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! Spotify: https://bit.ly/spotify-rhq Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/   The post Ultrasound of Acute Cholecystitis appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of acute cholecystitis, including gangrenous and emphysematous cholecystitis! Key teaching points include: <ul> <li>Acute cholecystitis = Acute gallbladder inflammation.</li> <li>Most often (95%) caused by an impacted, obstructing gallstone in the cystic duct or gallbladder neck = Acute calculous cholecystitis.</li> <li>Clinically presents as persistent RUQ pain that may radiate to right shoulder, often with N/V and fever.</li> <li>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.</li> <li>Sonographic Murphy sign = Maximal abdominal tenderness from transducer pressure over gallbladder. PPV of gallstones and a positive sonographic Murphy sign = 92%.</li> <li>Pericholecystic fluid occurs in less than 20% of patients with acute cholecystitis, usually seen in more advanced cases.</li> <li>Gangrenous cholecystitis = Most common complication of acute cholecystitis. Ischemia with necrosis of gallbladder wall. Increased mortality compared to uncomplicated acute cholecystitis.</li> <li>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).</li> <li>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.</li> <li>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.</li> </ul> To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the <a href="https://www.youtube.com/@RadiologistHQ/community" rel="noopener nofollow" target="_blank">YouTube Community tab</a> or follow on social media for bonus teaching material posted throughout the week! Spotify: <a href="https://bit.ly/spotify-rhq" rel="noopener nofollow" target="_blank">https://bit.ly/spotify-rhq</a> Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/ultrasound-of-acute-cholecystitis/" rel="nofollow" target="_blank">Ultrasound of Acute Cholecystitis</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Acute Cholecystitis

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! Spotify: https://bit.ly/spotify-rhq Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/ The post Ultrasound of Intussusception appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of ileocolic and small bowel-small bowel intussusception in children! Key teaching points include: <ul> <li>Intussusception occurs when bowel is pulled into itself or into neighboring bowel.</li> <li>Intussusceptum is the prolapsing bowel pulled into intussuscipiens which receives the bowel.</li> <li>Two major types: Ileocolic and small bowel-small bowel.</li> <li>If ileocolic not reduced = Bowel ischemia and perforation.</li> <li>Most occur in children beyond 3 months of age.</li> <li>Usually no lead point in children (unlike adults), suspected that due to hypertrophic lymphoid tissue after infection.</li> <li>Clinical triad of colicky abdominal pain, vomiting, palpable abdominal mass seen in less than 50% of cases.</li> <li>Red-currant jelly stool = Stool mixed with blood and mucus, can be seen with bowel ischemia.</li> <li>Ultrasound gold standard in diagnosis: Sensitivity and specificity 98%, false negative rate less than 1%.</li> <li>“Target” sign (short axis) and “pseudokidney” sign (long axis) may be seen.</li> <li>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.</li> <li>Treatment of ileocolic intussusception: Enema with air or contrast material.</li> <li>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.</li> </ul> To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the <a href="https://www.youtube.com/@RadiologistHQ/community" rel="noopener nofollow" target="_blank">YouTube Community tab</a> or follow on social media for bonus teaching material posted throughout the week! Spotify: <a href="https://bit.ly/spotify-rhq" rel="noopener nofollow" target="_blank">https://bit.ly/spotify-rhq</a> Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/ultrasound-of-intussusception/" rel="nofollow" target="_blank">Ultrasound of Intussusception</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Intussusception

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! Spotify: https://bit.ly/spotify-rhq Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/ The post Ultrasound of Polycystic Ovarian Syndrome appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of polycystic ovarian syndrome (PCOS)! Key teaching points include: <ul> <li>PCOS often presents with the clinical triad of oligomenorrhea and/or anovulation, hirsutism, and obesity. Associated with subfertility and recurrent pregnancy loss.</li> <li>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.</li> <li>Ovaries can be sonographically normal in PCOS. “Hyperandrogenic anovulation” proposed as a more accurate term.</li> <li>Ovaries can also appear polycystic on ultrasound without clinical diagnosis of PCOS.</li> <li>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).</li> <li>Specific diagnostic cutoffs debated, and 20-25 or more follicles has been more recently suggested as a more accurate cutoff.</li> <li>Supportive morphologic features of PCOS include the “string of pearls sign” (peripheral location of follicles) and prominent, hyperechoic central ovarian stroma.</li> <li>Ovarian morphology typically more important than ovarian size, although a single enlarged, polycystic ovary sufficiently meets ultrasound criteria for PCOS.</li> <li>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.</li> <li>In post-menopausal women with new or worsening hyperandrogenism, also consider androgen-secreting tumors of ovaries or adrenal glands.</li> </ul> To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the <a href="https://www.youtube.com/@RadiologistHQ/community" rel="noopener nofollow" target="_blank">YouTube Community tab</a> or follow on social media for bonus teaching material posted throughout the week! Spotify: <a href="https://bit.ly/spotify-rhq" rel="noopener nofollow" target="_blank">https://bit.ly/spotify-rhq</a> Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/ultrasound-of-polycystic-ovarian-syndrome/" rel="nofollow" target="_blank">Ultrasound of Polycystic Ovarian Syndrome</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Polycystic Ovarian Syndrome

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.  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! Spotify: https://bit.ly/spotify-rhq Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/ The post Ultrasound of Pleomorphic Adenoma of the Parotid Gland appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of pleomorphic adenoma of the parotid gland! Key teaching points include: <ul> <li>Pleomorphic adenoma AKA benign mixed tumor.</li> <li>Most common salivary gland tumor, most common benign salivary gland tumor, and most common in the parotid gland.</li> <li>Most common in patients aged 40-50, slightly more common in females.</li> <li>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%.</li> <li>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.</li> <li>On ultrasound, appears as a well-defined mass with lobulated borders, hypoechoic with posterior acoustic enhancement, and with homogeneity of internal echoes common.</li> <li>When large, may have cystic degeneration and internal heterogeneity mimicking malignancy.</li> <li>Vascularity is variable.</li> <li>Describe lesion location, image-guided biopsy planning, evaluate for cervical lymphadenopathy.</li> <li>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.</li> <li>Treatment is typically excision due to risk of malignant degeneration carcinoma ex pleomorphic adenoma if not completely excised.</li> <li>DDx includes Warthin tumor: Second most common benign parotid tumor, bilateral in 20%, often exhibit cystic components, most common in elderly.</li> <li>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.</li> <li>Mucoepidermoid carcinoma: Most common salivary gland malignancy, most common in parotid gland.</li> <li>Adenoid cystic carcinoma: Second most common parotid malignancy, but most common submandibular and minor salivary gland malignancy.</li> <li>Higher risk of perineural spread: Patients may present with facial pain and facial nerve paralysis.</li> </ul> To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Spotify: <a href="https://bit.ly/spotify-rhq" rel="noopener nofollow" target="_blank">https://bit.ly/spotify-rhq</a> Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/case-review-ultrasound-of-pleomorphic-adenoma-of-the-parotid-gland/" rel="nofollow" target="_blank">Ultrasound of Pleomorphic Adenoma of the Parotid Gland</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Pleomorphic Adenoma of the Parotid Gland

In this radiology lecture, we review the ultrasound appearance of epidermal inclusion cyst! Key teaching points include:  Epidermal inclusion cyst is the most common cutaneous cyst. Can occur anywhere: Head, neck, trunk, extremities. Benign, keratin-containing cyst lined by a wall of stratified squamous epithelium. On ultrasound, appears as a well-circumscribed, round to oval mass with broad (50%) contact with dermis, nonvascular and with posterior acoustic enhancement. Hypoechoic to minimally hyperechoic with internal linear echogenic and anechoic debris = “Pseudotestis.” Presence of a focal hypoechoic tract extending towards epidermis adds specificity = “Submarine sign.” May see overlying punctum on skin surface = Small, dark-colored opening. Epidermal inclusion cysts are different from sebaceous cysts. Sebaceous cysts originate from sebaceous glands, contain sebum and are less common. Epidermal inclusion cysts contain keratin, not sebum, but are often incorrectly referred to as sebaceous cysts. Epidermal inclusion cyst vs. epidermoid cyst. Epidermoid cyst is a non-neoplastic cyst lined only by squamous epithelium. Epidermal inclusion cyst is a specific type of epidermoid cyst caused by implantation of epidermal elements in the dermis. All epidermal inclusion cysts are epidermoid cysts, but not all epidermoid cysts are epidermal inclusion cysts. Can become ruptured or infected: Ill-defined or lobular margins, internal blood flow, peri-lesional soft tissue inflammation, adjacent fat focally hyperechoic or hyperemic. DDx for complicated epidermal inclusion cyst: Neurogenic tumors and other neoplasms. Uncomplicated cysts typically do not require treatment, but if infected may require I&amp;D or excision. Growing cysts may also require excision. Rare (1%) malignant degeneration to squamous cell carcinoma, less commonly basal cell carcinoma.  References: Jacobson JA, Middleton WD, Allison SJ, et al. Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2022; 304:18-30. https://pubs.rsna.org/doi/full/10.1148/radiol.211101 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! Spotify: https://bit.ly/spotify-rhq Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/ The post Ultrasound of Epidermal Inclusion Cyst appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of epidermal inclusion cyst! Key teaching points include: <ul> <li>Epidermal inclusion cyst is the most common cutaneous cyst.</li> <li>Can occur anywhere: Head, neck, trunk, extremities.</li> <li>Benign, keratin-containing cyst lined by a wall of stratified squamous epithelium.</li> <li>On ultrasound, appears as a well-circumscribed, round to oval mass with broad (50%) contact with dermis, nonvascular and with posterior acoustic enhancement.</li> <li>Hypoechoic to minimally hyperechoic with internal linear echogenic and anechoic debris = “Pseudotestis.”</li> <li>Presence of a focal hypoechoic tract extending towards epidermis adds specificity = “Submarine sign.” May see overlying punctum on skin surface = Small, dark-colored opening.</li> <li>Epidermal inclusion cysts are different from sebaceous cysts. Sebaceous cysts originate from sebaceous glands, contain sebum and are less common.</li> <li>Epidermal inclusion cysts contain keratin, not sebum, but are often incorrectly referred to as sebaceous cysts.</li> <li>Epidermal inclusion cyst vs. epidermoid cyst. Epidermoid cyst is a non-neoplastic cyst lined only by squamous epithelium. Epidermal inclusion cyst is a specific type of epidermoid cyst caused by implantation of epidermal elements in the dermis. All epidermal inclusion cysts are epidermoid cysts, but not all epidermoid cysts are epidermal inclusion cysts.</li> <li>Can become ruptured or infected: Ill-defined or lobular margins, internal blood flow, peri-lesional soft tissue inflammation, adjacent fat focally hyperechoic or hyperemic. DDx for complicated epidermal inclusion cyst: Neurogenic tumors and other neoplasms.</li> <li>Uncomplicated cysts typically do not require treatment, but if infected may require I&amp;D or excision. Growing cysts may also require excision.</li> <li>Rare (1%) malignant degeneration to squamous cell carcinoma, less commonly basal cell carcinoma.</li> </ul> References: Jacobson JA, Middleton WD, Allison SJ, et al. Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2022; 304:18-30. <a href="https://pubs.rsna.org/doi/full/10.1148/radiol.211101" rel="noopener nofollow" target="_blank">https://pubs.rsna.org/doi/full/10.1148/radiol.211101</a> To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the <a href="https://www.youtube.com/@RadiologistHQ/community" rel="noopener nofollow" target="_blank">YouTube Community tab</a> or follow on social media for bonus teaching material posted throughout the week! Spotify: <a href="https://bit.ly/spotify-rhq" rel="noopener nofollow" target="_blank">https://bit.ly/spotify-rhq</a> Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/case-review-ultrasound-of-epidermal-inclusion-cyst/" rel="nofollow" target="_blank">Ultrasound of Epidermal Inclusion Cyst</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Epidermal Inclusion Cyst

In this radiology lecture, we review the ultrasound appearance of torsion of the appendix testis and appendix epididymis! Key teaching points include:  Appendix testis is a vestigial appendage usually located between upper pole of testis and head of epididymis. AKA hydatid of Morgagni, the appendix testis is commonly present as a normal finding. Appendix epididymis typically arises from epididymal head. Both scrotal appendages are often pedunculated which increases risk of torsion. Torsion occurs when appendage twists, occluding blood supply. Torsion of the appendix testis is one of most common causes of acute scrotal pain in prepubertal children. Peak age 7-12 years old, but can occur at any age. Normal appendix testis: Oval-shaped, less than 6 mm in size, homogeneously isoechoic to epididymis, and demonstrates little to no blood flow on color Doppler. Torsed appendix testis: 6 mm or larger in size, variable echogenicity, hypoechoic before 24 hours, hyperechoic or heterogeneous after 24 hours. In setting of appendix torsion, hyperemia of surrounding structures with hydrocele and scrotal wall thickening often present. Torsed appendage can detach and become free floating in scrotum. Patients may present with pain localized to upper pole of testis or epididymis. Physical examination may yield the “blue dot” sign: Small, palpable nodule at superior aspect of testis with bluish discoloration of overlying skin due to ischemic appendix. Cremasteric reflex typically intact, and testicle not high riding (unlike testicular torsion). Hyperemia of surrounding structures can be difficult to differentiate from bacterial epididymitis. However, in children, epididymitis usually secondary to inflammation from direct trauma, torsion of a scrotal appendage, or urine reflux into epididymis. Urine dipstick/urinalysis helpful to differentiate from infection. Treatment: Pain management with analgesics, ice, rest. If not recognized, may be treated unnecessarily with antibiotics. Scrotal exploration may be necessary if testicular torsion cannot be excluded.  References: Baldisserotto M, Ketzer de Souza JC, Pertence AP, Dora MD. Color Doppler sonography of normal and torsed testicular appendages in children. AJR 2005; 184:1287–1292 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://radiologisthq.com/ Spotify Video Podcast: https://bit.ly/spotify-rhq Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/ The post Ultrasound of Torsion of the Appendix Testis appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of torsion of the appendix testis and appendix epididymis! Key teaching points include: <ul> <li>Appendix testis is a vestigial appendage usually located between upper pole of testis and head of epididymis.</li> <li>AKA hydatid of Morgagni, the appendix testis is commonly present as a normal finding.</li> <li>Appendix epididymis typically arises from epididymal head.</li> <li>Both scrotal appendages are often pedunculated which increases risk of torsion.</li> <li>Torsion occurs when appendage twists, occluding blood supply.</li> <li>Torsion of the appendix testis is one of most common causes of acute scrotal pain in prepubertal children.</li> <li>Peak age 7-12 years old, but can occur at any age.</li> <li>Normal appendix testis: Oval-shaped, less than 6 mm in size, homogeneously isoechoic to epididymis, and demonstrates little to no blood flow on color Doppler.</li> <li>Torsed appendix testis: 6 mm or larger in size, variable echogenicity, hypoechoic before 24 hours, hyperechoic or heterogeneous after 24 hours.</li> <li>In setting of appendix torsion, hyperemia of surrounding structures with hydrocele and scrotal wall thickening often present.</li> <li>Torsed appendage can detach and become free floating in scrotum.</li> <li>Patients may present with pain localized to upper pole of testis or epididymis.</li> <li>Physical examination may yield the “blue dot” sign: Small, palpable nodule at superior aspect of testis with bluish discoloration of overlying skin due to ischemic appendix.</li> <li>Cremasteric reflex typically intact, and testicle not high riding (unlike testicular torsion).</li> <li>Hyperemia of surrounding structures can be difficult to differentiate from bacterial epididymitis.</li> <li>However, in children, epididymitis usually secondary to inflammation from direct trauma, torsion of a scrotal appendage, or urine reflux into epididymis. Urine dipstick/urinalysis helpful to differentiate from infection.</li> <li>Treatment: Pain management with analgesics, ice, rest. If not recognized, may be treated unnecessarily with antibiotics. Scrotal exploration may be necessary if testicular torsion cannot be excluded.</li> </ul> References: Baldisserotto M, Ketzer de Souza JC, Pertence AP, Dora MD. Color Doppler sonography of normal and torsed testicular appendages in children. AJR 2005; 184:1287–1292 To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the <a href="https://www.youtube.com/@RadiologistHQ/community" rel="noopener nofollow" target="_blank">YouTube Community tab</a> or follow on social media for bonus teaching material posted throughout the week! Website: <a href="https://radiologisthq.com/" rel="noopener nofollow" target="_blank">https://radiologisthq.com/</a> Spotify Video Podcast: <a href="https://bit.ly/spotify-rhq" rel="noopener nofollow" target="_blank">https://bit.ly/spotify-rhq</a> Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/case-review-ultrasound-of-torsion-of-the-appendix-testis/" rel="nofollow" target="_blank">Ultrasound of Torsion of the Appendix Testis</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Torsion of the Appendix Testis

In this radiology lecture, we review the ultrasound appearance of Hashimoto’s thyroiditis with three unique cases! Key teaching points include:  Normal thyroid gland isthmus measures less than 0.4 cm, transverse and AP lobe diameters measure less than 2 cm. Hashimoto’s thyroiditis is an autoimmune thyroiditis caused by antibodies to thyroid proteins. Most common in middle-aged females. May coexist with other autoimmune disorders: Lupus, rheumatoid arthritis. AKA chronic autoimmune lymphocytic thyroiditis: Gland is infiltrated with lymphocytes and plasma cells, fibrotic reaction replaces normal parenchyma. Leads to hypothyroidism = Most common cause in USA. Increased risk of thyroid cancer, including thyroid lymphoma. On ultrasound, gland is normal-sized or enlarged in initial phase with heterogeneously hypoechoic parenchymal echotexture. May have hypoechoic micronodules (1-6 mm) yielding a “pseudonodular” or “giraffe” pattern = High positive predictive value. Can also present with thin echogenic fibrous strands, lobulated contour, and geographic hypoechogenicity without discrete nodules. Gland may be atrophic in chronic cases. Variable color Doppler flow, may be hypervascular. Reactive, morphologically-normal neck nodes may be present. Can be difficult to differentiate from other forms of thyroiditis on ultrasound. Laboratory/serologic diagnosis: Thyroid function tests (TSH, free T4 test), thyroid peroxidase (TPO) antibodies present in most (95%) patients, and antithyroglobulin antibodies. Treatment: Thyroid hormone replacement if hypothyroid.  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! Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/   The post Ultrasound of Hashimoto’s Thyroiditis appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of Hashimoto’s thyroiditis with three unique cases! Key teaching points include: <ul> <li>Normal thyroid gland isthmus measures less than 0.4 cm, transverse and AP lobe diameters measure less than 2 cm.</li> <li>Hashimoto’s thyroiditis is an autoimmune thyroiditis caused by antibodies to thyroid proteins.</li> <li>Most common in middle-aged females.</li> <li>May coexist with other autoimmune disorders: Lupus, rheumatoid arthritis.</li> <li>AKA chronic autoimmune lymphocytic thyroiditis: Gland is infiltrated with lymphocytes and plasma cells, fibrotic reaction replaces normal parenchyma.</li> <li>Leads to hypothyroidism = Most common cause in USA.</li> <li>Increased risk of thyroid cancer, including thyroid lymphoma.</li> <li>On ultrasound, gland is normal-sized or enlarged in initial phase with heterogeneously hypoechoic parenchymal echotexture.</li> <li>May have hypoechoic micronodules (1-6 mm) yielding a “pseudonodular” or “giraffe” pattern = High positive predictive value.</li> <li>Can also present with thin echogenic fibrous strands, lobulated contour, and geographic hypoechogenicity without discrete nodules.</li> <li>Gland may be atrophic in chronic cases.</li> <li>Variable color Doppler flow, may be hypervascular.</li> <li>Reactive, morphologically-normal neck nodes may be present.</li> <li>Can be difficult to differentiate from other forms of thyroiditis on ultrasound.</li> <li>Laboratory/serologic diagnosis: Thyroid function tests (TSH, free T4 test), thyroid peroxidase (TPO) antibodies present in most (95%) patients, and antithyroglobulin antibodies.</li> <li>Treatment: Thyroid hormone replacement if hypothyroid.</li> </ul> To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/case-review-ultrasound-of-hashimotos-thyroiditis/" rel="nofollow" target="_blank">Ultrasound of Hashimoto’s Thyroiditis</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Hashimoto’s Thyroiditis

In this radiology lecture, we review the ultrasound appearance of acute appendicitis with three unique cases! Key teaching points include:  Ultrasound is the first-line imaging modality in pediatric and pregnant patients due to lack of ionizing radiation: Sensitivity/specificity approximately 80%. Technique: Linear transducer with graded compression at site of maximal tenderness using gradual increased pressure to displace normal bowel gas. Inflamed appendix appears as a noncompressible, blind-ending tubular structure arising from cecum. Outer appendiceal diameter with compression: Less than 6 mm almost always normal, 6-8 mm borderline, greater than 8 mm highly suspicious. Thickened appendiceal wall (greater than 2 mm). Wall hyperemia: “Dot flow” normal, continuous linear/curvilinear flow highly suspicious. Increased echogenicity and expansion of peri-appendiceal fat due to infiltration by inflammatory cells and edema. Hyperechoic appendicolith with posterior acoustic shadowing supportive. Identify terminal ileum separate from appendix to differentiate from ileitis, Meckel’s diverticulum, or other small bowel abnormality. Appendix does not exhibit peristalsis. Right lower quadrant free fluid and lymphadenopathy supportive, but nonspecific in isolation. Loss of wall stratification suspicious for necrotic/gangrenous appendicitis, and color Doppler flow may be absent. Gas in appendix appears as dirty shadowing and ring-down artifact. Intraluminal gas sometimes helpful to exclude appendicitis, but can also be seen with gangrenous complication. Peri-appendiceal gas-containing collections highly suspicious for perforation. CT may be needed for clarification.  References: 1) Madhuripan N, Jawahar A, Jeffrey RB, Olcott EW. The Borderline-Size Appendix: Grayscale, Color Doppler, and Spectral Doppler Findings That Improve Specificity for the Sonographic Diagnosis of Acute Appendicitis. Ultrasound Q. 2020;36(4):314-320. 2) Fallon SC, Orth RC, Guillerman RP, et al. Development and validation of an ultrasound scoring system for children with suspected acute appendicitis. Pediatr Radiol. 2015;45(13):1945-1952. 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! Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/ The post Ultrasound of Acute Appendicitis appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of acute appendicitis with three unique cases! Key teaching points include: <ul> <li>Ultrasound is the first-line imaging modality in pediatric and pregnant patients due to lack of ionizing radiation: Sensitivity/specificity approximately 80%.</li> <li>Technique: Linear transducer with graded compression at site of maximal tenderness using gradual increased pressure to displace normal bowel gas.</li> <li>Inflamed appendix appears as a noncompressible, blind-ending tubular structure arising from cecum.</li> <li>Outer appendiceal diameter with compression: Less than 6 mm almost always normal, 6-8 mm borderline, greater than 8 mm highly suspicious.</li> <li>Thickened appendiceal wall (greater than 2 mm).</li> <li>Wall hyperemia: “Dot flow” normal, continuous linear/curvilinear flow highly suspicious.</li> <li>Increased echogenicity and expansion of peri-appendiceal fat due to infiltration by inflammatory cells and edema.</li> <li>Hyperechoic appendicolith with posterior acoustic shadowing supportive.</li> <li>Identify terminal ileum separate from appendix to differentiate from ileitis, Meckel’s diverticulum, or other small bowel abnormality.</li> <li>Appendix does not exhibit peristalsis.</li> <li>Right lower quadrant free fluid and lymphadenopathy supportive, but nonspecific in isolation.</li> <li>Loss of wall stratification suspicious for necrotic/gangrenous appendicitis, and color Doppler flow may be absent.</li> <li>Gas in appendix appears as dirty shadowing and ring-down artifact. Intraluminal gas sometimes helpful to exclude appendicitis, but can also be seen with gangrenous complication.</li> <li>Peri-appendiceal gas-containing collections highly suspicious for perforation. CT may be needed for clarification.</li> </ul> References: 1) Madhuripan N, Jawahar A, Jeffrey RB, Olcott EW. The Borderline-Size Appendix: Grayscale, Color Doppler, and Spectral Doppler Findings That Improve Specificity for the Sonographic Diagnosis of Acute Appendicitis. Ultrasound Q. 2020;36(4):314-320. 2) Fallon SC, Orth RC, Guillerman RP, et al. Development and validation of an ultrasound scoring system for children with suspected acute appendicitis. Pediatr Radiol. 2015;45(13):1945-1952. To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/case-review-ultrasound-of-acute-appendicitis/" rel="nofollow" target="_blank">Ultrasound of Acute Appendicitis</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Acute Appendicitis

In this radiology lecture, we review the ultrasound appearance of thyroglossal duct cyst with two unique cases! Key teaching points include:  Thyroglossal duct cyst is the most common congenital neck cyst. Most present before age 18 as a midline, fluctuant neck mass near hyoid bone. Often asymptomatic unless superinfected = Abscess, draining sinus. Epithelial-lined cysts caused by failure of normal involution of thyroglossal duct. Can occur anywhere from foramen cecum of tongue to thyroid gland. Most are infrahyoid, followed by hyoid and suprahyoid. Most are midline, but can be paramedian (more likely if infrahyoid). If infrahyoid, typically embedded in strap muscles. May move with swallowing and elevates with tongue protrusion. Presence of normal thyroid gland should be confirmed. When simple, typically appears as an anechoic midline neck mass near hyoid bone. Cyst complexity usually due to superinfection: Proteinaceous internal debris and septations, thick irregular walls, increased blood flow and surrounding inflammation. Solid components may indicate ectopic thyroid or rarely (less than 1% of cases) thyroid cancer (typically papillary subtype). Tx: Resection of cyst, surrounding tissue along the thyroglossal tract, and midline portion of hyoid bone = Sistrunk procedure.  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! Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/ The post Ultrasound of Thyroglossal Duct Cyst appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of thyroglossal duct cyst with two unique cases! Key teaching points include: <ul> <li>Thyroglossal duct cyst is the most common congenital neck cyst.</li> <li>Most present before age 18 as a midline, fluctuant neck mass near hyoid bone.</li> <li>Often asymptomatic unless superinfected = Abscess, draining sinus.</li> <li>Epithelial-lined cysts caused by failure of normal involution of thyroglossal duct.</li> <li>Can occur anywhere from foramen cecum of tongue to thyroid gland.</li> <li>Most are infrahyoid, followed by hyoid and suprahyoid.</li> <li>Most are midline, but can be paramedian (more likely if infrahyoid).</li> <li>If infrahyoid, typically embedded in strap muscles.</li> <li>May move with swallowing and elevates with tongue protrusion.</li> <li>Presence of normal thyroid gland should be confirmed.</li> <li>When simple, typically appears as an anechoic midline neck mass near hyoid bone.</li> <li>Cyst complexity usually due to superinfection: Proteinaceous internal debris and septations, thick irregular walls, increased blood flow and surrounding inflammation.</li> <li>Solid components may indicate ectopic thyroid or rarely (less than 1% of cases) thyroid cancer (typically papillary subtype).</li> <li>Tx: Resection of cyst, surrounding tissue along the thyroglossal tract, and midline portion of hyoid bone = Sistrunk procedure.</li> </ul> To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the <a href="https://www.youtube.com/c/RadiologistHeadquarters/community" rel="noopener nofollow" target="_blank">YouTube Community tab</a> or follow on social media for bonus teaching material posted throughout the week! Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/case-review-ultrasound-of-thyroglossal-duct-cyst/" rel="nofollow" target="_blank">Ultrasound of Thyroglossal Duct Cyst</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Thyroglossal Duct Cyst

In this radiology lecture, we review the ultrasound appearance of scrotal varicocele with three unique cases. Key teaching points include:  Varicocele is abnormal dilatation of pampiniform venous plexus = Peritesticular veins. Seen in up to 15% of adult and adolescent males. Caused by incompetent or absent testicular vein valves. Upper limit of normal for scrotal vein caliber = 2 mm, varicocele when greater than 2-3 mm. Flow in varicocele usually too slow to detect with color Doppler and is typically better seen with Valsalva or with standing position. 85% left sided, 15% bilateral: Left testicular vein drains into left renal vein at 90-degree angle, and superior mesenteric artery compresses left renal vein = Increased pressure and venous backflow. Right vein drains into IVC at acute angle. Symptoms: Scrotal mass, pain, infertility/subfertility. Low grade: Reflux only seen with Valsalva, inguinal canal/supratesticular location, vessels enlarged only in standing position. High grade: Reflux seen at rest, infratesticular location, vessels enlarged in supine position. Solitary right varicocele raises concern for compression of the right testicular vein from a retroperitoneal mass. Ultrasound of upper abdomen should be considered when an isolated right-sided varicocele or asymmetrically large right-sided varicocele found. However, most patients typically present with additional signs and symptoms of malignancy: “No patient in our cohort was found to have an unsuspected malignancy for which isolated right-sided varicocele was the only presenting sign.”*  *Gleason A, Bishop K, Xi Y et al. Isolated Right-Sided Varicocele: Is Further Workup Necessary? AJR 2019; 212:802-807 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! Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/ The post Ultrasound of Varicocele appeared first on Radiologist Headquarters.

In this radiology lecture, we review the ultrasound appearance of scrotal varicocele with three unique cases. Key teaching points include: <ul> <li>Varicocele is abnormal dilatation of pampiniform venous plexus = Peritesticular veins.</li> <li>Seen in up to 15% of adult and adolescent males.</li> <li>Caused by incompetent or absent testicular vein valves.</li> <li>Upper limit of normal for scrotal vein caliber = 2 mm, varicocele when greater than 2-3 mm.</li> <li>Flow in varicocele usually too slow to detect with color Doppler and is typically better seen with Valsalva or with standing position.</li> <li>85% left sided, 15% bilateral: Left testicular vein drains into left renal vein at 90-degree angle, and superior mesenteric artery compresses left renal vein = Increased pressure and venous backflow. Right vein drains into IVC at acute angle.</li> <li>Symptoms: Scrotal mass, pain, infertility/subfertility.</li> <li>Low grade: Reflux only seen with Valsalva, inguinal canal/supratesticular location, vessels enlarged only in standing position.</li> <li>High grade: Reflux seen at rest, infratesticular location, vessels enlarged in supine position.</li> <li>Solitary right varicocele raises concern for compression of the right testicular vein from a retroperitoneal mass.</li> <li>Ultrasound of upper abdomen should be considered when an isolated right-sided varicocele or asymmetrically large right-sided varicocele found.</li> <li>However, most patients typically present with additional signs and symptoms of malignancy: “No patient in our cohort was found to have an unsuspected malignancy for which isolated right-sided varicocele was the only presenting sign.”*</li> </ul> *Gleason A, Bishop K, Xi Y et al. Isolated Right-Sided Varicocele: Is Further Workup Necessary? AJR 2019; 212:802-807 To learn more about the Samsung RS85 Prestige ultrasound system, please visit: <a href="https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4" rel="noopener nofollow" target="_blank">https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4</a> Click the <a href="https://www.youtube.com/c/RadiologistHeadquarters/community" rel="noopener nofollow" target="_blank">YouTube Community tab</a> or follow on social media for bonus teaching material posted throughout the week! Instagram: <a href="https://www.instagram.com/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.instagram.com/radiologistHQ/</a> Facebook: <a href="https://www.facebook.com/radiologistHeadQuarters/" rel="noopener nofollow" target="_blank">https://www.facebook.com/radiologistHeadQuarters/</a> Twitter: <a href="https://twitter.com/radiologistHQ" rel="noopener nofollow" target="_blank">https://twitter.com/radiologistHQ</a> Reddit: <a href="https://www.reddit.com/user/radiologistHQ/" rel="noopener nofollow" target="_blank">https://www.reddit.com/user/radiologistHQ/</a> The post <a href="https://radiologisthq.com/case-review-ultrasound-of-varicocele/" rel="nofollow" target="_blank">Ultrasound of Varicocele</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Ultrasound of Varicocele

Please keep them coming.  I enjoy these and will improve my interpretation of radiographs.

I’m lovin it

Excellent case review and discussions. Looking forwards many more, hopefully!

Excellent

Radiology Lectures | Radiologist Headquarters

In this video lecture, we focus on variants and malignant mimics of hemangioma and discuss how to characterize these masses on ultrasound, CT and MRI. Key points include:  The ultrasound “target” sign is typical for hepatic metastases and appears as a lesion with a hypoechoic periphery and echogenic center. Hemangiomas in a fatty liver may appear hypoechoic and mimic a more serious tumor but can be definitively characterized with MRI. Sclerosed or hyalinized hemangiomas contain fibrous tissue and therefore have variable enhancement and diminished T2 hyperintensity. Hemangiomas can be associated with arterioportal shunts and may be surrounded by areas of transient hepatic enhancement difference (THED) and peritumoral sparing of fatty infiltration. Differential diagnostic considerations for hepatic hemangioma include hypervascular liver metastases (including melanoma and pancreatic neuroendocrine tumor), intrahepatic mass-forming cholangiocarcinoma, and hepatic angiosarcoma. Irregular rim enhancement is not the same as interrupted peripheral nodular enhancement and should raise suspicion for malignancy in a solid mass. Metastatic tumors may progressively fill in and mimic hemangioma, but often show less pronounced “evil grey” T2 hyperintensity isointense to spleen, restrict diffusion, and have atypical enhancement. Mass-forming, peripheral intrahepatic cholangiocarcinoma can mimic hemangioma as both tumors demonstrate gradual progressive enhancement, but cholangiocarcinoma enhancement will be heterogeneous and not usually isointense to blood pool. Intrahepatic cholangiocarcinoma is heterogeneously T2 hyperintense often with central hypointensity and overlying capsular retraction but may not have associated biliary ductal dilatation.  The post Hepatic Hemangioma: Pitfalls &amp; Mimics, Part II appeared first on Radiologist Headquarters.

In this video lecture, we focus on variants and malignant mimics of hemangioma and discuss how to characterize these masses on ultrasound, CT and MRI. Key points include: <ul> <li>The ultrasound “target” sign is typical for hepatic metastases and appears as a lesion with a hypoechoic periphery and echogenic center.</li> <li>Hemangiomas in a fatty liver may appear hypoechoic and mimic a more serious tumor but can be definitively characterized with MRI.</li> <li>Sclerosed or hyalinized hemangiomas contain fibrous tissue and therefore have variable enhancement and diminished T2 hyperintensity.</li> <li>Hemangiomas can be associated with arterioportal shunts and may be surrounded by areas of transient hepatic enhancement difference (THED) and peritumoral sparing of fatty infiltration.</li> <li>Differential diagnostic considerations for hepatic hemangioma include hypervascular liver metastases (including melanoma and pancreatic neuroendocrine tumor), intrahepatic mass-forming cholangiocarcinoma, and hepatic angiosarcoma.</li> <li>Irregular rim enhancement is not the same as interrupted peripheral nodular enhancement and should raise suspicion for malignancy in a solid mass.</li> <li>Metastatic tumors may progressively fill in and mimic hemangioma, but often show less pronounced “evil grey” T2 hyperintensity isointense to spleen, restrict diffusion, and have atypical enhancement.</li> <li>Mass-forming, peripheral intrahepatic cholangiocarcinoma can mimic hemangioma as both tumors demonstrate gradual progressive enhancement, but cholangiocarcinoma enhancement will be heterogeneous and not usually isointense to blood pool.</li> <li>Intrahepatic cholangiocarcinoma is heterogeneously T2 hyperintense often with central hypointensity and overlying capsular retraction but may not have associated biliary ductal dilatation.</li> </ul> The post <a href="https://radiologisthq.com/hepatic-hemangioma-pitfalls-mimics-part-ii/" rel="nofollow" target="_blank">Hepatic Hemangioma: Pitfalls &amp; Mimics, Part II</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Hepatic Hemangioma: Pitfalls & Mimics, Part II

In this video lecture, we discuss the diagnosis and imaging appearance of malignant adrenal masses: adrenal metastases including collision tumor, adrenocortical carcinoma and adrenal lymphoma. Key points include:  Adrenal metastases are the most common malignant lesion involving the adrenal gland. Lung carcinoma is the most common primary malignancy to metastasize to the adrenal glands. Adrenal metastases are often bilateral and greater than 3 cm in size. When malignant adrenal lesions are compared to adenomas, SUV cutoff of 3.1 has a 99% negative predictive value. Adrenal-to-liver SUV ratio cutoff value of 1.4 has a specificity of 100% in differentiating adrenal adenomas and metastases. Collision tumors are two histologically distinct tumors that abut or are near each other in the adrenal gland, and PET/CT is the best way to characterize these lesions without biopsy. An enlarging defect within adrenal signal dropout on T1-weighted opposed-phase GRE images is suspicious for a metastatic collision tumor abutting a lipid-rich adrenal adenoma. Renal cell carcinoma metastases can be slow growing and occur many years after the initial tumor presentation. Adrenocortical carcinoma has a bimodal age distribution, may be hormonally functioning and has a poor prognosis. Adrenocortical carcinoma usually presents as a large (greater than 6 cm) mass with internal hemorrhage, necrosis and sometimes calcification. Venous invasion is common with adrenocortical carcinoma. Adrenal lymphoma will be round or adreniform in shape and frequently shows restricted diffusion, a feature that can be helpful in differentiating from adrenal hyperplasia. Diffuse large B-cell lymphoma is the most common type of adrenal lymphoma, and patients usually present with B-cell symptoms and/or adrenal insufficiency. Adrenal lymphoma is usually bilateral and may invade the adjacent kidney(s).  The post Malignant Adrenal Masses appeared first on Radiologist Headquarters.

In this video lecture, we discuss the diagnosis and imaging appearance of malignant adrenal masses: adrenal metastases including collision tumor, adrenocortical carcinoma and adrenal lymphoma. Key points include: <ul> <li>Adrenal metastases are the most common malignant lesion involving the adrenal gland.</li> <li>Lung carcinoma is the most common primary malignancy to metastasize to the adrenal glands.</li> <li>Adrenal metastases are often bilateral and greater than 3 cm in size.</li> <li>When malignant adrenal lesions are compared to adenomas, SUV cutoff of 3.1 has a 99% negative predictive value.</li> <li>Adrenal-to-liver SUV ratio cutoff value of 1.4 has a specificity of 100% in differentiating adrenal adenomas and metastases.</li> <li>Collision tumors are two histologically distinct tumors that abut or are near each other in the adrenal gland, and PET/CT is the best way to characterize these lesions without biopsy.</li> <li>An enlarging defect within adrenal signal dropout on T1-weighted opposed-phase GRE images is suspicious for a metastatic collision tumor abutting a lipid-rich adrenal adenoma.</li> <li>Renal cell carcinoma metastases can be slow growing and occur many years after the initial tumor presentation.</li> <li>Adrenocortical carcinoma has a bimodal age distribution, may be hormonally functioning and has a poor prognosis.</li> <li>Adrenocortical carcinoma usually presents as a large (greater than 6 cm) mass with internal hemorrhage, necrosis and sometimes calcification.</li> <li>Venous invasion is common with adrenocortical carcinoma.</li> <li>Adrenal lymphoma will be round or adreniform in shape and frequently shows restricted diffusion, a feature that can be helpful in differentiating from adrenal hyperplasia.</li> <li>Diffuse large B-cell lymphoma is the most common type of adrenal lymphoma, and patients usually present with B-cell symptoms and/or adrenal insufficiency.</li> <li>Adrenal lymphoma is usually bilateral and may invade the adjacent kidney(s).</li> </ul> The post <a href="https://radiologisthq.com/malignant-adrenal-masses/" rel="nofollow" target="_blank">Malignant Adrenal Masses</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Malignant Adrenal Masses

In the conclusion of this introductory series, we discuss the basics of computed tomography (CT) urography, bladder and urethral diverticula, and scrotal pathology including varicocele, epididymo-orchitis, and testicular neoplasm. Topics include:  CT urography post-processing techniques: maximum intensity projection (MIP) and 3D volume-rendered (VR) imaging. Appearance of transitional cell carcinoma in the ureters and bladder on excretory phase CT mages. Papillary necrosis. Weigert-Meyer rule for duplicated collecting systems and tips to remember it. Urethral diverticula appearance on magnetic resonance imaging (MRI) and voiding cystourography (VCUG). Scrotal varicocele and the importance of recognizing the implications of right-sided versus left-sided. Acute scrotal pathology: testicular torsion and epididymo-orchitis. Differentiating seminomatous and non-seminomatous testicular neoplasms via ultrasound.  The post Introduction to Genitourinary Radiology, Part III appeared first on Radiologist Headquarters.

In the conclusion of this introductory series, we discuss the basics of computed tomography (CT) urography, bladder and urethral diverticula, and scrotal pathology including varicocele, epididymo-orchitis, and testicular neoplasm. Topics include: <ul> <li>CT urography post-processing techniques: maximum intensity projection (MIP) and 3D volume-rendered (VR) imaging.</li> <li>Appearance of transitional cell carcinoma in the ureters and bladder on excretory phase CT mages.</li> <li>Papillary necrosis.</li> <li>Weigert-Meyer rule for duplicated collecting systems and tips to remember it.</li> <li>Urethral diverticula appearance on magnetic resonance imaging (MRI) and voiding cystourography (VCUG).</li> <li>Scrotal varicocele and the importance of recognizing the implications of right-sided versus left-sided.</li> <li>Acute scrotal pathology: testicular torsion and epididymo-orchitis.</li> <li>Differentiating seminomatous and non-seminomatous testicular neoplasms via ultrasound.</li> </ul> The post <a href="https://radiologisthq.com/introduction-genitourinary-radiology-part-iii/" rel="nofollow" target="_blank">Introduction to Genitourinary Radiology, Part III</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Introduction to Genitourinary Radiology, Part III

In this video lecture, we discuss the imaging appearance of lipid-rich and lipid-poor adrenal adenomas, explain the CT washout calculation, and review the choice of CT vs. MRI for the evaluation of adrenal nodules. Also, we compare the 2017 ACR (American College of Radiologists) Incidental Findings Committee recommendations to the AACE/AAES (American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons) medical guidelines in the evaluation of adrenal incidentalomas. Key points include:  70% of adrenal adenomas will be lipid-rich with a low-density of 10 or less Hounsfield units (HU) on CT. Adrenal nodules with greater than 60% enhancement washout and greater than 40% relative washout are consistent with adenomas. Using chemical shift, MRI may be helpful in characterizing a mass which is indeterminate on non-contrast CT, particularly if the non-contrast density is less than 20-30 HU. If the non-contrast density of an adrenal nodule is greater than 20-30 HU, MRI should be avoided, as washout CT is typically the test of choice. While the AACE/AAES and ACR follow-up algorithms for adrenal nodules differ in many respects, they agree that surgical resection should be considered for adrenal masses measuring 4 cm or more in size, and that biochemical evaluation should at least be considered for most adrenal masses.  The post Imaging of Adrenal Adenomas &amp; Incidentalomas appeared first on Radiologist Headquarters.

In this video lecture, we discuss the imaging appearance of lipid-rich and lipid-poor adrenal adenomas, explain the CT washout calculation, and review the choice of CT vs. MRI for the evaluation of adrenal nodules. Also, we compare the 2017 ACR (American College of Radiologists) Incidental Findings Committee recommendations to the AACE/AAES (American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons) medical guidelines in the evaluation of adrenal incidentalomas. Key points include: <ul> <li>70% of adrenal adenomas will be lipid-rich with a low-density of 10 or less Hounsfield units (HU) on CT.</li> <li>Adrenal nodules with greater than 60% enhancement washout and greater than 40% relative washout are consistent with adenomas.</li> <li>Using chemical shift, MRI may be helpful in characterizing a mass which is indeterminate on non-contrast CT, particularly if the non-contrast density is less than 20-30 HU.</li> <li>If the non-contrast density of an adrenal nodule is greater than 20-30 HU, MRI should be avoided, as washout CT is typically the test of choice.</li> <li>While the AACE/AAES and ACR follow-up algorithms for adrenal nodules differ in many respects, they agree that surgical resection should be considered for adrenal masses measuring 4 cm or more in size, and that biochemical evaluation should at least be considered for most adrenal masses.</li> </ul> The post <a href="https://radiologisthq.com/imaging-of-adrenal-adenomas-incidentalomas/" rel="nofollow" target="_blank">Imaging of Adrenal Adenomas &amp; Incidentalomas</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Imaging of Adrenal Adenomas & Incidentalomas

Quiz yourself with this week’s interactive video lecture as we present a total of 5 interesting musculoskeletal imaging cases followed by a diagnosis reveal and key teaching points after each case, all in just a few minutes! The post 5 Cases in 5 Minutes: Musculoskeletal #1 appeared first on Radiologist Headquarters.

Quiz yourself with this week’s interactive video lecture as we present a total of 5 interesting musculoskeletal imaging cases followed by a diagnosis reveal and key teaching points after each case, all in just a few minutes! The post <a href="https://radiologisthq.com/5-cases-in-5-minutes-musculoskeletal-1/" rel="nofollow" target="_blank">5 Cases in 5 Minutes: Musculoskeletal #1</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

5 Cases in 5 Minutes: Musculoskeletal #1

In this video lecture, we discuss the imaging appearance of adrenal cysts and myelolipomas, as well as differential diagnostic considerations. Key points include: Adrenal cysts typically have density of simple fluid ranging from 20 to -10 Hounsfield units (HU).Adrenal pseudocysts may be symptomatic, may have a complicated appearance and may have peripheral calcification.The “claw” sign can be helpful in differentiating adrenal from renal masses.Gastric diverticula can mimic adrenal cysts but can be differentiated by identifying communication of gastric diverticulum with adjacent stomach, as well as the presence of oral contrast and/or gas with the diverticulum. Adrenal myelolipomas are benign neoplasms that have varying degrees of macroscopic fat and hematopoietic soft tissue elements.Fat density within myelolipomas on CT ranges from -30 to -90 HU.Up to 30% of myelolipomas contain small calcifications.Unlike myelolipomas, malignant retroperitoneal sarcomas are usually ill-defined and displace or invade adjacent structures.Because myelolipomas contain macroscopic fat, they show greater signal loss (darkening) on fat-saturated images compared to T1 opposed-phase chemical shift images. Conversely, lipid-rich adrenal adenomas contain microscopic fat (also known as intracellular, intracytoplasmic, or intravoxel fat) and therefore show greater signal loss on T1 opposed-phase images than on fat-saturated images.  The post Adrenal Cysts and Myelolipomas appeared first on Radiologist Headquarters.

In this video lecture, we discuss the imaging appearance of adrenal cysts and myelolipomas, as well as differential diagnostic considerations. Key points include: <ul><li>Adrenal cysts typically have density of simple fluid ranging from 20 to -10 Hounsfield units (HU).</li><li>Adrenal pseudocysts may be symptomatic, may have a complicated appearance and may have peripheral calcification.</li><li>The “claw” sign can be helpful in differentiating adrenal from renal masses.</li><li>Gastric diverticula can mimic adrenal cysts but can be differentiated by identifying communication of gastric diverticulum with adjacent stomach, as well as the presence of oral contrast and/or gas with the diverticulum. </li><li>Adrenal myelolipomas are benign neoplasms that have varying degrees of macroscopic fat and hematopoietic soft tissue elements.</li><li>Fat density within myelolipomas on CT ranges from -30 to -90 HU.</li><li>Up to 30% of myelolipomas contain small calcifications.</li><li>Unlike myelolipomas, malignant retroperitoneal sarcomas are usually ill-defined and displace or invade adjacent structures.</li><li>Because myelolipomas contain macroscopic fat, they show greater signal loss (darkening) on fat-saturated images compared to T1 opposed-phase chemical shift images. </li><li>Conversely, lipid-rich adrenal adenomas contain microscopic fat (also known as intracellular, intracytoplasmic, or intravoxel fat) and therefore show greater signal loss on T1 opposed-phase images than on fat-saturated images. </li></ul> The post <a href="https://radiologisthq.com/adrenal-cysts-and-myelolipomas/" rel="nofollow" target="_blank">Adrenal Cysts and Myelolipomas</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Adrenal Cysts and Myelolipomas

Join us in this interactive video lecture as we present a total of 5 unknown vascular imaging cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post 5 Cases in 5 Minutes: Vascular #1 appeared first on Radiologist Headquarters.

Join us in this interactive video lecture as we present a total of 5 unknown vascular imaging cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post <a href="https://radiologisthq.com/5-cases-in-5-minutes-vascular-1/" rel="nofollow" target="_blank">5 Cases in 5 Minutes: Vascular #1</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

5 Cases in 5 Minutes: Vascular #1

Quiz yourself with this week’s interactive video lecture as we present a total of 5 unknown vascular imaging cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post 5 Cases in 5 Minutes: Vascular #2 appeared first on Radiologist Headquarters.

Quiz yourself with this week’s interactive video lecture as we present a total of 5 unknown vascular imaging cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post <a href="https://radiologisthq.com/5-cases-in-5-minutes-vascular-2/" rel="nofollow" target="_blank">5 Cases in 5 Minutes: Vascular #2</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

5 Cases in 5 Minutes: Vascular #2

Quiz yourself with this week’s interactive video lecture as we present a total of 5 interesting vascular imaging cases followed by a diagnosis reveal and key teaching points after each case, all in just a few minutes! The post 5 Cases in 5 Minutes: Vascular #4 appeared first on Radiologist Headquarters.

Quiz yourself with this week’s interactive video lecture as we present a total of 5 interesting vascular imaging cases followed by a diagnosis reveal and key teaching points after each case, all in just a few minutes! The post <a href="https://radiologisthq.com/5-cases-in-5-minutes-vascular-4/" rel="nofollow" target="_blank">5 Cases in 5 Minutes: Vascular #4</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

5 Cases in 5 Minutes: Vascular #4

In this video lecture, we discuss the imaging appearance of adrenal hemorrhage on CT, MRI and ultrasound. Causes of adrenal hemorrhage will also be reviewed.  Key points include: On CT scan, adrenal hemorrhage typically appears as a nonenhancing round or oval hyperdense mass with density of 50-90 HU. MRI is the most sensitive and specific modality for diagnosing adrenal hemorrhage. The “high signal intensity rim” rim sign seen on T1-weighted images is characteristic of subacute adrenal hemorrhage. Adrenal hemorrhage may appear solid or cystic on ultrasound depending on the age of hemorrhage.Adrenal hemorrhage is more common in neonates than in children and adults and is the most common adrenal mass in infancy.Trauma is the most common cause and is usually unilateral and right-sided. Atraumatic adrenal hemorrhage is usually unilateral. The post Adrenal Hemorrhage appeared first on Radiologist Headquarters.

In this video lecture, we discuss the imaging appearance of adrenal hemorrhage on CT, MRI and ultrasound. Causes of adrenal hemorrhage will also be reviewed.  Key points include: <ul><li>On CT scan, adrenal hemorrhage typically appears as a nonenhancing round or oval hyperdense mass with density of 50-90 HU. </li><li>MRI is the most sensitive and specific modality for diagnosing adrenal hemorrhage. </li><li>The “high signal intensity rim” rim sign seen on T1-weighted images is characteristic of subacute adrenal hemorrhage. </li><li>Adrenal hemorrhage may appear solid or cystic on ultrasound depending on the age of hemorrhage.</li><li>Adrenal hemorrhage is more common in neonates than in children and adults and is the most common adrenal mass in infancy.</li><li>Trauma is the most common cause and is usually unilateral and right-sided. </li><li>Atraumatic adrenal hemorrhage is usually unilateral.</li></ul> The post <a href="https://radiologisthq.com/adrenal-hemorrhage/" rel="nofollow" target="_blank">Adrenal Hemorrhage</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Adrenal Hemorrhage

In the second part of this video lecture, we discuss the MRI appearance of pelvic inflammatory disease (PID), including tips on how to differentiate pyosalpinx from both hydrosalpinx and hematosalpinx.  The computed tomography (CT) and ultrasound appearance of associated complications of PID are also reviewed. Topics include:  Using diffusion-weighted imaging to differentiate pyosalpinx/tubo-ovarian abscess (TOA) from hydrosalpinx. Association between hematosalpinx and endometriosis. Fitz-Hugh-Curtis perihepatitis syndrome and its CT appearance on both late hepatic arterial phase and portal venous phase imaging. Imaging appearance of endometritis, including fluid-filled dilated endometrial cavity, subendometrial enhancement, gas, “dirty” shadowing and (most importantly) presence of clinical suspicion. Ovarian vein thrombosis, with emphasis on identifying enhancing, thickened venous walls and perivenous inflammation as findings of thrombophlebitis. TOA secondary to diverticulitis. How oxidized regenerated cellulose can mimic pelvic abscess and can normally contain gas for at least a month after surgery, highlighting the importance of reviewing the details of the operative history.  References:  Revzin MV,  Mathur M, Dave HB, et al. Pelvic inflammatory disease: Multimodality imaging approach with clinical-pathologic correlation. Radiographics. 2016;36(5):1579-1596. Kim D, Kim TU, Lee JW, et al. The perihepatic space: Comprehensive anatomy and CT features of pathologic conditions. Radiographics. 2007;27(1):129 –143. Bennett GL, Slywotzky CM, Giovanniello G. Gynecologic causes of acute pelvic pain: Spectrum of CT findings. Radiographics. 2002;22(4):785–801. Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 2002;22(6):1327–1334. Kaakaji Y, Nghiem HV, Nodell C, Winter. TC. Sonography of obstetric and gynecologic emergencies. Part II, Gynecologic emergencies. AJR Am J Roentgenol. 2000 Mar;174(3):651-656. Kim MY, Rha SE, Oh SN, et al. MR imaging findings of hydrosalpinx: a comprehensive review. Radiographics. 2009;29(2):495-507. Ha HK, Lim GY, Cha ES, et al. MR imaging of tubo-ovarian abscess. Acta Radiol. 1995;36(5):510-4. Wilbur AC, Aizenstein RI, Napp TE. CT findings in tuboovarian abscess. AJR Am J Roentgenol. 1992;158(3):575-9. Young ST, Paulson EK, McCann RL, Baker ME. Appearance of oxidized cellulose (Surgicel) on postoperative CT scans: similarity to postoperative abscess. AJR Am J Roentgenol. 1993;160(2):275-277.  Sandrasegaran K, Lall C, Rajesh A, Maglinte DT. Distinguishing gelatin bioabsorbable sponge and postoperative abdominal abscess on CT. AJR Am J Roentgenol. 2005;184(2):475-480.  The post Imaging of Pelvic Inflammatory Disease, Part II appeared first on Radiologist Headquarters.

In the second part of this video lecture, we discuss the MRI appearance of pelvic inflammatory disease (PID), including tips on how to differentiate pyosalpinx from both hydrosalpinx and hematosalpinx.  The computed tomography (CT) and ultrasound appearance of associated complications of PID are also reviewed. Topics include: <ul> <li>Using diffusion-weighted imaging to differentiate pyosalpinx/tubo-ovarian abscess (TOA) from hydrosalpinx.</li> <li>Association between hematosalpinx and endometriosis.</li> <li>Fitz-Hugh-Curtis perihepatitis syndrome and its CT appearance on both late hepatic arterial phase and portal venous phase imaging.</li> <li>Imaging appearance of endometritis, including fluid-filled dilated endometrial cavity, subendometrial enhancement, gas, “dirty” shadowing and (most importantly) presence of clinical suspicion.</li> <li>Ovarian vein thrombosis, with emphasis on identifying enhancing, thickened venous walls and perivenous inflammation as findings of thrombophlebitis.</li> <li>TOA secondary to diverticulitis.</li> <li>How oxidized regenerated cellulose can mimic pelvic abscess and can normally contain gas for at least a month after surgery, highlighting the importance of reviewing the details of the operative history.</li> </ul> References: <ul> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/27618331" rel="noopener noreferrer nofollow" target="_blank">Revzin MV,  Mathur M, Dave HB, et al. Pelvic inflammatory disease: Multimodality imaging approach with clinical-pathologic correlation. Radiographics. 2016;36(5):1579-1596.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/17235003" rel="noopener noreferrer nofollow" target="_blank">Kim D, Kim TU, Lee JW, et al. The perihepatic space: Comprehensive anatomy and CT features of pathologic conditions. Radiographics. 2007;27(1):129 –143.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/12110710" rel="noopener noreferrer nofollow" target="_blank">Bennett GL, Slywotzky CM, Giovanniello G. Gynecologic causes of acute pelvic pain: Spectrum of CT findings. Radiographics. 2002;22(4):785–801.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/12432105" rel="noopener noreferrer nofollow" target="_blank">Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 2002;22(6):1327–1334.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/10701603" rel="noopener noreferrer nofollow" target="_blank">Kaakaji Y, Nghiem HV, Nodell C, Winter. TC. Sonography of obstetric and gynecologic emergencies. Part II, Gynecologic emergencies. AJR Am J Roentgenol. 2000 Mar;174(3):651-656.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/19325061" rel="noopener noreferrer nofollow" target="_blank">Kim MY, Rha SE, Oh SN, et al. MR imaging findings of hydrosalpinx: a comprehensive review. Radiographics. 2009;29(2):495-507.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/7640096" rel="noopener noreferrer nofollow" target="_blank">Ha HK, Lim GY, Cha ES, et al. MR imaging of tubo-ovarian abscess. Acta Radiol. 1995;36(5):510-4.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/1738998" rel="noopener noreferrer nofollow" target="_blank">Wilbur AC, Aizenstein RI, Napp TE. CT findings in tuboovarian abscess. AJR Am J Roentgenol. 1992;158(3):575-9.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/8424333" rel="noopener noreferrer nofollow" target="_blank">Young ST, Paulson EK, McCann RL, Baker ME. Appearance of oxidized cellulose (Surgicel) on postoperative CT scans: similarity to postoperative abscess. AJR Am J Roentgenol. 1993;160(2):275-277. </a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/15671366?dopt=Abstract" rel="noopener noreferrer nofollow" target="_blank">Sandrasegaran K, Lall C, Rajesh A, Maglinte DT. Distinguishing gelatin bioabsorbable sponge and postoperative abdominal abscess on CT. AJR Am J Roentgenol. 2005;184(2):475-480.</a></li> </ul> The post <a href="https://radiologisthq.com/imaging-pelvic-inflammatory-disease-part-ii/" rel="nofollow" target="_blank">Imaging of Pelvic Inflammatory Disease, Part II</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Imaging of Pelvic Inflammatory Disease, Part II

Join us in this interactive video lecture as we present a total of 5 unknown thoracic imaging cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post 5 Cases in 5 Minutes: Thoracic #1 appeared first on Radiologist Headquarters.

Join us in this interactive video lecture as we present a total of 5 unknown thoracic imaging cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post <a href="https://radiologisthq.com/5-cases-in-5-minutes-thoracic-1/" rel="nofollow" target="_blank">5 Cases in 5 Minutes: Thoracic #1</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

5 Cases in 5 Minutes: Thoracic #1

In this video lecture, we discuss tips and tricks to diagnose everybody’s favorite hepatic tumor on CT, MRI and ultrasound. Key points include:  Hemangioma is the most common benign hepatic tumor, and it is more common in females. These tumors are usually asymptomatic and typically require no treatment, but can rarely cause pain, rupture if large, or cause Kasabach-Merritt syndrome. On nonenhanced CT, hemangiomas will be hypodense to liver parenchyma and homogeneously isodense to the blood pool. There are three major enhancement patterns for typical hemangiomas, and all patterns will show persistent delayed enhancement without contrast washout. Peripheral, nodular, interrupted enhancement with gradual centripetal progression to uniform enhancement is the most common pattern. Smaller lesions (less than 1-2 cm) can have immediate uniform enhancement and appear flash-filling. Larger hemangiomas may have a central scar that does not enhance. MRI is highly specific in the diagnosis of hemangioma. On MRI, hemangiomas will appear T1 hypointense and T2 hyperintense to liver parenchyma, or (perhaps more importantly) T1 isointense to the blood pool and T2 hyperintense to the spleen. Hemangiomas usually do not show restricted diffusion. If present, the central scar of hemangioma will appear T1 hypointense and T2 hyperintense on MRI. Additional liver masses that may have a central scar include focal nodular hyperplasia, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, and hepatocellular carcinoma. On ultrasound, hemangiomas are usually uniformly echogenic. 40% of hemangiomas can have a “reverse target” appearance with an echogenic periphery and hypoechoic center. Hemangiomas usually have no color Doppler flow on ultrasound, but they may occasionally exhibit mild flow.  The post Hepatic Hemangioma: Pitfalls &amp; Mimics, Part I appeared first on Radiologist Headquarters.

In this video lecture, we discuss tips and tricks to diagnose everybody’s favorite hepatic tumor on CT, MRI and ultrasound. Key points include: <ul> <li>Hemangioma is the most common benign hepatic tumor, and it is more common in females.</li> <li>These tumors are usually asymptomatic and typically require no treatment, but can rarely cause pain, rupture if large, or cause Kasabach-Merritt syndrome.</li> <li>On nonenhanced CT, hemangiomas will be hypodense to liver parenchyma and homogeneously isodense to the blood pool.</li> <li>There are three major enhancement patterns for typical hemangiomas, and all patterns will show persistent delayed enhancement without contrast washout.</li> <li>Peripheral, nodular, interrupted enhancement with gradual centripetal progression to uniform enhancement is the most common pattern.</li> <li>Smaller lesions (less than 1-2 cm) can have immediate uniform enhancement and appear flash-filling.</li> <li>Larger hemangiomas may have a central scar that does not enhance.</li> <li>MRI is highly specific in the diagnosis of hemangioma.</li> <li>On MRI, hemangiomas will appear T1 hypointense and T2 hyperintense to liver parenchyma, or (perhaps more importantly) T1 isointense to the blood pool and T2 hyperintense to the spleen.</li> <li>Hemangiomas usually do not show restricted diffusion.</li> <li>If present, the central scar of hemangioma will appear T1 hypointense and T2 hyperintense on MRI.</li> <li>Additional liver masses that may have a central scar include focal nodular hyperplasia, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, and hepatocellular carcinoma.</li> <li>On ultrasound, hemangiomas are usually uniformly echogenic.</li> <li>40% of hemangiomas can have a “reverse target” appearance with an echogenic periphery and hypoechoic center.</li> <li>Hemangiomas usually have no color Doppler flow on ultrasound, but they may occasionally exhibit mild flow.</li> </ul> The post <a href="https://radiologisthq.com/hepatic-hemangioma-pitfalls-mimics-part-i/" rel="nofollow" target="_blank">Hepatic Hemangioma: Pitfalls &amp; Mimics, Part I</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

Hepatic Hemangioma: Pitfalls & Mimics, Part I

Quiz yourself with this week’s interactive video lecture as we present a total of 5 unknown thoracic imaging cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post 5 Cases in 5 Minutes: Thoracic #2 appeared first on Radiologist Headquarters.

Quiz yourself with this week’s interactive video lecture as we present a total of 5 unknown thoracic imaging cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post <a href="https://radiologisthq.com/5-cases-in-5-minutes-thoracic-2/" rel="nofollow" target="_blank">5 Cases in 5 Minutes: Thoracic #2</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

5 Cases in 5 Minutes: Thoracic #2

Join us in this interactive lecture as we present a total of 5 unknown cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post 5 Cases in 5 Minutes: Ultrasound #4 appeared first on Radiologist Headquarters.

Join us in this interactive lecture as we present a total of 5 unknown cases followed by a diagnosis reveal and key teaching points after each case, all in about 5(ish) minutes! The post <a href="https://radiologisthq.com/5-cases-in-5-minutes-ultrasound-4/" rel="nofollow" target="_blank">5 Cases in 5 Minutes: Ultrasound #4</a> appeared first on <a href="https://radiologisthq.com" rel="nofollow" target="_blank">Radiologist Headquarters</a>.

5 Cases in 5 Minutes: Ultrasound #4

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