Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘ultrasound’ Category

Cord Insertion Types

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Required element in a complete >14wk OB ultrasound report.

Cord Insertion types: central, eccentric, marginal, and velamentous

Nice youtube video for ultrasound images.

Written by lmwong

May 16, 2013 at 11:05 am

Posted in OB, ultrasound

Vascular Anomalies, ISSVA Classification

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2 categories: vascular tumors or vascular malformations. Distinction determines therapy.

Vascular Tumors

  • 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

PDF link

Written by lmwong

April 23, 2012 at 12:57 pm

Ultrasound Landmarks for Early Pregnancy Failure

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Written by lmwong

March 6, 2011 at 7:45 am

Posted in OB, ultrasound

Beta-HCG levels and Gestational Age

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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

 

Written by lmwong

December 11, 2010 at 5:04 pm

Posted in OB, ultrasound

Congenital Diaphragmatic Hernia

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  • MC is Bochdalek hernia
  • MC left side
  • diagnosed at prenatal US, follow with MRI
  • up to 50% mortality
  • 50% have CHD
  • most have malrotation

read more

Written by lmwong

January 30, 2010 at 9:47 am

Decreased renal echogenicity

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  • Acute pyelonephritis
  • Renal vein thrombosis
  • Acute glomerulonephritis
  • Lupus nephritis
  • Lymphoma

Written by lmwong

January 22, 2010 at 1:46 am

Increased renal echogenicity

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Cortical only:

  • Acute/Chronic Glomerulonephritis
  • Nephrosclerosis
  • Acute tubular necrosis

Medullary only:

  • Medullary nephrocalcinosis
  • Renal pyramidal fibrosis

Cortical and Medullary:

  • Chronic Plyeonephritis
  • Chronic Glomerulonephritis

Patchy:

  • Infection
  • Scarring
  • Renal Vein thrombosis

Written by lmwong

January 22, 2010 at 1:44 am

Porcelain Gallbladder

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  • calcification of gallbladder wall
  • associated with chronic inflammation, 95% have gallstones
  • up to 61% risk of malignancy, needs prophylactic cholecystectomy

Written by lmwong

June 6, 2008 at 5:45 pm

Adenomyomatosis of gallbladder

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  • mucosal hyperplasia and thickening of muscular layer
  • Rokitansky-Aschoff sinuses = mucosal herniation through muscle layer, contain cholesterol crystals
  • U/S: bright reflections with comet-tail artifacts

Written by lmwong

June 6, 2008 at 5:38 pm

Gallbladder polyps

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  • less than 5mm or 5-10mm in size, nonmobile, no shadow
  • most common polyp is a cholesterol polyp
  • others: adenomas, papillomas, leiomyomas, lipomas, neuromas
  • metastatic melanoma produces gallbladder polyps
  • 5-10mm polyps require folllow up.

Written by lmwong

June 6, 2008 at 5:32 pm

Cervical Incompetence

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  • ultrasound diagnosis: funnelling of proximal cervix
  • reduced cervical length of less than 30 mm
  • increased risk of preterm delivery
  • place patient in Trendelenburg position and call OB STAT.

Written by lmwong

May 24, 2008 at 7:46 pm

Posted in OB, ultrasound

Ectopic Pregnancy

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  • 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.

Risk Factors

  • prior infection
  • developmental defects or prior tubal surgery
  • IUD
  • ovulation-inducing agents
  • IVF
  • prior ectopic

Intrauterine Findings

  • normal or thickened endometrial lining
  • look for IUP (gestational sac with yolk sac and DDS sign)

Extrauterine findings

  • 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


http://www.iame.com/learning/ectopic/ectopic.html

Written by lmwong

April 27, 2008 at 4:35 am

Posted in ectopic, OB, ultrasound

Cholecystitis

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  • 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

Findings

  • 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

Differential

  • polyp (nonmobile)
  • sludge (no shadowing)

Written by lmwong

April 25, 2008 at 1:29 pm

Resistive Index on Renal Doppler

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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

Written by lmwong

April 11, 2008 at 3:55 pm

Increased liver echogenicity

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  • fatty liver
  • steatohepatitis
  • chronic hepatitis
  • cirrhosis
  • vacuolar degeneration

Written by lmwong

April 11, 2008 at 2:53 am

Ultrasound Core Biopsy Dictation

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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].

PROCEDURE:
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.

IMPRESSION

Ultrasound-guided core biopsy of [right/left] breast mass. Pathology pending.

Written by lmwong

April 7, 2008 at 9:40 pm

Ultrasound Needle Localization Dictation

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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 .

Written by lmwong

April 7, 2008 at 9:39 pm

Screening Bilateral Breast Ultrasound Dictation

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Clinical History: [x] year old woman referred for bilateral breast ultrasound. [x]

Comparison: [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.

Impression:

No sonographic evidence of a lesion in either breast.

Recommendation:

Screening mammogram in [x]

Findings and recommendations were discussed with the patient following this evaluation.

Written by lmwong

April 7, 2008 at 9:38 pm

Pelvis Ultrasound – Emergency department OB ultrasound Dictation

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INDICATION: [x]

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]

FINDINGS:
*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
Normal
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].

Written by lmwong

April 7, 2008 at 4:08 am

Pelvic Ultrasound Dictation

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Indication: [x]

Technique: A sonogram of the pelvis was performed utilizing [transabdominal and transvaginal] approaches assessing gray-scale appearance and color Doppler flow.

Comparison: [x]

Findings:
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.

Impression: [x]

Written by lmwong

April 7, 2008 at 4:07 am

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