Thursday, March 15, 2012

Rt. iliac fossa pain in middle aged lady- ultrasound quiz

This middle aged lady has severe right iliac fossa pain. What is your diagnosis based on these ultrasound and color Doppler images?

Answer; acute appendicitis. The appendix is swollen with hypoechoic fluid within it and hyperemia.

Monday, March 12, 2012

Quiz- a case of Pyrexia

 Bladder (above):

Kidneys: (above):

Prostate TRUS scan (above)
What is your diagnosis in this elderly male with high fever?
Answer: The ultrasound images of the kidneys show that they are edematous and swollen with compression of the central, renal sinus (pelvis) echoes. This is typically seen in renal infection (nephritis). The high vascularity of the prostate suggests prostatitis. This is a classic case of urinary tract infection, involving the entire urinary tract. 

Sunday, March 11, 2012

Elastography of thyroid nodules

Thyroid elastography application is still in its infancy and though elastography has been proven to be successful in breast nodules, its thyroid use is yet to be undertaken on a large scale. However, the basic principles are the same for elastography of the thyroid or breast.
This is a female patient with multiple hypoechoic lesions of both lobes of the thyroid.

Color Doppler study was inconclusive as there was not any significant increase in vascularity of any of the lesions:

Elastogram of the thyroid (right lobe) shows a different picture:

The elastography was done using repeated gentle vibratory motions of the probe vertically applied to the surface of the thyroid. The images were frozen when the vertical green bar (on the upper left of the image) shows full green appearance. This is considered as an optimal elastogram. The right lobe shows a variety of hues ranging from red (soft- S) and green (moderately hard) to blue (Hard-H). The hardness is measured  using the color coding (see the vertical bar on the right of the image) from hard (H) to soft (S). The right lobe of thyroid in this case shows extensive blue color suggesting a largely hard nodular thyroid, which is potentially malignant.
For more on thyroid ultrasonography, visit: