This document contains information on various ultrasound findings including: 1. Intracapsular rupture of a breast implant seen as the "stepladder sign" of multiple parallel linear echoes within the implant lumen. 2. Strangulated umbilical hernia seen as inflammation and edema in herniated fat and gut suggesting vascular compromise. 3. Aggressive periosteal reaction on bone seen as interrupted lamellated or "onion skin" patterns indicating rapid bone formation from infection or malignancy. 4. Diverticulitis seen as focal fat stranding next to a colonic diverticulum with possible fluid or gas locules.

1. Dr Arun Gupta
Director imaging
Dr Rakhee gupta
Dr Vinayak Mittal
Dr Niharika Mahajan
Dr Gaurav Sharma
Dr Ritesh Mahajan
ADVANCED
USG
LOUNGE

2. ULTRASOUND IMAGE GALLARY
 INTRACAPSULAR RUPTURE OF BREAST
IMPLANT .
 STRANGULATED UMBILICAL HERNIA
 DIVERTICULITIS.
 AGGRESSIVE PERIOSTEAL REACTION ON
USG .
 ECTOPIC FETAL KIDNEY.
 EJACULATORY DUCT CYST.

3. BREAST IMPLANT RUPTURE
( INTRACAPSULAR)
STEP LADDER SIGN
ON ULTRASOUND IN CASE OF
INTRACAPSULAR
BREAST IMPLANT RUPTURE

4. Breast implant ruptures are a recognized complication of a breast
implant. It can be intra- or extracapsular.
Pathology
After implantation of a silicone or saline breast implant, a fibrous
capsule (scar) forms around the implant shell. Implant ruptures may be
intracapsular(~85%) or extracapsular (~15%) .
Intracapsular rupture
An intracapsular rupture occurs when the shell of the implant ruptures
but the fibrous capsule formed by the breast remains intact. Silicone
does not freely extravasate.This makes it difficult to detect on clinical
exam or mammography. Intracapsular rupture is best seen on MRI.
Extracapsular rupture
An extracapsular rupture can lead to a change in the implant contour
and may be detected on clinical examination or mammography. An
extracapsular rupture implies intracapsular rupture as well.

5. The stepladder sign is a
sonographic sign indicating an intra-
capsular breast implant rupture. It is
considered the most reliable
ultrasonographic finding in silicone
gel breast implant intra-capsular
rupture. It is identified as multiple,
discontinuous, parallel, linear echoes
in the lumen, and is analogous to
the linguine sign at MRI.
Normal
Contour/ core
Of the implant

6. Multiple,
discontinuous,
parallel, linear
echoes in the
lumen of the
breast implant

7. STRANGULATED
UMBILICAL HERNIA

8. There is a mechanical bowel
obstruction associated with the
hernia and/or if there is evidence
of strangulation, i.e. constriction to
the vascular supply of the hernial
sac contents at the level of the
neck. In this case there is
apparent inflammation in the
herniated fat strongly suggesting
that strangulation is present.
Hernia sac with gut as content
• Mural edema appreciated in
gut .
• Inflammation in the sac
contents appreciated
• Sac contents are irreducible
on probe insinuation

9. PERIOSTEAL REACTION
ON USG ( AGGRESSIVE)
Periosteal reaction, also known as
a periostitis/periosteitis, is a non
specific radiographic finding that
occurs with periosteal irritation.
Periosteal reactions may be broadly
characterized as benign or
aggressive, or more specifically
broken down by pattern.

10. Benign periosteal reaction
Low-grade chronic irritation allows time for the
formation of normal or near-normal cortex. The
cortex will be thick and dense and have a wavy or
uniform appearance.
Benign periosteal reactions can be seen in callus
formation in a fracture or with slowly growing
tumours.
Aggressive periosteal reaction
Rapid irritative processes do not allow the
periosteum time to lay down and consolidate new
bone to form normal cortex. The cortex may appear
lamellated, amorphous, or sunburst-like.
Aggressive periosteal reactions can not only be
seen with malignant tumours, but also with more
benign processes like infection , eosiophilic
granuloma , ABC , osteoid osteoma and trauma .

11. Cortical break
PERIOSTEAL REACTION
Interrupted / onion skin type
Periosteal reaction ( aggressive)

13. DIVERTICULITIS
Diverticulitis is one of the
presentations of diverticular
disease and is most often a
complication of colonic diverticulosis.

14. On imaging, a non-complicated
diverticulitis is characterised by a
focal fat stranding adjacent to a
colonic diverticulum, usually the
sigmoid. A small amount of
extraluminal fluid and gas locules
may be present.
DIVERTICULA
APPRECIATED AS OUTPOUCHING
WITH ASSOCIATED
REACTIONARY INFLAMMATORY
STRANDING SEEN AS INCREASED
ECHOGENICITY OF THE ADJACENT
PERIDIVERTICULAR FAT PLANES .

15. FETAL PELVIC KIDNEY

16. FETAL PELVIC KIDNEY
Fetal kidneys
Migrate to renal fossa after
crossing the
Arterial fork formed from the
Umbilical arteries .
Sometimes these kidneys fail to
Cross this arterial fork
And remain in pelvis only close
to
Common iliac arteries .
This process of ascent is
completed by 10wks
Hence diagnosis of the fetal
pelvic kidney
Can be made as early as in first
trimester also .

17. EJACULATORY DUCT
ECTASIA

18. DILATED EJACULATORY DUCT

19. REFERENCE
DIAGNOSTIC
ULTRASOUND
FOURTH EDITION
Carol M. Rumack, MD, FACR
J. William Charboneau, MD, FACR
Deborah Levine, MD, FACR
Ultrasound of Congenital
Fetal AnomaliesDifferential
Diagnosis and Prognostic
Indicators
Dario Paladini MD
Head, Fetal Cardiology Unit
Department of Obstetrics and
GynecologyUniversity Federico II
of NaplesNaplesItaly
Paolo Volpe MD
Head, Fetal Medicine Unit
Department of Obstetrics and
GynecologyHospital Di Venere
Bari