Ultrasound of the urinary tract - Renal infectionsSamir Haffar
Ultrasound can detect various renal infections including:
1) Acute pyelonephritis seen as renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation on ultrasound.
2) Renal abscesses appear as hypoechoic masses with thick irregular walls that increase in distinctness over time.
3) Pyohydronephrosis is infection of the obstructed collecting system seen as echogenic debris and fluid-fluid levels.
4) Emphysematous pyelonephritis involves gas in the renal parenchyma seen as high amplitude echoes and dirty shadowing.
Doppler ultrasound of the portal system - Normal findingsSamir Haffar
This document provides an overview of Doppler ultrasound of the normal portal system, including:
1. Principles of Doppler ultrasound and how to adjust settings like color box size, velocity scale, gain, and wall filter to optimize the examination.
2. Sites for duplex insonation of the portal system and techniques for obtaining spectral waveforms.
3. Normal Doppler ultrasound findings of the portal vein, hepatic veins, and hepatic artery, including measurements and anatomy.
This document discusses Doppler ultrasound in peripheral arterial disease. It begins by explaining Doppler ultrasound waveforms and how they relate to blood flow direction and velocity. It then covers topics like antegrade versus retrograde flow, pulsatile versus nonpulsatile flow, and directionality. The document also discusses spectral broadening and differentiating high- versus low-resistance arteries. It provides diagrams to illustrate topics like stenosis, collateral flow, and the definitions of upstream and downstream. Finally, it outlines the criteria for classifying and grading peripheral arterial stenosis using Doppler ultrasound.
Doppler ultrasound of carotid arteriesSamir Haffar
This document discusses Doppler ultrasound of carotid arteries. It begins with the anatomy of carotid arteries and then discusses normal Doppler ultrasound findings of the carotid arteries including flow patterns and spectral waveforms. It describes various pathologies that can cause carotid artery disease such as atherosclerosis and other non-atherosclerotic diseases. It also discusses how diseases outside the carotid arteries can affect them. The document provides detailed information on ultrasound techniques for evaluating the carotid arteries and interpreting ultrasound findings for plaque characterization and grading stenosis.
This document discusses renal Doppler ultrasound techniques and findings. It describes three main approaches to imaging the renal arteries - anterior, oblique, and flank. Normal and abnormal Doppler waveforms are presented. Evaluation of renal artery stenosis can be done directly by imaging the renal arteries or indirectly by imaging intrarenal arteries. Findings suggestive of stenosis include increased velocities, renal/aortic ratios over 3.5, absence of the early systolic peak, and tardus parvus waveforms. Pathologies of renal transplants like rejection, infarction, and arterial or venous stenosis are also summarized.
Presentation1.pptx, radiological imaging of scrotal diseases.Abdellah Nazeer
This document provides an overview of radiological imaging of scrotal diseases. It begins with the anatomy of the scrotum and its layers. It then discusses congenital diseases like cryptorchidism, which is the absence of one or both testes from the scrotum. Cryptorchidism can occur if the testes fail to descend from the abdomen into the scrotum. The document presents various imaging examples of cryptorchidism showing undescended testes in the inguinal canal or abdomen. It also discusses inflammatory diseases, trauma, testicular torsion, masses, and other pathologies that can be imaged and evaluated radiologically.
Doppler ultrasound in deep vein thrombosisSamir Haffar
Doppler ultrasound is the preferred method for diagnosing deep vein thrombosis (DVT). It has high specificity and sensitivity for detecting thrombi in the proximal leg veins. Isolated calf vein thrombi can be missed by Doppler in up to 30% of cases. Clinical evaluation alone is only positive for DVT in about 50% of cases. While D-dimer tests are sensitive, they are not specific for DVT. Doppler ultrasound can directly visualize thrombi as noncompressible segments within veins. Indirect signs of DVT on Doppler include loss of phasicity with respiration and loss of flow augmentation with distal compression. Contrast venography remains the gold standard but is rarely used due to risks of contrast agents and limited
Ultrasound of the urinary tract - Renal tumorsSamir Haffar
This document discusses ultrasound imaging of renal tumors. It begins by stating that ultrasound is often the first imaging modality used for the kidneys and plays an important role in diagnosing renal tumors. It then discusses technical advances in ultrasound imaging that have improved detection of renal tumors. The document goes on to describe normal kidney anatomy and various benign and malignant renal tumors that can be identified on ultrasound, including renal cell carcinoma, angiomyolipomas, cysts, and others. It provides ultrasound images and characteristics of different renal pathologies.
Ultrasound of the urinary tract - Renal infectionsSamir Haffar
Ultrasound can detect various renal infections including:
1) Acute pyelonephritis seen as renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation on ultrasound.
2) Renal abscesses appear as hypoechoic masses with thick irregular walls that increase in distinctness over time.
3) Pyohydronephrosis is infection of the obstructed collecting system seen as echogenic debris and fluid-fluid levels.
4) Emphysematous pyelonephritis involves gas in the renal parenchyma seen as high amplitude echoes and dirty shadowing.
Doppler ultrasound of the portal system - Normal findingsSamir Haffar
This document provides an overview of Doppler ultrasound of the normal portal system, including:
1. Principles of Doppler ultrasound and how to adjust settings like color box size, velocity scale, gain, and wall filter to optimize the examination.
2. Sites for duplex insonation of the portal system and techniques for obtaining spectral waveforms.
3. Normal Doppler ultrasound findings of the portal vein, hepatic veins, and hepatic artery, including measurements and anatomy.
This document discusses Doppler ultrasound in peripheral arterial disease. It begins by explaining Doppler ultrasound waveforms and how they relate to blood flow direction and velocity. It then covers topics like antegrade versus retrograde flow, pulsatile versus nonpulsatile flow, and directionality. The document also discusses spectral broadening and differentiating high- versus low-resistance arteries. It provides diagrams to illustrate topics like stenosis, collateral flow, and the definitions of upstream and downstream. Finally, it outlines the criteria for classifying and grading peripheral arterial stenosis using Doppler ultrasound.
Doppler ultrasound of carotid arteriesSamir Haffar
This document discusses Doppler ultrasound of carotid arteries. It begins with the anatomy of carotid arteries and then discusses normal Doppler ultrasound findings of the carotid arteries including flow patterns and spectral waveforms. It describes various pathologies that can cause carotid artery disease such as atherosclerosis and other non-atherosclerotic diseases. It also discusses how diseases outside the carotid arteries can affect them. The document provides detailed information on ultrasound techniques for evaluating the carotid arteries and interpreting ultrasound findings for plaque characterization and grading stenosis.
This document discusses renal Doppler ultrasound techniques and findings. It describes three main approaches to imaging the renal arteries - anterior, oblique, and flank. Normal and abnormal Doppler waveforms are presented. Evaluation of renal artery stenosis can be done directly by imaging the renal arteries or indirectly by imaging intrarenal arteries. Findings suggestive of stenosis include increased velocities, renal/aortic ratios over 3.5, absence of the early systolic peak, and tardus parvus waveforms. Pathologies of renal transplants like rejection, infarction, and arterial or venous stenosis are also summarized.
Presentation1.pptx, radiological imaging of scrotal diseases.Abdellah Nazeer
This document provides an overview of radiological imaging of scrotal diseases. It begins with the anatomy of the scrotum and its layers. It then discusses congenital diseases like cryptorchidism, which is the absence of one or both testes from the scrotum. Cryptorchidism can occur if the testes fail to descend from the abdomen into the scrotum. The document presents various imaging examples of cryptorchidism showing undescended testes in the inguinal canal or abdomen. It also discusses inflammatory diseases, trauma, testicular torsion, masses, and other pathologies that can be imaged and evaluated radiologically.
Doppler ultrasound in deep vein thrombosisSamir Haffar
Doppler ultrasound is the preferred method for diagnosing deep vein thrombosis (DVT). It has high specificity and sensitivity for detecting thrombi in the proximal leg veins. Isolated calf vein thrombi can be missed by Doppler in up to 30% of cases. Clinical evaluation alone is only positive for DVT in about 50% of cases. While D-dimer tests are sensitive, they are not specific for DVT. Doppler ultrasound can directly visualize thrombi as noncompressible segments within veins. Indirect signs of DVT on Doppler include loss of phasicity with respiration and loss of flow augmentation with distal compression. Contrast venography remains the gold standard but is rarely used due to risks of contrast agents and limited
Ultrasound of the urinary tract - Renal tumorsSamir Haffar
This document discusses ultrasound imaging of renal tumors. It begins by stating that ultrasound is often the first imaging modality used for the kidneys and plays an important role in diagnosing renal tumors. It then discusses technical advances in ultrasound imaging that have improved detection of renal tumors. The document goes on to describe normal kidney anatomy and various benign and malignant renal tumors that can be identified on ultrasound, including renal cell carcinoma, angiomyolipomas, cysts, and others. It provides ultrasound images and characteristics of different renal pathologies.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
The document discusses various pediatric retroperitoneal masses. It begins by noting that abdominal masses are most common in children under 5 years old and retroperitoneal masses in neonates are often kidney-related and benign. It then characterizes the retroperitoneal space and lists common retroperitoneal organs. Several pathologies are discussed in detail, including neuroblastoma, Wilms tumor, nephroblastomatosis, and renal cell carcinoma. Imaging findings for many conditions are provided. The document serves as an overview of pediatric retroperitoneal masses and their imaging appearances.
This document discusses Doppler ultrasound of the kidneys. It begins with the normal anatomy of the kidneys and renal vasculature. It then describes how to perform grayscale and Doppler ultrasound of the kidneys, including imaging planes and settings. Normal Doppler waveforms of renal arteries are presented. Key measurements like resistive index, acceleration time, and peak systolic velocity of renal arteries are discussed. Variants of renal and renal vein anatomy are also reviewed.
This document discusses the Doppler ultrasound assessment of the portal venous system. It begins with an overview of the sonographic and Doppler evaluation of the portal system's anatomy and normal circulation. It then covers the assessment of specific vessels like the portal vein, hepatic veins, and hepatic artery through grayscale ultrasound and Doppler evaluation. Key aspects like normal vessel diameters, waveforms, and flow direction are defined. The document concludes by outlining the important Doppler assessment techniques and parameters used to evaluate the portal system.
Presentation1, ultrasound of the bowel loops and the lymph nodes.AbdullahNazeerYassin
Ultrasonography is useful for evaluating bowel loops and abdominal lymph nodes. The normal bowel wall has 5 layers but only 2 are usually visible on ultrasound. Pathologies like hypertrophic pyloric stenosis, intramural duodenal hematoma, midgut volvulus, incarcerated hernia and various inflammatory conditions can be diagnosed using ultrasound. Acute appendicitis and its complications are also commonly evaluated. Ultrasound is helpful for assessing conditions like celiac disease, acute pancreatitis and focal acute bacterial nephritis.
Doppler ultrasound of lower limb arteriesSamir Haffar
This document provides information on Doppler ultrasound of lower limb arteries. It begins with the anatomy of lower limb arteries including the abdominal aorta, iliac arteries, femoral arteries, and crural arteries. It then discusses normal Doppler ultrasound findings of lower limb arteries including normal arterial diameters, waveforms, and velocities. Finally, it covers duplex ultrasound criteria for arterial evaluation and various causes of lower limb arterial diseases such as atherosclerosis, thrombosis, aneurysms, and arterial occlusions.
This document summarizes ultrasound findings related to the gallbladder. It begins by describing normal gallbladder anatomy and ultrasound appearance. It then discusses various congenital gallbladder abnormalities that can be seen on ultrasound. Finally, it details gallbladder pathologies that can be identified ultrasonographically such as gallstones, sludge, acute and chronic cholecystitis, polyps and carcinoma. For each finding, it provides ultrasound images and descriptions of characteristic ultrasound features.
Ultrasound of the urinary tract - Renal cystsSamir Haffar
This document discusses ultrasound findings of renal cysts and cystic renal lesions. It provides details on:
1) The Bosniak classification system used to characterize renal cysts and cystic masses as benign (Classes I and II) or malignant (Classes III and IV).
2) Characteristics of simple renal cysts, complex cysts, cystic renal cell carcinomas, and other cystic lesions.
3) Cystic manifestations of conditions like polycystic kidney disease, von Hippel-Lindau disease, and tuberous sclerosis.
The document discusses the radiological anatomy of the scrotum, including normal gross anatomy, radiological anatomy using ultrasound and MRI, and various disorders. It covers the embryology of the scrotum and provides details on ultrasound assessment of the testis and epididymis, noting that testicular echogenicity and vascularity can help identify disorders. The role of ultrasound in testicular and scrotal trauma is also examined, alongside extratesticular scrotal masses. Diagrams and images are included to illustrate anatomical structures and various conditions.
Presentation1, radiological imaging of undescended testis.Abdellah Nazeer
This document discusses radiological imaging techniques for undescended testes (cryptorchidism). Ultrasound has moderate sensitivity and specificity for locating undescended testes, but MRI is the best imaging method, with sensitivity around 90% and specificity of 100%. MRI can identify locations of undescended testes that may be intra-abdominal, inguinal, or ectopic. The document presents several case examples demonstrating appearances of undescended testes on different imaging techniques.
This document provides information on performing and interpreting CT angiography of the lower limbs. It discusses scanning techniques, protocols, contrast injection, and principles of timing acquisitions. Image post-processing includes MIP, VR, and MPR. Interpretation requires scrutinizing calcifications and stents to avoid overestimating stenosis. Peripheral CTA is useful for evaluating occlusive disease, aneurysms, trauma, infections, embolism, and postoperative surveillance. Examples demonstrate various vascular pathologies.
This document discusses Doppler ultrasonography and the spectral waveforms used to analyze blood flow patterns in vessels. It provides details on:
- The Doppler spectrum which represents blood flow velocities over time on a graph with frequency on the vertical axis and time on the horizontal axis.
- Characteristics of normal flow patterns seen in major vessels and how they relate to vessel anatomy and organ function.
- Abnormal flow patterns seen in pseudoaneurysms and arteriovenous fistulas which involve damage to vessel walls. Specific waveform patterns are described that indicate these conditions.
This document provides an overview of ultrasound for evaluating hernias. It describes the anatomy of the inguinal region and sites of common hernias. Inguinal hernias can be indirect or direct. Spigelian hernias occur along the spigelian fascia. Femoral hernias are located in the femoral canal. Linea alba hernias occur through the abdominal wall. Umbilical and incisional hernias also are reviewed. Ultrasound is useful for diagnosing hernia contents and complications like incarceration, obstruction, and strangulation. Findings suggestive of strangulation include hyperechoic fat, thickened sac walls, fluid within the sac, and
This document discusses the anatomy and ultrasound evaluation of veins in the upper extremity. It describes the cephalic, basilic, brachial, axillary, subclavian, and internal jugular veins. The technical procedure for venous doppler ultrasound is outlined, including patient positioning, scanning techniques, and diagnostic criteria. Potential pitfalls like rouleaux and limited windows are noted. Chronic changes after deep vein thrombosis like valve changes and collateral veins are also described. Ultrasound is useful for evaluating suspected deep vein thrombosis and mapping veins for dialysis access planning.
Presentation1.pptx, radiological imaging of prostatic diseasesAbdellah Nazeer
This document discusses radiological imaging of prostatic diseases. It begins with an overview of prostate anatomy and zones. It then discusses various imaging modalities used to evaluate the prostate, including MRI, ultrasound, CT, and bone scans. Specific applications are covered such as imaging characteristics of prostate cancer, benign prostatic hypertrophy, prostatitis, and abscesses. Imaging findings of different prostate cancer stages are also reviewed. In summary, the document provides a comprehensive overview of radiological imaging techniques and findings for evaluating diseases of the prostate gland.
Presentation1.pptx, ultrasound examination of the urinary bladder and prostate.Abdellah Nazeer
This document provides information on ultrasound examination of the urinary bladder and prostate. It begins with descriptions of normal ultrasound images of the bladder and prostate. It then discusses the role of ultrasound in assessing these structures. Common pathologies that can be identified include trabeculation, diverticula, calculi, ureterocele, infections, and cancers. Scanning techniques for bladder and prostate ultrasound are outlined. The document concludes with ultrasound images demonstrating various normal and abnormal findings of the bladder and prostate.
Renal Doppler ultrasound can be used to evaluate several renal pathologies. It is useful for detecting renal artery stenosis, thrombosis, aneurysms, arteriovenous communications including fistulas and malformations, and nutcracker syndrome. It can also help characterize renal masses and assess for venous invasion. Doppler is limited compared to CT for evaluating renal masses but can identify tumor vascularization. It is also used to evaluate nephropathies, kidney stones, hydronephrosis, ureteropelvic junction obstruction, and Fraley syndrome. Physiological changes and resistive indices measured by Doppler can help differentiate pathological conditions.
This document provides an overview of gallbladder sonography including anatomy, variations, techniques, and common findings. Key points include:
1. The gallbladder is normally located beneath the liver adjacent to the interlobar fissure.
2. Technique involves scanning from subcostal and intercostal approaches with the patient in various positions to fully visualize the gallbladder.
3. Common findings include gallstones, sludge, acute cholecystitis, carcinoma, polyps, metastases, and adenomyomatosis. Gallstones appear as echogenic structures that cast shadows while sludge has low-level reflectors without shadows.
This document discusses Doppler ultrasound of the kidneys. It begins by describing the normal anatomy of the kidneys and renal vasculature. It then discusses how to perform grayscale and Doppler ultrasound exams of the kidneys, including identifying normal anatomical variants. Technical parameters for optimizing Doppler signals are provided. Normal Doppler waveform indices for the renal arteries are defined, including peak systolic velocity, resistive index, acceleration time and acceleration index.
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
The document discusses various pediatric retroperitoneal masses. It begins by noting that abdominal masses are most common in children under 5 years old and retroperitoneal masses in neonates are often kidney-related and benign. It then characterizes the retroperitoneal space and lists common retroperitoneal organs. Several pathologies are discussed in detail, including neuroblastoma, Wilms tumor, nephroblastomatosis, and renal cell carcinoma. Imaging findings for many conditions are provided. The document serves as an overview of pediatric retroperitoneal masses and their imaging appearances.
This document discusses Doppler ultrasound of the kidneys. It begins with the normal anatomy of the kidneys and renal vasculature. It then describes how to perform grayscale and Doppler ultrasound of the kidneys, including imaging planes and settings. Normal Doppler waveforms of renal arteries are presented. Key measurements like resistive index, acceleration time, and peak systolic velocity of renal arteries are discussed. Variants of renal and renal vein anatomy are also reviewed.
This document discusses the Doppler ultrasound assessment of the portal venous system. It begins with an overview of the sonographic and Doppler evaluation of the portal system's anatomy and normal circulation. It then covers the assessment of specific vessels like the portal vein, hepatic veins, and hepatic artery through grayscale ultrasound and Doppler evaluation. Key aspects like normal vessel diameters, waveforms, and flow direction are defined. The document concludes by outlining the important Doppler assessment techniques and parameters used to evaluate the portal system.
Presentation1, ultrasound of the bowel loops and the lymph nodes.AbdullahNazeerYassin
Ultrasonography is useful for evaluating bowel loops and abdominal lymph nodes. The normal bowel wall has 5 layers but only 2 are usually visible on ultrasound. Pathologies like hypertrophic pyloric stenosis, intramural duodenal hematoma, midgut volvulus, incarcerated hernia and various inflammatory conditions can be diagnosed using ultrasound. Acute appendicitis and its complications are also commonly evaluated. Ultrasound is helpful for assessing conditions like celiac disease, acute pancreatitis and focal acute bacterial nephritis.
Doppler ultrasound of lower limb arteriesSamir Haffar
This document provides information on Doppler ultrasound of lower limb arteries. It begins with the anatomy of lower limb arteries including the abdominal aorta, iliac arteries, femoral arteries, and crural arteries. It then discusses normal Doppler ultrasound findings of lower limb arteries including normal arterial diameters, waveforms, and velocities. Finally, it covers duplex ultrasound criteria for arterial evaluation and various causes of lower limb arterial diseases such as atherosclerosis, thrombosis, aneurysms, and arterial occlusions.
This document summarizes ultrasound findings related to the gallbladder. It begins by describing normal gallbladder anatomy and ultrasound appearance. It then discusses various congenital gallbladder abnormalities that can be seen on ultrasound. Finally, it details gallbladder pathologies that can be identified ultrasonographically such as gallstones, sludge, acute and chronic cholecystitis, polyps and carcinoma. For each finding, it provides ultrasound images and descriptions of characteristic ultrasound features.
Ultrasound of the urinary tract - Renal cystsSamir Haffar
This document discusses ultrasound findings of renal cysts and cystic renal lesions. It provides details on:
1) The Bosniak classification system used to characterize renal cysts and cystic masses as benign (Classes I and II) or malignant (Classes III and IV).
2) Characteristics of simple renal cysts, complex cysts, cystic renal cell carcinomas, and other cystic lesions.
3) Cystic manifestations of conditions like polycystic kidney disease, von Hippel-Lindau disease, and tuberous sclerosis.
The document discusses the radiological anatomy of the scrotum, including normal gross anatomy, radiological anatomy using ultrasound and MRI, and various disorders. It covers the embryology of the scrotum and provides details on ultrasound assessment of the testis and epididymis, noting that testicular echogenicity and vascularity can help identify disorders. The role of ultrasound in testicular and scrotal trauma is also examined, alongside extratesticular scrotal masses. Diagrams and images are included to illustrate anatomical structures and various conditions.
Presentation1, radiological imaging of undescended testis.Abdellah Nazeer
This document discusses radiological imaging techniques for undescended testes (cryptorchidism). Ultrasound has moderate sensitivity and specificity for locating undescended testes, but MRI is the best imaging method, with sensitivity around 90% and specificity of 100%. MRI can identify locations of undescended testes that may be intra-abdominal, inguinal, or ectopic. The document presents several case examples demonstrating appearances of undescended testes on different imaging techniques.
This document provides information on performing and interpreting CT angiography of the lower limbs. It discusses scanning techniques, protocols, contrast injection, and principles of timing acquisitions. Image post-processing includes MIP, VR, and MPR. Interpretation requires scrutinizing calcifications and stents to avoid overestimating stenosis. Peripheral CTA is useful for evaluating occlusive disease, aneurysms, trauma, infections, embolism, and postoperative surveillance. Examples demonstrate various vascular pathologies.
This document discusses Doppler ultrasonography and the spectral waveforms used to analyze blood flow patterns in vessels. It provides details on:
- The Doppler spectrum which represents blood flow velocities over time on a graph with frequency on the vertical axis and time on the horizontal axis.
- Characteristics of normal flow patterns seen in major vessels and how they relate to vessel anatomy and organ function.
- Abnormal flow patterns seen in pseudoaneurysms and arteriovenous fistulas which involve damage to vessel walls. Specific waveform patterns are described that indicate these conditions.
This document provides an overview of ultrasound for evaluating hernias. It describes the anatomy of the inguinal region and sites of common hernias. Inguinal hernias can be indirect or direct. Spigelian hernias occur along the spigelian fascia. Femoral hernias are located in the femoral canal. Linea alba hernias occur through the abdominal wall. Umbilical and incisional hernias also are reviewed. Ultrasound is useful for diagnosing hernia contents and complications like incarceration, obstruction, and strangulation. Findings suggestive of strangulation include hyperechoic fat, thickened sac walls, fluid within the sac, and
This document discusses the anatomy and ultrasound evaluation of veins in the upper extremity. It describes the cephalic, basilic, brachial, axillary, subclavian, and internal jugular veins. The technical procedure for venous doppler ultrasound is outlined, including patient positioning, scanning techniques, and diagnostic criteria. Potential pitfalls like rouleaux and limited windows are noted. Chronic changes after deep vein thrombosis like valve changes and collateral veins are also described. Ultrasound is useful for evaluating suspected deep vein thrombosis and mapping veins for dialysis access planning.
Presentation1.pptx, radiological imaging of prostatic diseasesAbdellah Nazeer
This document discusses radiological imaging of prostatic diseases. It begins with an overview of prostate anatomy and zones. It then discusses various imaging modalities used to evaluate the prostate, including MRI, ultrasound, CT, and bone scans. Specific applications are covered such as imaging characteristics of prostate cancer, benign prostatic hypertrophy, prostatitis, and abscesses. Imaging findings of different prostate cancer stages are also reviewed. In summary, the document provides a comprehensive overview of radiological imaging techniques and findings for evaluating diseases of the prostate gland.
Presentation1.pptx, ultrasound examination of the urinary bladder and prostate.Abdellah Nazeer
This document provides information on ultrasound examination of the urinary bladder and prostate. It begins with descriptions of normal ultrasound images of the bladder and prostate. It then discusses the role of ultrasound in assessing these structures. Common pathologies that can be identified include trabeculation, diverticula, calculi, ureterocele, infections, and cancers. Scanning techniques for bladder and prostate ultrasound are outlined. The document concludes with ultrasound images demonstrating various normal and abnormal findings of the bladder and prostate.
Renal Doppler ultrasound can be used to evaluate several renal pathologies. It is useful for detecting renal artery stenosis, thrombosis, aneurysms, arteriovenous communications including fistulas and malformations, and nutcracker syndrome. It can also help characterize renal masses and assess for venous invasion. Doppler is limited compared to CT for evaluating renal masses but can identify tumor vascularization. It is also used to evaluate nephropathies, kidney stones, hydronephrosis, ureteropelvic junction obstruction, and Fraley syndrome. Physiological changes and resistive indices measured by Doppler can help differentiate pathological conditions.
This document provides an overview of gallbladder sonography including anatomy, variations, techniques, and common findings. Key points include:
1. The gallbladder is normally located beneath the liver adjacent to the interlobar fissure.
2. Technique involves scanning from subcostal and intercostal approaches with the patient in various positions to fully visualize the gallbladder.
3. Common findings include gallstones, sludge, acute cholecystitis, carcinoma, polyps, metastases, and adenomyomatosis. Gallstones appear as echogenic structures that cast shadows while sludge has low-level reflectors without shadows.
This document discusses Doppler ultrasound of the kidneys. It begins by describing the normal anatomy of the kidneys and renal vasculature. It then discusses how to perform grayscale and Doppler ultrasound exams of the kidneys, including identifying normal anatomical variants. Technical parameters for optimizing Doppler signals are provided. Normal Doppler waveform indices for the renal arteries are defined, including peak systolic velocity, resistive index, acceleration time and acceleration index.
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
This lecture proves an overview of assessing the thyrod nodule upon presentation. The use of imaging, including nuclear medicine, PET, CT/MR and Ultrasound is discussed.
There is more detail on ultrasound evaluation with particular emphasis on ACR TIRADS
Extended focus assessment with sonography for traumaSamir Haffar
The document discusses extended focused assessment with sonography for trauma (E-FAST), an ultrasound technique used to rapidly detect fluid in body cavities resulting from trauma. It describes the indications, views, techniques, findings and advantages of E-FAST. Key points include that E-FAST can detect blood or fluid in the abdomen, chest or heart within 3-5 minutes without radiation. It is a useful first-line tool to identify life-threatening bleeding but does not replace definitive diagnostic tests if findings are uncertain or positive. E-FAST examination involves six standard views of the abdomen, chest and heart and can be repeated as needed at the bedside to dynamically monitor trauma patients.
Ultrasound has become an essential tool in obstetrics, allowing visualization of the fetus and assessment of growth and well-being. Doppler ultrasound can evaluate blood flow in fetal and maternal vessels. While ultrasound is generally safe, concerns have been raised about potential neurological effects with prolonged or frequent use. Estimation of fetal weight and biophysical profiling helps monitor high-risk pregnancies. Overall, ultrasound has dramatically improved prenatal care and outcomes over the past decades.
The document discusses emergency ultrasound in trauma patients. It describes how focused abdominal sonography for trauma (FAST) uses 4 views to detect free fluid in trauma patients in 3 minutes or less. Studies show FAST has a sensitivity of 81-98% and specificity of 88-100% for detecting intra-abdominal bleeding. While not showing specific injuries, FAST effectively detects patients needing surgery. The document also discusses using ultrasound to detect hemothorax, pericardial fluid, and penetrating cardiac wounds.
How to differentiate between testicular torsion and acute testicular disorders before taking the patient to O.R., is one of the most important questions that phases E.R. physicians & urologists in medicine, & I wish this presentation will help you in answering such questions when encountered
Radiological Findings in Infertile Men in a Fertility Centre in Jos, Nigeria.QUESTJOURNAL
ABSTRACT:Infertility is a great psychological burden to the infertile couple. Scrotal ultrasonography and colour Doppler imaging of the scrotum are useful adjuncts to clinical examination in assessing intratesticular and extratesticular abnormalities. Methodology:All men who presented with infertility were evaluated. These included comprehensive history, physical examination and investigation, in this case seminal fluid analysis and scrotal ultrasonography. Results:This was prospective study carried out at the Jos University Teaching Hospital and a fertility centre in Jos from 2012 to 2017. A total of 67 men were involved in this study. The mean age was 39.39yrs. Age range was 28 to 59yrs. Sixty three (N=63) of the men had abnormal semen parameters representing 94.03% while four men (N=4) had normal semen parameters. Thirty eight patients representing 56.72% had azoospermia while 5.97% had normozoospermia following seminal fluid analysis. The mean volume of the right testis was 11.93ml. The range was 2.9ml to 25ml. The mean volume of the left testis was 11.76ml. The range was 2.9ml to 22ml. Overall mean testicular volume was 11.85ml. Forty two men (N=42) had abnormalities on scrotal ultrasound representing 62.69%. Abnormalities on ultrasonographyinclude varicocele33%, cryptorchidism31%, hydrocele 17%, testicularmicrolithiasis7%, multiple complex testicular cyst5%, epididymal cyst5% and echogenic testis2%. Conclusion:Scrotal ultrasonography is important in the assessment of testicular volume and abnormalities such as varicocele, cryptorchidism and hydrocele which affects male fertility.
Ultrasound assisted thrombolysis for vte turkish experienceuvcd
This document summarizes the key findings from several studies on using ultrasound-accelerated thrombolysis to treat pulmonary embolism and deep vein thrombosis. The ULTIMA trial found that low-dose catheter-directed ultrasound-accelerated thrombolysis was superior to anticoagulation alone in reversing right ventricular dysfunction in pulmonary embolism patients. The SEATTLE II study aimed to evaluate this technique for submassive and massive pulmonary embolism. A single-center retrospective review of 106 patients treated for chronic deep vein thrombosis found that over 90% reported significant symptom improvement and ultrasound follow-up showed high patency rates over time. The mechanism of action is that ultrasound energy exposes plasminogen receptor sites and increases
This document discusses the use of emergency ultrasound in trauma patients. It presents a clinical case of a 62-year-old male who slipped on ice and experienced pain in his lower chest. Bedside ultrasound revealed a liver laceration and 500cc of blood in the peritoneal cavity. The document then reviews diagnostic modalities for blunt abdominal trauma such as diagnostic peritoneal lavage, CT scan, and focused assessment with sonography for trauma (FAST). It provides details on performing and interpreting the FAST exam, including views of the right upper quadrant, left upper quadrant, and pelvis. The document concludes with a discussion of using ultrasound to detect occult penetrating cardiac trauma.
Ultrasound has many useful applications in critical care. It can reinvigorate the physical exam by providing valuable information about patients with limited mobility. Basic ultrasound skills should be part of critical care training, as brief training allows intensivists to perform limited transthoracic echocardiography and change patient management in many cases. Ultrasound is portable, avoids radiation, and can be repeated as needed at the bedside. It is useful for diagnosing problems like venous thrombosis, pulmonary diseases, and acute respiratory failure. The BLUE protocol allows rapid ultrasound evaluation of the lungs. Bedside echocardiography also has applications in critical care for assessing hemodynamics, infections, and postoperative complications.
In this presentation we will discuss about the
Anatomy of Prostate
Technique of Transrectal US
Carcinoma Prostate and
Different modes of prostatic biopsy.
Testicular torsion refers to the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle.
Urological emergency; early diagnosis and treatment are vital.
Mainly disease of Neonates, Adolescents.
The rate of testicular viability decreases significantly after 6 hours from onset of symptoms.
This document discusses various radiation methods used to diagnose thyroid diseases and conditions, including ultrasound, radionuclide imaging, CT, and MRI. It provides details on how each modality is used, what they image, and their indications. Specific attention is given to ultrasound-guided fine needle aspiration biopsy of thyroid nodules. Examples of thyroid conditions imaged by radionuclide scans are also shown, such as hyperthyroidism, multinodular goiter, and thyroid nodules. Emergency thoracic and abdominal conditions that can be imaged are also reviewed, including pneumothorax, pleural effusions, bowel obstructions, and perforated ulcers.
Blood Can Be Very Very Bad - CMC Neuroimaging Case StudiesSean M. Fox
Drs. Faith Meyers and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center and interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this initial educational slideset, they are also joined by Dr. Andrew Perron, the creator of the “Blood Can Be Very Bad” Head CT interpretation framework. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
- The Neuroimaging Framework “Blood Can Be Very Very Bad.”
Cystic liver lesions - An ultrasound perspectiveSamir Haffar
This document summarizes the diagnosis and imaging findings of various cystic hepatic lesions. It describes simple hepatic cysts, hydatid cysts, and congenital fibrocystic liver diseases including biliary hamartomas, peribiliary cysts, choledochal cysts, and polycystic liver disease. Imaging findings on ultrasound, CT, MRI, and MRCP are provided for each condition to aid diagnosis. Differential features between lesion types are emphasized, along with WHO classification of hydatid cyst appearance and post-operative evaluation of hydatid cyst treatment.
This document summarizes the potential for using near infrared spectroscopy (NIRS) to diagnose testicular torsion in a non-invasive manner. It describes a case of a 14-month-old male presenting with left scrotal swelling and pain whose ultrasound and Doppler were equivocal. NIRS was used and found a 6.8% lower tissue saturation index in the left testis compared to the right, correctly identifying a 1080 degree torsion requiring left orchiectomy. Animal and limited human studies support NIRS' ability to distinguish torsed from non-torsed testes by detecting lower oxygen saturation in torsed tissues. NIRS offers a non-invasive, radiation-free alternative to ultrasound for diagn
Ultrasonography is a useful tool for examining the thyroid gland and detecting abnormalities. It can help characterize thyroid nodules as benign or malignant based on features such as shape, margins, echogenicity, calcifications, and blood flow patterns. Common benign nodules appear well-marginated, hypoechoic or cystic, and may contain internal debris or a peripheral halo. Diffuse thyroid diseases like multinodular goiter, Graves' disease, and Hashimoto's thyroiditis can also be identified. Ultrasound is also used to guide biopsies and monitor treatment response.
This document provides a pictorial review of ultrasound images to illustrate benign and malignant features of thyroid nodules according to the U1-U5 classification system of the British Thyroid Association. It begins with an overview of normal thyroid ultrasound appearance and anatomy as a baseline for comparison. The majority of the document then features ultrasound images paired with descriptions of thyroid nodules demonstrating benign characteristics, such as a halo sign, microcystic/spongiform appearance, peripheral egg shell calcification, or peripheral vascularity, which correspond to a U2 classification. The aim is to help radiologists and clinicians recognize sonographic patterns to determine whether fine needle aspiration is necessary.
Similar to Doppler ultrasound of acute scrotum (20)
High resolution manometry (HRM) is the most accurate non-invasive test for diagnosing sliding hiatal hernia. HRM can classify hiatal hernias as no hernia, small (1-2 cm separation), or large (>2 cm separation) based on the distance between the lower esophageal sphincter and crural diaphragm pressure zones. A study found HRM had 94% sensitivity and 91% specificity for diagnosing hiatal hernia compared to open surgical assessment, outperforming barium swallow radiography and upper endoscopy. HRM is concluded to be the best test for accurately diagnosing and classifying the size of sliding hiatal hernias.
Assessment of liver fibrosis by us elastographySamir Haffar
Liver fibrosis assessment techniques such as ultrasound elastography were discussed. Liver biopsy is currently the gold standard for fibrosis staging but has limitations like sampling error and invasiveness. Transient elastography is a validated method for noninvasive fibrosis assessment that provides a reliable result with 10 valid measurements where the interquartile range is less than 30% of the median. Normal liver stiffness values are below 5 kPa while values above 12.5 kPa indicate cirrhosis. Factors like acute hepatitis, congestive heart failure, and obesity can affect elastography results. ARFI and shear wave elastography are alternative ultrasound methods for evaluating liver fibrosis in a noninvasive manner.
Doppler ultrasound of visceral arteriesSamir Haffar
Doppler ultrasound of different diseases of visceral arteries including arterial stenosis and occlusion, arterial aneurysm, artrial pseudoaneurysm, arterio-venous fistula, artrial dissection, and abdominal vascular compression syndromes
1. The document discusses ultrasound techniques for diagnosing acute appendicitis, including visualizing the normal appendix and primary and secondary signs of inflammation.
2. Primary ultrasound signs of acute appendicitis include an appendix diameter over 6mm, a target sign of hypoechoic center with hyper- and hypoechoic rings, tenderness over the appendix, lack of compressibility, and increased vascularity of the wall.
3. Secondary ultrasound signs include free fluid around the appendix, abscess formation, thickening of surrounding tissues, and signs of small bowel obstruction.
1) Carotid intima-media thickness (CIMT) measurement is used to assess subclinical atherosclerosis and predict cardiovascular risk. It involves ultrasound imaging of the carotid arteries.
2) Standardized protocols have been developed for measuring CIMT at specific locations in the carotid arteries. Automated methods have good correlation with manual measurements.
3) Higher CIMT is associated with increasing age. Baseline and progression of CIMT over time can predict future cardiovascular events independent of traditional risk factors. However, other emerging risk markers may provide better prediction than CIMT alone.
Esophageal pH monitoring in pediatricsSamir Haffar
This document summarizes esophageal pH monitoring techniques in pediatrics, including 24-hour pH monitoring, wireless pH monitoring, and pH-impedance monitoring. It describes the indications, methodology, analysis, and normal values for each technique. Key points include that 24-hour pH monitoring is the standard but wireless and pH-impedance monitoring can provide additional information. A normal composite score on 24-hour pH monitoring is less than 11.99 using the Boix-Ochoa scale. pH-impedance monitoring allows detection of acid and non-acid reflux and differentiation of liquid versus gas contents.
JNET classification of colo rectal polypsSamir Haffar
This document discusses the JNET classification of colorectal polyps based on narrow-band imaging (NBI) endoscopy. It provides a brief history of NBI development and discusses the need for a new universal polyp classification system. The Japan NBI Expert Team (JNET) developed a novel 4-type classification system in 2014 using magnifying NBI endoscopy and considering both vessel and surface patterns. Type 1 correlates with hyperplastic/sessile serrated polyps, type 2A with low-grade dysplasia, type 2B can range from low-grade dysplasia to deep submucosal invasion, and type 3 correlates with deep submucosal invasion. A validation study found high accuracy
This document discusses different types of clinical studies used in evidence-based medicine, including case reports/series, ecological studies, cross-sectional studies, case-control studies, cohort studies, randomized clinical trials, systematic reviews, and meta-analyses. It provides details on study designs, strengths and limitations, and how to interpret results including risk ratios, odds ratios, confidence intervals, and p-values. Key concepts covered include biases, confounding factors, prevalence versus incidence, and how study size influences precision.
Yes, the results are statistically significant since the confidence interval does not cross 1. The results are also precise since the confidence interval is narrow. There is no information given to determine if there is publication bias.
This document discusses the history and process of scientific peer review. It begins by outlining some of the earliest documented uses of peer review in the 9th century by Ishaq bin Ali Al-Rahawi and in the 18th century by the Royal Society of London. It then describes how peer review evolved in the early 1900s in scientific journals and was facilitated by the introduction of photocopiers. The document outlines different peer review systems and their advantages and disadvantages. It also discusses ways to improve peer review, including the roles of authors, editors, reviewers, and publishers. Overall, the document provides a high-level overview of the development and current state of scientific peer review.
Artifacts in esophageal high resolution manometrySamir Haffar
(1) Normal esophageal HRM shows decreasing pressure during inspiration and increasing pressure during expiration at rest, and characteristic pressure patterns after wet swallows including striated muscle contraction in S1 and smooth muscle contractions in S2 and S3.
(2) Common artifacts in HRM include vascular artifacts seen as rhythmic distal esophageal pressure, folded catheter artifacts appearing as mirrored pressure patterns, sensor failure artifacts visible as solid bands of pressure or chatter, and air entrapment artifacts causing very high measured pressures along the entire catheter length.
(3) Artifacts can potentially provide useful information but must be distinguished from normal patterns, and issues like a folded catheter require repositioning to avoid damage.
Normal & abnormal swallows in chicago classification version 3.0Samir Haffar
(1) This document discusses the technical aspects and metrics used in Chicago Classification version 3.0 for analyzing high resolution manometry studies of swallowing. It includes definitions for the different types of esophagogastric junction morphology, measurements of esophageal contraction vigor and pattern, and thresholds for classifying swallows as normal or abnormal.
(2) Key metrics discussed include integrated relaxation pressure for analyzing esophagogastric junction relaxation, distal contractile integral for measuring contraction vigor, and distal latency for evaluating premature contractions.
(3) The document provides illustrations and examples of how to identify landmarks like the contractile deceleration point and measure these various metrics to characterize swallows according to the Chicago Classification.
Indications, examination protocol & results of conventional anorectal manometrySamir Haffar
This document discusses conventional anorectal manometry (ARM), including the equipment, examination protocol, normal values, and interpretations. ARM involves using catheters to measure pressures in the anal canal and rectum at rest and during maneuvers like squeezing, coughing, and simulated defecation. It provides normal ranges for metrics like anal canal resting pressure, squeeze pressure, and the presence of the rectoanal inhibitory reflex. Interpretations of atypical results are discussed to aid in diagnosing conditions like fecal incontinence, Hirschsprung's disease, and dyssynergia.
Endoanal ultrasound can be used to evaluate several anal diseases:
(1) It can identify anal sphincter lesions such as defects from obstetrical trauma, surgery, or accidental injury. Defects involve disruption of the internal and/or external anal sphincters and ultrasound can determine the extent and muscles involved.
(2) It is useful for evaluating perianal fistulas by identifying their tracts.
(3) Anal canal tumors like carcinoma can be imaged with endoanal ultrasound.
(4) It can also assess miscellaneous anal conditions including endometriosis and hemorrhoidal prolapse.
Endorectal ultrasound in rectal diseasesSamir Haffar
ERUS can be used to stage rectal tumors by assessing tumor depth (T staging), nodal status (N staging), and distance to circumferential resection margins. It has high sensitivity and specificity for T1-3 staging but is less accurate for T4 tumors and nodal metastases. ERUS is useful for evaluating submucosal invasion depth and predicting tumors amenable to endoscopic resection. Limitations include difficulty distinguishing post-treatment changes from residual tumor. ERUS provides complementary information to MRI for locoregional staging of rectal cancers.
Ultrasound & doppler ultrasound in liver transplantationSamir Haffar
1) Doppler ultrasound is useful for detecting vascular complications following liver transplantation such as hepatic artery thrombosis, stenosis, and pseudoaneurysm as well as portal vein stenosis and thrombosis.
2) Reversible Doppler findings in the immediate postoperative period include elevated hepatic artery velocities and pulsatile portal vein flow that typically resolve within a few days.
3) Biliary cast syndrome is a rare but serious complication characterized by hard casts within the biliary ducts that can cause strictures, dilatation, and abscesses, often requiring surgery or endoscopic removal. Doppler ultrasound may demonstrate associated hepatic artery stenosis.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...
Doppler ultrasound of acute scrotum
1. Doppler ultrasound of acute scrotum
Samir Haffar M.D.
Assistant Professor of Internal Medicine
2. Doppler ultrasound of acute scrotum
• Normal anatomy of scrotum
• Normal US of scrotum
• Normal Doppler US of scrotum
• Doppler US of acute scrotum
3. Diagrammatic representation
of testis in cross-section
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
250 – 400 lobules
Each lobule contains 1 – 3 seminiferous tubules
Sspermatocyte – Sertoli cell – Leydig cell (testesterone)
4. Rete testis within mediastinum testis
Carkaci S et al. J Clin Ultrasound 2010 ; 38 : 21 – 37.
Rete testis drains into epididymis through 10 – 15 efferent ductules
Epididymis consists of head, body, & tail
Tail of epididymis continues as vas deferens
5. Anatomy of epididymis
6 cm in length – Best evaluated in longitudinal view
• Head Superior pole of testes
5 – 12 mm Usually isoechoic to testis
• Body Posterolateral aspect of testis
2 – 4 mm Usually hypoechoic to testis
• Tail Inferior pole of testes
5 – 12 mm Usually hypoechoic to testes
Curves to form ductus deferens
Lee JC et al. Ultrasound Quarterly 2008 ; 24 : 3 – 16.
6. Arterial supply & venous drainage of scrotal contents
Zwiebel WJ et al. Introduction to vascular ultrasonography.
Elesevier Saunders, Philadelphia, USA, 5th edition, 2005.
8. Wittenberg AF et al. Curr Probl Diagn Radiol 2006 ; 35 : 12 – 21.
Testicular artery
Deferential artery
Cremasteric artery
Pampiniform venous plexus
Vas deferens
Genito-femoral nerve
Components of spermatic cord
9. Doppler ultrasound of acute scrotum
• Normal anatomy of scrotum
• Normal US of scrotum
• Normal Doppler US of scrotum
• Doppler US of acute scrotum
10. Equipment
Canadian Association for Radiologists
• Real time linear or curved linear transducers
• Highest frequency: 7 MHz or higher
• Sufficient resolution to detect characteristics of lesions
• Highest possible Doppler frequencies: 5 to 10 MHz
• Total US exposure as low as reasonably achievable
ALARA principle
• Standoff pads can be used to improve imaging
www.car.ca
Atri M et al. CAR standard for performing scrotal ultrasound examinations. April 28, 2011
11. Sonographic technique of scrotum – 1
• Supine position & scrotum supported by towel
• Testes examined in two planes: longitudinal & transverse
• Skin thickness in each hemi-scrotum evaluated
• Color & pulsed Doppler optimized for low-flow velocity
• Compare both testes for size, echogenicity & vascularity
• Compare both epididymis for size, echogenicity & vascularity
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
12. Scanning technique of scrotum – 2
• Bilateral testicular spectral Doppler tracings recorded
• Palpable scrotal lesion Palpate lesion & put probe on it
• Acute scrotum Asymptomatic side scanned first
Power Doppler also used
• Tumor of testis found Search for abdominal adenopathies
• Additional techniques Valsalva or upright positioning
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
13. Tunica vaginalis
Scrotal wall thickness: Normal value 2 – 8 mm
Tunica vaginalis: Small amount of fluid between two layers
Tapping CR & Cast JE. Ultrasound 2008 ; 16 : 226 – 233.
14. Tunica albuginea
Echogenic line surrounding testis
Better visualized in presence of small amount of fluid
Dogra VS et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
Longitudinal sonogram of testis
15. Normal adult testis
Length: 4 – 5 cm
Width: 2 – 4 cm
Antero-posterior: 3 cm
Cokkinos DD et al. Curr Probl Diagn Radiol 2011 ; 40 : 1 – 14.
Transverse viewLongitudinal view
16. Side-by-side comparaison image
Gray scale image Color Doppler
Median raphe
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
18. Normal rete testis
Normal structure seen in 20% of patients
Hypoechoic striated appearance of rete testis
Finger-like projections into parenchyma
Adjacent to mediastinum testis
Wittenberg AF et al. Curr Probl Diagn Radiol 2006 ; 35 : 12 – 21.
19. “two-tone testes”
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
Portion nearest probe: normal testicular reflectivity
Portion distal to vessel: decreased testicular reflectivity
Refractive artefact through walls of trans-mediastinal vessels
Trans-mediastinal vessels causing „„two-tone‟‟ artefact
20. • Presentation Painless mass – More often on left
• Two types Type 1: reproductive potential
Type 2: no reproductive potential
• Association Cryptorchidism, indirect inguinal hernia,
hydrocoele, microlithiasis, rete testis, cancer
• US features Well-defined testis with identical reflectivity
Color Doppler as ipsilateral testis
Mediastinum observed helps in diagnosis
• Management Conservative
Polyorchidism
100 reported cases – More than two testes
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
21. Polyorchidism
Fewer than 100 reported cases
Carkaci S et al. J Clin Ultrasound 2010 ; 38 : 21 – 37.
Normal vascularity in
both left testes
Color Doppler USCoronal gray-scale US
Normal right testis
Two normal left testes
Two testes on left
Normal right testis
T2-weighted MRI
22. Normal epididymis
Deurdulian C et al. RadioGraphics 2007 ; 27 : 357 – 369.
Normal epididymal head
Isoechoic to testis
Sagittal US image
Normal epididymal body & tail
Hypoechoic to testis
Coronal US image
23. Scrotal appendages
Sellars MEK et al. Eur Radiol 2003 ; 13 : 127 – 135.
Appendix testis: Upper pole of testis – 90%
Appendix epididymis: Head of epididymis – 6%
On occasion, both appendages may be seen in same patient
5 scrotal appendages formed during development
24. Testicular appendages
Detectable only when hydrocele is present
Woodward PJ et al. RadioGraphics 2003 ; 23 : 215 – 240.
Appendix testis
Upper pole of testis
Müllerian duct remnant
Appendix epididymis
Head of epididymis
Mesonephric remnant
25. Doppler ultrasound of acute scrotum
• Normal anatomy of scrotum
• Normal US of scrotum
• Normal Doppler US of scrotum
• Doppler US of acute scrotum
26. Doppler ultrasound of scrotum
• Color, power & spectral Doppler
• Low flow settings
• Identical Doppler settings to evaluate symmetry of flow
Flow in symptomatic side vs asymptomatic side
• If color Doppler imaging cannot detect flow
Use of power Doppler to increase flow sensitivity
27. • Increased gain
• Decreased PRF
• Small color box
• Low wall filter
Low flow settings
28. Side-by-side comparaison image
Color Doppler image
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
Important component of each testicular examination
29. Prominent trans-mediastinal artery & vein
Normal variant
Branch of testicular artery traverses toward center of testis
Seen unilaterally in 50% or bilaterally in 25%
Usually in superior half of testis
Usually accompanied by large vein
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
30. Centripetal artery & recurrent rami
Centripetal artery coursing toward mediastinum
Then curving back as recurrent rami
Transverse color Doppler US of normal testis
Cindy A et al. J Diag Med Sonography 2006 ; 22 : 221 – 230.
31. Flow in intra-testicular, epididymal
& cremasteric artery
1 Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
2 Schneble F et al. Ultraschall Med 2011 ; 32 : E51 – E56.
Low flow
High resistance
Cremasteric artery
High flow
Low resistance
Epididymal arteryIntra-testicular artery
High flow
Low resistance
Normal RI: 0.54 0.08 2
32. Color & power Doppler US in normal testis
68 normal children – 6 weeks to 13 years
Barth RA & Shortliffe LD. Radiology 1997 ; 204 : 389 – 393.
Power Doppler more sensitive than color Doppler
for detection of intra-testicular blood flow in children
• Color Doppler Intra-testicular blood flow in 88%
• Power Doppler Intra-testicular blood flow in 97%
• Combined Intra-testicular blood flow in 100%
33. Doppler ultrasound of acute scrotum
• Normal anatomy of scrotum
• Normal US of scrotum
• Normal Doppler US of scrotum
• Doppler US of acute scrotum
35. Acute scrotum
Inflammatory conditions
– Acute epididymitis Most common cause
– Acute orchitis
– Testicular abscess
– Cellulitis
– Fournier gangrene
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
36. Doppler US findings in epididymo-orchitis
Ultrasound
Direct signs Enlarged heterogenous epididymis
Enlarged heterogeneous testis
Indirect signs Reactive hydrocele or pyocele
Scrotal wall thickening
Doppler
Epididymal or testicular hypervascularity
High flow PSV > 15 cm/sec
Low resistance RI < 0.5
Easily detectable venous flow
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
37. Acute epididymo-orchitis
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
Increased vascularity of both
testis & epididymis
Heterogeneous epididymis & testis
Enlargement of epididymal head
Reactive hydrocele
38. Epididymo-orchitis / pyocele
Low-level echoes – Multiple septations
Thickening of overlying scrotal skin
Sidhu PS et al. European Course Book – Ultrasound of the scrotum – 2011.
European Foundation of Societies of Ultrasound in Medicine & Biology.
39. Epididymo-orchitis / Epididymal abscess
Sidhu PS et al. European Course Book – Ultrasound of the scrotum – 2011.
European Foundation of Societies of Ultrasound in Medicine & Biology.
Acute epididymitis not responding to anti-bacterial therapy
Focal area of mixed reflectivity containing debris
in epididymal head
40. Orchitis
• Causes Usually in patients with epididymitis
Primary orchitis (rare): mumps – HIV
• US 1. Edema: diffuse low reflectivity
2. Striated pattern
3. Venous infarction (hemorrhage)
Areas of mixed or increased reflectivity
• Complications Abscess – Infarction – Necrosis
• Evolution Resolve completely
Small testis with fibrosis: heterogeneous
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
41. Orchitis / Striated testis
Striated appearance
Small complex hydrocele
Gray-scale ultrasound
Significant hyperemia
Color Doppler US
Loberant N et al. Ultrasound Quarterly 2010 ; 26 : 37 – 44.
42. Complicated orchitis
Sidhu PS et al. European Course Book – Ultrasound of the scrotum – 2011.
European Foundation of Societies of Ultrasound in Medicine & Biology.
Predominantly low reflective testis
Multiple areas of high reflectivity
43. Causes of striated testis
• Prominent rete testis
• Orchitis
• Torsion
• Testicular fibrosis
• Trauma
• Neoplasm (lymphoma – leukemia)
Striated pattern without clinical findings & normal
color Doppler has no clinical importance
Loberant N et al. Ultrasound Quarterly 2010 ; 26 : 37 – 44.
44. Striated testis / Senile fibrosis
First described in 1996 1
1 Cohn EL et al. J Urol 1996 ; 156 : 180 – 181.
2 Loberant N et al. Ultrasound Quarterly 2010 ; 26 : 37 – 44.
Striated pattern without clinical findings & normal
color Doppler has no clinical importance
Striated atrophic right testis
Spectacle view US
Normal vascularity
Color Doppler image
45. Testicular abscess
• Cause Usually secondary to epididymo-orchitis
• Suspicion Testicular swelling persists after treatment
• US Irregular walls
Low level internal echoes
Hypervascular margins of lesion
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
Not distinguished from acute epididymitis at early stage
46. Testicular abscess
Hypervascular margin of lesion
No flow within lesion
Color Doppler USGray-scale ultrasound
Heterogeneous hypoechoic complex
collection within enlarged testicle
Wittenberg AF et al. Curr Probl Diagn Radiol 2006 ; 35 : 12 – 21.
70-year-old diabetic patient with acute epididymo-orchitis
47. Brucellosis
Genitourinary complications: 2 – 10% of patients
Lee JC et al. Ultrasound Quarterly 2008 ; 24 : 3 – 16.
Hypoechoic nodules within testis & epididymis
Small hydrocele
Gradual onset, longer duration, no leukocytosis, & positive serology
48. Cellulitis
4 day-old male with swollen penis & scrotum after circumcision
Skin thickening
Hyperemia of scrotal skin
Peri-testicular fluid collection
Sagittal sonogram
Bilateral scrotal abscesses incised & drained at surgery
Transverse sonogram
Increased flow around testis
Adjacent complex fluid collection
Sung T et al. Am J Roentgenol 2006; 186 : 483 – 490.
49. Fournier’s gangrene
Aggressive necrotizing fasciitis of perineum
• Presentation Males 50-70 years – Diabetes 50%
Soft-tissue gas detected as “crepitus”
• Delay of dg Onset of symptoms to diagnosis: 5 days
• US Scrotal wall thickening
Multiple pockets of gas: “dirty shadow”
Normal underlying testes
• Treatment Surgical resection of devitalized tissues
• Prognosis High morbidity & mortality rate
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
50. Fournier gangrene
Emergency – Prompt medical & surgical treatment
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
Thickening
of scrotal skin Foci with dirty
shadowing (air)
US detects gas before it becomes clinically palpable
Normal testis
52. Presentation of acute testicular torsion
• Young patients: almost all under age of 20
• Sudden pain followed by nausea, vomiting, & low-grade fever
• Pain cannot be relieved by elevating the scrotum
• Swollen, tender, & inflamed hemi-scrotum
• Cremasteric reflex usually absent
• Transverse location of testis instead of vertical position
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
53. Salvage rate in acute torsion
• Within first 6 hours 100% salvage rate
• Within 6 to 12 hours 70% salvage rate
• Within 12 to 24 hours 20% salvage rate
Patriquin HB et al. Radiology 1993 ; 188 : 781 – 5.
54. Normal anatomy
Tunica vaginalis attached to posterior lateral aspect of scrotal wall
Prando D. Ultrasound Quarterly 2002 ; 18 : 41 – 57.
Extra-vaginal torsion
Less frequent
Peri-pubertal
56. Doppler US of acute testicular torsion
• US Enlarged testis
Normal or decreased echogenicity of testis
Multifocal hyperechogenicity of testis: infarction
Enlargement & nodularization of epididymis
Reactive hydrocele
Thickening of scrotal skin
• Doppler Complete (≥ 360 ) Absence of flow
Partial (< 360 ) Decreased flow& elevated RI
Prando D. Ultrasound Quarterly 2002 ; 18 : 41 – 57.
57. Acute torsion / less than 6 hours
Longitudinal view of left testis
Power Doppler
No flow to left testis
Spectacle US view
No abnormalities
Longitudinal view of right testis
Power & pulsed Doppler
Blood flow to right testis
58. Acute torsion / more than 6 hours
Heterogeneous echotexture
Areas of increased echogenicity
“hemorrhage”
Side-by-side image
Lack of flow within left testis
Color Doppler US of left testis
Stengel JW et al. Am J Roentgenol 2008 ; 190 : S35 – S41.
59. Acute torsion / Bell-clapper anomaly
Bilateral in most cases
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
Diagnosed by US in presence of moderate hydrocele
Hydrocele encircling distal third of spermatic cord
Testis
Hydrocele
Spermatic cord
60. Acute torsion / whirlpool sign of spermatic cord
Aso C et al. RadioGraphics 2005 ; 25 : 1197 – 1214.
Absence of color flow
Reactive hydrocele
Scrotal wall thickening
Right testis
Normal color flow
Left testis
Edematous spermatic cord
with anechoic structures
“dilated lymphatic vessels”
Right spermatic cord
61. Acute torsion / Incomplete or partial (< 360°)
Mernagh JR et al. Curr Probl Diagn Radiol 2004 ; 33 : 60 – 73.
Two weeks later
62. Acute torsion / Incomplete or partial (< 360°)
Prando D et al. Abdom Imaging 2009 ; 34 : 648 – 661.
Pulsed Doppler US
Increased RI Absent diastolic flow Reversed diastolic flow
Absent or reversed diastolic flow:
Severe epididymo-orchitis (venous infarction)
Scrotal trauma (venous occlusion)
63. Acute torsion / Torsion-detorsion syndrome
Intermittent left scrotal pain - Asymptomatic at examination
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
Increased blood flow to left testis
Left testis
Hyperemia with resolution of pain is highly suggestive
Right testis
Normal blood flow to right testis
64. Doppler US in acute testicular torsion
Normal color Doppler US does not exclude:
1. Early torsion
2. Partial torsion
3. Torsion/detorsion syndrome
If high clinical suspicion: repeat Doppler US in 1 – 4 hours
Datta V et al. Ultrasound Quarterly 2011 ; 27 : 127 – 128.
65. Conditions with decreased blood flow in testes
• Poor technical parameters
• Pediatric population: small testicular volume
• Large hydrocele & hematoma
• Marked scrotal edema: poor penetration of US
• Epididymo-orchitis resulting in testicular infarction (rare)
• Idiopathic testicular infarct (rare)
• Vasculitis: Polyarteritis nodosa – Lupus
• Protein S & antithrombin III deficiency
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
66. Testicular torsion mimic
Large hydrocele
Decreased blood flow to right testis
Pressure on testis from large hydrocele
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
Normal blood flow of
left testis
67. • Causes Idiopathic – Acute epididymitis – Trauma
Sickle cell disease – Hypercoagulable states
• Presentation Testicular pain
• US Low reflective area may be wedge-shaped
• Doppler Poor or absent color Doppler flow
• DD Malignant lesion: ↑ color Doppler flow
Segmental testicular infarction
dg made following orchidectomy for suspected tumor
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
68. Segmental testicular infarction / Round shape
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
Negative tumor markers – Regression in size on follow-up US
Focal mixed reflective area No color Doppler within lesion
Patient with underlying epididymitis
69. Segmental testicular infarction / Wedged shape
Saxon P et al. Emerg Radiol 2012 in press.
MRI or CEUS when Doppler US findings are equivocal
Gray-scale US
Low reflective wedged shape area
Color Doppler US
No power Doppler flow
70. Testicular appendigeal torsion
7 to 14 years old boys – Appendix testis (95%)
• Examination Firm nodule on upper testis
Bluish discoloration: “blue dot sign”
Cremasteric reflex still be elicited
• US Iso, hypo or hyperechoic appendix ≥ 5 mm
Peri-appendiceal blood flow
Reactive hydrocele (common)
Skin thickening (common)
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
Role of US: exclude torsion or acute epididymo-orchitis
72. Testicular appendigeal torsion
Hypoechoic extra-testicular mass
Peripheral hyperemia separate from epididymis
Resolved on follow-up
Dogra et al. Ultrasound Clin 2006 ; 1 : 55 – 66.
10-year-old boy with testicular pain
73. • CDU imaging is now the gold standard for diagnosis
• CDU imaging highly operator dependent
• Cut-off values Vein diameter 2 2.4 mm at rest
2.9 mm Valsalva
Reflux duration 1 sec – 2 sec
• Classifications Sarteschi Supine & standing
Dubin Supine
Idiopathic varicocele
15% of adult – Almost always on left – Bilateral in 30%
1 Liguori G et al. World J Urol 2004 ; 22 : 378 – 381.
2 Pilatz A et al. World J Urol 2011 ; 29 : 645 – 650.
74. Idiopathic varicocele
Reversed flow lasting longer than 1 - 2 seconds
Detected during Valsalva maneuver & resolved with its release
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
75. Sarteschi’s classification of varicocele
Supine & standing positions
Sarteschi LM. G Ital Ultrasonologia 1993 ; 4 : 43 – 9.
Examinations done in supine & standing positionsGrade 1 Reflux in inguinal channel only during Valsalva
Scrotal varicosity not evident in standard US study
Grade 2 Small varicosities extend to superior pole of testis
Diameters increase & venous reflux seen only during Valsalva
Grade 3 Vessels enlarged at inferior pole of testis only in standing position
No enlargement detected in supine position
Reflux observed only during Valsalva
Grade 4 Vessels appear enlarged in supine position
Dilatation increased in upright position & during Valsalva
Testicular hypotrophy common at this stage
Grade 5 Venous ectasia even in prone decubitus and supine positions
Reflux at rest & does not increase during Valsalva
76. Sarteschi’s classification/Grade 1
Pauroso S et al. J Ultrasound 2011 ; 14 : 199 – 204.
Reflux in vessels seen
only during Valsalva
Valsalva’s maneuver
No varicosity in inguinal channel
on standard US examination
Relaxing condition
77. Sarteschi’s classification/Grade 2
Pauroso S et al. J Ultrasound 2011 ; 14 : 199 – 204.
Small varicosities exhibiting
reflux only during Valsalva
Valsalva’s maneuverRelaxing condition
Small varicosities extend to
superior pole of testis
78. Sarteschi’s classification/Grade 4
Pauroso S et al. J Ultrasound 2011 ; 14 : 199 – 204.
Relaxing condition
Venous reflux evident in
basal condition
Venous diameter increases
during Valsalva
Valsalva’s maneuver
79. Sarteschi’s classification/Grade 5
Pauroso S et al. J Ultrasound 2011 ; 14 : 199 – 204.
Venous diameter does not
increases during Valsalva
Valsalva’s maneuverRelaxing condition
Venous reflux evident in
basal condition
80. • Presentation Testicular pain
• Association Extra-testicular varicocele: common – left
• US Anechoic structures from mediastinum testis
Involvement of sub-capsular veins described
• Doppler Vascular flow of venous type
• DD Cystic structures: Prominent rete testis
Intra-testicular cyst
Intra-testicular varicocele
Uncommon (< 2% in symptomatic population)
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
81. Intra-testicular varicocele
Color Doppler US
Valsalva maneuver
demonstrating color Doppler flow
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
Serpiginous structure in center of
testis with „„tumbling‟‟ echoes within
Gray-scale US
82. Secondary varicocele
Increased pressure on abdominal spermatic vein
Dogra VS et al. Radiology 2003 ; 227 : 18 – 36.
Non-compressible varicoceles on left or right:
Retroperitoneal evaluation for retroperitoneal mass
LRV evaluation for thrombus or tumor extension
• Hydronephrosis
• Cirrhosis with PHT
• Nutcracker phenomenon
• Abdominal & retroperitoneal neoplasm
83. Henoch-Schönlein purpura
Aso CE et al. RadioGraphics 2005 ; 25 : 1197 – 1214.
Scrotal wall thickening
Scrotal tunica thickening
Epididymal enlargement
Reactive hydrocele
Two days later
Typical purpuric lesions on both legs
84. Thrombosis of pampiniform plexus veins / rare
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
Thrombus within veins of
pampiniform plexus
Hypoechoic & thickened
vessel walls
34-year-old man presenting with acute scrotum
86. • Scrotal or testicular edema
• Testicular fracture or rupture
• Scrotal hematoma
• Scrotal hydrocele
• Scrotal hematocele
Most common findings of scrotal trauma
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
Several of which are usually concurrent
87. Testicular Trauma / Intra-testicular hematoma
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
2 hypoechoic lesions in right testis
Areas of rounded high reflectivity
Patient involved in motorcycle accident
Gray-scale US Color Doppler US
Absence of vascularity
Traumatic intra-testicular hematoma
88. Testicular Trauma / Tunica albuginea rupture
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
Discontinuation of tunica albuginea (arrows)
Protrusion of testicular contents from ruptured tunica (arrowheads)
Associated scrotal wall hematoma (asterisk)
Necessitates emergent surgery
89. Testicular Trauma / Fracture line
Fracture line through mid-aspect of testis
Sidhu PS et al. European Course Book – Ultrasound of the scrotum – 2011.
European Foundation of Societies of Ultrasound in Medicine & Biology.
90. Testicular trauma / Hematocele
Kurian R & de Bruyn R. Ultrasound 2006 ; 14 : 216 – 222.
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
Large left hydrocele
Containing multiple echoes within
Acute hematocele Chronic hematocele
Complex peritesticular collection
Thick internal septations
Compressing ipsilateral testis
91. Evolution of testicular hematoma
Longitudinal view 2 weeks later
Hematoma has largely resolved
Poorly defined hypoechoic area
representing hematoma
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
Longitudinal US view Longitudinal US two weeks later
95. Doppler US of testicular tumors
• Usual appearance
Homogenous & low reflectivity
• Wide range of appearances
High reflectivity
Heterogeneous with calcification & cystic changes
• Doppler US
Increased vascularity even in small tumor (new transducers)
Sidhu PS et al. European course book: Ultrasound of the scrotum.
European Foundation of Societies of Ultrasound in Medicine & Biology, 2011.
Distinguishing various cell types not practical
Any suspected mass prompts orchiectomy or surgical biopsy
96. Classic testicular seminoma
Hypoechoic – Homogeneous
Gray-scale US
Hypoechoic lobulated lesion
Power Doppler US
Mildly increased flow
Wittenberg AF et al. Curr Probl Diagn Radiol 2006 ; 35 : 12 – 21.
97. Testicular teratoma
Dogra VS et al. RadioGraphics 2001 ; 21 : S273 – S281.
Multiple cystic areas (2 - 15 mm)
Process involves nearly whole testis
dd: testicular tubular ectasia
Immature teratoma
Septated cystic lesion
Two solid nodules within
Mature teratoma
98. Burned-out germ cell tumor / Azzopardi scars
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
Coarse calcification in lower pole
Longitudinal view of left testis
Retroperitoneal mass
Axial color view of abdomen
Grown quickly outstripping their blood supply
Appear as anything from small echogenic foci to hypoechoic masses
99. Sertoli cell tumor
Sidhu PS et al. European Course Book – Ultrasound of the scrotum – 2011.
European Foundation of Societies of Ultrasound in Medicine & Biology.
Well defined tumor with linear wall calcification
100. Peutz-Jeghers syndrome
Aso C Eet al. RadioGraphics 2005 ; 25 : 1197 – 1214.
Melanin pigmentation of lips
Characteristic of Peutz-Jeghers
Several echogenic lesions
Burned-out Sertoli cell tumors
Bilateral
101. Para-aortic lymph node in testicular cancer
Enlarged para-aortic lymph node with cystic degeneration
Cokkinos DD et al. Curr Probl Diagn Radiol 2011 ; 40 : 1 – 14.
102. Testicular macro-calcification
• Benign lesion Intra-testicular cyst
Epidermoid cyst
Sertoli cell tumor
Granulomatous disease of testes
• Malignant lesion “burnt-out” tumor
Primary testicular tumor
Sidhu PS et al. European Course Book – Ultrasound of the scrotum – 2011.
European Foundation of Societies of Ultrasound in Medicine & Biology.
103. Testicular microlithiasis
Bright foci of 1 – 2 mm without acoustic shadowing
Stengel JW et al. Am J Roentgenol 2008 ; 190 : S35 – S41.
Limited: < 5 microliths per US field
Classical: > 5 microliths per US field
Relative risk of concurrent neoplasm 20 fold
Annual sonographic examination
105. Non-Hodgkin lymphoma
< 1% of patients with lymphoma
Hypoechoic mass replacing
most of testis
Longitudinal view of right testis
Blood flow in tumor
Color Doppler US
106. Testicular metastases
Malignant melanoma
Robertson E & Baxter G. Ultrasound 2010 ; 18 : 86 – 88.
Hypervascularity of hypoechoic areas
Blood flow of tumor deposits
Color Doppler imageGray-scale image
Multiple hypoechoic lesions
Highly suspicious of tumor deposits
107. • Presentation Mass which may be painful
• Involvement Most commonly involves epididymis
Solitary testicular involvement uncommon
• US Low reflective focal lesions
• DD Primary testicular malignancy
Clinical evidence of sarcoid elsewhere
Multiple focal lesions
Epididymal involvement
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
Genital sarcoidosis
Multi-system disorder – Non-caseating epitheloid granulomas
108. Testicular sarcoidosis
Recent diagnosis of sarcoidosis from skin lesion biopsy
Multiple hypoechoic areas within testis & epididymis
Lee JC et al. Ultrasound Quarterly 2008 ; 24 : 3 – 16.
109. Testicular adrenal rests
Essential to recognize (avoid unnecessary orchidectomy)
• Cause Congenital adrenal hyperplasia
More commonly 21-hydroxylase deficiency
• US Multiple hypoechoic areas near mediastinum
Usually bilateral
Frequent epididymal involvement
• Doppler Hypervascular: vessels course without θ changes
• DD Bilateral malignant tumors: rare (2 – 3%)
110. Adrenal rest / Adrenal remnants
Aso CE et al. RadioGraphics 2005 ; 25 : 1197 – 1214.
Nodule in epididymal head
Several hypoechoic lesions in upper pole of testis
111. • Presentation Painless lump – Most common on left
• US Homogeneous hypoechoic mass
Difficult to separate from testis
• Doppler Central vascular pattern toward periphery
Disorganized pattern in primary tumor
• DD Testicular tumor
99mTc-sulphur colloid scan diagnostic
Spleno-gonadal fusion
Accessory spleen in pelvis or scrotum fused to gonadal organs
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
112. Spleno-gonadal fusion
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
Color Doppler US
Ordered vessels at central aspect
Splenic tissue at histology
Iso-echoic lesion at upper pole
Simulating primary testicular tumor
Gray-scale US of left testis
114. Cyst of tunica albuginea
Ma OJ et al. Emergency ultrasound, 2nd edition.
Bhatt S et al. Diagn Interv Radiol 2011 ; 17 : 52 – 63.
Alvarez DM et al. J Clin Imaging Sci 2011 ; 1 : 5 -
Partially calcified cyst
of tunica albuginea
Well defined cyst
Posterior enhancement
Tunica albuginea cyst
with milk of calcium
115. Cyst of tunica vaginalis
Tunica vaginalis cyst visible in presence of hydrocele
Sidhu PS et al. European Course Book – Ultrasound of the scrotum – 2011.
European Foundation of Societies of Ultrasound in Medicine & Biology.
116. Intra-testicular simple cyst
≥ 40 years – Solitary – Near mediatinum
• Causes Congenital, post-trauma, post-inflammatory
• Size 2 – 20 mm in diameter
• Association Extra-testicular spermatocele
• Examination Usually not palpable – Not firm even if large
• US Anechoic, thin wall, posterior enhancement
• Treatment No treatment
Palapable cyst should be removed 2
1 Dogra VS et al. RadioGraphics 2001 ; 21 : S273 – S281.
2 Hamm B et al. Radiology 1988; 168 : 19 – 23.
117. Intra-testicular cyst
Anechoic lesion – Imperceptible wall – Posterior enhancement
Surrounding thin rim of testicular parenchyma → intratesticular cyst
Search for wall irregularity which may suggest cystic tumor
Kim W et al. RadioGraphics 2007 ; 27 : 1239 – 1253.
118. Epidermoid cyst
Mistaken for malignancy if absence of classic US findings
• Manifestation Painless mass in 20 – 40 year old patient
• US features Varies with degree of maturation
Type 1 „„Onion-ring‟‟ – Suggestive – Teratoma
Type 2 Densely calcified mass
Type 3 Cyst with rim & peripheral/central calcification
Type 4 Mixed pattern: heterogeneous & poorly defined
Suggestive No color Doppler flow - Negative tumor markers
• Treatment Enucleation – Orchidectomy (often performed)
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
119. Intra-testicular epidermoid cyst
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
Stengel JW et al. AJR 2008 ; 190 : S35 – S41.
“Onion-ring‟‟appearance
Layers of compacted keratin
Well-circumscribed mass
Thick hyperechogenic wall
Heterogeneous with sonolucent center
120. Tubular ectasia of rete testis
Benign – Very common – > 50 years – Bilateral in 1/3
• Causes Epididymal obstruction (infection – trauma)
Post-vasectomy patients
• US Multiple hypoechoic oval structures
Located in mediastinum testes
Absence of color Doppler flow
• DD Intra-testicular varicocele
Cystic dysplasia of testes: congenital
Cystic malignant tumor: Teratoma
Stewart VR & Sidhu PS. Clin Radiology 2007 ; 62 : 289 – 302.
121. Tubular ectasia of rete testis
Frequent association with spermatocele or epididymal cyst
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
Fluid-filled dilated tubular structures
Nearby intra-testicular cyst
Sagittal gray-scale US
122. Cystic dysplasia of testes
Rare – Congenital – Renal malformation
Enlarged testis
Multiple irregular anechoic areas
measuring few millimeters each
Pathology specimen
showing multiple cysts
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
123. Epididymal cyst
Common (20 – 40% of asymptomatic men)
Lee JC et al. Ultrasound Quarterly 2008 ; 24 : 3 – 16.
Epididymal tailEpididymal bodyEpididymal head
Indistinguishable
from spermatocele
124. Spermatocele
Cystic dilatations of efferent ductules
Well defined cyst in epididymal head – Fluid debris level
Typical of spermatocele
Lee JC et al. Ultrasound Quarterly 2008 ; 24 : 3 – 16.
Differentiate spermatocele from epididymal cyst by US not possible
126. Inguinal hernia
Turgut AT et al. Ultrasound Clin 2008 ; 3 : 93 – 107.
Bowel loop herniation into scrotum
Increased tunical fluid surrounding the testis
Diagnosis supported by visualization of peristaltic activity
Fluid
Hernia Testis
127. Complications of inguinal herniorrhaphy
• Hernia recurrence
• Epididymo-orchitis
• Hematoma Inguinal canal & scrotum
• Testicular ischemia Rare - more in recurrent hernia repair
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
128. Scrotal wall edema
Marked thickening of scrotal wall
Following inguinal hernia repair
Sidhu PS et al. European Course Book – Ultrasound of the scrotum – 2011.
European Foundation of Societies of Ultrasound in Medicine & Biology.
129. Testicular ischemia
after inguinal hernia repair
Dellabianca C et al. J Ultrasound 2011 ; 14 : 205 – 207.
No intra-testicular vascular signal
Cremasteric vessel hypertrophy
Inhomogeneous hypoechoic testis
Bowel loop in scrotum
(recurrence of hernia)
131. Acute idiopathic scrotal edema
• Etiology Possible allergic origin
• Presentation From 4 months to 18 years
Sudden onset of non-hemorrhagic edema
Redness of scrotal wall
• US Scrotal walls thickening & hypervascularity
Characteristic findings
• Evolution Resolves spontaneously in 3 – 4 days
One or more relapses in next years
• Treatment Conservative
Aso CE et al. RadioGraphics 2005 ; 25 : 1197 – 1214.
Halb C et al. Ann Dermatol Vénéréol 2010 ; 137 : 775 – 781.
132. Acute idiopathic scrotal edema
Aso C Eet al. RadioGraphics 2005 ; 25 : 1197 – 1214.
Marked thickening of scrotal walls
Normal testes & tunicae
Increased vascularity seen at color Doppler imaging
1-year-old boy
Testes are ovoid in shape with medium-level echoes and measure 5×3×2 cm each. Tunica albugineais the fibrous covering of the testicle and is covered by the tunica vaginalis. The tunica albuginea can be seen with a high-frequency transducer as an echogenic line. Septa extend from the tunica albuginea into the testicle, dividing the testis into 250 to 400 lobules. The posterior surface of the tunica albuginea is reflected into the interior of the testis, forming the incomplete septum known as the mediastinum testis. Sonographically, the mediastinum testis is seen as an echogenic band running in a cephalocaudal direction. Each lobule consists of one to three seminiferous tubules supporting the Sertoli cells, Leydig cells sceretingtestesterone and the spermatocytes that give rise to sperm. The seminiferous tubules open through the tubulirectiinto dilated spaces called the rete testis within the mediastinum.
The rete testis drains into the epididymis through 10 to 15 efferent ductules. The epididymis, consisting of a head, body, and tail, is located superior to and is contiguous with the posterior aspect of the testis.The tail of the epididymis continues as the vas deferens.
Testicular artery Arise from aorta Supply testis High flow – Low resistanceDeferential artery Arise from vesical artery Supply epididymis & vas deferens High flow – Low resistance Cremasteric artery Arise from inferior epigastric artery Supply wall of scrotum Low-flow – high-resistancePampiniform venous plexus is the draining vein of the testicle, which forms around the upper half of the epididymis and continues into the testicular vein through the inguinal ring.The right testicular vein empties into the IVC and the left testicular vein drains into the left renal vein.
Anterior & posterior epididymal artery arise from testicular artery.
The scrotum is divided into right and left halves by a fibrous septum called the “median raphe”. Each testis is able to move in the scrotum by the presence of the tunica vaginalis, which has two layers, a visceral layer attached to the surface of the testis and a parietal layer attached to the scrotal wall. A minute amount of fluid is interposed between the two layers. This is similar to the visceral and parietal pleura. The tunica vaginalis does not cover the posterior aspect of the testis at its attachment to the scrotal wall.
Even if infection and torsion are not clinically suspected, a sonographic evaluation of testicular blood flow must be routinely included.
Each testis is able to move in the scrotum by the presence of the tunica vaginalis, which has two layers, a visceral layer attached to the surface of the testis and a parietal layer attached to the scrotal wall. A minute amount of fluid is interposed between the two layers. This is similar to the visceral and parietal pleura. The tunica vaginalis does not cover the posterior aspect of the testis at its attachment to the scrotal wall.
Low resistance flow in the epididymis because anterior & posterior epididymal arteries originate from testicular artery.
One study demonstrated that the resistive index of testes of healthy volunteers is rarely less than 0.5More than half of patients with epididymo-orchitis, the resistive index is less than 0.5.Use of a peak systolic velocity threshold of 15 cm/s results in a diagnostic accuracy of 90% for orchitis & 93% for epididymitis.
Sexually transmitted Chlamydia trachomatisand Neisseria gonorrhea are frequent pathogens in men younger than age 35. In prepubertal boys and men older than age 35, the disease is most frequently caused by Escherichia coli and Proteus mirabilis.Acute epididymitis first affects the tail of the epididymis in retrograde spread of infection from the bladder and prostate via vas deferens.If there is continued progression, it involves the body and head of the epididymis and, eventually, the testes. Orchitis develops in 20% to 40% of cases of epididymo-orchitis by direct spread of infection. Isolated orchitis is rare and is generally due to viral causes such as mumps, human immunodeficiency virus (HIV) or due to post-traumatic inflammation.
Linear bands of varying appearance radiate within the testis perpendicular to its long axis, in a similar orientation to the testicularfibrous septae. These striations may be hypoechoic against normal background of low-level echoes or may appear as hypoechoic & hyperechoic bands. First described in 1996, striated testis may be unilateral or bilateral, may involve a portion or the entire testis, and may be seen in a symptomatic or asymptomatic testis.
Scrotal wall cellulitis can develop in obese, diabetic, or immunocompromised patients. Clinically, the scrotum is swollen, tense, warm, and red. Sonographic features: increased scrotal wall thickness & hypoechoic areas showing hypervascularity on color Doppler US.Scrotal wall cellulitis may progress to form scrotal abscess that usually is identified by presence of irregular walls & low-level internal echoes
Differential diagnosis: 1- scrotal hernia with gas-containing bowel2- penetrating trauma to the scrotum
Degree of torsion can vary from one-quarter twist (90°) to up to three complete turns (1,080°) of the vascular pedicle.
Diffuse hypoechogenicity and enlargement when compared with the contralateral side.
The bell-clapper deformityThe tunica vaginalis completely encircles distal spermatic cord, epididymis & testis rather than attaching to posterolateral aspect of testis.
Arterial flow need not be absent for torsion to be present.Since venous obstruction usually precedes arterial obstruction (veins have thinner walls than the arteries and consequently are more sensitive to the compression), the early manifestation of the testicular torsion can be a diminished arterial velocity and a decreased diastolic flow with a consequently increased resistive index, indicating severe obstruction or occlusion to the outflow of blood.Evaluation of the Doppler waveform obtained in normal testicular arteries yielded an RI of 0.67 ± 0.07(range 0.50–0.80) [35] or a mean RI of 0.62 (range, 0.48–0.75).Reference: Siegel MJ (1997) The acute scrotum. RadiolClin North Am 35:959–976.
Firm palpable nodule on superior aspect of testisBluish discoloration on overlying skinCremasteric reflex still be elicited
Idiopathic varicoceles are more common on the left side where the left spermatic vein enters perpendicular to the left renal vein.The right spermatic vein enters obliquely into the inferior vena cava and this appears to have some protective effect on the right side.
Several classification systems have been proposed. The most widely used are the ones developed by Sarteschi which involves examinations done with the patient lying down and standing and distinguishes five different stages and by Dubin which requires examination of patients in supine position & includes three stages. Sarteschi classification: Grade 4:enhancement of venous reflux after Valsalva’smanoeuvre is the criteria that allows the distinction between this grade from the previous and the next one.
Nutcracker phenomenon: Compression of left renal vein between superior mesenteric artery and aorta.
Several systemic diseases can occur with scrotal involvement. The testes are affected in 15%–37% of patients with Henoch-Schoinleinpurpura. In this disease, scrotal symptoms may precede other manifestations. US findings include scrotal wall thickening, epididymal enlargement, and reactive hydrocele. Involvement is bilateral in the vast majority of cases; hence, this entity should be considered when bilateral US findings similar to those of inflammatory epididymitisare visualized.
The venous return of the left testicle may be impaired for various reasons, including the longer course of left spermatic vein & ‘‘nutcracker phenomenon’’ corresponding to entrapment of the left renal vein by the superior mesenteric artery anteriorly andthe aorta posteriorly. Theoretically this condition may, in turn, be a predisposing factor for stasis and thrombosis.
Potential complications of delayed diagnosisTesticular ischemic necrosisAbscessLoss of spermatogenesis
Discontinuity of the echogenic tunica albuginea is indicative of testicular rupture and necessitates emergent surgery
Scrotal massTwo important questions to answer.Is the mass intratesticular or extratesticular?Is the mass cystic or solid?A good rule of thumb is that intratesticular masses are malignant until proven otherwise, whereas extratesticularintrascrotal masses are generally benign.A second rule of thumb is that a solid lesion is malignant until proven otherwise,whereas cystic lesion is generally benign.
Ten percent of patients with testicular tumors present with acute scrotum, most likely from intratumoral hemorrhage.
Seminomatous is the most common tumor type accounting for approximately 50% of germ cell tumors. Seminomatoustumours occur almost exclusively in men in their 40s and rarely in younger men/boys.They have one of the best prognoses as they are sensitive to radiotherapy and chemotherapy. They are often associated with elevated b-human chorionic gonadotrophin hormone (bHCG). A large amount of the testis can be replaced by tumor; necrosis is common histologically and 10% have been shown to have cystic areas.Lymphatic spread to retroperitoneal lymph nodes and/or haematogenous spread to the lungs and/or brain can occur.
Much has been written about the sonographic appearance of the various malignant testicular tumors. Although of intellectual and academic interest, diagnosing and distinguishing among the various cell types is rarely of practical import to general radiologist because the finding of any potentially malignant mass within testicle generally prompts orchiectomy or at least biopsy.Percutaneous testicular biopsy should never be performed in the setting of intratesticular mass. Rare exception being the young leukemia patient with probable testicular leukemia.
Cystic teratomas may manifest as cystic massUsual appearance: inhomogeneous mass containing cystic & solid areas of various sizes which helps differentiate them from simple cysts.
Azzopardi:
First a brief word on testicular biopsy. Percutaneous testicular biopsy is technically feasible and is often performed in the evaluation of male infertility.However, percutaneous testicular biopsy should never be performed in the setting of an intratesticular massA rare exception being the young leukemia patient with probable testicular leukemia. Requests for percutaneous biopsy of a focal testicular mass generally arise from young trainees in academic centers (usually in the month of July). These requests should be courteously but emphatically denied, and the patient should be scheduled for an open biopsy in theoperating room. There, the urologist delivers the testicle via an inguinal approach before bivalve, random or ultrasound guidedbiopsy of the gland on a sterile towel. This way, if the testicular lesion is malignant, any potential tumor spillage occurs on the towel rather than into the patient, and long-term prognosis is significantly improved. Of note, recent reports from outside the United States state that percutaneous biopsy of focal testicular masses may be safe, but this should be avoided until further data are available and the standard of care allows this practice
Limited testicular microlithasis (LTM): < 5 microliths on one US image.Testicular microlithiasis can be associated with several conditions such as: CryptorchidismAlveolar microlithiasiscongenital urethroperineal fistulaKlinefelter syndromeGerm cell neoplasm.In our series, associated cryptorchidism was the most common (four of eight cases [50%]).
Testicular adrenal rests are hyperplastic adrenal cortical tissue originating from aberrant adrenal tissue that adheres to the gonads anddescends with the testes or ovary during the developmental stages.
Testicular adrenal remnants grow under adrenocorticotropic hormonesLeading to “adrenal rest tumors”Essential to recognize this association to avoid unnecessary orchidectomy.
Hamm et al stress the importance of palpability and claim that palpable intratesticular cysts should be removed.This recommendation would include simple cysts if they were palpable. However, Hamm et al reported that all of their cystic neoplasms (13 of 16, excluding three epidermoid cysts) except one had US features of complicated cyst. They did not encounter a cyst that appeared simple at US, was palpable, and turned out to be a neoplasm. Reference: Hamm B, Fobbe F, Loy V. Testicular cysts: differentiation with US and clinical findings. Radiology 1988; 168:19–23.
Epidermoid cysts are the commonest benign tumours arising from the testis though accounting for only 1-2% of all resected testicular masses.As the ultrasound findings are frequently non-specific, orchidectomy is often performed.
Also known as cystic transformation of rete testis.
Cystic dysplasia of the testis is a rare congenital malformation, usually found in children and occasionally in young adults, that consists of multiple small cysts, affecting part or the whole testis and originating in the mediastinal area. This disorder results in enlargement of the testis and atrophy of the remaining parenchyma. The dysplasia has been explained on the basis of an embryologic defect that prevented connection of the tubules of the rete testis with the efferent ducts. Of interest is the association of cystic dysplasia with renal agenesis, bilateral renal dysplasia, and duplication of the renal collecting systems. On ultrasound, it appears as an enlarged testis with multiple irregular anechoic areas measuring a few millimeters each.
Epididymal cysts contain clear serous fluid. The etiology of cyst formation is unclear. Trauma and epididymitis are implicated as possible contributory factors.
Almost always arise in the epididymal head.Low level echo within it. Indistinguishable from epididymal cysts when present within the epididymal head.
Causes of testicular ischemia: 1- Spermatic cord torsion: most common cause 2- Secondary to severe epididymitis with vessel compression3- Inguinal hernia repair4- Spontaneous thrombosis of funicular vessels5- Xanthogranulomatous or filarialfuniculitis