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
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
Duodenal Intussusception Secondary to Hamartomatous Polyps of the Duodenum an...semualkaira
Hamartomas of the duodenum are benign duodenal tumors comprising approximately 5-10% of duodenal tumors. The incidence is <0.01%. Typically asymptomatic, they may
manifest as intestinal obstruction, gastrointestinal hemorrhage,
biliary obstruction or intussusception. Intussusception as a manifestation of duodenal hamartoma is rare in itself with less than 200
cases reported in the literature
Duodenal Intussusception Secondary to Hamartomatous Polyps of the Duodenum an...semualkaira
Hamartomas of the duodenum are benign duodenal tumors comprising approximately 5-10% of duodenal tumors. The incidence is <0.01%. Typically asymptomatic, they may
manifest as intestinal obstruction, gastrointestinal hemorrhage,
biliary obstruction or intussusception. Intussusception as a manifestation of duodenal hamartoma is rare in itself with less than 200
cases reported in the literature.
Duodenal Intussusception Secondary to Hamartomatous Polyps of the Duodenum an...semualkaira
Hamartomas of the duodenum are benign duodenal tumors comprising approximately 5-10% of duodenal tumors. The incidence is <0.01%. Typically asymptomatic, they may
manifest as intestinal obstruction, gastrointestinal hemorrhage,
biliary obstruction or intussusception. Intussusception as a manifestation of duodenal hamartoma is rare in itself with less than 200
cases reported in the literature
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Presentation1, Ultrasound of the bowel loops and the lymph nodes..pptx
1. Ultrasonography of the Bowel loops
and the abdominal lymph nodes.
Dr/ ABD ALLAH NAZEER. MD.
2. Normal bowl wall anatomy:
The bowl wall consists of 5 layers, of different echogenicity.
Typically, only 2 layers are visible on US, including an inner
hyperechoic layer and outer hypoechoic layer. Normally, bowel
loops are compressible, show minimal vascularity, and have
wall thickness < 2 mm.
Technique:
It is mandatory to check the SMA/SMV relation in every case
Scan is started with a 3.5- to 8-MHz convex probe to provide a
broad overview, to assess the extent of bowel involvement and
to avoid overlooking of extra-intestinal “deeper” associated
findings. Then a high-frequency (4–13 MHz) linear array probe
is used to assess bowel wall thickness and wall layer
discrimination. Specific technique tips and tricks will be
discussed in detail at each pathology.
3. Normal “gut signature” Mucosal interface with lumen (hyperechoic), mucosa (hypoechoic), submucosa
(hyperechoic), muscularis propria(hypoechoic) and serosa (hyperechoic). B: Normal SMA/SMV relationship
in gray scale and color Doppler image.SMA has echogenic rim and seen to the left of the SMV.
4. Normal gastrointestinal tract in ultrasound. A:Normal pylorus. B: Normal
duodenum. C: Normal proximal jejunal loops in LUQ. D:Normal ileal loops
in the right lower quadrant. E: Normal appendix. F: Normal colon (orange
arrows-Haustra).G:Normal distal jejunal loops in the LLQ.
5. Pathologies:
Hypertrophic Pyloric Stenosis (HPS) vs. pyloric spasm:
Ultrasound technique:
The baby is placed in the right oblique position, first the gallbladder
is identified, as the pylorus is usually located slightly medial and
posterior to the gallbladder, then assess the appearance and
measurements of the pylorus. Finally, assess the gastric emptying
through the pylorus and the presence of hyperperistalsis. If the
stomach is empty, the baby is fed with small amount of water.
HPS is common in males (M: F= 4:1), diagnosed in those aged 3-12
weeks. Babies present with projectile non-bilious vomiting, due to
thickened pyloric muscularis propria.
In pyloric spasm, the muscularis propria is either not hypertrophied,
or slightly thick, but < 3 mm thick, with visualized pyloric opening.
Pyloric spasm requires observation while HPS is treated with
surgical pyloromyotomy.
6. 6 week old baby with projectile vomiting for 1 week. Target sign/doughnut sign/ CERVIX sign, with
symmetrical muscular wall thickening of 5 mm, elongated pyloric canal (20 mm) Double internal
layer of crowded mucosa (nipple sign "arrow") Lack of gastric emptying with hyperperistalsis;
typical of hypertrophic pyloric stenosis. B: The pyloric canal is 10 mm long and muscularis propria
is 3 mm in thickness, mild gastric emptying, ongoing with pyloric spasm. C: examination in
the right oblique position, using linear transducer parallel to the right costal margin.
7. Intramural Duodenal hematoma:
Ultrasound technique:
The epigastric region is surveyed with a
linear transducer, duodenal hematoma is
seen lateral or posterior to the pancreatic
head.
It may occur as a result of blunt
abdominal trauma, non-accidental injury to
children. The retroperitoneal attachment and
the lack of a mesentery along with the
proximity of especially the third part to the
spine may account for vulnerability in blunt
8. 2 year old with vomiting and history of trauma 3 days ago. A:a heterogenous, hypoechoic with
irregular cystic areas, well defined lesion in the epigastric region, B: no internal vascularity
demonstrated on color Doppler. CT was done to confirm the diagnosis of duodenal hematoma.
C & D: Axial with (E) coronal enhanced CT images of the upper abdomen, show cystic non
enhancing lesion in the location of the 2nd and 3rd parts of the duodenum (H).
9. Midgut volvulus:
Ultrasound technique:
The position of superior mesenteric artery (SMA) in
relation to superior mesenteric vein (SMV) is recorded in
gray scale and Color Doppler imaging. Whirlpool sign is
looked for and finally the peristalsis, diameter, vascularity
and collapsibility of the rest of the bowel loops is
assessed.
Inverse orientation of the superior mesenteric artery
(SMA) and the superior mesenteric vein (SMV) (i.e. SMV
seen to the left or SMA) is a sign of malrotation.
Whirlpool sign, corresponding to a clockwise wrapping of
the SMV around the SMA, has a high predicting value and
is an imaging characteristic of midgut volvulus.
10. 7-month-old boy. abnormal SMA/SMV correlation was seen, Color Doppler ultrasound
in the epigastric region show whirling vessels and was diagnosed with mid gut volvulus.
11. Incarcerated/ Strangulated inguinal hernia:
Ultrasound technique:
Both inguinal regions along with scrotum are
examined with linear transducer, presence of
bowel peristalsis, wall thickness and vascularity
are recorded.
The bowel, ovaries, or fallopian tubes are the
organs that most commonly incarcerate into the
inguinal region, through a patent processus
vaginalis, which may progress rapidly to
strangulation (vascular compromise and
infarction) of the incarcerated contents. (Fig.6)
12. An 8 month old boy with scrotal swelling and abdominal distension. Longitudinal
images through the inguinal region, show dilated, thick hyperechoic walled, fluid
filled, aperistaltic small bowel loop seen superior to the testis (*) with preserved
vascularity. Findings are consistent with incarcerated inguino-scrotal hernia.
13. Henoch Schönlein Purpura
HSP is a small-vessel, immune-mediated
vasculitis associated with
immunoglobulin
A (IgA) deposition. Peak incidence 3-10
years. Gastrointestinal symptoms are
encountered in 70% of the cases. Seen
as multifocal bowel thickening, vascular
engorgement and intussusception,
typically ileoileal type.
14. 8 year old boy, known case of Henoch Schonlein Purpura, (1)long segment of thickened ileal
bowel loop in the right lumbar region, (2) in the right iliac fossa and (3) a short segment of
thickened jejunal loop in the left upper quadrant, with normal peristalsis. All thickened bowel
loops are fluid filled,loss of normal stratification, due to intramural hemorrhage.
15. Crohn’s disease:
Crohn's disease may present with acute,
appendicitis-like symptoms. US may play
an important role in establishing the initial
diagnosis, assessing the extent of bowel
involvement and diagnosing possible
complications.
The sensitivity of US for detecting ileocecal
Crohn's disease of over 95%.
16. Axial US images of a 12 year old girl, a known case of crohn’s disease in remission. (A):
Hypoechoic thickened terminal ileal wall with total loss of stratification, fatty aggregation
(B) mild hypervascularization at color-Doppler. (C)Thickened colon in the right lumbar
region. (D&E) follow up study done 6 months post treatment, shows mild ileal and colonic
thickening with preserved stratification and significant regression of fatty aggregation.
17. 14year old boy, with abdominal pain and vomiting. Irregularly thickened long segment of ilium
extends from RIF (A) till the supra-pubic region (B&C) with loss of normal stratification and
significant surrounding fatty aggregation (*) a sign of longstanding Crohn’s disease. Axial
balanced FFE (D) and post contrast T1 MR images of the correspond to the US findings
18. 14 year old boy, known case of Crohn’s disease, (A) axial enhanced CT image of the lower
abdomen show thickened segments of ileal bowel loops and ascending colon, mucosal
enhancement, surrounding free fluid and fat stranding in going with active Crohn’s disease.
He presented with vomiting and high inflammatory markers 6 months after initial diagnosis
(C) US of the pelvis shows a large collection with multiple air foci, confirmed by CT (D & E).
19. Idiopathic Ileocolic vs. Eneteroenteric Intussusception:
Ultrasound Technique:
Bowel is screened with five to six vertically oriented, overlapping
lanes 'mowing the lawn technique' using a linear high frequency
probe.
Intussusception occurs when a proximal bowel loop invaginate into
an adjacent distal bowel loop, typically within the ileocecal region,
90% of the time without a lead point, rather due to hypertrophy of
Peyer’s patches. Predominantly seen in children 3 months to 3 years
of age. When it occurs outside of the typical age range, it is likely to
be associated with a pathologic lead point (Meckel’s diverticulum,
duplication cyst, polyps, non-Hodgkin’s lymphoma).
Small bowel intussusception is transitory, usually seen in the side of
the abdomen during scanning. It contains less mesenteric fat and
lymph nodes, with a small outer diameter (less than 2.5 cm), short
segmental invagination (less than 3 cm), and peristaltic wall motion.
20. Baby girl, with vomiting and colic. (A) Concentric parallel rings of bowel wall ”Target/ doughnut
or pseudokidney sign” ,in the RUQ, its diameter >2.5 cm, ongoing with ileocolic intussusception.
(B) Color Doppler: preserved vascularity. (C) longitudinal view: long segment of invagination
(opposed to short segments seen in enteroenteric intussusception. (D) Another case with ileocecal
intussusception, notice layering of fluid between the telescoped bowel loops and mesenteric
lymph nodes, when seen reflects decreased probability of reducability. (E) A case of entero-enteric
intussusception seen in the LUQ, its diameter <2.5 cm. Self limited, needs no reduction.
21. Acute Appendicitis:
Ultrasound Technique:
Graded-compression is applied with the linear
transducer at the point of maximal tenderness.
If no abnormality is seen, a thorough search for
direct or indirect signs of appendicitis in the right
iliac fossa, right lumbar and subhepatic regions is
sought[6] in supine and left oblique positions.
Most commonly occurs in school agers. Diagnosis
can be challenging as inflammatory markers are
not elevated in 20% of cases and clinical
presentation is variable or atypical in 30-45%
of cases, especially in the preschool agers.
23. Direct and secondary signs of acute appendicitis as reported by
Gerhard Mostbeck et al, ‘’ How to diagnose acute appendicitis:
24. 7 months baby, with vomiting and bloody diarrhea, a case of phlegmonous acute appendicitis.
US of the right hypochondrial region show thickened non compressible appendix, with preserved
stratification, omental fatty aggregation (*) and an overlying dilated hyperechoic small bowel loop
(B). B: 8 year old, a case of gangrenous acute appendicitis. The appendix shows interruption
of the mucosal continuity (->),hypervascularity and periappendiceal fatty prominence (*).
25. A 2 year old boy, with abdominal pain for 3 days and vomiting. Acute gangrenous tip
appendicitis with interrupted mucosa (->), appendicolith (A) and fatty aggregation
superior to the inflamed tip, peri-ileal (*) The normal proximal appendix (N)
26. (A): A 4 year old, x-ray shows dilated small bowel loops. US shows fluid filled dilated
bowel loops in the LLQ with hyperechoic thickened wall and hypoperistalsis. RIF has ill-
defined hypoechoic fluid (F) and omental fat (*) prominence, suggestive of perforated
appendix. (B) Another case of perforated appendicitis, characterized by disruption
of the entire thickness of the appendicular wall with periappendiceal free fluid.
27. 4 different cases of appendicular abscesses (A&B) are subhepatic,(C,D&E) are
pelvic, showing varying echogenicities, ranging from cystic with internal debris
(A), hypoechoic (B), heterogenous predominantly hypoechoic (C), heterogenous
with predominant cystic component (D) or heterogenous with an appendicolith.
29. Acute gastroenteritis
Symptom-wise, the commonest mimicker of
acute appendicitis. the most common causes
of gastroenteritis in children are viruses
(rotaviruses, adenoviruses, enteroviruses),
bacteria (food poisoning, pathogens like
Salmonella, E. Coli, Listeria), and intestinal
parasites (like amoeba histolytica & Giardia
lamblia).
30. A 3-year-old girl, with vomiting and bloody diarrhea. Thickened
sigmoid colon seen with predominant submucosal layer thickening.
(B & C)diffusely thickened colon in the RIF/LIF, with loss of Normal
bowel stratification. Small bowel loops were not thickened.
31. TUS in Celiac Disease
Despite the fact, that gold standard for the diagnosis of celiac disease is
histologic confirmation of the intestinal damage in serologically positive
individuals, in patients with untreated celiac disease we can regularly find
out several sonographic signs that raise suspicion of this chronic disease
also in clinically asymptomatic persons. Increased fluid content in
moderately dilated bowel loops (25 to 35 mm) with hyperperistalsis in
fasting state, lightly thickened bowel wall (3–5 mm) and thickened
valvulae conniventes are most frequently seen in patients with untreated
celiac sprue. Reduced number of jejunal folds and increase of ileal folds
(jejunalization of ileum) intermittent intussusceptions due to
hyperperistalsis, presence of slightly enlarged mesenterial lymph nodes
(5–10 mm in short axis)and dilatation of SMA with low resistive index are
also very frequent. In comparison to controls, celiac patients had higher
superior mesenteric artery blood velocity and flow, with lower resistance
indexes and higher portal vein velocity and flow in comparison to
controls. Presence of small amount of free peritoneal fluid and increased
gallbladder volume are also seen in these patients.
32. Celiac sprue: (a) Dilated loops of small bowel with thickened wall, and valvulae conniventes hyperperistalsis—
standard abdominal probe. (b) Intussusception of jejunum in transverse (left) and longitudinal section in celiac
sprue—high resolution probe. (c) Dilated SMA (9 mm) in a patient with untreated celiac disease—standard
probe. (d) Low resistive index-RI (0.69) in SMA in untreated celiac disease—standard probe.
33. Acute pancreatitis:
It is rare in children, occurs in all age
groups. Diffuse or focal enlargement of
the pancreas is attributable to edema;
however, pancreatic enlargement has
been reported to be absent on
ultrasound in approximately 50% of the
patients.
34. A 30 month old girl, with vomiting. Ultrasound showed (A) hyperechoic pancreatic
parenchyma (B) Bulky pancreatic head (H) with fluid in the lesser sac (open arrow),
C: Rim of hypoechoic peri-pancreatic fluid (arrow) and heterogeneous body - tail
junction (*) D: companion case of normal pancreas, iso-echoic to the liver.
36. Focal acute bacterial nephritis:
It is due to a localized non-
liquefactive inflammatory renal
bacterial infection and considered
to be a midpoint in the spectrum
ranging from uncomplicated
pyelonephritis to intrarenal
abscess.
37. 8 year old boy, with fever and vomiting. (A) A geographic area of hypoechogenicity in the
upper pole of the right kidney (*), (B) Color Doppler image shows patent renal vein and
segmental renal arteries, (C ) Power Doppler image shows focal hypoperfusion of the
upper polar renal parenchyma (*), (D) Coronal enhanced CT image shows right upper
polar wedge shaped enhancement defect (arrow) no abscess formation.
38. Ovarian torsion:
Complete or partial torsion of ovary on its
pedicle vascular supply due to long &
flexible mesoovary. It accounts for
approximately 3% of all cases of children
with acute abdominal pain. More common
in adolescents after menarche. The presence
of vomiting, short duration of abdominal
pain, and elevated CRP level (>5 mg/L) have
a predictive value for the diagnosis of OT.
39.
40. A 13 year old female, with acute ovarian torsion. The right ovary is in the
mid-line, enlarged, measures 4.5 cm in largest diameter, with a volume of
33 ml, compared to left ovary which was 10 ml (not shown). Multiple
peripheral small follicles seen. Lack of arterial and venous blood flow.
41. TUS in Detection of Small Bowel Tumors
The most frequently visualized tumors of SB are localized in duodenum and
terminal ileum. Tumors in other parts of SB can be viewed after gaining
significant volume and are causing clinical symptomatology. Among the
malignant tumors are more frequent adenocarcinoma localized prevalently
in duodenum, then Carcinoid with prevalent localization in terminal ileum,
followed by lymphomas in ileum and jejunum, and less frequent
mesenchymal tumors, predominantly in jejunum. Most of the
adenocarcinoma occurred in the duodenum and their relative frequency
decreased in aboral direction: 29.9% in the jejunum and 16.0% in the ileum.
The carcinoids showed an opposite trend, an increasing relative frequency in
aboral direction: 3.9% in the duodenum, 9.2% in the jejunum and 86.7% in
the ileum. Lymphomas were more frequent in the ileum (49.5%) compared to
jejunum (29.4%) and duodenum (21.0%). Most sarcomas occurred along the
jejunum (46.7%). Carcinoid tumors are oval hypoechogenic vascularised
lesions and , lymphomas circularly affecting bowel segment with stenosis
and dilatations of lumen. Most of gastro-intestinal lymphomas cause
circumferential involvement of the bowel wall. Metastatic tumors of SB
as well as benign tumors are sporadically visualized by TUS due to
intussusception caused by these tumors.
42. Tumors of small bowel. (a) Solid oval tumor in the lumen of terminal ileum with hypervascularization in CFD
(a) High resolution probe. (b) Oval solid tumor in D2 segment of duodenum—Standard abdominal probe. (e)
Longitudinal section of thickened small bowel loop (S) with stenosis and dilatation (D) of lumen. Standard
abdominal probe. (f)Transversal view with high resolution probe in dilated segment shows hypervascularization
of thickened wall (f). Surgery confirmed suspected T-lymphoma of jejunum in untreated celiac disease.
43. Conventional ultrasound (US) is the recommended imaging method
for lymph node (LN) diseases with the advantages of high
resolution, real time evaluation and relative low costs. Current
indications of transcutaneous ultrasound and endoscopic
ultrasound include the detection and characterization of lymph
nodes and the guidance for LN biopsy. Recent advances in US
technology, such as contrast enhanced ultrasound (CEUS), contrast
enhanced endoscopic ultrasound (CE-EUS), and real time
elastography show potential to improve the accuracy of US for the
differential diagnosis of benign and malignant lymph nodes. In
addition, CEUS and CE-EUS have been also used for the guidance
of fine needle aspiration and assessment of treatment response.
Complementary to size criteria, CEUS could also be used to evaluate
response of tumor angiogenesis to antiangiogenic therapies. In this
paper we review current literature regarding evaluation of
lymphadenopathy by new and innovative US techniques.
Lymph node.
46. Circle enhancement (Tuberculosis). Left figure: the CEUS mode, the red
circle: lymph node, the yellow circle: surrounding tissue, the blue circle:
artery; Right figure: the comparative gray-scale ultrasonography.
48. Non-Hodgkin’s lymphoma
involving the inguinal
region. A: Sonoelastography
reliability test evaluation
reveals typically asymmetric
and circumscribed
infiltrated harder (blue)
lymph node tissue in low
grade follicular cell
lymphoma; B: Elastography
(acoustic structured
quantification) reveals
mainly homogenous diffuse
infiltration in high grade
follicular cell lymphoma.
49. Colorectal carcinoma
with presacral
circumscribed lymph
node metastasis
proven by colonic
endoscopic ultrasound
using Fine Needle
Aspiration Cytology.
Sonoelastography
reliability test
evaluation reveals
typically harder (blue)
area in the lymph
node.