Diagnostic Ultrasound - Abdomen and Pelvis
Share Embed Flag
Download ePaper

Diagnostic Ultrasound - Abdomen and Pelvis

powerstage
09.07.2019 Views

Approach to Bowel Sonography (Left) Abnormal circumferential thickening of the right colon is shown. Calipers indicate the single wall thickness. Note the loss of the stratified layers of the bowel and lobular outline. These are hallmarks of neoplastic disease. (Right) Corresponding color Doppler US shows the relatively hypovascular nature of the colonic mass . Note linear arc of gas with reverberation artifact denoting the stenosed ulcerated lumen. Diagnoses: Bowel (Left) Axial US demonstrates long segment confluent thickening of centrally placed small bowel in a patient with known Crohn disease. Thickened segment is angulated and rigid with surrounding hyperemic fat . This makes the thickened bowel more conspicuous. (Right) Corresponding US in the same patient shows increased vascularity in keeping with a significant active inflammatory component. Note that with the presence of significant inflammation, there maybe loss of the gut wall layers . (Left) Transvaginal US (TVUS) shows a distended pelvic appendix with calcified appendicoliths in the base, in keeping with an acute pelvic appendicitis. This was not visible on abdominal US, hence the value of TVUS. (Right) Thickening of the valvulae conniventes in the distal ileum and dilatation of the distal ileum with fluid are shown in a patient with known celiac disease. This reversal of the small bowel folds and dilatation with fluid from impaired motility is clearly seen and well recognized in celiac disease. 645

Appendicitis Diagnoses: Bowel TERMINOLOGY • Acute inflammation of appendix, which may be precipitated by obstruction of lumen IMAGING • US: Thick-walled noncompressible appendix (outer diameter ≥ 7 mm) ○ Periappendiceal edema seen as echogenic fat ○ Increased vascularity on power Doppler • CT: Distension &/or wall thickening; single wall thickness > 3 mm ○ Hyperenhancement of wall ○ Periappendiceal inflammation seen as fat stranding • Additional findings: Appendicolith, periappendiceal fluid • US technique: Abdominal scan with graded compression • US method 1st choice in children, thin young adults, and pregnant patients • CT performed for patients with inconclusive US, if complications suspected, or in obese patients KEY FACTS • MR: Useful in pregnancy TOP DIFFERENTIAL DIAGNOSES • Mesenteric adenitis • Cecal diverticulitis/ileocolitis • Appendicular mucocele • Normal appendix with mucosal lymphoid hyperplasia • Appendiceal/cecal carcinoma • Pelvic inflammatory disease • Segmental omental infarction/epiploic appendagitis • Meckel diverticulitis PATHOLOGY • Could be obstructive or nonobstructive CLINICAL ISSUES • Periumbilical pain migrating to RLQ; peritoneal irritation at McBurney point; atypical signs in 1/3 of patients • Prognosis ○ Excellent with early surgery (Left) Graphic shows the typical location and morphology of an inflamed appendix. The direction of the tip of the appendix and length can vary. (Right) Axial ultrasound through the right iliac fossa shows a thickwalled blind-ending tubular structure representing an inflamed appendix. Note the mural stratification ſt and the base invaginating into the medial cecal wall. (Left) In this axial oblique US of the same patient, note the blind-ending tip st and mural stratification ſt. (Right) Power Doppler ultrasound of the inflamed appendix shows increased flow ſt. 646

Appendicitis<br />

Diagnoses: Bowel<br />

TERMINOLOGY<br />

• Acute inflammation of appendix, which may be<br />

precipitated by obstruction of lumen<br />

IMAGING<br />

• US: Thick-walled noncompressible appendix (outer<br />

diameter ≥ 7 mm)<br />

○ Periappendiceal edema seen as echogenic fat<br />

○ Increased vascularity on power Doppler<br />

• CT: Distension &/or wall thickening; single wall thickness > 3<br />

mm<br />

○ Hyperenhancement of wall<br />

○ Periappendiceal inflammation seen as fat str<strong>and</strong>ing<br />

• Additional findings: Appendicolith, periappendiceal fluid<br />

• US technique: Abdominal scan with graded compression<br />

• US method 1st choice in children, thin young adults, <strong>and</strong><br />

pregnant patients<br />

• CT performed for patients with inconclusive US, if<br />

complications suspected, or in obese patients<br />

KEY FACTS<br />

• MR: Useful in pregnancy<br />

TOP DIFFERENTIAL DIAGNOSES<br />

• Mesenteric adenitis<br />

• Cecal diverticulitis/ileocolitis<br />

• Appendicular mucocele<br />

• Normal appendix with mucosal lymphoid hyperplasia<br />

• Appendiceal/cecal carcinoma<br />

• Pelvic inflammatory disease<br />

• Segmental omental infarction/epiploic appendagitis<br />

• Meckel diverticulitis<br />

PATHOLOGY<br />

• Could be obstructive or nonobstructive<br />

CLINICAL ISSUES<br />

• Periumbilical pain migrating to RLQ; peritoneal irritation at<br />

McBurney point; atypical signs in 1/3 of patients<br />

• Prognosis<br />

○ Excellent with early surgery<br />

(Left) Graphic shows the<br />

typical location <strong>and</strong><br />

morphology of an inflamed<br />

appendix. The direction of the<br />

tip of the appendix <strong>and</strong> length<br />

can vary. (Right) Axial<br />

ultrasound through the right<br />

iliac fossa shows a thickwalled<br />

blind-ending <br />

tubular structure representing<br />

an inflamed appendix. Note<br />

the mural stratification ſt<br />

<strong>and</strong> the base invaginating into<br />

the medial cecal wall.<br />

(Left) In this axial oblique US<br />

of the same patient, note the<br />

blind-ending tip st <strong>and</strong> mural<br />

stratification ſt. (Right)<br />

Power Doppler ultrasound of<br />

the inflamed appendix shows<br />

increased flow ſt.<br />

646

logo

products

Resources

Company

Terms of service
Privacy policy
Cookie policy
Cookie settings
Imprint
Change language
Made with love in Switzerland
© 2024 Yumpu.com all rights reserved

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!