LATEST LECTURES

In this radiology lecture, we review the ultrasound appearance of adenomyomatosis of the gallbladder! Key teaching points include: 1) Common cause of benign gallbladder wall thickening seen in up to 9% of patients 2) Incidence increases with age 3) Usually asymptomatic, but may be associated with sporadic RUQ pain 4) Hyperplastic changes of gallbladder wall with mucosal overgrowth. Mucosal herniations protrude into muscular layer forming tiny, bile-filled cystic spaces = Rokitansky-Aschoff sinuses 5) If large, sinuses may appear as discrete cystic spaces in gallbladder wall 6) Cholesterol crystals in sinuses cause comet-tail reverberation artifact: Most common finding and highly specific for adenomyomatosis. Can exaggerate comet-tail with addition of color Doppler 7) Three types: Focal/fundal, segmental/annular and diffuse. Regardless of type, comet-tail artifacts and/or cystic spaces are key to diagnosis 8) Focal/fundal type: Most common. Often exhibits an “ovary on the gallbladder” appearance. Can be confused with a gallbladder mass. High-frequency linear transducer may be helpful to identify morphology 9) Segmental/annular type: Narrows waist of gallbladder yielding a figure 8 or hourglass configuration. Gallstones and/or sludge often form in proximal lumen due to increased stasis 10) If necessary, MRI helpful for problem solving: T2 hyperintense pearl necklace/string of beads appearance sensitive and specific To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4 Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Website: https://Radquarters.com/ Spotify Video Podcast: https://spoti.fi/462r0F2 Apple Video Podcast: https://apple.co/3ZhHuGu Instagram: https://www.instagram.com/Radquarters/ Facebook: https://www.facebook.com/Radquarters/ X (Twitter): https://twitter.com/Radquarters Reddit: https://www.reddit.com/user/radiologistHQ/
Ultrasound of Gallbladder Adenomyomatosis
In this radiology lecture, we review the ultrasound appearance of de Quervain’s Tenosynovitis! Key teaching points include: 1) Stenosing tenosynovitis of first extensor compartment tendons = Extensor pollicis brevis (EPB) and abductor pollicis longus (APL) 2) Second most common hand entrapment tendinopathy after trigger finger 3) Most common in middle-aged females 4) Associations include repetitive hand motions, pregnancy, arthritis, and trauma 5) Clinical presentation: Pain with thumb and wrist movement, tenderness and swelling at radial styloid 6) Positive Finkelstein maneuver may be present: Grasp thumb, ulnar deviate hand = Pain over distal radius 7) Ultrasound findings: Increased fluid in EPB/APL tendon sheath (tenosynovitis), hypoechoic, edematous tendon thickening (tendinosis), and thickening of extensor retinaculum (comparison scanning of contralateral thumb helpful) 8) Advanced findings: Impaired tendon movement, tendon tear (anechoic clefts), retinacular and peritendinous hyperemia 9) Don’t confuse normal APL slips with longitudinal tear (“lotus root” sign) 10) Important to identify variant intertendinous septa: Helps to properly guide steroid injection, increased incidence of asymmetric EPB involvement 11) If conservative therapy fails, surgical decompression may be required. More likely when septum present To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4 Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Website: https://Radquarters.com/ Spotify Video Podcast: https://spoti.fi/462r0F2 Apple Video Podcast: https://apple.co/3ZhHuGu Instagram: https://www.instagram.com/Radquarters/ Facebook: https://www.facebook.com/Radquarters/ X (Twitter): https://twitter.com/Radquarters Reddit: https://www.reddit.com/user/radiologistHQ/
Ultrasound of de Quervain’s Tenosynovitis
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