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In this radiology lecture, we review the ultrasound appearance of hydrosalpinx, pyosalpinx and tubo-ovarian abscess! Key teaching points include: 1) Hydrosalpinx = Fluid-filled, blocked fallopian tube 2) Hydrosalpinx causes include pelvic inflammatory disease (most common), endometriosis, prior surgery, adhesions 3) Hydrosalpinx ultasound appearance: Thin-walled, tubular structure filled with anechoic simple fluid. Dilated tube may fold upon itself forming tubular C-shaped or S-shaped cystic mass. Incomplete septations common 4) With chronic hydrosalpinx, may see “beads-on-a-string” sign: Short, round, 2-3 mm projections seen along inner tubal walls in cross section = Flattened, fibrotic remnants of endosalpingeal folds. Don’t confuse with solid mural nodules 5) O-RADS US v2022 management of hydrosalpinx = Imaging: None. Clinical: Gynecologist 6) Pyosalpinx: Inflamed, blocked fallopian tube filled with purulent debris. Indicates pelvic inflammatory disease 7) Pyosalpinx ultrasound appearance: Thick-walled tubal structure filled with complex fluid. Like hydrosalpinx, typically conforms to a C or S-shape 8) “Cogwheel” sign of pyosalpinx: Thickened endosalpingeal folds with surrounding tubal wall thickening. Typical of acute tubal inflammation 9) Tubal wall hyperemia more common with pyosalpinx than hydrosalpinx 10) Tubo-ovarian complex (TOC): With severe salpingo-oophoritis, ovary and tube adhere to each other. Can distinctly identify ovary from tube but cannot separate the two with transducer pressure. Tx: Antibiotics 11) Tubo-ovarian abscess (TOA): As pelvic inflammatory disease progresses, complete or near-complete loss of adnexal architecture with pockets of purulent fluid develop. Multiloculated mass with septations, irregular margins, may be bilateral. Tx: Antibiotics, percutaneous drainage, surgery 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 Hydrosalpinx, Pyosalpinx & Tubo-ovarian Abscess
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
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