This presentation briefly outlines the role of ultrasound in differential diagnosis of right iliac fossa pain.
Reference :- White, E. and Rudralingam, V. ‘Seeing past the appendix: the role of ultrasound in right iliac fossa pain’.
A 3-day-old female child presented with abdominal distension and inability to pass meconium. Examination revealed a normal anal opening but resistance to passage of a feeding tube beyond 2 cm. An invertogram showed rectal atresia. Endoscopy visualized a distal rectal membrane, which was incised. A fistulogram then revealed a fistula between the upper anal canal and the labia. Key points discussed include techniques for evaluating anorectal malformations like invertograms and classifications of ARM like the Wingspread and PENA systems. Relationship between sacral development and pelvic floor muscle function is also summarized.
This document discusses the anatomy and imaging of the scrotum. It begins with the anatomy of the scrotum, testis, epididymis and spermatic cord. It then covers imaging modalities used including ultrasound and MRI techniques and protocols. Common pathological conditions are summarized such as infections, trauma, tumors and congenital anomalies. Specific conditions like torsion, epididymitis and testicular cancer are described in detail with imaging findings.
Presentation1.pptx, ultrasound examination of the appendix.Abdellah Nazeer
Ultrasound is useful for evaluating appendicitis and differentiating it from other causes of right lower quadrant pain. The appendix appears as a tubular, non-compressible structure greater than 6mm in diameter with thickened walls and surrounding inflammatory changes. Other mimics include mesenteric adenitis seen as clustered lymph nodes, bacterial ileocecitis showing thickened terminal ileum and cecum, and epiploic appendagitis appearing as an inflamed fatty mass adjacent to the colon. A normal appendix helps rule out appendicitis when other gastrointestinal or gynecological conditions are present.
This document provides an overview of acute appendicitis and its ultrasound evaluation. It discusses:
1. The clinical presentation of acute appendicitis including symptoms like right lower quadrant pain and signs like rebound tenderness.
2. Laboratory findings that support a diagnosis of appendicitis, such as elevated white blood cell count and CRP level.
3. The ultrasound technique for visualizing the appendix and criteria for a normal appendix versus findings indicative of appendicitis, including size, shape, compressibility and wall vascularity.
4. Potential pitfalls in ultrasound diagnosis like air in the appendix or lymphoid hyperplasia that can mimic appendicitis.
The liver is the largest solid organ located in the right upper quadrant of the abdomen. It is divided into eight segments based on vascular and biliary anatomy. The document describes the normal anatomy of the liver and common variations. It also discusses ultrasound techniques for imaging the liver and provides details on identifying different liver lesions including cysts, benign and malignant tumors, infections, and vascular anomalies on ultrasound scans.
This document provides information about ultrasound use in urology. It discusses the history of ultrasound in urology from 1963 onwards. It then covers basic ultrasound principles including modes, probes, imaging planes and documentation. Applications to the kidney, bladder, prostate and testes are described. Common abnormalities like hydronephrosis, cysts, masses and infections are outlined. In summary, the document is an overview of ultrasound techniques and their use in evaluating the urinary tract and common urologic conditions.
Presentation1, ultrasound of the bowel loops and the lymph nodes.AbdullahNazeerYassin
Ultrasonography is useful for evaluating bowel loops and abdominal lymph nodes. The normal bowel wall has 5 layers but only 2 are usually visible on ultrasound. Pathologies like hypertrophic pyloric stenosis, intramural duodenal hematoma, midgut volvulus, incarcerated hernia and various inflammatory conditions can be diagnosed using ultrasound. Acute appendicitis and its complications are also commonly evaluated. Ultrasound is helpful for assessing conditions like celiac disease, acute pancreatitis and focal acute bacterial nephritis.
Presentation1.pptx, ultrasound examination of the urinary bladder and prostate.Abdellah Nazeer
This document provides information on ultrasound examination of the urinary bladder and prostate. It begins with descriptions of normal ultrasound images of the bladder and prostate. It then discusses the role of ultrasound in assessing these structures. Common pathologies that can be identified include trabeculation, diverticula, calculi, ureterocele, infections, and cancers. Scanning techniques for bladder and prostate ultrasound are outlined. The document concludes with ultrasound images demonstrating various normal and abnormal findings of the bladder and prostate.
A 3-day-old female child presented with abdominal distension and inability to pass meconium. Examination revealed a normal anal opening but resistance to passage of a feeding tube beyond 2 cm. An invertogram showed rectal atresia. Endoscopy visualized a distal rectal membrane, which was incised. A fistulogram then revealed a fistula between the upper anal canal and the labia. Key points discussed include techniques for evaluating anorectal malformations like invertograms and classifications of ARM like the Wingspread and PENA systems. Relationship between sacral development and pelvic floor muscle function is also summarized.
This document discusses the anatomy and imaging of the scrotum. It begins with the anatomy of the scrotum, testis, epididymis and spermatic cord. It then covers imaging modalities used including ultrasound and MRI techniques and protocols. Common pathological conditions are summarized such as infections, trauma, tumors and congenital anomalies. Specific conditions like torsion, epididymitis and testicular cancer are described in detail with imaging findings.
Presentation1.pptx, ultrasound examination of the appendix.Abdellah Nazeer
Ultrasound is useful for evaluating appendicitis and differentiating it from other causes of right lower quadrant pain. The appendix appears as a tubular, non-compressible structure greater than 6mm in diameter with thickened walls and surrounding inflammatory changes. Other mimics include mesenteric adenitis seen as clustered lymph nodes, bacterial ileocecitis showing thickened terminal ileum and cecum, and epiploic appendagitis appearing as an inflamed fatty mass adjacent to the colon. A normal appendix helps rule out appendicitis when other gastrointestinal or gynecological conditions are present.
This document provides an overview of acute appendicitis and its ultrasound evaluation. It discusses:
1. The clinical presentation of acute appendicitis including symptoms like right lower quadrant pain and signs like rebound tenderness.
2. Laboratory findings that support a diagnosis of appendicitis, such as elevated white blood cell count and CRP level.
3. The ultrasound technique for visualizing the appendix and criteria for a normal appendix versus findings indicative of appendicitis, including size, shape, compressibility and wall vascularity.
4. Potential pitfalls in ultrasound diagnosis like air in the appendix or lymphoid hyperplasia that can mimic appendicitis.
The liver is the largest solid organ located in the right upper quadrant of the abdomen. It is divided into eight segments based on vascular and biliary anatomy. The document describes the normal anatomy of the liver and common variations. It also discusses ultrasound techniques for imaging the liver and provides details on identifying different liver lesions including cysts, benign and malignant tumors, infections, and vascular anomalies on ultrasound scans.
This document provides information about ultrasound use in urology. It discusses the history of ultrasound in urology from 1963 onwards. It then covers basic ultrasound principles including modes, probes, imaging planes and documentation. Applications to the kidney, bladder, prostate and testes are described. Common abnormalities like hydronephrosis, cysts, masses and infections are outlined. In summary, the document is an overview of ultrasound techniques and their use in evaluating the urinary tract and common urologic conditions.
Presentation1, ultrasound of the bowel loops and the lymph nodes.AbdullahNazeerYassin
Ultrasonography is useful for evaluating bowel loops and abdominal lymph nodes. The normal bowel wall has 5 layers but only 2 are usually visible on ultrasound. Pathologies like hypertrophic pyloric stenosis, intramural duodenal hematoma, midgut volvulus, incarcerated hernia and various inflammatory conditions can be diagnosed using ultrasound. Acute appendicitis and its complications are also commonly evaluated. Ultrasound is helpful for assessing conditions like celiac disease, acute pancreatitis and focal acute bacterial nephritis.
Presentation1.pptx, ultrasound examination of the urinary bladder and prostate.Abdellah Nazeer
This document provides information on ultrasound examination of the urinary bladder and prostate. It begins with descriptions of normal ultrasound images of the bladder and prostate. It then discusses the role of ultrasound in assessing these structures. Common pathologies that can be identified include trabeculation, diverticula, calculi, ureterocele, infections, and cancers. Scanning techniques for bladder and prostate ultrasound are outlined. The document concludes with ultrasound images demonstrating various normal and abnormal findings of the bladder and prostate.
1. The document discusses the use of ultrasound imaging techniques for diagnosing bowel pathology in cases of acute abdomen. It outlines normal ultrasound appearances of the bowel and key signs of various diseases.
2. Dynamic ultrasound techniques like assessing peristalsis, compressibility, and the valsalva maneuver can provide additional diagnostic information. Focused scanning with high-frequency probes can aid in evaluating superficial lesions.
3. Ultrasound has benefits as a first-line imaging method due to its availability, low cost, and lack of radiation or contrast agents. With experience in ultrasound appearances of the bowel and careful technique, it can effectively evaluate abdominal complaints and guide management.
This document discusses the imaging techniques used to evaluate abdominal trauma, including plain radiography, ultrasound, CT scan, and their findings. It focuses on injuries to solid organs like the spleen, liver, pancreas and kidneys. For each organ, it describes typical injuries seen like lacerations, hematomas, active bleeding and their grading systems. CT scan is highlighted as the most sensitive modality for evaluating abdominal trauma and detecting injuries to retroperitoneal structures and blood vessels.
Radiological approach to gastric ulcer diseaseNavneet Ranjan
This document discusses barium meal (contrast x-ray) studies and their uses in evaluating gastrointestinal conditions. It notes that barium meals are now largely replaced by endoscopy but are still used when endoscopy is incomplete, confusing, or to better visualize certain morphological changes. It then describes the normal radiographic appearance of the stomach and discusses findings for conditions like acute gastritis, peptic ulcers, ulcer complications, and bleeding sites identified on scintigraphy scans.
The pancreas normally has a head, body, tail, and uncinate process. It develops from two anlagen that fuse during embryological development. The pancreatic duct typically drains the entire pancreas. Acute pancreatitis is diagnosed based on abdominal pain, elevated pancreatic enzymes, and imaging findings of pancreatic swelling, decreased echogenicity, and heterogeneity. Sonography can detect pancreatic enlargement, duct dilation, peripancreatic fluid collections, and decreased echogenicity in acute pancreatitis.
Ultrasonography is the most valuable imaging modality for evaluating the thyroid gland. It is a simple, non-invasive exam that allows visualization of the thyroid anatomy and assessment of focal lesions. Normal thyroid gland appears homogeneous and mildly hypoechoic relative to surrounding tissues, with few small blood vessels visible on Doppler. Common benign thyroid findings include nodules, colloid cysts, and inflammatory nodules from chronic thyroiditis. Malignant nodules tend to have irregular margins, microcalcifications, and increased vascularity but appearance alone is not definitive.
This document discusses acute scrotum imaging and provides information on various etiologies of acute scrotal pain including ischemia, infection, trauma, inflammation, hernia, and acute on chronic events. It describes ultrasound findings for conditions like testicular torsion, epididymitis, orchitis, hydrocele, hematocele, and Fournier's gangrene. Key points are made about Doppler ultrasound findings in torsion and the importance of prompt evaluation and treatment of acute scrotum to preserve testicular viability. Anatomy of the scrotum and imaging appearances of various acute pathologies are depicted through multiple ultrasound images.
Presentation1.pptx, radiological imaging of scrotal diseases.Abdellah Nazeer
This document provides an overview of radiological imaging of scrotal diseases. It begins with the anatomy of the scrotum and its layers. It then discusses congenital diseases like cryptorchidism, which is the absence of one or both testes from the scrotum. Cryptorchidism can occur if the testes fail to descend from the abdomen into the scrotum. The document presents various imaging examples of cryptorchidism showing undescended testes in the inguinal canal or abdomen. It also discusses inflammatory diseases, trauma, testicular torsion, masses, and other pathologies that can be imaged and evaluated radiologically.
Ultrasound renal stone differential diagnosis .AHMED ESAWY
renal sinus ultrasound
stone location in calyx
(not in medulla,not in cortex)
echogenic foci
acoustic shadowing
twinkle artifact on colour Doppler
color comet tail artifact
Staghorn calculi
Ultrasound beam-stone angle
Difference between kidney gravel & stone
RENAL ECHOCONCRETION
Vascular Reflectors (Normal or calcified renal vessels are the most
notable and common causes of intrarenal
bright echo reflectors)
Segmental Arteries
Arcuate Arteries
Sinus Vessels
renal vein thrombosis calcification
Calcifications of the branches of the renal artery
Nonvascular Reflectors: Prominent Papillae
Reflectors Within the Renal Parenchyma
Milk of Calcium Cysts
Renal Cortical Calcification
Junctional Parenchymal Line
Angiomyolipomas
Foreign Bodies
Bright echoes within the Renal Parenchyma
medullary nephrocalcinosis
focal pyelonephritis.
Echogenic tips of the renal pyramids apex
Transient pyramidal echogenicity
echogenic neonate renal pyramids (Tamm-Horsfall protein)
fungal balls
blood clots
Renal calcification in infants with Furosemid therapy
The document discusses the radiological anatomy of the scrotum, including normal gross anatomy, radiological anatomy using ultrasound and MRI, and various disorders. It covers the embryology of the scrotum and provides details on ultrasound assessment of the testis and epididymis, noting that testicular echogenicity and vascularity can help identify disorders. The role of ultrasound in testicular and scrotal trauma is also examined, alongside extratesticular scrotal masses. Diagrams and images are included to illustrate anatomical structures and various conditions.
This document discusses various radiological views of the nose and paranasal sinuses. It describes the Water's view, Caldwell view, lateral view, submentovertical view, and right and left vertical views. For each view, it provides details on the positioning of the patient and structures that can be seen. The Water's view shows the maxillary sinuses best while the Caldwell view shows the frontal sinuses best. X-rays are useful for examining nasal fractures, though modern digital imaging provides better resolution of bone and soft tissues.
This document provides an overview of abdominal CT scans, including terminology, anatomy, and examples of normal and pathological findings. It discusses how CT scans work, key anatomical structures visible in the abdomen, and techniques for interpreting scans. The document emphasizes that while clinicians can interpret basic CT findings, radiologists have specialized expertise, and clinical judgment is also needed to make diagnoses based on imaging results.
Imaging orchitis epidydmitis epidydmo orchitis
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound TRANSRECTAL ULTRASOUND images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
This document provides an overview of ultrasound imaging of the thyroid and neck region. It describes the ultrasound appearance and features of normal thyroid anatomy, common thyroid pathologies including nodules, thyroiditis, and lymph nodes. Details are given on imaging techniques, vascular anatomy, and pathologies of the parathyroid glands and salivary glands.
This document provides an overview of ultrasound for evaluating hernias. It describes the anatomy of the inguinal region and sites of common hernias. Inguinal hernias can be indirect or direct. Spigelian hernias occur along the spigelian fascia. Femoral hernias are located in the femoral canal. Linea alba hernias occur through the abdominal wall. Umbilical and incisional hernias also are reviewed. Ultrasound is useful for diagnosing hernia contents and complications like incarceration, obstruction, and strangulation. Findings suggestive of strangulation include hyperechoic fat, thickened sac walls, fluid within the sac, and
1. The document discusses ultrasound techniques for diagnosing acute appendicitis, including visualizing the normal appendix and primary and secondary signs of inflammation.
2. Primary ultrasound signs of acute appendicitis include an appendix diameter over 6mm, a target sign of hypoechoic center with hyper- and hypoechoic rings, tenderness over the appendix, lack of compressibility, and increased vascularity of the wall.
3. Secondary ultrasound signs include free fluid around the appendix, abscess formation, thickening of surrounding tissues, and signs of small bowel obstruction.
This document describes several radiological signs named after animal ears:
- The "mouse ear sign" describes bone erosions at finger joints resembling mouse ears.
- The "bladder ears" sign refers to normal protrusion of the bladder into the groin resembling ears.
- The "dog ear sign" identifies fluid in the pelvis separating from the bladder, resembling a dog's face and ear.
- The "rabbit ear sign" describes slit-like ventricles displaced inward, resembling a rabbit's ears.
Chest x-ray is a common imaging technique used to examine the lungs, heart and chest. It involves taking frontal and lateral x-ray images of the chest while the patient inspires fully. The x-ray must be carefully interpreted by following a problem-oriented approach and assessing key structures like the diaphragm, heart, mediastinum, lungs and thoracic cage. Other imaging techniques like CT, MRI, ultrasound and nuclear scans provide additional information in certain clinical settings. Common chest x-ray abnormalities include signs of airspace filling, collapse, masses, nodules and pleural effusions which indicate various underlying lung diseases.
Presentation1.pptx, ultrasound study of the spleen and pancreas.Abdellah Nazeer
This document provides an overview of ultrasound imaging of the spleen and pancreas. It describes the normal ultrasound appearance and measurements of the spleen and pancreas. Common pathological conditions are also discussed, including splenomegaly, cysts, hematomas, abscesses, and tumors. Accessory spleens, splenosis, wandering spleen, and variations such as small spleen and asplenia are also mentioned. For the pancreas, conditions such as lipomatosis, cysts, pseudocysts, serous and mucinous cystic neoplasms are reviewed. Imaging features of different pathological entities are demonstrated through ultrasound images.
This document provides an introduction to bowel ultrasound. It describes the normal ultrasound appearance of the gut layers from inside to outside and examples of pathologies that can be identified. Key points covered include:
- The normal gut signature appears as 5 echogenic or hypoechoic layers representing the mucosa, submucosa, muscularis propria, and serosa.
- Appendicitis can be diagnosed by assessing changes to the gut signature from preserved to lost layers as the inflammation progresses from catarrhal to gangrenous phases.
- Diverticulitis predominantly affects the muscularis propria layer while infectious enterocolitis affects the submucosa.
- Assessment of the bowel wall,
Testicular seminoma with lung and pleural metastases.
Findings:
- Chest X-ray: Multiple round well defined opacities ("cannon ball metastases") in both lungs with right sided pleural effusion.
- CT chest: Enhancing right testicular mass with multiple enhancing lung nodules and right pleural effusion.
Important differentials:
- Non seminomatous GCT (teratoma, embryonal cell carcinoma etc.)
- Lymphoma
- Metastatic disease from other primary
The document discusses appendicitis, including:
- The blood and lymph drainage of the appendix, supplied by the appendicular artery.
- The symptoms of appendicitis include colicky abdominal pain shifting to the right lower quadrant, fever, nausea and vomiting.
- The diagnosis is clinical, using tests like the Alvarado score, and may include ultrasound or CT scans.
- Treatment is usually an appendectomy, which can be open or laparoscopic. Complications include wound infections, intra-abdominal abscesses, and adhesive bowel obstructions. Rarely, appendicitis can be treated non-operatively with antibiotics.
1. The document discusses the use of ultrasound imaging techniques for diagnosing bowel pathology in cases of acute abdomen. It outlines normal ultrasound appearances of the bowel and key signs of various diseases.
2. Dynamic ultrasound techniques like assessing peristalsis, compressibility, and the valsalva maneuver can provide additional diagnostic information. Focused scanning with high-frequency probes can aid in evaluating superficial lesions.
3. Ultrasound has benefits as a first-line imaging method due to its availability, low cost, and lack of radiation or contrast agents. With experience in ultrasound appearances of the bowel and careful technique, it can effectively evaluate abdominal complaints and guide management.
This document discusses the imaging techniques used to evaluate abdominal trauma, including plain radiography, ultrasound, CT scan, and their findings. It focuses on injuries to solid organs like the spleen, liver, pancreas and kidneys. For each organ, it describes typical injuries seen like lacerations, hematomas, active bleeding and their grading systems. CT scan is highlighted as the most sensitive modality for evaluating abdominal trauma and detecting injuries to retroperitoneal structures and blood vessels.
Radiological approach to gastric ulcer diseaseNavneet Ranjan
This document discusses barium meal (contrast x-ray) studies and their uses in evaluating gastrointestinal conditions. It notes that barium meals are now largely replaced by endoscopy but are still used when endoscopy is incomplete, confusing, or to better visualize certain morphological changes. It then describes the normal radiographic appearance of the stomach and discusses findings for conditions like acute gastritis, peptic ulcers, ulcer complications, and bleeding sites identified on scintigraphy scans.
The pancreas normally has a head, body, tail, and uncinate process. It develops from two anlagen that fuse during embryological development. The pancreatic duct typically drains the entire pancreas. Acute pancreatitis is diagnosed based on abdominal pain, elevated pancreatic enzymes, and imaging findings of pancreatic swelling, decreased echogenicity, and heterogeneity. Sonography can detect pancreatic enlargement, duct dilation, peripancreatic fluid collections, and decreased echogenicity in acute pancreatitis.
Ultrasonography is the most valuable imaging modality for evaluating the thyroid gland. It is a simple, non-invasive exam that allows visualization of the thyroid anatomy and assessment of focal lesions. Normal thyroid gland appears homogeneous and mildly hypoechoic relative to surrounding tissues, with few small blood vessels visible on Doppler. Common benign thyroid findings include nodules, colloid cysts, and inflammatory nodules from chronic thyroiditis. Malignant nodules tend to have irregular margins, microcalcifications, and increased vascularity but appearance alone is not definitive.
This document discusses acute scrotum imaging and provides information on various etiologies of acute scrotal pain including ischemia, infection, trauma, inflammation, hernia, and acute on chronic events. It describes ultrasound findings for conditions like testicular torsion, epididymitis, orchitis, hydrocele, hematocele, and Fournier's gangrene. Key points are made about Doppler ultrasound findings in torsion and the importance of prompt evaluation and treatment of acute scrotum to preserve testicular viability. Anatomy of the scrotum and imaging appearances of various acute pathologies are depicted through multiple ultrasound images.
Presentation1.pptx, radiological imaging of scrotal diseases.Abdellah Nazeer
This document provides an overview of radiological imaging of scrotal diseases. It begins with the anatomy of the scrotum and its layers. It then discusses congenital diseases like cryptorchidism, which is the absence of one or both testes from the scrotum. Cryptorchidism can occur if the testes fail to descend from the abdomen into the scrotum. The document presents various imaging examples of cryptorchidism showing undescended testes in the inguinal canal or abdomen. It also discusses inflammatory diseases, trauma, testicular torsion, masses, and other pathologies that can be imaged and evaluated radiologically.
Ultrasound renal stone differential diagnosis .AHMED ESAWY
renal sinus ultrasound
stone location in calyx
(not in medulla,not in cortex)
echogenic foci
acoustic shadowing
twinkle artifact on colour Doppler
color comet tail artifact
Staghorn calculi
Ultrasound beam-stone angle
Difference between kidney gravel & stone
RENAL ECHOCONCRETION
Vascular Reflectors (Normal or calcified renal vessels are the most
notable and common causes of intrarenal
bright echo reflectors)
Segmental Arteries
Arcuate Arteries
Sinus Vessels
renal vein thrombosis calcification
Calcifications of the branches of the renal artery
Nonvascular Reflectors: Prominent Papillae
Reflectors Within the Renal Parenchyma
Milk of Calcium Cysts
Renal Cortical Calcification
Junctional Parenchymal Line
Angiomyolipomas
Foreign Bodies
Bright echoes within the Renal Parenchyma
medullary nephrocalcinosis
focal pyelonephritis.
Echogenic tips of the renal pyramids apex
Transient pyramidal echogenicity
echogenic neonate renal pyramids (Tamm-Horsfall protein)
fungal balls
blood clots
Renal calcification in infants with Furosemid therapy
The document discusses the radiological anatomy of the scrotum, including normal gross anatomy, radiological anatomy using ultrasound and MRI, and various disorders. It covers the embryology of the scrotum and provides details on ultrasound assessment of the testis and epididymis, noting that testicular echogenicity and vascularity can help identify disorders. The role of ultrasound in testicular and scrotal trauma is also examined, alongside extratesticular scrotal masses. Diagrams and images are included to illustrate anatomical structures and various conditions.
This document discusses various radiological views of the nose and paranasal sinuses. It describes the Water's view, Caldwell view, lateral view, submentovertical view, and right and left vertical views. For each view, it provides details on the positioning of the patient and structures that can be seen. The Water's view shows the maxillary sinuses best while the Caldwell view shows the frontal sinuses best. X-rays are useful for examining nasal fractures, though modern digital imaging provides better resolution of bone and soft tissues.
This document provides an overview of abdominal CT scans, including terminology, anatomy, and examples of normal and pathological findings. It discusses how CT scans work, key anatomical structures visible in the abdomen, and techniques for interpreting scans. The document emphasizes that while clinicians can interpret basic CT findings, radiologists have specialized expertise, and clinical judgment is also needed to make diagnoses based on imaging results.
Imaging orchitis epidydmitis epidydmo orchitis
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound TRANSRECTAL ULTRASOUND images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
This document provides an overview of ultrasound imaging of the thyroid and neck region. It describes the ultrasound appearance and features of normal thyroid anatomy, common thyroid pathologies including nodules, thyroiditis, and lymph nodes. Details are given on imaging techniques, vascular anatomy, and pathologies of the parathyroid glands and salivary glands.
This document provides an overview of ultrasound for evaluating hernias. It describes the anatomy of the inguinal region and sites of common hernias. Inguinal hernias can be indirect or direct. Spigelian hernias occur along the spigelian fascia. Femoral hernias are located in the femoral canal. Linea alba hernias occur through the abdominal wall. Umbilical and incisional hernias also are reviewed. Ultrasound is useful for diagnosing hernia contents and complications like incarceration, obstruction, and strangulation. Findings suggestive of strangulation include hyperechoic fat, thickened sac walls, fluid within the sac, and
1. The document discusses ultrasound techniques for diagnosing acute appendicitis, including visualizing the normal appendix and primary and secondary signs of inflammation.
2. Primary ultrasound signs of acute appendicitis include an appendix diameter over 6mm, a target sign of hypoechoic center with hyper- and hypoechoic rings, tenderness over the appendix, lack of compressibility, and increased vascularity of the wall.
3. Secondary ultrasound signs include free fluid around the appendix, abscess formation, thickening of surrounding tissues, and signs of small bowel obstruction.
This document describes several radiological signs named after animal ears:
- The "mouse ear sign" describes bone erosions at finger joints resembling mouse ears.
- The "bladder ears" sign refers to normal protrusion of the bladder into the groin resembling ears.
- The "dog ear sign" identifies fluid in the pelvis separating from the bladder, resembling a dog's face and ear.
- The "rabbit ear sign" describes slit-like ventricles displaced inward, resembling a rabbit's ears.
Chest x-ray is a common imaging technique used to examine the lungs, heart and chest. It involves taking frontal and lateral x-ray images of the chest while the patient inspires fully. The x-ray must be carefully interpreted by following a problem-oriented approach and assessing key structures like the diaphragm, heart, mediastinum, lungs and thoracic cage. Other imaging techniques like CT, MRI, ultrasound and nuclear scans provide additional information in certain clinical settings. Common chest x-ray abnormalities include signs of airspace filling, collapse, masses, nodules and pleural effusions which indicate various underlying lung diseases.
Presentation1.pptx, ultrasound study of the spleen and pancreas.Abdellah Nazeer
This document provides an overview of ultrasound imaging of the spleen and pancreas. It describes the normal ultrasound appearance and measurements of the spleen and pancreas. Common pathological conditions are also discussed, including splenomegaly, cysts, hematomas, abscesses, and tumors. Accessory spleens, splenosis, wandering spleen, and variations such as small spleen and asplenia are also mentioned. For the pancreas, conditions such as lipomatosis, cysts, pseudocysts, serous and mucinous cystic neoplasms are reviewed. Imaging features of different pathological entities are demonstrated through ultrasound images.
This document provides an introduction to bowel ultrasound. It describes the normal ultrasound appearance of the gut layers from inside to outside and examples of pathologies that can be identified. Key points covered include:
- The normal gut signature appears as 5 echogenic or hypoechoic layers representing the mucosa, submucosa, muscularis propria, and serosa.
- Appendicitis can be diagnosed by assessing changes to the gut signature from preserved to lost layers as the inflammation progresses from catarrhal to gangrenous phases.
- Diverticulitis predominantly affects the muscularis propria layer while infectious enterocolitis affects the submucosa.
- Assessment of the bowel wall,
Testicular seminoma with lung and pleural metastases.
Findings:
- Chest X-ray: Multiple round well defined opacities ("cannon ball metastases") in both lungs with right sided pleural effusion.
- CT chest: Enhancing right testicular mass with multiple enhancing lung nodules and right pleural effusion.
Important differentials:
- Non seminomatous GCT (teratoma, embryonal cell carcinoma etc.)
- Lymphoma
- Metastatic disease from other primary
The document discusses appendicitis, including:
- The blood and lymph drainage of the appendix, supplied by the appendicular artery.
- The symptoms of appendicitis include colicky abdominal pain shifting to the right lower quadrant, fever, nausea and vomiting.
- The diagnosis is clinical, using tests like the Alvarado score, and may include ultrasound or CT scans.
- Treatment is usually an appendectomy, which can be open or laparoscopic. Complications include wound infections, intra-abdominal abscesses, and adhesive bowel obstructions. Rarely, appendicitis can be treated non-operatively with antibiotics.
Intussusception in Adults-Submucosal Lipoma at Transverse colon-A rare causeDr.Santosh Atreya
This document discusses a rare case of lipoma at the transverse colon causing intussusception in an adult. It begins with an introduction to colonic lipomas and intussusception, noting that lipomas are a rare cause of adult intussusception. The document then covers the etiology, epidemiology, clinical presentation, radiological features, and management of adult intussusception caused by colonic lipomas. Key points include that adult intussusception is usually caused by a focal lesion acting as a lead point, and surgical removal of the lead point is typically required for treatment.
The spleen is located in the left upper quadrant of the abdomen. It filters blood and fights infections. The spleen develops from embryonic tissue and is supplied by the splenic artery and drained by the splenic vein. It can vary in size and shape. Accessory spleens are common. Injuries from trauma are most often seen in the spleen. Conditions like infections, cancers, blood disorders can cause abnormalities. Imaging with ultrasound, CT scan, MRI and nuclear medicine scans are used to evaluate the spleen.
This document discusses a case of intussusception in an adult patient presenting with vomiting and abdominal pain. An abdominal CT scan found the characteristic "target" appearance of intussusception on axial images and a "sausage-shaped bowel mass" on coronal images, allowing the radiologist to make a diagnosis of intussusception. CT is identified as the most accurate imaging modality for identifying intussusception in adults.
The chest x-ray shows a soft tissue mass along the right mediastinal border behind the heart. There is no gastric air bubble seen below the left hemidiaphragm. These findings suggest a mediastinal mass, such as a mediastinal gastric duplication cyst, causing compression of the esophagus and absence of the gastric air bubble. Differential diagnoses include mediastinal tumor or lymphadenopathy.
The document provides information on performing and interpreting abdominal x-rays, including technical factors, indications, normal anatomy and abnormalities. Key points include: technical factors like patient positioning, exposure settings and coverage area; indications like bowel obstruction or acute abdomen; normal bowel gas patterns and organ appearances; and signs of abnormalities like pneumoperitoneum, calcifications or enlarged organs. The document also describes different views used for an acute abdomen protocol and what each view aims to show.
The spleen is responsible for filtering blood and mounting immune responses. Indications for splenectomy include trauma, idiopathic thrombocytopenic purpura refractory to steroids, and hematological conditions causing abnormal red blood cell morphology. Splenectomy may be performed open or laparoscopically and indications include trauma, hematological diseases, neoplasms, and spontaneous rupture. Complications include infection, bleeding, and thrombocytosis.
common surgical problem in pediatrics done.pptxpapurva49
This document discusses several common surgical problems in children. It begins by explaining the need for pediatricians to have knowledge of these conditions. It then lists and provides brief overviews of various issues such as cleft lip/palate, gastroesophageal reflux disease, Hirschsprung's disease, intestinal malformations, hernias, and genitourinary problems. For several conditions, it describes symptoms, investigations, management, and associated abnormalities. Throughout, it includes diagrams and images to illustrate key points.
This document discusses the role of imaging in evaluating patients presenting with an acute abdomen. It begins by defining an acute abdomen and describing the nonspecific clinical presentation. Potential causes are categorized as self-limiting, life-threatening, or surgical vs. nonsurgical. The role of imaging is to help determine if surgery is needed and to narrow the differential diagnosis. Imaging modalities discussed include plain radiography, ultrasound, CT scan, and others. The document then reviews how different modalities can help evaluate for specific common acute abdominal conditions like appendicitis, cholecystitis, and diverticulitis. It also describes signs to screen for on imaging like free air, free fluid, bowel wall thickening, and ileus.
1) The appendix is a worm-like structure extending from the cecum that can become inflamed due to obstruction, known as appendicitis.
2) Appendicitis is usually caused by a fecalith obstructing the appendiceal lumen and is diagnosed through physical exam findings and imaging.
3) Treatment involves antibiotics for uncomplicated cases or an appendectomy to remove the inflamed appendix for complicated cases.
The document discusses the acute abdomen and various imaging modalities used to evaluate it. It covers:
1) The causes of acute abdomen including perforation, obstruction, inflammation and others.
2) The imaging modalities used including plain films, ultrasound, CT and their roles in evaluating specific causes.
3) How different conditions present on imaging including bowel obstruction, perforation, appendicitis and others.
Small intestine/Intestinal obstruction/crohns disease/ileostomy/viscous organ...RajeevPandit10
all about small intestine, anatomy, physiology, intestinal obstruction, crohns disease/ileostomy/viscous organ perforation, meckels diverticulum, mysenteric ischemia, short bowel syndrome, celiac disease
Spigelian hernia is a rare type of hernia that occurs in the Spigelian fascia of the abdominal wall. It was first described in the 17th century by Adriaan van den Spiegel. Spigelian hernias account for about 1% of all ventral hernias. They most commonly occur in adults ages 40-70 and present with pain. Diagnosis can be challenging as physical exam may not reveal a bulge. Imaging like ultrasound or CT can help identify the hernia defect. Treatment options include open herniorrhaphy or laparoscopic repair with mesh. Laparoscopy is preferred to minimize morbidity and allow for treatment of other hernias if present. Recurrence after
This document provides information on various radiology procedures including aspirations, drainages, and biopsies. It describes how cyst aspirations are performed using ultrasound guidance to insert a needle and drain fluid from cysts in the breast or elsewhere. It also discusses paracentesis for draining ascites and thoracocentesis for draining pleural effusions. The document outlines patient positioning and technical steps for each procedure. Biopsy procedures are also summarized, including how ultrasound is used to precisely guide needle placement and obtain tissue samples from organs like the liver and kidneys.
Abdominal Imaging Case Studies #27.pptxSean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
• Iatrogenic Esophageal Perforation
• Emphysematous Cystitis
• Meckel’s Diverticulum
• Paraesophageal Hernia
1) The document discusses various imaging modalities used to diagnose conditions that present with acute abdomen such as abdominal pain, including plain radiography, ultrasound, CT, and MRI.
2) Common causes of acute abdomen discussed include appendicitis, diverticulitis, cholecystitis, small bowel obstruction, mesenteric lymphadenitis, epiploic appendagitis, urolithiasis, ruptured aneurysm, and acute pancreatitis.
3) Imaging findings for diagnosing these conditions are provided, with ultrasound and CT noted as important first-line tests to identify the cause of acute abdomen and exclude serious complications.
Basic principles of ultrasound.
Terms used in ultrasound.
Advantages of ultrasound.
Definition of acute abdomen.
Differential Diagnosis.
Abdominal ultrasound technique.
USG findings in most common pathologies.
Conclusion.
This document discusses the diagnosis of abdominal tuberculosis through imaging. It provides details on the pathological spectrum of abdominal TB and its clinical presentations. Key findings on imaging investigations like ultrasound, barium studies, CT and MRI are described. These include lymphadenopathy, bowel wall thickening, ascites, omental thickening and mesenteric involvement. Imaging plays an important role in the diagnosis of abdominal TB and distinguishing it from other conditions.
Similar to Role of ultrasound in right iliac fossa pain (20)
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
3. Introduction
■ Initial assessment is performed with a curvilinear (5-7 MHz) probe to look at the solid
organs, gallbladder, biliary tree and the pelvic viscera.
■ Once a general survey has been carried out, a more targeted assessment of the right
iliac fossa can be performed. The bowel is usually interrogated with both a curvilinear
and a high-resolution linear probe (9-12 MHz).
■ In our practice, we start in the right upper quadrant with the curvilinear probe, and
trace the colon down from the hepatic flexure to the caecal pole, using graded
compression sonography. The linear probe should be routinely used to scrutinise
suspicious regions
■ When normal bowel is compressed, the intra-luminal gas is displaced away and
peristaltic activity can be visualised. In contrast, abnormal bowel has a striking
appearance showing no peristalsis and does not alter with compression.
4. Appendicitis
■ The normal appendix is a thin-walled, compressible blind ending tubular structure,
arising from the posteromedial aspect of the caecum where the taenia coli
converge.
■ It usually measures 4 mm in diameter and 8 cm in length.
■ Inflammation of the appendix occurs secondary to obstruction of the appendiceal
lumen. Continued mucous secretion causes dilation of the appendix and increased
intraluminal pressure, compromising venous return and causing eventual necrosis.
■ The classical history for appendicitis is a patient presenting with central umbilical
pain that moves to the right iliac fossa.
■ On examination, the patient has signs of localized peritonism in the right iliac
fossa. Blood tests often demonstrate a mildly raised white cell count and CRP.
5. ■ Ultrasound examination has been found to be most specific if performed using the
graded compression technique, which involves applying slowly increasing pressure
with a high-frequency transducer over the region of maximal tenderness.
■ The sonographic features of acute appendicitis are visualisation of an aperistaltic,
thick-walled, blind-ending, tubular structure with a diameter >6 mm with
compression.
■ The presence of an appendicolith with posterior acoustic shadowing is a specific
feature but not seen in all cases.
■ However, the only sonographic sign may be echogenic fat within the right iliac
fossa. This is non-specific and indicates inflammation in the right iliac fossa.
■ If this is found in isolation, then further imaging with either CT or MRI is advised to
further assess. If the appendix has perforated, a pericaecal fluid collection or even
a discontinuity in the wall of the appendix may be demonstrated.
6.
7.
8. Crohn’s disease: terminal ileitis
■ Crohn’s disease is a chronic inflammatory disorder of the gastrointestinal tract.
The terminal ileum and colon are most commonly affected, but any part of the
gastrointestinal tract may be involved.
■ The disease is characterised by full thickness bowel wall inflammation with
aphthous ulcers, deep fissures and luminal narrowing.
■ Ultrasound has an important role in the imaging of both acute exacerbations and
long-term follow-up of the disease.
■ Ultrasound is a sensitive, non-invasive imaging modality which does not involve the
use of ionising radiation. This is particularly relevant in the young populations
frequently affected.
9. ■ Sonographic features of acute Crohn’s disease include concentric mural thickening
involving a long segment of terminal ileum with decreased peristalsis.
■ The wall echogenicity varies dependent on the activity of disease. Typically, there is
exaggeration of the stratified layers of the gut wall. Echogenic inflamed fat may be
seen ‘creeping’ over the wall with adjacent separation of bowel loops, and enlarged
mesenteric nodes.
■ Hyperaemia may be observed on Doppler in active disease and careful assessment
should be made to look for evidence of localised complications such as fistula,
abscess or obstruction.
10.
11. Right-sided diverticulitis
■ Right-sided disease is known to affect a younger population. The aetiology of true
right-sided diverticular disease is uncertain.
■ In acute right-sided diverticulitis, the clinical presentation is usually
indistinguishable from acute appendicitis.
■ On ultrasound, the inflamed diverticulum is seen as an out-pouching arising from
the right colon, containing either fluid or a faecolith, surrounded by echogenic
inflamed fat. Some studies have shown ultrasound to have a similar diagnostic
accuracy to CT imaging.
■ Recognising this condition is crucial as this can usually be managed
conservatively with intravenous antibiotics and settles without surgery.
12.
13. Caecal tumour
■ In the older patient population, who present with acute right iliac fossa pain, an
important diagnosis to consider is an underlying obstructing caecal tumour at the
base of the appendix, presenting as acute appendicitis.
■ Alternatively, the caecal tumour may itself be the primary diagnosis due to
localised tumour perforation or peritoneal infiltration.
■ On ultrasound, neoplastic thickening usually involves a short segment of bowel
with disruption of the gut wall layers.
■ The bowel wall typically appears solid and hypoechoic. If a solid mass is identified
within the right colon on ultrasound, then CT is recommended to further assess.
■ CT will provide more information on the nature of thickening, stage of the tumour
and help determine optimum management for the patient
14.
15.
16. Intussusception
■ Intussusception is the telescopic invagination of a segment of bowel, intussusceptum,
into a segment of more distal bowel, intussuscipiens.
■ Presenting features include pain and vomiting (90%) and in 60% of paediatric cases
blood per rectum (‘redcurrant stool’). A palpable mass may also be felt. Although an
intussusception can occur at any point in the ileum or colon, the most common type in
children is ileocolic (>75%), where a segment of terminal ileum invaginates into the
caecum.
■ A prompt diagnosis is particularly important to make in a paediatric patient, as the aim
is to avoid vascular compromise of the bowel secondary to strangulation of the
mesentery.
■ This is in contrast to adult patients, where the condition can be a transient self-limiting
phenomenon.
17. ■ Ultrasound is the initial investigation of choice, with high sensitivity and specificity
of between 98–100% and 88–100%, respectively.
■ The classical sonographic finding in the transverse plane is a ‘target’ or ‘doughnut’
sign.
■ This is the result of concentric hypoechoic and hyperechoic rings (representing the
intussuscipiens), with a central more echogenic portion (representing the inflamed
mesentery or the intussusceptum).
■ In the longitudinal plane, the same representation is seen in long section and has
been described as a ‘sandwich’ or ‘hayfork’ sign. These sonographic findings are
highly specific for intussusception.
18.
19. Ovarian torsion
■ Ovarian torsion occurs when there is twisting of the vascular pedicle of the ovary,
fallopian tube or both. This can result in ischaemia, and ultimately infarction of
these structures.
■ Sonographic features include a unilateral, uniformly enlarged ovary containing
multiple small peripheral ovarian follicles measuring 8–12 mm in diameter,
reflecting congestion of the ovary . This sign is specific but not very sensitive.
■ Colour and pulse wave Doppler assessment is important as absence of Doppler
flow within the ovary may be demonstrated in torsion. Typically, there is initial loss
of the venous flow, followed by absence of both arterial and venous flow.
■ The whirlpool sign represents the twisted vascular pedicle of the ovary and is a
definitive sign of torsion.
20.
21. Haemorrhagic ovarian cyst
■ Functional cysts such as follicular cysts and corpus luteum cysts have the potential
to develop internal haemorrhage.
■ In cases of mimicked appendicitis, typical appearances include a single unilateral
cyst of the right ovary with internal echoes but no internal Doppler flow.
■ In the acute stage, a ‘fishnet weave’ pattern or lacelike reticular pattern is often
seen. Clot may adhere to the cyst wall and this can resemble papillary projections
seen in neoplastic processes; importantly in a benign haemorrhagic cyst these will
not demonstrate blood flow.
22. ■ Haemorrhagic ovarian cysts usually resolve spontaneously and a repeat ultrasound
scan performed in 6–8 weeks will commonly show involution of the cyst.
■ Premenopausal patients with cysts measuring greater than 5 cm in maximum
diameter and early postmenopausal patients with cysts of any size should be
followed up at 6 weeks.
■ In late postmenopausal women, findings consistent with a haemorrhagic cyst
should be considered neoplastic until proven otherwise and should be referred to a
gynaecologist for further investigation including Ca125 levels and an MRI to
further characterise the lesion.
23.
24. Ectopic pregnancy +/- rupture
■ Confirmation of an intrauterine pregnancy virtually excludes the diagnosis of an
ectopic pregnancy.
■ There are a number of corroborating findings that can also support the diagnosis
of an ectopic pregnancy.
■ These include a complex adnexal mass with the ovary identified separately or a
tubal ring sign – an echogenic rim surrounding an unruptured ectopic pregnancy
with striking hyperaemia on colour Doppler assessment – may be seen.
■ This is commonly referred to as the ‘ring of fire’ sign. Free fluid in the pelvis is a
common finding and can often represent complex haemorrhagic ascites.
■ An ectopic pregnancy is a gynaecological emergency and ultrasound examination
should be performed in conjunction with prompt referral to the gynaecology team.
25.
26. Pyosalpinx
■ In a pyosalpinx, the fallopian tube is filled with pus. Patients present with acute
lower abdominal pain as well as elevated inflammatory markers and white cell
count.
■ The sonographic findings are a convoluted tubular structure with an echogenic
wall, representing the dilated tube; a fluid-fluid level representing pus or blood can
sometimes be seen.
■ The ovary should be visualised as a separate structure. Dependent on the clinical
situation, patients are often treated with intravenous antibiotics in the first
instance, with surgery reserved for more complex cases or those that do not
improve
27.
28. Vesicoureteric junction stone
■ The ureter is relatively narrow at three points: the pelviureteric junction (PUJ),
where the ureter crosses the common iliac vessels and at the vesicoureteric
junction (VUJ); and it is at these sites calculi are most likely to become lodged.
■ If a partial or complete obstruction occurs, it can result in renal colic – acute and
severe spasmodic flank pain, which can radiate to the groin or pelvic area.
29. ■ A non-contrast low-dose CT examination is now the gold standard investigation for
the investigation of renal calculi. However, due to the variable presentation,
ultrasound can often be the first investigation in these patients.
■ A calculus at the VUJ will be seen as a well-defined echogenicity with posterior
acoustic shadowing. The ipsilateral ureteric jet, seen using colour Doppler, will be
absent in cases of complete obstruction or reduced in partial obstruction.
■ If there is resultant hydroureter and hydronephrosis, this can also be appreciated.
30.
31. Adrenal haemorrhage
■ This is most commonly seen in neonates but can present in adults following
trauma, acute physiological stress and in patients who are anticoagulated or who
have a coagulopathy.
■ On ultrasound, a complex echogenic mass is seen superior to and separate from
the upper pole of the kidney. The pelvis and paracolic region should be imaged for
free fluid.
■ The contralateral side should be carefully interrogated as in cases of bilateral
haematomas, there is the potential for the development of adrenal insufficiency.
■ Diagnosis can be confirmed on CT imaging, which will reveal a high-density,
enlarged adrenal gland.
32.
33. Pyelonephritis
■ Ultrasound is not a sensitive imaging modality for pyelonephritis with over 50% of
scans having normal appearances.
■ In the diffuse form, the kidney may be enlarged and appear hypoechoic, with
surrounding hyperechoic fat due to inflammation. The corticomedullary
differentiation may also be blurred.
■ In focal pyelonephritis the findings are similar, but the areas of abnormal renal
parenchyma are separated by normal parenchyma.
■ Patients are treated conservatively with intravenous antibiotics. Careful inspection
of the collecting system should be made to assess for pyonephrosis, which is seen
as low-level echoes within the collecting system, as this may warrant drainage of
the collecting system.
34.
35. Omental infarction
■ This is a rare cause of acute abdominal pain that results from vascular
compromise of a focal area of the greater omentum.
■ In cases of Primary omental infarction, the right iliac fossa is the most common
site of pain. This is thought to be due to the more tenuous nature of blood supply of
the right lateral free omental edge and the tendency of veins to kink deep within
the anterior pelvis, particularly on the right side. It may also occur in
hypercoagulable states.
■ Secondary omental infarction may occur in trauma, surgical intervention or
inflammation.
36. ■ Sonographic findings include a well-defined focal area of increased echogenicity,
which is not related to any solid abdominal organ with absent Doppler flow within.
■ The adjacent bowel is usually spared, although rarely a degree of wall thickening
may be seen.
■ A definitive diagnosis is difficult to make on clinical findings and ultrasound
imaging alone, and further cross-sectional imaging is usually required.
■ Management is usually conservative, although it is important to be aware of
potential complications such as abscess formation.
37.
38. Rectus sheath haematoma
■ It is the result of a direct tear to the rectus muscles or following damage to the
superior or inferior epigastric arteries or their branches.
■ On clinical examination, Carnett’s sign – unchanged or increase in abdominal pain
upon tensing of the abdominal muscles – may be elicited, which points towards
pathology within the abdominal wall rather than an intra-abdominal cause.
■ Most commonly, a well-defined echogenic area within the rectus muscle is seen. It
is important to recognise the extraperitoneal location, which should help to direct
towards the correct diagnosis and exclude other causes of abdominal pain.
39.
40. Conclusion
■ By following a systematic approach, it is possible to detect a number of sensitive
sonographic findings that can aid diagnosis in the patient presenting with right
iliac fossa pain.
■ Ultrasound is a dynamic test which distinguishes it from other cross-sectional
techniques and additionally it helps to limit exposure to ionising radiation, which is
particularly important when managing conditions that commonly affect a young
population.
41. References
■ Seeing past the appendix: the role of ultrasound in right iliac fossa pain
White EK, MacDonald L, Johnson G and Rudralingham V
Ultrasound 2014; 22: 104–112. DOI: 10.1177/1742271X13514385