvement and the sandwich sign of enlarged lymph nodes. Fig. 132 High-grade lymphoma hypoechoic, sharply circumscribed rounded mass with an echogenic center LN . The patient presented clinically with palpable inguinal lymph nodes Fig. 133 High-grade lymphoma same patient as in Fig. 132 . CDS shows irregular central blood vessels. The patient presented clinically...

Circumscribed Changes in the Renal Parenchyma

Complex Renal Cysts Images

Table 48 Circumscribed changes in the renal parenchyma Table 48 Circumscribed changes in the renal parenchyma Benign cystic lymphangioma p. 275 Lymphocele p. 275 Tuberculosis p. 275 Intracystic hemorrhage p. 275 n Simple cysts Bosniak type I, Fig. 388 dysontogenetic cysts tubular retention cysts Classification by location - Subcapsular perirenal cysts - Parapelvic cysts of the renal sinus generally lymphatic cysts, but occasionally tubular retention cysts projecting into the central echo...

Aorta and Arteries

False Aneurysm True Aneurysm

, lt u Table 31 Classification of sonographic findings by etiology s Anomalies Traumatic and postoperative lesions C Duplications False aneurysm p. 195 Arterial variants p. 194 Arteriovenous fistula p. 195 Sequelae of hypertension and atherosclerosis Displacement, compression, infiltration Aortic or arterial elongation p. 197 Benign masses p. 200 Aortic ectasia p. 197 Malignant masses p. 200 Aortic or arterial stenosis p. 197 Aneurysms p. 198 n Duplication anomalies renal artery Fig. 255 ,...

Joint Pain and Swelling

Bicipital Bursa Calcification

N Incidence Pain in or around the joints and swelling of the joints are common reasons for seeking medical attention. In many cases a presumptive diagnosis can be made based on the history and physical examination alone. n Principal signs and symptoms Pain at rest, joint tenderness, or pain during joint movement Active and or passive limitation of motion Favoring the affected joint Swelling and local warmth n Causes Inflammatory e.g., articular synovitis, tenosynovitis, bursitis Degenerative...

Circumscribed Changes in the Renal Pelvis and Renal Sinus

Parapelvic Cysts Ultrasound

Table 49 Circumscribed changes in the renal pelvis or renal sinus Anechoic or hypoechoic Isoechoic or echogenic Parapelvic cyst solitary, multiple, p. 284 Hemorrhagic cyst p. 287 Sinus lipomatosis p. 284 Pyelocalyceal stone p. 288 Parenchymal bands, hypertrophic renal columns Foreign body drainage tube, p. 288 p. 284 Inflammatory tumor, liquefying tumor p. 287 Xanthogranulomatous pyelonephritis p. 287 Carcinoma of the renal pelvis p. 287 Renal cell carcinoma, metastasis p. 287 n Solitary...

Changes in Size Shape and Location

Gallbladder Hydrops

Congested gallbladder, Courvoisier gallbladder Hydrops p. 336 Cystic duct obstruction p. 332 Gallbladder tumor p. 341, 352 Change in gallbladder shape Gallbladder diverticulum p. 337 Siphon gallbladder p. 337 Phrygian cap p. 337 Nonvisualization of the gallbladder p. 337 p. 336 Contracted gallbladder p. 336 Empty gallbladder p. 337 Hypoplasia p. 340 Shrunken gallbladder p. 340 , perforated gallbladder p. 337 Change in gallbladder location Atypical location p. 337 Table 57 Changes in the size,...

Mm

Ica Waveform Images

A Decreased flow velocity with an intact frequency spectrum upstream of the stenosis. b Markedly decreased flow velocity just proximal to the stenosis. c Increased flow velocity in the stenosis, with Vmax up to 140cm s Ipsilateral ICA spectral waveform cannot be recorded Figs. 315c and 316f Ipsilateral ECA turbulence and increased flow velocity Fig. 315 Ipsilateral CCA spectral waveform resembles that of the ECA with ICA occlusion, the CCA becomes a pure resistance vessel, Fig. 316 Fig. 315a-d...

N Chronic prostatitis prostatic calcifications

Heterogenous Appearance Epididymi

Hyperechoic or heterogeneous internal echo pattern intensely echogenic calcifications with acoustic shadows secondary to inspissated secretions or inflammation, Fig. 582 Fig. 582 Prostate stones calculi, arrow in a patient with presumed chronic prostatitis very hyperechoic intraprostatic masses with distal acoustic shadows S . B bladder, P prostate n Orchitis, abscess, hematoma Figs. 583, 584 and 413 see also Fig. 586a, p. 393 Orchitis Fig. 583 e.g., viral orchitis, mumps - Homogeneous...

N True epitheliumlined cysts rare

Nodular Goiter

Round and anechoic with smooth margins Distal acoustic enhancement Fig. 621a, b Cystic transformation. a Cystic regression in a nodular goiter. CDS avascular nodular area. b Cystic transformation with coarse, floating echoes correlating with a fresh intranodular hemorrhage cursors Fig. 621a, b Cystic transformation. a Cystic regression in a nodular goiter. CDS avascular nodular area. b Cystic transformation with coarse, floating echoes correlating with a fresh intranodular hemorrhage cursors n...

Changes in the Portal Venous System

Portosystemic Collaterals Sites

N In portal hypertension, the luminal size transverse diameter of the portal veins correlates poorly with the portal pressure. Thus, the diagnosis of portal hypertension relies not only on increased portal vein diameter but also on the results of CDS with spectral analysis and the assessment of flow characteristics. Definite signs of portal hypertension by CDS are flow reversal and an absence of flow. n The causes of raised portal venous pressure are classified as follows Prehepatic portal vein...