Rad p pt 2013

Ultrasound cases 9.24.13

Punctate echogenicities in thyroid nodules.

Frates M C et al. Radiology 2005;237:794-800

©2005 by Radiological Society of North America

Punctate echogenicities in thyroid nodules.



Abnormal cervical lymph nodes.



Abnormal cervical lymph nodes.



Abnormal Neck Lymph Nodes

• Heterogeneous echotexture, calcifications, and cystic areas

• Round Lymph node

• Size is less reliable than shape or architecture

• Lymph nodes measuring > 7mm in short axis are suspicious

Inguinal hernias

Figure 2

FIGURE 2. A, Abdominal CT showing no evidence of femoral hernias visualized. B, Transverse image of the femoral canal during quite respiration appearing normal. C, Transverse image of the femoral canal during Valsalva showing bilateral fat containing hernias with the right being larger than the left (arrows).

Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 11

Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall

Stavros, A. Thomas; Rapp, Cindy

Ultrasound Quarterly. 26(3):135-169, September 2010.

doi: 10.1097/RUQ.0b013e3181f0b23f

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http://journals.lww.com/ultrasound-quarterly/Fulltext/2010/09000/Dynamic_Ultrasound_of_Hernias_of_the_Groin_and.4.aspx

Figure 3

FIGURE 3. Long-axis image of an indirect inguinal hernia (arrows) that contains only fat. IEA indicates inferior epigastric artery.





doi: 10.1097/RUQ.0b013e3181f0b23f

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Figure 4

FIGURE 4. Long-axis image of a fluid-containing femoral hernia that presented with pain and swelling.





doi: 10.1097/RUQ.0b013e3181f0b23f

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Figure 5

FIGURE 5. Short-axis view of the inguinal canal in the upright position showing an indirect inguinal hernia that contains bowel.





doi: 10.1097/RUQ.0b013e3181f0b23f

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Figure 6

FIGURE 6. Split-screen long-axis views of a fat-containing indirect inguinal hernia during quiet respiration and Valsalva maneuvers. The left image shows the hernia during quiet respiration (arrows). The right image, obtained during a Valsalva maneuver, shows the hernia contents being forced distally in a horizontal direction within the inguinal canal (arrows and dotted arrows).





doi: 10.1097/RUQ.0b013e3181f0b23f

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Figure 7

FIGURE 7. Left image and diagram showing a typical shape for direct inguinal hernia, a wide neck in comparison to the fundus. This hernia shape correlates with complete reducibility. Right image and diagram show a typical shape for a an linea alba hernia, a very narrow neck in comparison to the fundal width. This hernia shape correlates with nonreducibility and with an increased risk of strangulation.





doi: 10.1097/RUQ.0b013e3181f0b23f

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Figure 8

FIGURE 8. A, Long-axis view of a moderate-sized indirect inguinal hernia obtained in the supine position during a Valsalva maneuver and showing it to contain only fat. B, Long-axis view of the same hernia obtained immediately after the patient was placed in the upright position. The hernia appears slightly larger than it was in the previous image but still contains only fat. C, Delayed imaging in the upright position now showing that the hernia also contains fluid. This proves that the hernia contains intraperitoneal contents not just preperitoneal contents.





doi: 10.1097/RUQ.0b013e3181f0b23f

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Figure 9

FIGURE 9. Diagram and images of the main landmark for evaluating the inguinal area, the inferior epigastric vessels (EIVs). Image 1 is obtained in a transverse plane about half-way between the umbilicus and the pubic symphysis. The inferior epigastric artery and its paired veins lie along the midlateral posterior surface of the rectus abdominis muscle. Image 2 is obtained several centimeters inferiorly, and the EIVs lie more laterally. Image 3 is obtained at a level where the IEVs (arrow) lie at the edge of the rectus muscle. (This is the level at which most spigelian hernias occur.) Image 4 shows that once the origin of the inferior epigastric artery, the transducer should be rotated into planes that are parallel and perpendicular to the inguinal canal-long-axis and short-axis views.





doi: 10.1097/RUQ.0b013e3181f0b23f

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Figure 10

FIGURE 10. Abdominal and pelvic CT image, reformatted in the coronal plane, illustrating the locations of the 4 types of "groin" hernias. Indirect inguinal hernias arise within the internal or deep inguinal ring, which lies in the crotch between the external iliac artery and the proximal inferior epigastric artery. Direct inguinal hernias arise through the "conjoined tendon," which lies inferior and medial to the origin of the inferior epigastric artery. Spigelian hernias arise through the spigelian fascia just lateral to the inferior epigastric artery where it reaches the lateral margin of the rectus muscle. Femoral hernias lie within the femoral canal, inferior to the inguinal canal and inguinal ligament.





doi: 10.1097/RUQ.0b013e3181f0b23f

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Health & Medicine

Rad p pt 2013