Podcasts Archives - Radquarters

Ultrasound of Endometrial Polyps

In this radiology lecture, we review the ultrasound appearance of endometrial polyps!

Key teaching points include:

Endometrial polyps are benign hyperplastic overgrowths of endometrial tissue.
Sessile or pedunculated, can cause endometrial thickening.
Often asymptomatic, may cause abnormal uterine bleeding or be associated with infertility.
US appearance: Focal, echogenic, round or ovoid. Often best seen in proliferative phase of menstrual cycle (as opposed to secretory phase) due to increased contrast between echogenic polyp and hypoechoic functional layer of endometrium. May see hypoechoic halo inside margin of endometrium. Usually solid, but can have cystic changes.
By comparison, submucosal fibroids are usually hypoechoic with posterior shadowing.
A feeding vessel/vascular pedicle on color Doppler is 95% specific for endometrial polyp.
Polyps can prolapse into cervix or vagina.
Tx: Polypectomy if symptomatic.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://usa.samsunghealthcare.com/ultrasound/general-imaging/rs85-prestige

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This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

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Ultrasound of Gout

In this radiology lecture, we review the ultrasound appearance of gout!

Key teaching points include:

Gout is a crystal arthropathy due to monosodium urate crystal deposition in and around joints
Most common in males over age 40
Risk factors: Metabolic (hyperuricemia, obesity, diabetes, hypertension), renal (chronic kidney disease), dietary (high purine foods, sugary drinks, alcohol), and genetic (family history)
Typically presents as acute monoarthritis with a red, inflamed, swollen joint. First metatarsophalangeal joint most common site of involvement (podagra)
Can progress to asymmetric polyarticular disease and chronic tophaceous gout
Ultrasound findings include: Joint effusion +/- hyperechoic foci (crystals/microtophi), synovial hypertrophy, and erosions typically at medial aspect of distal first metatarsal
Erosions are juxtaarticular in distribution with overhanging edges yielding a “punched-out” appearance
Gouty tophus: Amorphous, echogenic area containing internal hyperechoic foci surrounded by an anechoic inflammatory halo. May have associated cortical erosions
Tophi may involve tendons, tendon sheaths, and bursae. Other common sites include olecranon region (elbow), patellar and popliteal tendons (knee)
Double contour sign, AKA urate icing: Hyperechoic monosodium urate crystals coating hyaline cartilage surface. Disappears when serum urate levels drop below 6 mg/dL*
Distinct from chondrocalcinosis seen in calcium pyrophosphate deposition disease which will have echogenic crystals within cartilage as opposed to on surface

References:

*Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int. 2010;30(4):495–503
Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 3rd ed. Elsevier; 2018

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

Click the YouTube posts tab or follow on social media for bonus teaching material posted throughout the week!

This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

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Ultrasound of Choledocholithiasis (Common Bile Duct Stones)

In this radiology lecture, we review the ultrasound appearance of choledocholithiasis (common bile duct stones)!

Key teaching points include:

Choledocholithiasis = Stones within common bile duct (CBD)
Seen in up to 15% of patients with cholelithiasis
Clinical presentation: Asymptomatic, biliary colic, cholangitis, pancreatitis, jaundice
On ultrasound, see rounded stone or stones in CBD
Shadowing of stone less common than with cholelithiasis, twinkling artifact may help
CBD dilatation defined as greater than 6 mm allowing for an additional 1 mm per decade above 60, or greater than 10 mm post-cholecystectomy.
Intrahepatic dilatation and cholelithiasis may be present
Sensitivity of US up to 40% for detecting CBD stones, but US accuracy 90% for detecting CBD dilatation
If US negative and high clinical suspicious for choledocholithiasis, MRCP can be considered
CT has reduced sensitivity with only 15-20% gallstones visible on CT
Supportive lab values: Elevated serum bilirubin, alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). AST and ALT may also be elevated, but less specific. Labs can even be normal in the setting of choledocholithiasis
Tx may include endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Intraoperative cholangiogram during cholecystectomy

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

Click the YouTube posts tab or follow on social media for bonus teaching material posted throughout the week!

This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

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Ultrasound of Intersection Syndrome

In this radiology lecture, we review the ultrasound appearance of intersection syndrome, a friction tenosynovitis at the forearm and wrist!

Key teaching points include:

Intersection syndrome is an overuse tenosynovitis (inflammation of tendon and tendon sheath) secondary to repetitive friction at site of intersection
Proximal intersection syndrome: Occurs at musculotendinous junctions of first extensor wrist compartment (extensor pollicis brevis, abductor pollicis longus) crossing tendons of second compartment (extensor carpi radialis brevis, extensor carpi radialis longus). Intersection occurs 4-8 cm proximal to Lister’s tubercle
Results from repetitive extension/flexion activities: Rowing, skiing, racket sports, horseback riding, weight-lifting
Clinical presentation: Radial forearm or wrist pain, worsens with extension/flexion
Ultrasound findings: Pain with transducer pressure at intersection site, peritendinous edema and fluid
Distal intersection syndrome: Less common, occurs at third compartment tendon (extensor pollicis longus) crossing second compartment tendons distal to Lister’s tubercle
Tx: Rest, activity modification, splinting, anti-inflammatory medications. Corticosteroid injection or surgical release may be required if refractory

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

Click the YouTube posts tab or follow on social media for bonus teaching material posted throughout the week!

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This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

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Ultrasound of Giant Cell Tumor of the Tendon Sheath

In this radiology lecture, we review the ultrasound appearance of giant cell tumor of the tendon sheath!

Key teaching points include:

AKA tenosynovial giant cell tumor, localized nodular tenosynovitis
2nd most common mass of hand & wrist after ganglion cyst
Most common at volar aspect of first 3 digits. Less commonly at wrist, ankle, foot, knee
On ultrasound, usually homogeneously hypoechoic with well-defined lobulated margins
Closely associated with tendon, but will not move with tendon = Arises from tendon sheath, not tendon itself
May show posterior acoustic enhancement, but internal vascular flow typically present
Usually benign. Can be locally aggressive, rarely malignant. Tx: Surgical excision
Fibroma of the tendon sheath has a similar ultrasound appearance and location but is less common. Benign. Tx: Surgical excision

References:

Middleton WD, Patel V, Teefey SA, Boyer MI. Giant cell tumors of the tendon sheath: analysis of sonographic findings. AJR Am J Roentgenol. 2004;183(2):337-339.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

Click the YouTube posts tab or follow on social media for bonus teaching material posted throughout the week!

This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

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Ultrasound of Submandibular Sialolithiasis (Salivary Stones)

In this radiology lecture, we review the ultrasound and CT appearance of submandibular stone disease, together with floor of mouth anatomy!

Key teaching points include:

Submandibular glands are paired salivary glands located inferior to body of mandible
Submandibular glands are intermediate in size compared to the larger parotid and smaller sublingual glands, and they do not contain lymph nodes
The submandibular duct (= Wharton’s duct) extends from gland hilum and travels superiorly to open at floor of mouth on either side of base of frenulum of tongue. The duct is not typically seen unless abnormally dilated
On ultrasound, normal submandibular glands appear as encapsulated structures with homogeneous echotexture similar to the parotid. Fine linear echodensities may be present representing intraglandular ductules. Physiologic intravascular flow is typically evident. Superficial portion of the gland is almond-shaped, deep portion triangular
Sialolithiasis = Salivary calculous disease. Most common in submandibular gland because gland secretes a more alkaline, viscous saliva, and the long submandibular duct drains uphill = Increased salivary stasis
With acute obstruction, gland becomes enlarged (= sialadenitis) and duct proximal to stone dilated. Presents with colicky pain most pronounced around times of eating
US can detect even radiolucent stones, but small stones may not shadow
At the floor of mouth, the submandibular space (SMS) and sublingual space (SLS) are divided by mylohyoid musculature = Inferior sling of mouth. SMS is below (inferolateral to) mylohyoid, and SLS is above (superomedial to) mylohyoid
SMS contains: Submandibular glands, lymph nodes, anterior belly of digastric muscle
SLS contains: Sublingual glands, submandibular duct, and anterior aspect of hyoglossus muscle
Remember that while the submandibular glands are in the submandibular space, the submandibular duct is located in the sublingual space!
The submandibular duct travels between the hyoglossus and mylohyoid muscles, which are both useful sonographic landmarks aiding in duct location

References:

Ching AS, Ahuja AT. High-resolution sonography of the submandibular space: anatomy and abnormalities. AJR Am J Roentgenol. 2002 Sep;179(3):703-8.
Grewal JS, Jamal Z, Ryan J. Anatomy, Head and Neck, Submandibular Gland. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

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!

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Ultrasound of Trigger Finger (Stenosing Tenosynovitis)

In this radiology lecture, we review the ultrasound appearance of trigger finger!

Key teaching points include:

Pulleys are fibrous retinacula on ventral finger that secure flexor tendons to phalanges preventing tendon displacement and bowstringing with finger flexion
Finger has 5 annular pulleys. Odd-numbered at joints, even-numbered at phalanges: A1, A3, A5 are located about the MCP, PIP, DIP joints, respectively. A2 is located at the proximal phalanx, and A4 at the middle phalanx
Cruciform pulleys lie between annular pulleys, but are not usually well-seen on ultrasound
Trigger finger, also known as stenosing tenosynovitis, is characterized by impaired flexor tendon movement due to thickened pulley leading to tendon constriction
Most common at A1 pulley, but can also occur at A2/A3 pulleys, palmar aponeurosis (A0) and wrist
Symptoms: Triggering/locking when flexed, painful snapping when extended, pain, joint stiffness
Most common in female patients, history of diabetes mellitus, and rheumatoid arthritis
Often idiopathic, can occur with repetitive microinjury (flexion-extension). Can also be post-traumatic or due to compressive mass/cyst
Tx: Splinting, NSAIDs, US-guided corticosteroid injection, surgical release
A1 pulley thickness cutoff = 0.62 mm*. Mean normal thickness = 0.5 mm, range with trigger finger 1.1-2.9 mm**. Comparison with asymptomatic side helpful
Additional findings: Pulley hyperemia, nodular tendon thickening (tendinosis) or tear, buckling of flexor tendon on dynamic imaging, “dark tendon” sign (anisotropic hypoechogenicity due to tendon constriction), synovial sheath effusion (acute), and peri-pulley cyst/cystic degeneration

References:

*Spirig A, Juon B, Banz Y, Rieben R, Vogelin E. Correlation between sonographic and in vivo measurement of A1 pulleys in trigger fingers. Ultrasound Med Biol 2016; 42:1482–1490.
**Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, Feydy A, Drapé JL. Sonographic appearance of trigger fingers. J Ultrasound Med. 2008 Oct;27(10):1407-13.
Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. J Ultrasound Med. 2019 Dec;38(12):3141-3154.
Shohda E, Sheta RA. Misconceptions about trigger finger: a scoping review. Definition, pathophysiology, site of lesion, etiology. Trigger finger solving a maze. Adv Rheumatol. 2024 Jul 11;64(1):53.

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!

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Ultrasound of Hydrosalpinx, Pyosalpinx & Tubo-ovarian Abscess

In this radiology lecture, we review the ultrasound appearance of hydrosalpinx, pyosalpinx and tubo-ovarian abscess!

Key teaching points include:

Hydrosalpinx = Fluid-filled, blocked fallopian tube
Hydrosalpinx causes: Pelvic inflammatory disease (most common), endometriosis, prior surgery, adhesions
Hydrosalpinx US: 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
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
O-RADS US v2022 management of hydrosalpinx = Imaging: None. Clinical: Gynecologist
Pyosalpinx: Inflamed, blocked fallopian tube filled with purulent debris. Indicates pelvic inflammatory disease
Pyosalpinx US: Thick-walled tubal structure filled with complex fluid. Like hydrosalpinx, typically conforms to a C or S-shape
“Cogwheel” sign of pyosalpinx: Thickened endosalpingeal folds with surrounding tubal wall thickening. Typical of acute tubal inflammation
Tubal wall hyperemia more common with pyosalpinx than hydrosalpinx
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
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!

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Ultrasound of Gallbladder Adenomyomatosis

In this radiology lecture, we review the ultrasound appearance of adenomyomatosis of the gallbladder!

Key teaching points include:

Common cause of benign gallbladder wall thickening seen in up to 9% of patients
Incidence increases with age
Usually asymptomatic, but may be associated with sporadic RUQ pain
Hyperplastic changes of gallbladder wall with mucosal overgrowth. Mucosal herniations protrude into muscular layer forming tiny, bile-filled cystic spaces = Rokitansky-Aschoff sinuses
If large, sinuses may appear as discrete cystic spaces in gallbladder wall
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
Three types: Focal/fundal, segmental/annular and diffuse. Regardless of type, comet-tail artifacts and/or cystic spaces are key to diagnosis
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
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
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!

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Ultrasound of de Quervain’s Tenosynovitis

In this radiology lecture, we review the ultrasound appearance of de Quervain’s Tenosynovitis!

Key teaching points include:

Stenosing tenosynovitis of first extensor compartment tendons = Extensor pollicis brevis (EPB) and abductor pollicis longus (APL)
Second most common hand entrapment tendinopathy after trigger finger
Most common in middle-aged females
Associations include repetitive hand motions, pregnancy, arthritis, and trauma
Clinical presentation: Pain with thumb and wrist movement, tenderness and swelling at radial styloid
Positive Finkelstein maneuver may be present: Grasp thumb, ulnar deviate hand = Pain over distal radius
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)
Advanced findings: Impaired tendon movement, tendon tear (anechoic clefts), retinacular and peritendinous hyperemia
Don’t confuse normal APL slips with longitudinal tear (“lotus root” sign)
Important to identify variant intertendinous septa: Helps to properly guide steroid injection, increased incidence of asymmetric EPB involvement
If conservative therapy fails, surgical decompression may be required. More likely when septum present