This document discusses various pathologies of the carotid arteries that can be detected using Doppler ultrasound. It begins by discussing non-arteriosclerotic diseases such as fibromuscular dysplasia, carotid and vertebral dissection, vasospasm, aneurysms, arterio-venous fistulas, and arteritis. It then focuses on the ultrasound appearance and diagnostic criteria for spontaneous carotid and vertebral dissection. The document also reviews limitations of carotid ultrasound examinations and advantages of power Doppler mode. Throughout it provides ultrasound images to illustrate the different pathologies.
This document provides an overview of Doppler ultrasound of the normal portal system. It discusses adjusting spectral Doppler settings and interpreting normal and abnormal findings. Key points include:
- Normal Doppler findings of the portal vein include a velocity of 13-23 cm/sec and antegrade flow. Increased diameter or retrograde flow indicate portal hypertension.
- Hepatic vein Doppler shows a triphasic waveform. Increased pulsatility can be seen with tricuspid regurgitation or right heart failure. Loss of phasicity indicates outflow obstruction.
- The hepatic artery has a resistive index over 0.7 normally. Values under 0.55 may indicate stenosis.
- Transjugular intrahepatic portos
In this part of presentation we will discuss the role of Doppler Ultrasound in the Diagnosis of other causes of stenosis and variable pattern in circulation.
In my opinion this presentation will help u to identify even rare pathologies.
Doppler ultrasound of A-V access for hemodialysisSamir Haffar
This document discusses Doppler ultrasound evaluation of arteriovenous (A-V) access for hemodialysis. It begins with an overview of normal Doppler ultrasound findings of the upper extremity arteries and veins. It then covers preoperative ultrasound vascular mapping to determine suitable sites for A-V access creation. The document reviews the different types of A-V accesses used for hemodialysis and the normal Doppler ultrasound findings of functioning A-V accesses. It also discusses routine surveillance of asymptomatic patients and complications that can be identified with Doppler ultrasound of A-V accesses.
1) Carotid Doppler ultrasound is used to evaluate the carotid arteries for stenosis or occlusion. It involves using grayscale, color Doppler, and spectral Doppler to examine the anatomy and flow of the carotid arteries.
2) A normal carotid Doppler ultrasound will show triphasic waveforms within the carotid arteries with velocities under 125 cm/sec. The intima-media thickness should be less than 0.8-0.9mm.
3) Carotid artery disease is most commonly caused by atherosclerosis which can be evaluated using Doppler ultrasound parameters like peak systolic velocity, end diastolic velocity, and ICA/CCA velocity ratios to grade the severity of stenosis.
Role of medical imaging in management of arteriovenous fistula Dr. Muhammad B...Dr. Muhammad Bin Zulfiqar
This presentation is very helpful for vascular sergeons, interventional radiologists and sonographers that how to map Vasculature before construction of AV fistula for hemodialysis, how to check its patency, how to check its proper functioning ,to comment on its failure and decide when to reintervene.
Contrast-enhanced, cardiac-gated CT is highly accurate for determining the cause of acute aortic syndrome, which can be due to aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or unstable thoracic aneurysm. CT accurately identifies the location and extent of disease and guides urgent surgical or endovascular repair when needed to treat life-threatening conditions such as type A aortic dissection or ruptured aneurysm.
Renal Color Doppler Ultrasound.
After studying this presentation one will be able to perform and interpret ultrasound.
This presntation in my opinion is best short analog to text.
This document discusses Doppler ultrasonography and the analysis of blood flow patterns. It contains the following key points:
1. Doppler spectroscopy provides a time-velocity waveform representing blood flow velocities during the cardiac cycle, showing how velocity and the number of reflecting red blood cells varies over time.
2. Normal vessels have characteristic flow patterns depending on their anatomy and the organ they supply. Widening of the spectral line and filling of the spectral window indicates high flow or small vessels.
3. Pseudoaneurysms are caused by a complete rupture of the artery wall. Doppler can detect the communicating channel showing a "to-and-fro" waveform as blood enters and leaves the pooling cavity.
4.
This document provides an overview of Doppler ultrasound of the normal portal system. It discusses adjusting spectral Doppler settings and interpreting normal and abnormal findings. Key points include:
- Normal Doppler findings of the portal vein include a velocity of 13-23 cm/sec and antegrade flow. Increased diameter or retrograde flow indicate portal hypertension.
- Hepatic vein Doppler shows a triphasic waveform. Increased pulsatility can be seen with tricuspid regurgitation or right heart failure. Loss of phasicity indicates outflow obstruction.
- The hepatic artery has a resistive index over 0.7 normally. Values under 0.55 may indicate stenosis.
- Transjugular intrahepatic portos
In this part of presentation we will discuss the role of Doppler Ultrasound in the Diagnosis of other causes of stenosis and variable pattern in circulation.
In my opinion this presentation will help u to identify even rare pathologies.
Doppler ultrasound of A-V access for hemodialysisSamir Haffar
This document discusses Doppler ultrasound evaluation of arteriovenous (A-V) access for hemodialysis. It begins with an overview of normal Doppler ultrasound findings of the upper extremity arteries and veins. It then covers preoperative ultrasound vascular mapping to determine suitable sites for A-V access creation. The document reviews the different types of A-V accesses used for hemodialysis and the normal Doppler ultrasound findings of functioning A-V accesses. It also discusses routine surveillance of asymptomatic patients and complications that can be identified with Doppler ultrasound of A-V accesses.
1) Carotid Doppler ultrasound is used to evaluate the carotid arteries for stenosis or occlusion. It involves using grayscale, color Doppler, and spectral Doppler to examine the anatomy and flow of the carotid arteries.
2) A normal carotid Doppler ultrasound will show triphasic waveforms within the carotid arteries with velocities under 125 cm/sec. The intima-media thickness should be less than 0.8-0.9mm.
3) Carotid artery disease is most commonly caused by atherosclerosis which can be evaluated using Doppler ultrasound parameters like peak systolic velocity, end diastolic velocity, and ICA/CCA velocity ratios to grade the severity of stenosis.
Role of medical imaging in management of arteriovenous fistula Dr. Muhammad B...Dr. Muhammad Bin Zulfiqar
This presentation is very helpful for vascular sergeons, interventional radiologists and sonographers that how to map Vasculature before construction of AV fistula for hemodialysis, how to check its patency, how to check its proper functioning ,to comment on its failure and decide when to reintervene.
Contrast-enhanced, cardiac-gated CT is highly accurate for determining the cause of acute aortic syndrome, which can be due to aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or unstable thoracic aneurysm. CT accurately identifies the location and extent of disease and guides urgent surgical or endovascular repair when needed to treat life-threatening conditions such as type A aortic dissection or ruptured aneurysm.
Renal Color Doppler Ultrasound.
After studying this presentation one will be able to perform and interpret ultrasound.
This presntation in my opinion is best short analog to text.
This document discusses Doppler ultrasonography and the analysis of blood flow patterns. It contains the following key points:
1. Doppler spectroscopy provides a time-velocity waveform representing blood flow velocities during the cardiac cycle, showing how velocity and the number of reflecting red blood cells varies over time.
2. Normal vessels have characteristic flow patterns depending on their anatomy and the organ they supply. Widening of the spectral line and filling of the spectral window indicates high flow or small vessels.
3. Pseudoaneurysms are caused by a complete rupture of the artery wall. Doppler can detect the communicating channel showing a "to-and-fro" waveform as blood enters and leaves the pooling cavity.
4.
This document discusses carotid Doppler ultrasound. It begins by outlining the anatomy of the carotid arteries and normal Doppler findings. It then discusses causes of carotid artery disease including atherosclerosis. Extra-carotid diseases that can affect the carotid arteries are also mentioned. The document provides detailed guidance on performing and interpreting carotid Doppler ultrasound scans including evaluating the intima-media thickness, flow patterns, spectral analysis, and grading stenosis. Imaging features of normal and diseased arteries are presented along with tips for accurate evaluation.
This document provides information on carotid Doppler ultrasound studies, including:
- Anatomy of the carotid arteries and branches
- Technique for performing carotid Doppler ultrasound exams, including patient positioning, transducer use, and Doppler settings
- Analysis of waveforms in normal carotid arteries versus arteries with disease
- Causes of carotid artery disease and common sites of extracranial arterial disease
- Characterization of carotid plaques based on echogenicity, morphology, and other properties.
Doppler ultrasound of normal venous flowSamir Haffar
This document discusses Doppler ultrasound findings of normal venous flow. It notes that normal venous flow is spontaneous without augmentation, changes with respiration, and veins compress fully in the transverse plane. It also describes augmented flow seen with distal compression and abdominal/pelvic vein patency seen during the Valsalva maneuver. The document provides images demonstrating normal venous flow patterns and measurements.
This document provides information on performing and interpreting renal Doppler ultrasounds. It discusses the optimal approaches for imaging the renal arteries, including the anterior, oblique, and flank approaches. It also outlines criteria for evaluating renal artery stenosis, including peak systolic velocity measurements and the renal-aortic ratio. Common renal pathologies that can be identified with Doppler ultrasound are also summarized, such as fibromuscular dysplasia, atherosclerosis, aneurysms, and hydronephrosis.
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 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
This document summarizes the diagnostic criteria and causes of misdiagnosis for computed tomography angiography (CTA) of pulmonary embolism (PE). It outlines the diagnostic criteria for acute and chronic PE seen on CTA images, including signs such as intraluminal filling defects and vessel occlusion. It then discusses numerous technical, anatomic and pathological factors that can cause misdiagnosis of PE on CTA images, such as respiratory motion artifact, image noise, vascular bifurcations and lymph node enlargement. Patient-related, equipment and interpretation factors are all reviewed in detail to help reduce incorrect diagnosis.
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.
Ultrasound Assessment Of Chronic Venous Diseasejavier.fabra
This document summarizes how to perform an ultrasound scan to assess chronic venous disease in the lower limbs. It outlines the anatomy of the venous system, including the superficial and deep veins and perforating veins. It describes how to evaluate for reflux in the veins using Doppler ultrasound, and provides guidance on scanning the different areas of the lower limbs to investigate sources of reflux or varicose veins. The goal is to identify reflux or obstructions in the deep or superficial veins and perforating veins to determine the cause of chronic venous disease.
Carotid artery Doppler uses ultrasound to examine the carotid arteries in the neck. It can detect plaques, stenosis, dissections, and other abnormalities. A normal study shows the carotid bifurcation into the internal and external carotid arteries, with the internal carotid having low resistance flow and the external carotid having reduced diastolic flow. Doppler waveform analysis examines flow patterns to identify abnormalities. The test is used to evaluate risks of stroke and transient ischemic attacks.
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 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.
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.
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 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.
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.
Presentation given at Arab Health congress on Jan. 29th 2013, with information about (dual source) Cardiac CT of the coronary arteries with technical & practical information and some clinical use cases
Fundamentals of Vascular Ultrasound.
Looking at the basics of carotid, lower extremity arterial, renal, celiac, SMA studies, as well as touching on venous insufficiency. Part I of series.
Ultrasonography provides several advantages in clinical neurology. It can be used to assess neurovascular structures like arteries and veins, detect abnormalities associated with movement disorders like increased substantia nigra hyperechogenicity in Parkinson's disease, and evaluate peripheral nerves for entrapment neuropathies. Ultrasonography techniques like duplex ultrasonography and transcranial Doppler allow visualization of vessel structures, plaque composition, and blood flow velocities to diagnose vascular diseases, monitor treatment, and detect vasospasm. Transcranial Doppler is also used to evaluate movement disorders, cerebral circulation in stroke and brain injury, and support a diagnosis of brain death. Peripheral nerve ultrasonography examines cross-sectional area, echogenicity,
This document discusses carotid Doppler ultrasound. It begins by outlining the anatomy of the carotid arteries and normal Doppler findings. It then discusses causes of carotid artery disease including atherosclerosis. Extra-carotid diseases that can affect the carotid arteries are also mentioned. The document provides detailed guidance on performing and interpreting carotid Doppler ultrasound scans including evaluating the intima-media thickness, flow patterns, spectral analysis, and grading stenosis. Imaging features of normal and diseased arteries are presented along with tips for accurate evaluation.
This document provides information on carotid Doppler ultrasound studies, including:
- Anatomy of the carotid arteries and branches
- Technique for performing carotid Doppler ultrasound exams, including patient positioning, transducer use, and Doppler settings
- Analysis of waveforms in normal carotid arteries versus arteries with disease
- Causes of carotid artery disease and common sites of extracranial arterial disease
- Characterization of carotid plaques based on echogenicity, morphology, and other properties.
Doppler ultrasound of normal venous flowSamir Haffar
This document discusses Doppler ultrasound findings of normal venous flow. It notes that normal venous flow is spontaneous without augmentation, changes with respiration, and veins compress fully in the transverse plane. It also describes augmented flow seen with distal compression and abdominal/pelvic vein patency seen during the Valsalva maneuver. The document provides images demonstrating normal venous flow patterns and measurements.
This document provides information on performing and interpreting renal Doppler ultrasounds. It discusses the optimal approaches for imaging the renal arteries, including the anterior, oblique, and flank approaches. It also outlines criteria for evaluating renal artery stenosis, including peak systolic velocity measurements and the renal-aortic ratio. Common renal pathologies that can be identified with Doppler ultrasound are also summarized, such as fibromuscular dysplasia, atherosclerosis, aneurysms, and hydronephrosis.
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 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
This document summarizes the diagnostic criteria and causes of misdiagnosis for computed tomography angiography (CTA) of pulmonary embolism (PE). It outlines the diagnostic criteria for acute and chronic PE seen on CTA images, including signs such as intraluminal filling defects and vessel occlusion. It then discusses numerous technical, anatomic and pathological factors that can cause misdiagnosis of PE on CTA images, such as respiratory motion artifact, image noise, vascular bifurcations and lymph node enlargement. Patient-related, equipment and interpretation factors are all reviewed in detail to help reduce incorrect diagnosis.
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.
Ultrasound Assessment Of Chronic Venous Diseasejavier.fabra
This document summarizes how to perform an ultrasound scan to assess chronic venous disease in the lower limbs. It outlines the anatomy of the venous system, including the superficial and deep veins and perforating veins. It describes how to evaluate for reflux in the veins using Doppler ultrasound, and provides guidance on scanning the different areas of the lower limbs to investigate sources of reflux or varicose veins. The goal is to identify reflux or obstructions in the deep or superficial veins and perforating veins to determine the cause of chronic venous disease.
Carotid artery Doppler uses ultrasound to examine the carotid arteries in the neck. It can detect plaques, stenosis, dissections, and other abnormalities. A normal study shows the carotid bifurcation into the internal and external carotid arteries, with the internal carotid having low resistance flow and the external carotid having reduced diastolic flow. Doppler waveform analysis examines flow patterns to identify abnormalities. The test is used to evaluate risks of stroke and transient ischemic attacks.
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 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.
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.
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 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.
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.
Presentation given at Arab Health congress on Jan. 29th 2013, with information about (dual source) Cardiac CT of the coronary arteries with technical & practical information and some clinical use cases
Fundamentals of Vascular Ultrasound.
Looking at the basics of carotid, lower extremity arterial, renal, celiac, SMA studies, as well as touching on venous insufficiency. Part I of series.
Ultrasonography provides several advantages in clinical neurology. It can be used to assess neurovascular structures like arteries and veins, detect abnormalities associated with movement disorders like increased substantia nigra hyperechogenicity in Parkinson's disease, and evaluate peripheral nerves for entrapment neuropathies. Ultrasonography techniques like duplex ultrasonography and transcranial Doppler allow visualization of vessel structures, plaque composition, and blood flow velocities to diagnose vascular diseases, monitor treatment, and detect vasospasm. Transcranial Doppler is also used to evaluate movement disorders, cerebral circulation in stroke and brain injury, and support a diagnosis of brain death. Peripheral nerve ultrasonography examines cross-sectional area, echogenicity,
This document discusses imaging modalities for evaluating carotid artery atherosclerosis, a leading cause of stroke. It describes duplex ultrasound, CT angiography, MR angiography, and cerebral angiography for assessing carotid stenosis. Duplex ultrasound is the most common initial test due to its low cost and ability to detect significant stenosis. CT and MR angiography can provide additional anatomical details but involve contrast or radiation. Cerebral angiography remains the gold standard despite newer techniques. The degree of stenosis helps determine treatment options such as carotid endarterectomy.
This document provides an overview of imaging modalities used in ENT and summarizes the anatomy and common diseases of the ear, nose, paranasal sinuses, and throat. It describes the basic anatomy of the external, middle, and inner ear. Common ENT diseases discussed include chronic suppurative otitis media, cholesteatoma, otosclerosis, deviated nasal septum, nasal bone fractures, enlarged adenoids, sinonasal polyposis, and juvenile nasopharyngeal angiofibroma. Imaging findings for various diseases such as croup are also presented.
MRI is the most useful imaging modality for evaluating the spine. It can be used to diagnose degenerative spinal diseases, spinal infections, bone marrow diseases, congenital anomalies, and craniovertebral junction abnormalities. MRI provides high quality images of soft tissues and bones without radiation, allowing early detection and diagnosis of various spinal pathologies important for orthopedic surgeons. It is particularly useful for diagnosing degenerative disc disease, spinal infections like tuberculosis and pyogenic spondylitis, and bone marrow disorders.
This document provides an introduction to basic radiology concepts for non-radiologists. It summarizes key information about chest x-rays including positioning, exposure quality indicators, and anatomy. Common chest x-ray findings are described such as cardiomegaly, effusions, masses, and lung diseases. CT and MRI imaging concepts are briefly introduced. Common brain pathologies detectable on scans like hemorrhages, infarcts, and disc issues are listed. The document aims to familiarize non-specialists with radiology fundamentals and basic image interpretations.
This document discusses Doppler ultrasound findings related to portal vein thrombosis and Budd-Chiari syndrome. It provides details on the causes, classifications, and diagnostic criteria for each condition based on ultrasound appearance. Key findings include identifying partial or complete thrombosis, portal cavernoma formation, presence of collateral vessels, and reversed or absent flow in involved vessels. Ultrasound is established as the primary imaging method for diagnosing Budd-Chiari syndrome by detecting thrombus or narrowing of hepatic veins.
Carotid artery stenosis refers to atherosclerotic narrowing of the carotid arteries. While a correlation between stenosis level and stroke risk is expected, the relationship is unclear. Carotid artery stenosis is variably defined as 60-99% or 50-99% narrowing. Screening for carotid artery stenosis can be done with neck auscultation or ultrasound, but both have limitations in sensitivity and specificity compared to angiography. Noninvasive imaging techniques like ultrasound and MRI are better options for screening and diagnosis of carotid artery stenosis.
This document provides an overview of normal musculoskeletal imaging. It discusses basic x-ray concepts and densities. It then reviews normal anatomy as seen on x-rays of the skull, spine, pelvis, chest, and extremities. Key anatomical structures are labeled on example x-rays for the shoulder, hip, knee, and foot. Quizzes are included to test recognition of anatomical structures and patient age based on x-rays.
Purpose of this presentation is to educate non radiologist about basic CT anatomy of abdominal viscera and basic interpretation of very common diseases
Dr Pawan Kumar presented on MRI principles, techniques, and reading. MRI works by using a strong magnetic field to align proton spins in the body. Radiofrequency pulses excite the protons, causing them to emit signals as they relax back to equilibrium. These signals are used to form MRI images. Key hardware includes magnets, gradient coils, and RF coils. MRI contrast depends on tissue T1 and T2 relaxation times and the chosen TR and TE parameters. Different sequences like T1-weighted, T2-weighted, and FLAIR are used to highlight various tissues and pathologies. Contrast agents can also be used to improve tissue contrast on MRI scans.
This document provides an overview of MRI techniques and protocols for musculoskeletal imaging. It discusses common musculoskeletal injuries and conditions that can be identified on MRI, including meniscal tears, ligament tears, tendon injuries, osteochondral lesions, and bone marrow abnormalities. For each condition, it describes the MRI appearance and features that help characterize the severity and chronicity of the problem. Images are included to demonstrate the MRI findings for many common orthopedic pathologies.
Doppler ultrasound can be used in obstetrics and gynecology in several ways. It allows assessment of blood flow in various fetal and maternal vessels. In pregnancy, Doppler is commonly used to evaluate blood flow in the umbilical artery, middle cerebral artery, uterine arteries, ductus venosus and other vessels. Abnormal flow patterns in these vessels can indicate fetal growth restriction, hypoxia, or the risk of conditions like preeclampsia. Doppler provides important information about fetal well-being and helps manage high-risk pregnancies.
Peripheral arterial disease (PAD) is a circulatory condition where narrowed arteries reduce blood flow to the limbs, typically causing leg pain with walking. Exercise and lifestyle changes can help manage PAD symptoms and prevent progression. A study found that arm ergometry exercise alone significantly improved walking ability and time to onset of pain in PAD patients over 12 weeks compared to baseline. Specific yoga poses and breathing techniques may also help PAD symptoms.
The document describes the anatomy of the anterior and posterior triangles of the neck. It details the bones, muscles, blood vessels, nerves and other structures found in each triangle. Key structures mentioned include the cervical vertebrae, carotid artery, thyroid gland, larynx, and various nerves such as the hypoglossal and recurrent laryngeal nerves. The triangles described are the submandibular, submental and carotid triangles located in the anterior neck region.
This document discusses the principles of Doppler ultrasound. It begins with a brief history of Doppler and how the Doppler effect was discovered. It then covers the basic physics of Doppler ultrasound including the Doppler equation. The remainder of the document discusses specific Doppler parameters and how to optimize the Doppler examination including:
- Adjusting spectral and color Doppler parameters
- Normal arterial and venous flow patterns
- Changes in flow related to stenosis
I am a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
I am presently working in Columbia asia hospitals, Bangalore.
My areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology, Endoscopic and minimally invasive Neurosurgery, Endoscopic spine surgery.
MRI uses magnetism and radio waves to produce detailed images of soft tissues in the body. It was developed based on principles of nuclear magnetic resonance and the first MRI exam took 5 hours to produce one image. Key components of an MRI scanner include powerful magnets to align hydrogen nuclei in tissues, gradient coils to localize images, and radiofrequency coils to transmit signals and receive returning signals used to construct images. MRI provides advantages over other imaging techniques by using no ionizing radiation and allowing cross-sectional imaging in any plane with good contrast resolution.
- Takayasu Arteritis is an idiopathic inflammatory disease that causes inflammation and narrowing of the large arteries, mainly the aorta and its branches.
- Early diagnosis is difficult due to nonspecific initial symptoms. Management is challenging due to the lack of reliable disease activity markers and low levels of evidence regarding treatment.
- High-dose corticosteroids are effective for inducing remission but relapses often occur upon tapering. Additional immunosuppressants are usually needed to sustain remission and prevent disease progression and damage.
Aortic dissection is a life-threatening condition where the inner layer of the aorta tears, allowing blood to flow between the layers. It is classified as type A if the ascending aorta is involved and type B if it is isolated to the descending aorta. Type A requires emergency surgery while type B can often be treated medically or with TEVAR. Complications include malperfusion, rupture, and aortic expansion which may require intervention. Imaging plays a key role in diagnosis and management. Treatment aims to seal the entry tear, relieve malperfusion, and prevent further complications through control of blood pressure and heart rate.
Presentation1.pptx, radiological imaging of lower limb ischemia.Abdellah Nazeer
This document discusses radiological imaging techniques for evaluating lower limb ischemia. It provides details on:
1. The definitions and classifications of acute versus chronic limb ischemia and their common etiologies such as embolism and thrombosis.
2. The imaging options for evaluating limb ischemia including digital subtraction angiography (DSA), duplex ultrasonography, CT angiography (CTA), and MR angiography (MRA) along with the advantages and disadvantages of each technique.
3. Examples of imaging findings in limb ischemia including occlusion sites and presence of collaterals. Imaging plays a key role in diagnosing the etiology and guiding treatment of lower limb ischemia.
Takayasu arteritis is an idiopathic inflammatory disease that primarily affects large elastic arteries, especially the aorta and its branches. It most commonly occurs in young females. The disease involves occlusive or ectatic changes in the arteries and can present with nonspecific early symptoms or later with signs of ischemia due to arterial occlusion. Diagnosis is based on criteria that consider clinical features, imaging findings, and laboratory tests showing inflammation. Treatment involves management of symptoms and immunosuppression.
This document provides an overview of aortic dissection, including:
- King George II's death in 1760 which was one of the first documented cases.
- The first successful surgical repair was performed by DeBakey in 1955.
- It involves a tear in the inner layer of the aorta that allows blood to enter and force open the middle layer.
- Presentation includes sudden, severe chest pain that may radiate to the back. Early mortality can be as high as 5% per hour without treatment.
- Risk factors include hypertension, connective tissue disorders like Marfan syndrome, and aortic abnormalities.
- Diagnosis involves features like widened mediastinum on C
The document provides guidelines for diagnosing and managing different types and severities of acute brain attacks or strokes. It discusses classifying strokes as TIA, mild, moderate or severe based on symptoms. For TIA and mild strokes, the guidelines recommend emergent diagnostic tests like CT scan and treating conditions like high blood pressure. For moderate strokes, the priorities are supportive care, monitoring vitals, diagnostics like blood tests and CT scan. The guidelines provide recommendations for diagnosing the type of stroke and identifying underlying causes through further diagnostic testing.
This document discusses the anatomy, pathophysiology, clinical presentations, investigations, and management of various spinal cord vascular syndromes. It begins by describing the vascular supply and drainage of the spinal cord from segmental and radiculomedullary arteries. It then discusses various etiologies that can lead to spinal cord ischemia or hemorrhage including arterial occlusion, venous drainage abnormalities, vascular malformations, trauma, and surgery. Clinical syndromes are described based on the vascular territory involved. Imaging findings and treatment options are also summarized.
1. The history of cerebral revascularization began in 1942 with various techniques being developed through the 1970s including EDAMS, CCA-ICA bypass, and STA-MCA bypass.
2. Revascularization can be direct, using vessel to vessel anastomoses, or indirect, promoting new capillary formation. Direct techniques provide immediate flow but require a recipient vessel over 1mm, while indirect revascularization relies on collateral formation.
3. Common indications for revascularization include moyamoya disease, complex aneurysms, skull base tumors, and cerebral ischemia. However, recent studies found no benefit for revascularization over medical management for treating ischemia.
The document discusses coronary artery anatomy and acute myocardial infarction. It describes:
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The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Stress-Induced Cardiomyopathy and is brought to you by Jenna Pallansch, MD, Claire Lawson, NP, Shelby Hixson, PA, Emily Lipsitz, PA, Ashley Moore-Gibbs, DNP, Laszlo Littmann, MD, and John Symanski, MD.
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This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
5. Occlusion of CCA
Reversed flow from ECA
to supply ICA & brain
“ECA-to-ICA collateralization”
Robbin ML et al. Ultrasound Clin 2006 ; 1 : 111 – 131.
6. Occlusion of CCA
Absence of flow in distal CCA
Reversed flow in ECA
Normal flow in ICA
Internalization of ECA
Delayed systolic acceleration (tardus)
Positive temporal tap maneuver
Tahmasebpour HR et al. RadioGraphics 2005 ; 25 : 1561 – 1575.
7. Ectatic CCA
Ectatic CCA as it arises from innominate artery
Responsible for pulsatile right supra-clavicular mass
12. Types of subclavian steal
Pre-steal or bunny waveform
Transient reversal of vertebral flow during systole
Converted to partial or complete by provocative
maneuver
Incomplete steal
Striking deceleration of velocity in mid or late systole
High-grade stenosis of subclavian rather than occlusion
Complete steal
Complete reversal of flow within vertebral artery
14. Provocative maneuver in steal syndrome
Inflation of pressure cuff on arm for 3 min & rapid deflation*
Pre-steal
More pronounced steal
Conversion of pre-steal waveform to more pronounced steal
following deflation of pressure cuff
15. Limitations of carotid US examination
• Short muscular neck
• High carotid bifurcation
• Tortuous vessels
• Calcified shadowing plaques
• Surgical sutures, postoperative hematoma, central line
• Inability to lie flat in respiratory or cardiac disease
• Inability to rotate head in patients with arthritis
• Uncooperative patient
Tahmasebpour HR et al. RadioGraphics 2005 ; 25 : 1561 – 1575.
16. Advantages of power mode Doppler
• Angle independent
• No aliasing
• Increases accuracy of grading stenosis
• Distinguish pre-occlusive from occlusive lesions
“detect low-velocity blood flow”
• Superior depiction of plaque surface morphology
17. Disadvantages of power mode Doppler
• Does not provide direction of flow
New machines provide direction of flow in power mode
• Does not provide velocity flow information
• Very motion sensitive (poor temporal resolution)
18. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
19. Fibromuscular dysplasia
Middle age women – Renal arteries – String of beads pattern
ICA
Alternating zones of vasoconstriction & vasodilation for 3 – 5 cm
ICA frequently – VA less frequently
Usually bilateral
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
20. Causes of carotid artery diseases
Arteriosclerotic disease
Most common cause
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
21. Carotid & vertebral dissection
• Spontaneous dissection Bleeding from vasa vasorum
Most common ICA & VA (atlas loop)
Intramural hematoma
Pain – Stenosis – Horner
• Vascular injury
• Stanford A dissection
Iatrogenic: puncture – surgery
CCA
Intramural hematoma ± intimal tear
Intimal rupture in ascending aorta
CCA
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
22. Dissection of aorta & cervical arteries
Patho-anatomy
Aorta
Intimal rupture with false lumen
Open or secondarily thrombosed
Cervical
External intramural hematoma
Lumen constriction
Rare intimal rupture
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
23. Spontaneous dissection of ICA
Asymmetric wall hematoma – Lumen stenosis – Expansion to outside
Diagnostic criteria (one sufficient)
Intramural hematoma
Intimal rupture/double lumen
Distal stenosis or occlusion
Symptoms: acute pain, Horner,
Course: recanalization in few weeks
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
24. Spontaneous dissection of VA
Wall hematoma in V1
Double lumen in V2
Diagnostic criteria (one sufficient):
Intramural hematoma (asymmetric, not concentric)
Intimal rupture/double lumen (rare)
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
25. Thoracic aortic dissection
Type A
Stanford classification
Dissection of ascending aorta
Possible continuation to supraaortic vessels
Type B
Dissection of descending aorta
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
26. Dissection of common carotid artery
Stanford A
Transverse view
Longitudinal view
Detection of two lumina & dissection membrane
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
27. Dissection of CCA / Stenosis
Residuum after end of aortic dissection
Doppler of true lumen
Stenosis of true lumen
Doppler of false lumen
Enlargement of false lumen
before cranial end
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
28. Causes of carotid artery diseases
Arteriosclerotic disease
Most common cause
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
29. Vasospasm
• Causes
idiopat
Migraine, eclampsia, vasculitis, drug abuse,
• Incidence Rarely identified (short duration)
Occur frequently & remain undetected
• Symptoms Cerebral or ocular ischemia
• US
• Dd
Direct &/or indirect signs of severe stenosis
Far above bifurcation – Sometimes bilateral
Complete regression in hours to days – Relapse
Dissection: wall hematoma – regression in weeks
• Treatment Calcium antagonists
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
31. Causes of carotid artery diseases
Arteriosclerotic disease
Most common cause
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
32. Extra-cranial ICA aneurysms
Color Doppler US
Power Doppler US
Incomplete delineation of aneurysm – Thrombi could not be excluded
Difficult definition for extracranial carotid artery aneurysms
due to normal dilatation of bulb
34. CCA aneurysm / Rupture
Clevert DA et al. Clin Hemorheology Microcirculation 2008 ; 39 : 133 – 146.
35. CCA pseudoaneurysm / Rare
One month after bilateral neck dissection
Color Doppler US
CCA Pseudoaneurysm
Large connecting neck
CE multidetector CT
CCA Pseudoaneurysm
Large connecting neck
Flor N et al. J Laryngol Otol 2007 ; 121 : 497 – 500.
36. Causes of carotid artery diseases
Arteriosclerotic disease
Most common cause
Non-arteriosclerotic diseases
Fibro muscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
37. Arterio-venous fistula
Attempt to perform US-guided jugular catheter insertion
IJV
CCA
Suspicion of communication between CCA & IJV
Turbulent flow in fistula track
High-velocity turbulent flow in track
38. Causes of carotid artery diseases
Arteriosclerotic disease
Most common cause
Non-arteriosclerotic diseases
Fibro muscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
39. Doppler ultrasound in arteritis
“macaroni sign” & “halo sign”
• 2 types
Takayasu
Young female – SCA & CCA
Horton
Old female – SCA, AA & Temporal A
Cannot be differentiated using US
• US signs Macaroni
Concentric hypoechoic wall
thickening
Halo
Dark halo around colorful lumen
All grades of stenosis – Thrombotic vessel
• Dd
Dissection
Eccentric hypoechoic wall thickening
Pronounced outward expansion
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
40. Takayasu’s arteritis
Young female – SCA [‘pulseless’ disease] – CCA
CCA
Long hypoechoic wall thickening
Visualized in color Doppler as dark halo around vascular lumen
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
41. Horton's arteritis / Giant cell arteritis
Concentric hypoechoic wall thickening
Superficial temporal artery
VA – Longitudinal view
VA – Transverse view
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
42. MA of US in diagnosis of temporal arteritis
Halo sign versus temporal artery biopsy
9 studies – 357 patients
Sensitivity
75% (67 – 82)
Specificity
83% (78 – 88)
sAUROC1
0.868
DOR2
17.96 (6.72 – 47.99)
Heterogeneity
I2 = 27%, P < 0.204
US relatively accurate for diagnosis of temporal arteritis
US as first-line investigation, biopsy if negative scan
1 sAUROC:
Summary Area Under Receiver Operating Characteristic
2 DOR: Diagnostic Odds Ratio
Ball EL et al. Br J Surg 2010 ; 97 : 1765 – 1771.
43. Causes of carotid artery diseases
Arteriosclerotic disease
Most common cause
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
44. Carotid body tumor / Rare
Histology
Paraganglioma of low malignant potential
Presentation
Palpable neck mass – Headache – Neck pain
US
Highly vascular mass in carotid bifurcation
Arteriography
Performed preoperatively – Embolization
Treatment
Resection to prevent local adverse events:
Laryngeal nerve palsy – carcinoma invasion
Result
Local recurrence 6% – Distant metastasis 2%
45. Carotid body tumor
Highly vascular mass in carotid bifurcation
Zwiebel WL. Introduction to vascular ultrasonography.
W.B. Saunders, Philadelphia, USA, 4th edition, 2000.
46. Causes of carotid artery diseases
Arteriosclerotic disease
Most common cause
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
47. Diagnosis of idiopathic carotidynia
International Headache Society (IHS)1
• At least one of following over CA:
Tenderness
Swelling
Increased pulsations
• Pain over affected side of neck that may project to head
• Appropriate investigations without structural
abnormality
Recent publications demonstrate radiological findings2
• Self-limiting syndrome of less than 2 weeks duration
1 International
2
Headache Society. Cephalalgia 1988 ; 8 (Suppl 7) : 1 – 96.
Kosaka N et al. Eur Radiol 2007 ; 17 : 2430 – 2433.
48. Idiopathic carotidynia
US findings comparable to dissection
US of distal CCA
Hypo-echoic soft tissue
around carotid artery
CE T1-weighted MRI
Enhanced tissue
around carotid artery
Three months later
Resolution of abnormal
soft tissue
Kosaka N et al. Eur Radiol 2007 ; 17 : 2430 – 2433.
49. Spontaneous dissection & carotidynia
Spontaneous dissection
Carotidynia
Location
Beyoud bifurcation
At or near bifurcation
Thickening layers
One wall layer
2 wall layers
Stenosis
May be detectable
Not detectable
Pain
Head
Neck
MRI
CAs
Native enhancement Enhancement after
In unclear cases, MRI enables differentiation
Arning C et al. Ultraschall Med 2008 ; 29 : 576 – 599.
50. Doppler US of carotid arteries
Anatomy of carotid arteries
Normal Doppler US of carotid arteries
Causes of carotid artery disease
Effect of extra-carotid diseases
51. Effect of extra-carotid diseases
• Idiopathic dilated cardiomyopathy
• Aortic regurgitation
• Aortic stenosis
• Stenosis of right innominate artery or origin of LCCA
• High & low PSV in CCA
• Stenosis of intra-cranial ICA
52. Idiopathic dilated cardiomyopathy
Pulsus alternans
PSV oscillating between two levels on sequential beats
Cardiac rhythm remains regular throughout
Rohren EM et al. Am J Roentgenol 2003 ; 181 : 1695 – 1704.
53. Aortic regurgitation
Bisferious waveform [“beat twice” in Latin]
Two systolic peaks separated by midsystolic retraction
Dicrotic notch
Found also with hypertrophic obstructive cardiomyopathy
Kallman CE et al. Am J Roentgenol 1991 ; 157 : 403 – 407.
Rohren EM et al. AJR 2003 ; 181 : 169 5– 1704.
54. Severe aortic regurgitation
Water-hammer spectral appearance
CCA
Normal or elevated PSV followed by precipitous decline
Revered flow during diastole
Rohren EM et al. Am J Roentgenol 2003 ; 181 : 1695 – 1704.
58. Normal PSV in CCA (45 – 125 cm/sec)
High flow > 125 cm/sec in both CCAs
High cardiac output:
Hypertensive patients
Young athletes
Low flow < 45 cm/sec in both CCAs
Poor cardiac output:
Cardiomyopathies
Valvular heart disease
Extensive myocardial
infarction Arrhythmias can be real problem
59. Stenosis of intra-cranial ICA
High resistance waveform
ICA
High-grade stenosis distally (intracranial ICA)
Major occlusive lesions of cerebral arteries (MCA, ACA)
Massive spasm of cerebral arteries from intracranial hemorrhage
The ECA is an important collateral pathway in patients with ipsilateral ICA occlusion and recurrent symptoms.This may influence the surgical decisions involving revascularization of the stenotic ECA.
Differentiation between these causes is important, as some centers are performing vertebral artery angioplasty and stent placement for significant vertebral artery stenosis.
Wall hematoma: Wall hematoma might be incorrectly interpreted as arteritis.However, an important differentiation criterion is the eccentric location of the wall thickening in the case of dissection as known from MRI findings, while vasculitis is characterized by concentric wall thickening.Double lumen:If double are detected, a pathological Doppler curve (showing stenosis or oscillating flow) will be found in at least one of the lumina. Therefore, fenestration of the VA (an anomaly with a double lumen in one vessel segment) cannot be confused with dissection becauseof the normal flow pulse curve in both lumina.Horner:
If 2 lumina are detected, a pathological Doppler curve (showing stenosis or oscillating flow) will be found in at least one of the lumina. Therefore, fenestration of the VA (an anomaly with a double lumen in one vessel segment) cannot be confused with dissection because of the normal flow pulse curve in both lumina.
True aneurysm generally defined as dilation of an artery to more than 150% of its normal diameterDifficult definition for extracranial carotid artery aneurysms due to normal dilatation of bulbDe Jong et al. proposed that ECAA of the bifurcation are better defined as a bulb dilatation greater than 200% of the diameter of the ICA or 150% of the diameter of the common carotid artery, and distal aneurysms of the extracranial internal carotid arteries (EICAA) as a dilatation greater than 120% of the diameter of the normal ipsilateral ICA.
Temporal (giant cell) arteritis affects the superficial temporal arteries in older women.The specificity of the method under qualified application is 97%. Therefore, given a clear vasculitis finding in the ultrasound image and an experienced examiner, a vascular biopsy can be dispensed with.In the case of unclear ultrasound findings or ultrasound findings without pathological findings and a clinical suspicion of arteritis, biopsy is still necessary.
Each diamond corresponds to a study estimate of sensitivity and specificity.Area of each diamond is proportional to the study sizeThe upper and lower curves represent the 95 per cent confidence intervals of the diagnostic odds ratio in the equation of curve.The presence of any of the markers of vascular inflammation (halo, stenosis, occlusion), compared with halo alone, seemed to improve sensitivity, while retaining specificity, although there was significant between-study heterogeneity (I2 = 81·7 per cent, P < 0·001).
“carotidynia” was initially described by Fay in 1927.Clinical criteria for dg of idiopathic carotidynia were established in 1988 by International Headache Society Classification Committee.The existence of this entity remained controversial and led the International Headache Society to remove carotidynia from their main classification of Headache Disorders in 2004.Severe pain on one side in the upper cervical region that responds well to cortisone or NSAIDs.
Pulsus alternans: نبض متناوبPatient with pulsus alternans caused by idiopathic dilated cardiomyopathy.
Pulsusbisferiens, Latin for ‘‘beat twice,’’ is the term used to describe a waveform characterized by two systolic peaks with an interposed midsystolic retraction. Visualization of this waveform suggests the presence of aortic insufficiency with or without concomitant aortic stenosis or hypertophicobstructive cardiomyopathy.Mechanism of pulsusbisferiens in aortic insufficiency is not well understood. One view is that first peak represents initial high-volume ejection of blood, which is followed by abrupt mid systolic flow deceleration caused by regurgitant valve, and second peak represents tidal wave reflected from distended aorta as it relaxes or from periphery of body.
Water Hammer: الطرق المائي (صوت طرق الماء على جوانب الأنبوب الذي يحتويه)Hammer: مطرقةSpectral waveforms mirror physical examination finding of water-hammer pulses in patients with severe aortic regurgitation.
Reduced right arm systolic blood pressure. A right-to-left difference of 20 mm Hg is considered significant.