Ultrasound of suprapatellar hematoma

The knee joint is an excellent example of superb ultrasound imaging using the newer high resolution sonographic probes in the market. Perhaps, ultrasound offers better resolution than MRI in studying certain aspects of knee joint pathology, the only hitch being the user dependence. This case study of suprapatellar hematoma or hemorrhagic effusion is a typical example. With the opportunity to image joints on both sides and actually study the effect of probe compression, sonography is in certain ways both cost effective and complementary to an MRI study of the knee joint. The extent of muscle, tendon and ligament detail that high resolution sonography of the knee joint offers, is at par if not better than MR imaging.
Visit: http://www.ultrasound-images.com/musculoskeletal.htm#Suprapatellar_effusion_%28suprapatellar_hematoma%29 a case of knee injury with hemorrhagic effusion extending into the suprapatellar bursa.

Schwannoma of parotid- a rare tumor

The parotid salivary gland can sometimes yield surprises in the form of rare tumors. One such instance is a Schwannoma of the parotid gland. This tumor arises from the facial nerve as it courses through the salivary gland. Visit: http://www.ultrasound-images.com/salivary-glands.htm#Parotid_gland_Schwannoma
This site shows ultrasound images of this well defined facial nerve mass in the parotid. This tumor has not much literature published both online or in print, pertaining to its sonography. However, the case above of Schwannoma of the right parotid was confirmed histo-pathologically after biopsy.
On ultrasound this tumor has all the appearances of a benign well defined mass with nothing to point to its exact diagnosis, making precise diagnosis of Schwannoma of the parotid, difficult, on sonography.

Orchitis in neonates:

This 15 days old male neonate has swelling of the left scrotum. Ultrasound images of the scrotum show a small left hydrocele with thickening of the scrotal wall. See image below:

The left testis also appears to have a shaggy outline suggesting inflammatory pathology of this organ.
Color Doppler image of the left scrotum show minimal increase in flow to the left testis:

However, this sign is not dependable in such young children, due to the poor pick up of color Doppler signals in neonatal scrotum.
Power Doppler study of the scrotum in this infant also proved to be only partially useful- see images below:

Both the above images show only the significant thickening of the left scrotal wall and not so much, the hyperemia.

Only the last image (above) shows some degree of increased flow (power Doppler image) in the left testis, and that too, at the lowest possible PRF (pulse repetition frequency) settings. This helped in ruling out left testicular torsion in this baby. The final diagnosis in this case, based on the ultrasound and color Doppler images above, was left orchitis, although mild in nature.
See this link for more: http://www.ultrasound-images.com/scrotum.htm
Also see: http://www.ultrasound-images.com/acute-scrotum.htm
Also:
http://www.ultrasound-images.com/ped-abdomen.htm

TRUS (transrectal ultrasound) imaging of bladder calculi:

TRUS (transrectal ultrasonography) is a well established method of imaging of the prostate and seminal vesicles. So how good is this method at imaging of the urinary bladder in the male patient? The answer can be seen below: This elderly male (70 years) patient had a history of chronic retention of urine due to benign hypetrophy of the prostate. He presented with severe hematuria for which routine sonography of the abdomen suggested multiple small calculi in the urinary bladder. There was also moderate enlargement of the prostate. TRUS ultrasonogaphy revealed the true nature of the calculi and their exact number and size more effectively than the transabdominal ultrasound.
The ultrasound images below show the urinary bladder to contain at least 4 to 6 stones (calculi) each of             4 to 7 mm. size. A precise evaluation of the size of the prostate and the degree of intravesical enlargement is also possible on Transrectal ultrasound study (see image below).

The conclusion - transrectal ultrasound imaging is an excellent tool to image small urinary bladder stones that may be hidden from view or inadequately visualized on routine transabdominal ultrasound.           

        For more on urinary bladder ultrasound see: http://www.ultrasound-images.com/urinary-bladder.htm

Quiz- neck:

 

Can anyone identify the structure (arrowed) in this ultrasound video of the neck. What does it show and what is the event that is happening?  You may send your replies in the comments section, below.
OK folks- the answer is out: this sonographic video clip shows peristaltic activity within the cervical esophagus (the part of the esophagus extending from the glottis to the thorax). One can see echogenic (bright) particles (air bubbles and fluid) going down the lumen of the esophagus as the patient swallows.
In addition, further ultrasound video imaging shows (see below) some degree of reflux as fluid from the fundus of stomach (the upper part), regurgitates upwards into the lower part of the food pipe (esopahgus).

 This lady had undergone a total thyroidectomy (surgical removal of the entire thyroid). Hence, the thyroid gland is not visualized in these clips.

Thickened colon:

                                                                           This ultrasound image shows grossly thickened wall of the large bowel (colon) in long section. The colonic wall thickness is a massive 1.1 cms. The anechoic line within the bowel represents the lumen. Note the diffuse increase in large bowel wall thickness, suggesting large area of involvement.                                                                          

                                                                                  And the above Power Doppler ultrasound image of the same area shows hyperemia in addition. Clearly, this patient has a chronic inflammatory bowel pathology. The differentials in this case include- ulcerative colitis, Chrohn disease and also acute conditions like infective enteritis/ colitis. This patient had h/o diarrhea and bleeding per rectum with passage of mucus and pus. The clinical history, favors an infective etiology. A barium enema would be helpful as also colonoscopy. (ultrasound images are courtesy of Dr. Vikas Shukla, MD, India).
 See: http://www.ultrasound-images.com/colon.htm for more images and description. on this topic.

Abdominal aorta and its main branches- Color Doppler video:

                                                                              The above color Doppler ultrasound video clip shows the normal upper part of the abdominal aorta withe 1st branch in the abdomen- the celiac artery, pointing almost perpendicularly from the anterior surface of the aorta. The aortic branch just below is the superior mesenteric artery, descending downwards.

                                                                                     The above Doppler video shows the celiac artery with the 2 main branches of this vessel- the branch heading towards the right being the common hepatic artery and the artery heading leftwards being the splenic artery. For more images and details on this topic visit: http://www.ultrasound-images.com/vascular.htm