Podcasts Archives - Radquarters

Ultrasound of Ovarian Serous Cystadenocarcinoma

In this radiology lecture, we review the ultrasound appearance of ovarian serous cystadenocarcinoma!

Key teaching points include:

Serous cystadenocarcinoma is the common ovarian malignancy and most common ovarian epithelial tumor
High-grade and low-grade types
Peak incidence 6th-7th decades
Ultrasound appearance: Mixed cystic and solid mass with papillary projections and thick septations
Elevated CA-125 in greater than 90%
Serous tumors are more commonly bilateral than other tumors
Four main categories of ovarian neoplasms: Epithelial (most common), germ cell (second most common), sex cord-stromal and metastases
Epithelial ovarian tumors are thought to originate outside the ovary (within fallopian tube or endometrium) and involve ovary secondarily
Epithelial ovarian tumor types: Serous, mucinous, endometrioid, clear cell and Brenner
60% of epithelial tumors are benign: Unilocular with thin wall or thin septations (less than 3 mm in thickness)
40% of epithelial tumors are malignant or borderline: Papillary projection (distinctive feature of epithelial tumors) with thick, irregular wall or septations (greater than 3 mm in thickness). Can also present as a large soft tissue mass with necrosis. Advanced findings include peritoneal implants, pelvic wall invasion, adenopathy and ascites

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 Sublingual Dermoid Cyst

In this radiology lecture, we review the ultrasound appearance of sublingual dermoid cyst and explain floor of mouth anatomy!

Key teaching points include:

The floor of the mouth is a horseshoe-shaped area beneath tongue and in between sides of mandible, inferiorly bounded by mylohyoid muscle, and containing sublingual space (SLS)
SLS medial border: Midline genioglossus/geniohyoid muscle complex; SLS inferolateral border: Mylohyoid muscle
Anterior margin of hyoglossus muscle projects into posterior SLS
Sublingual dermoid cyst is a rare, benign cyst with squamous epithelial lining and contains skin appendages
Dermoid and epidermoid cysts are in same family, terminology often used interchangeably, although epidermoid cysts less common and tend to contain fluid contents only
Dermoid cyst mean age of presentation late teens to twenties, average age 30
Presents as a slowly enlarging neck mass, may cause dysphagia
Often round or oval in shape and homogeneously hypoechoic with punctate echogenic foci
May have pathognomonic “sack of marbles” appearance
Relationship to mylohyoid is key for surgical planning: Intraoral resection for sublingual (above mylohyoid) location, extraoral approach for submental/submandibular (below mylohyoid) location
Most cysts are midline
DDx: Suprahyoid thyroglossal duct cyst, ranula (simple and diving), abscess and lymphangioma

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 Carpal Tunnel Syndrome

In this radiology lecture, we review the ultrasound appearance of carpal tunnel syndrome!

Key teaching points include:

Most common upper extremity entrapment neuropathy. Results from median nerve compression
With carpal tunnel syndrome, see hypoechoic enlargement of the median nerve as enters carpal tunnel with flattening of nerve = Notch sign, also volar bowing of flexor retinaculum
Median nerve area: Less than 8 mm2 = Normal; 8-12 mm2 = Borderline; greater than 12 mm2 = Abnormal
Most accurate to compare nerve area at proximal pronator quadratus muscle and carpal tunnel: Increase of 2 mm2 or more from proximal to distal = 99% sensitive and 100% specific for carpal tunnel syndrome. Measure inside the echogenic epineurium
Bifid median nerve: Normal variant in 15% of population, one trunk may take aberrant course through flexor digitorum superficialis musculature, and often associated with persistent median artery between the two trunks
Important to recognize persistent median artery pre-operatively because could be damaged during surgery
For diagnosis of carpal tunnel syndrome with bifid median nerve: Combined increase of 4 mm2 or more
After carpal tunnel release surgery, median nerve may return to normal diameter or remain enlarged regardless of clinical outcome. Retinaculum may appear thickened or disrupted
Carpal tunnel syndrome can be caused by extrinsic compression by a mass, ganglion cyst, or tenosynovitis

Reference: Klauser AS, Halpern EJ, De Zordo T, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-177.

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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Facebook: https://www.facebook.com/Radquarters/
Twitter: https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/

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Ultrasound of Ganglion Cyst & Wrist Anatomy Review

In this radiology lecture, we review the ultrasound appearance of ganglion cysts while highlighting relevant wrist ultrasound anatomy!

Key teaching points include:

Ganglion cysts are viscous, mucin-filled collections lacking a synovial lining
Most commonly occur at hand/wrist = Most common wrist mass
Location: Dorsum of wrist (60%), frequently adjacent to scapholunate ligament; volar wrist (20%), often between radial artery and flexor carpi radialis tendon; flexor tendon sheath (10%); associated with DIP joint (10%)
Grows out of tissues surrounding joint like a balloon on a stalk. May see a pedicle connecting to joint
Usually well-defined and multilocular, can be unilocular
Hypoechoic to anechoic with posterior acoustic enhancement
Noncompressible: Dorsal joint recess and bursal collections will typically collapse with transducer pressure or wrist movement
Typically no vascular flow, but septations may have vascularity. May see pulsation artifact from adjacent radial artery
Volar cysts can extend towards median nerve and may cause carpal tunnel syndrome
May displace or envelop radial artery
Tx: Watchful waiting, percutaneous US-guided aspiration and steroid injection, excision
Lister’s tubercle is a useful landmark for dorsal wrist anatomy
Relevant dorsal extensor tendons (from radial side to ulnar): Compartment 2 = Extensor carpi radialis longus, extensor carpi radialis brevis, Compartment 3 = Extensor pollicis longus (on ulnar side of Lister’s tubercle), Compartment 4 = Extensor digitorum and extensor indicis
Flexor carpi radialis overlies the ventral aspect of the scaphoid bone
Pisiform and scaphoid bone form the proximal “twin peaks” of the carpal tunnel at the ventral wrist crease
Median nerve diameter increase of 2 mm2 or more = Significant compression

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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Radquarters

Radiologist Headquarters has a new name: Radquarters! Same high-yield content, but now with a streamlined name that’s easier to remember.

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Ultrasound of Epididymitis & Orchitis

In this radiology lecture, we review the ultrasound appearance of acute epididymitis and orchitis!

Key teaching points include:

Epididymitis = Inflammation of epididymis. Usually bacterial, most commonly due to retrograde ascent from bladder or prostate.
Causative infectious agent varies based on age: Adults younger than 35: Neisseria gonorrhoeae, Chlamydia trachomatis (STDs). Adults older than 35: E. coli & other coliform bacteria.
Non-infectious causes of epididymitis: Trauma, repetitive activities such as sports (most common causes in males prior to sexual maturity), torsed appendix testis or appendix epididymis, vasculitis, and medications (amiodarone).
Presentation: Gradual onset of scrotal pain, swelling & urinary symptoms. Must exclude testicular torsion (usually more acute onset of pain).
Epididymitis US findings: Epididymal enlargement, hyperemia, hypoechogenicity. Hyperemia usually precedes grey scale changes. Infection usually spreads from tail to body and head.
20-30% of epididymitis cases have associated orchitis: Scrotal infection typically starts with epididymis then spreads to testis, scrotal sac, or scrotal wall.
Orchitis is less common than and usually secondary to epididymitis. Isolated orchitis uncommon, usually viral (mumps).
Orchitis US findings: Testicular enlargement, hyperemia and hypoechogenicity.
Complications: Scrotal wall inflammation, complicated hydrocele, pyocele (purulent fluid collection with mass effect), abscess (epididymal, testicular, scrotal wall), testicular ischemia and infarct due to obstructed venous outflow (decreased color Doppler testicular blood flow or reversed testicular diastolic arterial flow).

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 Acute Cholecystitis

In this radiology lecture, we review the ultrasound appearance of acute cholecystitis, including gangrenous and emphysematous cholecystitis!

Key teaching points include:

Acute cholecystitis = Acute gallbladder inflammation.
Most often (95%) caused by an impacted, obstructing gallstone in the cystic duct or gallbladder neck = Acute calculous cholecystitis.
Clinically presents as persistent RUQ pain that may radiate to right shoulder, often with N/V and fever.
Ultrasound findings of uncomplicated acute cholecystitis: Gallstones, sonographic Murphy sign, gallbladder wall thickening (greater than 3 mm) and edema, gallbladder distention (greater than 4 cm short axis), and pericholecystic fluid.
Sonographic Murphy sign = Maximal abdominal tenderness from transducer pressure over gallbladder. PPV of gallstones and a positive sonographic Murphy sign = 92%.
Pericholecystic fluid occurs in less than 20% of patients with acute cholecystitis, usually seen in more advanced cases.
Gangrenous cholecystitis = Most common complication of acute cholecystitis. Ischemia with necrosis of gallbladder wall. Increased mortality compared to uncomplicated acute cholecystitis.
Ultrasound findings of gangrenous cholecystitis: Wall disruption, ulceration, mucosal irregularity, and/or focal bulge, sloughed mucosal membranes, pericholecystic fluid, less likely to have positive Murphy sign, and increased risk of perforation (usually at fundus).
Emphysematous cholecystitis = Gallbladder wall necrosis with gas formation in wall and/or lumen. More common in elderly men with underlying diabetes. Higher risk of perforation, rapid progression, and increased mortality compared to uncomplicated acute cholecystitis. Emergent surgical intervention typically required.
Ultrasound findings of emphysematous cholecystitis: Bright reflectors from nondependent portions of gallbladder wall, dirty posterior acoustic shadowing, and ring-down artifact. CT can confirm if necessary.

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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Facebook: https://www.facebook.com/radiologistHeadQuarters/
Twitter: https://twitter.com/radiologistHQ
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Ultrasound of Intussusception

In this radiology lecture, we review the ultrasound appearance of ileocolic and small bowel-small bowel intussusception in children!

Key teaching points include:

Intussusception occurs when bowel is pulled into itself or into neighboring bowel.
Intussusceptum is the prolapsing bowel pulled into intussuscipiens which receives the bowel.
Two major types: Ileocolic and small bowel-small bowel.
If ileocolic not reduced = Bowel ischemia and perforation.
Most occur in children beyond 3 months of age.
Usually no lead point in children (unlike adults), suspected that due to hypertrophic lymphoid tissue after infection.
Clinical triad of colicky abdominal pain, vomiting, palpable abdominal mass seen in less than 50% of cases.
Red-currant jelly stool = Stool mixed with blood and mucus, can be seen with bowel ischemia.
Ultrasound gold standard in diagnosis: Sensitivity and specificity 98%, false negative rate less than 1%.
“Target” sign (short axis) and “pseudokidney” sign (long axis) may be seen.
Findings suggesting ileocolic (as opposed to small bowel-small bowel) intussusception: Location in right lower quadrant with absent normal ileocolic junction, hyperechoic center indicating mesenteric fat, diameter of hyperechoic core greater than outer wall, lymph nodes inside intussusception, larger AP diameter greater than 2 cm, and longer length greater than 3 cm.
Treatment of ileocolic intussusception: Enema with air or contrast material.
Findings suspicious for ischemia/necrosis and increased risk of enema reduction failure: Fluid trapped within the intussuscipiens, lack of internal vascular flow on Doppler within the intussusceptum, and irregular bowel wall or decreased bowel wall vascularity.

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 Polycystic Ovarian Syndrome

In this radiology lecture, we review the ultrasound appearance of polycystic ovarian syndrome (PCOS)!

Key teaching points include:

PCOS often presents with the clinical triad of oligomenorrhea and/or anovulation, hirsutism, and obesity. Associated with subfertility and recurrent pregnancy loss.
Rotterdam criteria (2003) states that PCOS diagnosis requires at least two of the following: Oligo- or anovulation (ovulatory dysfunction), hyperandrogenism (clinical and/or biochemical signs), and polycystic ovarian morphology on ultrasound.
Ovaries can be sonographically normal in PCOS. “Hyperandrogenic anovulation” proposed as a more accurate term.
Ovaries can also appear polycystic on ultrasound without clinical diagnosis of PCOS.
Rotterdam description of polycystic ovaries: 12 or more follicles 2-9 mm in size, and/or ovarian volume greater than 10 cc in at least one ovary (with no dominant cysts).
Specific diagnostic cutoffs debated, and 20-25 or more follicles has been more recently suggested as a more accurate cutoff.
Supportive morphologic features of PCOS include the “string of pearls sign” (peripheral location of follicles) and prominent, hyperechoic central ovarian stroma.
Ovarian morphology typically more important than ovarian size, although a single enlarged, polycystic ovary sufficiently meets ultrasound criteria for PCOS.
The term “polycystic” is generally incorrect and “multifollicular” has been offered as a more accurate ultrasound description, but PCOS remains the most widely used term.
In post-menopausal women with new or worsening hyperandrogenism, also consider androgen-secreting tumors of ovaries or adrenal glands.

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 Pleomorphic Adenoma of the Parotid Gland

In this radiology lecture, we review the ultrasound appearance of pleomorphic adenoma of the parotid gland!

Key teaching points include:

Pleomorphic adenoma AKA benign mixed tumor.
Most common salivary gland tumor, most common benign salivary gland tumor, and most common in the parotid gland.
Most common in patients aged 40-50, slightly more common in females.
For salivary gland masses in adults, the larger the gland, the more likely the tumor is benign: Parotid gland: 80%, submandibular gland: 50%, sublingual glands: 20%.
Parotid Gland 80% Rule: 80% of all salivary tumors are in the parotid, 80% of benign parotid gland tumors are pleomorphic adenomas, 80% of pleomorphic adenomas occur in the parotid gland, 80% of pleomorphic adenomas occur in the superficial lobe, and 80% of untreated pleomorphic adenomas stay benign, but 20% can undergo malignant degeneration.
On ultrasound, appears as a well-defined mass with lobulated borders, hypoechoic with posterior acoustic enhancement, and with homogeneity of internal echoes common.
When large, may have cystic degeneration and internal heterogeneity mimicking malignancy.
Vascularity is variable.
Describe lesion location, image-guided biopsy planning, evaluate for cervical lymphadenopathy.
Superficial and deep parotid lobes divided by facial nerve traveling through gland. Nerve not readily seen, but passes just superficial to adjacent retromandibular vein, which can be seen = Use as a landmark. Inferior to the retromandibular vein, may see branches of the external carotid artery.
Treatment is typically excision due to risk of malignant degeneration carcinoma ex pleomorphic adenoma if not completely excised.
DDx includes Warthin tumor: Second most common benign parotid tumor, bilateral in 20%, often exhibit cystic components, most common in elderly.
Malignant parotid tumors are also in the DDx and may appear with ill-defined margins, irregular shape, heterogeneous internal architecture, extraglandular extension, and adjacent lymphadenopathy.
Mucoepidermoid carcinoma: Most common salivary gland malignancy, most common in parotid gland.
Adenoid cystic carcinoma: Second most common parotid malignancy, but most common submandibular and minor salivary gland malignancy.
Higher risk of perineural spread: Patients may present with facial pain and facial nerve paralysis.