Archive for the ‘ultrasound’ Category
Required element in a complete >14wk OB ultrasound report.
2 categories: vascular tumors or vascular malformations. Distinction determines therapy.
- infantile hemangiomas: grow rapidly after birth, GLUT1+
- congenital hemangiomas (RICH and NICH): fully mature at birth, GLUT1-
- Tufted angioma
- Kaposiform hemangioendothelioma
- Spindle cell hemangioendotheliomas
- Dermatologic acquired vascular tumors
Vascular malformations (slow)
- capillary malformation (port-wine stain, telangiectasia, angiokeratoma)
- venous malformation
- lymphatic malformation
Vascular malformations (fast)
- arterial malformation
- arteriovenous fistula
- arteriovenous malformation
Discrim. Zone = 1500
3 weeks LMP: 5 – 50 mIU/ml
4 weeks LMP: 5 – 426 mIU/ml
5 weeks LMP: 18 – 7,340 mIU/ml
6 weeks LMP: 1,080 – 56,500 mIU/ml
7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
9 – 12 weeks LMP: 25,700 – 288,000 mIU/ml
13 – 16 weeks LMP: 13,300 – 254,000 mIU/ml
17 – 24 weeks LMP: 4,060 – 165,400 mIU/ml
25 – 40 weeks LMP: 3,640 – 117,000 mIU/ml
Non-pregnant females: <5.0 mIU/ml
Postmenopausal females: <9.5 mIU/ml
- MC is Bochdalek hernia
- MC left side
- diagnosed at prenatal US, follow with MRI
- up to 50% mortality
- 50% have CHD
- most have malrotation
- Acute pyelonephritis
- Renal vein thrombosis
- Acute glomerulonephritis
- Lupus nephritis
- Acute/Chronic Glomerulonephritis
- Acute tubular necrosis
- Medullary nephrocalcinosis
- Renal pyramidal fibrosis
Cortical and Medullary:
- Chronic Plyeonephritis
- Chronic Glomerulonephritis
- Renal Vein thrombosis
- Classic Triad of symptoms: irregular mestrual bleeding, pain, palpable adnexal mass
- gestational sac seen only if bHCG greater than 2000 IU/L
- Location: fallopian tubes (95%), in ampullary or isthmus
- heterotopic pregnancy 1 in 7000 pregnancies.
- prior infection
- developmental defects or prior tubal surgery
- ovulation-inducing agents
- prior ectopic
- normal or thickened endometrial lining
- look for IUP (gestational sac with yolk sac and DDS sign)
- extrauterine embryo with positive heart motion (100% PPV)
- adnexal mass containing a yolk sac or nonliving embryo (100%)
- Ring of Fire = “tubal” or “adnexal” ring surrounding a fluid collection (95%)
- Complex or solid adnexal mass (no embryo, yolk sac, or tubal ring) (92%)
- intraperitoneal fluid
distinguish ectopic from corpus luteal cyst:
- less vascularity
- intra-ovarian vs para-ovarian
- surrounding follicles
- obstruction of biliary outflow from bladder (ie. stone)
- U/S 95% sensitivity, 100% PPV and NPV for detecting stones
- 5% without stone; acalculous cholecystitis
- emphysematous cholecystitis
- occurs in elderly men, diabetics
- gas-forming organisms; e coli, clostridium
- 5 times more likely to perforate
- air reflections on US
- percutaneous cholecystostomy as temporizing measure
- gallstones (shadowing and mobile)
- gallbladder wall thickening (greater than 3 mm)
- gallbladder enlargement (greater than 4 x 10 cm)
- pericholecystic fluid
- stone impacted in gallbladder neck or cystic duct
- Murphy’s sign
- PPV of stone + Murphy’s sign = 92%
- bright reflection in non-dependent gall bladder wall = emphysematous cholecystitis
- polyp (nonmobile)
- sludge (no shadowing)
Normal RI <0.70.
- renal medical disease (vascular/tubulointerstitial process >> glomerular disease)
- significant systemic hypotension
- markedly decreased HR
- perinephric or subcapsular fluid collections
- neonate and infants
- fatty liver
- chronic hepatitis
- vacuolar degeneration
CLINICAL HISTORY: [x] year old woman referred for ultrasound-guided biopsy of a mass in the [right/left] breast.
The lesion was noted on previous ultrasound performed at [x] on [date]. Recent mammogram performed at [x] on [date] [demostrated/failed to demonstrate] the lesion.
Technique: [x] breast ultrasound guided core biopsy dated [x].
Preliminary ultrasound evaluation of the [right/left] breast with special attention to the area of [sonographic/mammographic/palpable] concern, confirms the presence of a [x] x [x] cm mass at the [x] o’clock position, approximately [x] cm from the nipple, at a depth of [x] cm from the skin.
Following universal protocol, patient and site verification was performed with a “time out” prior to the procedure.
Informed consent was obtained. The patient was positioned in the supine oblique position, and the lesion was localized with real-time sonography. The skin was cleansed with Chloraprep. [x] cc’s of 1% Lidocaine was used for local anesthesia. A [lateral/medial/oblique] approach to the target was used. An 18-gauge needle, secured to a spring-loaded device, was advanced to the preselected target. A total of [x] biopsy specimens were obtained, with pre- and post-fire images documenting needle placement for each pass. Specimens were sent for pathologic analysis, results pending.
Following the procedure, the wound was cleansed and compressed. Steri-strips and sterile gauze were applied and the patient was given post-biopsy instructions. The patient tolerated the procedure well and left the department in good condition.
Dr. [x] was in attendance during the entire procedure.
Ultrasound-guided core biopsy of [right/left] breast mass. Pathology pending.
CLINICAL HISTORY: [x] year old woman referred for needle localization of a mass in the [right/left] breast.
The lesion was noted on previous ultrasound performed at [x] on [x]. Recent mammogram performed at [x] on [x] revealed [x].
Technique: Needle localization under ultrasound guidance, specimen radiography
PROCEDURE: Following universal protocol, patient and site verification was performed with a “time out” prior to the procedure. Preliminary ultrasound of the [right/left] breast with special attention to the area of sonographic concern, confirms the presence of a [x] x [x] cm mass at the [x] o’clock axis, [x] cm from the nipple.
Informed consent was obtained. The patient was positioned in the supine oblique position. The skin was cleansed. 0.2 cc 1% Lidocaine was used for local anesthesia. Using a [lateral/medial/superior/inferior] approach, a [x] needle/wire assembly was used to localize the target under real-time sonographic guidance.
A post-localization mammographic view was obtained, and sent with the patient to the OR.
The patient tolerated the procedure well and left the department in good condition.
A surgical specimen submitted for radiography demonstrates the targeted lesion to be within the specimen. The [x] wire is intact. Dr. [x] was notified of these findings at the time of surgery.
IMPRESSION: Ultrasound-guided needle localization and documented excision [left/right] breast mass .
Clinical History: [x] year old woman referred for bilateral breast ultrasound. [x]
Technique: Bilateral breast ultrasound dated [x]
Findings: Real time ultrasound of both breasts was performed as per clinical request. There is no sonographic evidence of a discrete cystic or solid lesion in either visualized breast.
No sonographic evidence of a lesion in either breast.
Screening mammogram in [x]
Findings and recommendations were discussed with the patient following this evaluation.
TECHNIQUE: Limited sonographic obstetrical examination for the basis of emergency evaluation. This exam is not in lieu of a formal anatomical obstetrical scan. The exam was performed transabdominally.
*Transvaginal examination was also performed for assessment of the cervix.
COMPARISON EXAM: [x]
*Gestational Age: [x]
Status: Alive or Demise
Number: Singleton or Twin
Activity: Present or Absent
Position: Vertex, Breech, Tranverse head right , Tranverse head left, etc (if >25 weeks)
Placenta: State position and whether previa or not (if > 16 weeks)
Cervix: Cervix is greater than 3 cm and there is no funneling / Cervix is open and the residual cervix measures [x] cm
Amniotic fluid: if >16 weeks
Mild Oligo, Moderate Oligo, Severe Oligohydramnios
Mild Poly, Moderate Poly, Severe Polyhydramnios
Fetal cardiac activity: (Give FHR if <8weeks). Note as present or absent otherwise.
Ovaries: Both Normal
Right not seen, Left normal
Left not seen, Right normal
Both not seen
Other findings: [x]
*Basis for gestational age: LMP or EDC provided by patient
Findings were discussed with [x].
Technique: A sonogram of the pelvis was performed utilizing [transabdominal and transvaginal] approaches assessing gray-scale appearance and color Doppler flow.
The uterus measures [x] x [x] x [x] cm. No focal uterine masses are seen. The endometrium measures [x] cm in diameter.
The right ovary measures [x] cm x [x] cm x [x] cm. The left ovary measures [x] cm x [x] cm x [x] cm. No adnexal lesion is seen. Normal right and left ovarian arterial and venous waveforms are idenitifed with normal resistive indices of [x] and [x], respectively.
No free pelvic fluid is demonstrated.