Tuesday, February 7, 2023

Why are these veins so pulsatile?

First let's have a look at some examples of normal veins in 2 different patients. 
The above spectral Doppler ultrasound images are of 2 healthy patients with mild respiratory phasicity of normal popliteal and femoral veins. 
Next we see a patient with what I call moderately increased pulsatile veins. This is not normal. 
The above spectral Doppler ultrasound images show moderate increase in pulsatile waveforms in the veins. And they are bilateral. 
Why is this? This patient has bilateral pedal edema also. No evidence of deep vein thrombosis or DVT.
They are because of possible right heart failure. Right heart failure or congestive cardiac failure can cause increase in pulsatility of lower limb veins. 
Final diagnosis: increased pulsatility of veins due to possible CCF or congestive cardiac failure.
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Sunday, February 5, 2023

A small subcutaneous mass? Ultrasound scan to the rescue.

A small subcutaneous mass on abdomen. 


It measures a little over 2 cms in maximum diameter. 
It is mildly hyperechoic. Mostly homogeneous. 
Not tender or painful. Power Doppler ultrasound shows no significant vascularity. 
The first differential diagnosis here is:
Subcutaneous lipoma. 
2nd possibility: fibroma
Subcutaneous lipoma is usually small in size, usually less than 3 cms. 
Deep lipoma can be quite large, even > 7 cms. 
Lipoma is a benign mass and follow up ultrasound is usually done to look for changes in shape and size. The possibility of malignant change is very small. 

Final diagnosis: subcutaneous lipoma.

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What's that in the urinary bladder; uric acid crystals?

This male adult has high serum uric acid levels > 8 mg%
That's the diagnosis of gout.
We scanned his abdomen and this is what we found on sonography:
That's the urinary bladder with loads of crystals. What is the cause? Uric acid crystals in bladder is the likely cause. 
Pyuria or pus in bladder can produce a similar appearance. However, pus wouldn't be so brightly echogenic.
Had a look at the kidneys:
Looked initially to be a medium sized renal calculus. But change of posture produced a shift of the sediments. Clearly a case of a milk of calcium cyst. Measuring 1.5 cms. 

Diagnosis: renal milk of calcium cyst with crystaluria. Possibly the left renal MOC cyst is a calyceal diverticulum. Could it be the cause of release of crystals into the urinary bladder? 
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Saturday, February 4, 2023

Anything wrong with this heart?

Patient of hypertension. 
Did an echocardiography. 
What did we find?
Have a look 👀:
Just a 4 chamber view. Showing thickened interventricular septum. More than 13 mm.
Anything more than 11 mm is hypertrophy of the left ventricle. 
EPSS or end point septal separation. Normal at 4 mm.
Very nice EF or ejection fraction at 66 %
Normal flow across mitral and tricuspid valves. 
Asked the patient to control his blood pressure. Hypertension being the cause of his left ventricular hypertrophy. 
Final diagnosis: mild LVH
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Monday, January 30, 2023

Ovarian complex cyst. What could it be? A googly case.

Here are the ultrasound scan and color Doppler ultrasound images, both transabdominal and endocavity scans. 
There's obviously a cyst in the left ovary. 
But what can we say about the diagnosis?
Firstly, it's a complex cyst. Note the multiple septations. The transabdominal ultrasound scan suggests a possible hemorrhagic cyst. Indeed, the clinical diagnosis was similar. 
But the endocavity scan suggests something more than this.
Those septae are pretty thick. Also just observe the vessels within the septations. Not a likely finding in a hemorrhagic cyst. 
More along the lines of a serous cystadenoma. 
Final diagnosis: early stages of a serous cystadenoma of the left ovary. 

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Sunday, January 29, 2023

Strange looking papillary muscle?

This young adult male had history of epigastric pain. 
A quick echo study showed this strange looking mass in the left ventricle. 
What could it be?
Further echocardiography images show it to be the papillary muscle. A hypertrophied papillary muscle. 
Here's the axial view and another PLAX view. 
The color Doppler ultrasound image shows it to be papillary muscle again. 
Hypertrophied papillary muscle may be just an incidental finding. It may also be associated with chronic rheumatic mitral valve disease or a relatively unknown condition called Fabry disease. 
Further evaluation is advised. 
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Wednesday, January 25, 2023

Multiple liver masses, known case of hepatoma

Multiple echogenic liver masses in a known case of hepatoma. 
Multi-focal hepatoma is characterized by multiple echogenic liver masses on sonography. 
The hepatoma masses are of varying sizes, as seen on the ultrasound images above. 
Color Doppler ultrasound shows multiple areas of neo-vascularity with large vessels surrounding the liver masses. 
But observe the two lower images 👆.
Internal vascularity is present within the masses. 
Final diagnosis: multi-focal hepatoma or hepatocellular carcinoma. 
Differential diagnosis:
Possibilities include liver metastasis and focal nodular hyperplasia. 
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