Radiology Lectures | Radquarters

In this radiology lecture, we review the ultrasound appearance of endometrial polyps!Key teaching points include:Endometrial polyps are benign hyperplastic overgrowths of endometrial tissue.Sessile or pedunculated, can cause endometrial thickening.Often asymptomatic, may cause abnormal uterine bleeding or be associated with infertility.US appearance: Focal, echogenic, round or ovoid. Often best seen in proliferative phase of menstrual cycle (as opposed to secretory phase) due to increased contrast between echogenic polyp and hypoechoic functional layer of endometrium. May see hypoechoic halo inside margin of endometrium. Usually solid, but can have cystic changes.By comparison, submucosal fibroids are usually hypoechoic with posterior shadowing. A feeding vessel/vascular pedicle on color Doppler is 95% specific for endometrial polyp.Polyps can prolapse into cervix or vagina.Tx: Polypectomy if symptomatic.To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://usa.samsunghealthcare.com/ultrasound/general-imaging/rs85-prestigeClick the ⁠⁠YouTube posts tab⁠⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠⁠⁠⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound appearance of gout!Key teaching points include:Gout is a crystal arthropathy due to monosodium urate crystal deposition in and around jointsMost common in males over age 40Risk factors: Metabolic (hyperuricemia, obesity, diabetes, hypertension), renal (chronic kidney disease), dietary (high purine foods, sugary drinks, alcohol), and genetic (family history)Typically presents as acute monoarthritis with a red, inflamed, swollen joint. First metatarsophalangeal joint most common site of involvement (podagra)Can progress to asymmetric polyarticular disease and chronic tophaceous goutUltrasound findings include: Joint effusion +/- hyperechoic foci (crystals/microtophi), synovial hypertrophy, and erosions typically at medial aspect of distal first metatarsal Erosions are juxtaarticular in distribution with overhanging edges yielding a “punched-out” appearanceGouty tophus: Amorphous, echogenic area containing internal hyperechoic foci surrounded by an anechoic inflammatory halo. May have associated cortical erosionsTophi may involve tendons, tendon sheaths, and bursae. Other common sites include olecranon region (elbow), patellar and popliteal tendons (knee)Double contour sign, AKA urate icing: Hyperechoic monosodium urate crystals coating hyaline cartilage surface. Disappears when serum urate levels drop below 6 mg/dL*Distinct from chondrocalcinosis seen in calcium pyrophosphate deposition disease which will have echogenic crystals within cartilage as opposed to on surfaceReferences: 1) *Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int. 2010;30(4):495–5032) Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 3rd ed. Elsevier; 2018To learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the ⁠YouTube posts tab⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠⁠⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound appearance of choledocholithiasis (common bile duct stones)!Key teaching points include:Choledocholithiasis = Stones within common bile duct (CBD)Seen in up to 15% of patients with cholelithiasisClinical presentation: Asymptomatic, biliary colic, cholangitis, pancreatitis, jaundiceOn ultrasound, see rounded stone or stones in CBDShadowing of stone less common than with cholelithiasis, twinkling artifact may helpCBD dilatation defined as greater than 6 mm allowing for an additional 1 mm per decade above 60, or greater than 10 mm post-cholecystectomyIntrahepatic dilatation and cholelithiasis may be presentSensitivity of US up to 40% for detecting CBD stones, but US accuracy 90% for detecting CBD dilatationIf US negative and high clinical suspicious for choledocholithiasis, MRCP can be consideredCT has reduced sensitivity with only 15-20% gallstones visible on CTSupportive lab values: Elevated serum bilirubin, alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). AST and ALT may also be elevated, but less specific. Labs can even be normal in the setting of choledocholithiasisTx may include endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Intraoperative cholangiogram during cholecystectomy To learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the YouTube posts tab or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound and contrast-enhanced ultrasound appearance of focal nodular hyperplasia!Key teaching points include:Focal nodular hyperplasia (FNH) is the second most common benign liver tumor after hemangiomaMost common in women of reproductive age with highest incidence between the ages of 20-50. Female to male predilection 8:1No association with oral contraceptives (unlike hepatic adenoma)No risk of malignant potential, and no surgery required = A leave alone lesionUnclear etiology, thought to be a regenerative, hyperplastic response of normal hepatocytes to anomalous arteries within liverHamartomatous-type lesion containing dense collection of functional hepatocytes and malformed, blind-ending biliary ductules leading to slowed biliary excretionFunctioning Kupffer cells (hepatic macrophages) may be presentUS appearance variable: Can be hypoechoic, isoechoic or hyperechoic relative to liver parenchyma. May have an echogenic central scarSpoke-wheel sign of central vascularity is a helpful ancillary feature, and seen in up to 63% of FNH with microflow imaging*FNH appearance on contrast-enhanced ultrasound (CEUS): Immediate stellate enhancement radiating from the center of the lesion in centrifugal fashion, followed by diffuse homogeneous hyperenhancement relative to the surrounding parenchymaCEUS has high specificity in the diagnosis of FNH**References*Kang TW, et al. Comparison of Super-Resolution US and Contrast Material-enhanced US in Detection of the Spoke Wheel Sign in Patients with FNH. Radiology. 2021;298(1):82-90**Pei, X-Q et al. Quantitative analysis of contrast-enhanced ultrasonography: differentiating focal nodular hyperplasia from hepatocellular carcinoma. Br J Radiol. 2013 Mar;86(1023):20120536To learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube posts tab⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound appearanceof intersection syndrome, a friction tenosynovitis at the forearm and wrist!Key teaching points include:Intersection syndrome is an overuse tenosynovitis(inflammation of tendon and tendon sheath) secondary to repetitive friction at site of intersectionProximal intersection syndrome: Occurs at musculotendinous junctions of first extensor wrist compartment (extensor pollicis brevis, abductor pollicis longus) crossing tendons of second compartment (extensor carpi radialis brevis, extensor carpi radialis longus). Intersection occurs 4-8 cm proximal to Lister’s tubercle Results from repetitive extension/flexion activities: Rowing, skiing, racket sports, horseback riding, weight-liftingClinical presentation: Radial forearm or wrist pain, worsens with extension/flexionUltrasound findings: Pain with transducer pressure at intersection site, peritendinous edema and fluidDistal intersection syndrome: Less common, occurs at third compartment tendon (extensor pollicis longus) crossing second compartment tendons distal to Lister’s tubercleTx: Rest, activity modification, splinting, anti-inflammatory medications. Corticosteroid injection or surgical release may be required if refractoryTo learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube posts tab⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound appearance of giant cell tumor of the tendon sheath!Key teaching points include:AKA tenosynovial giant cell tumor, localized nodular tenosynovitis2nd most common mass of hand & wrist after ganglion cystMost common at volar aspect of first 3 digits. Less commonly at wrist, ankle, foot, kneeOn ultrasound, usually homogeneously hypoechoic with well-defined lobulated marginsClosely associated with tendon, but will not move with tendon = Arises from tendon sheath, not tendon itselfMay show posterior acoustic enhancement, but internal vascular flow typically presentUsually benign. Can be locally aggressive, rarely malignant. Tx: Surgical excisionFibroma of the tendon sheath has a similar ultrasound appearance and location but is less common. Benign. Tx: Surgical excision References:Middleton WD, Patel V, Teefey SA, Boyer MI. Giant cell tumors of the tendon sheath: analysis of sonographic findings. AJR Am J Roentgenol. 2004;183(2):337-339.To learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube posts tab⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound and CT appearance of submandibular stone disease, together with floor of mouth anatomy!Key teaching points include:Submandibular glands are paired salivary glands located inferior to body of mandibleSubmandibular glands are intermediate in size compared to the larger parotid and smaller sublingual glands, and they do not contain lymph nodesThe submandibular duct (= Wharton’s duct) extends from gland hilum and travels superiorly to open at floor of mouth on either side of base of frenulum of tongue. The duct is not typically seen unless abnormally dilatedOn ultrasound, normal submandibular glands appear as encapsulated structures with homogeneous echotexture similar to the parotid. Fine linear echodensities may be present representing intraglandular ductules. Physiologic intravascular flow is typically evident. Superficial portion of the gland is almond-shaped, deep portion triangular\Sialolithiasis = Salivary calculous disease. Most common in submandibular gland because gland secretes a more alkaline, viscous saliva, and the long submandibular duct drains uphill = Increased salivary stasisWith acute obstruction, gland becomes enlarged (= sialadenitis) and duct proximal to stone dilated. Presents with colicky pain most pronounced around times of eatingUS can detect even radiolucent stones, but small stones may not shadowAt the floor of mouth, the submandibular space (SMS) and sublingual space (SLS) are divided by mylohyoid musculature = Inferior sling of mouth. SMS is below (inferolateral to) mylohyoid, and SLS is above (superomedial to) mylohyoidSMS contains: Submandibular glands, lymph nodes, anterior belly of digastric muscleSLS contains: Sublingual glands, submandibular duct, and anterior aspect of hyoglossus muscleRemember that while the submandibular glands are in the submandibular space, the submandibular duct is located in the sublingual space!The submandibular duct travels between the hyoglossus and mylohyoid muscles, which are both useful sonographic landmarks aiding in duct locationReferences:Ching AS, Ahuja AT. High-resolution sonography of the submandibular space: anatomy and abnormalities. AJR Am J Roentgenol. 2002 Sep;179(3):703-8.Grewal JS, Jamal Z, Ryan J. Anatomy, Head and Neck, Submandibular Gland. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.To learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube Community tab⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound appearance of trigger finger!Key teaching points include:Pulleys are fibrous retinacula on ventral finger that secure flexor tendons to phalanges preventing tendon displacement and bowstringing with finger flexionFinger has 5 annular pulleys. Odd-numbered at joints, even-numbered at phalanges: A1, A3, A5 are located about the MCP, PIP, DIP joints, respectively. A2 is located at the proximal phalanx, and A4 at the middle phalanxCruciform pulleys lie between annular pulleys, but are not usually well-seen on ultrasoundTrigger finger, also known as stenosing tenosynovitis, is characterized by impaired flexor tendon movement due to thickened pulley leading to tendon constrictionMost common at A1 pulley, but can also occur at A2/A3 pulleys, palmar aponeurosis (A0) and wristSymptoms: Triggering/locking when flexed, painful snapping when extended, pain, joint stiffnessMost common in female patients, history of diabetes mellitus, and rheumatoid arthritisOften idiopathic, can occur with repetitive microinjury (flexion-extension). Can also be post-traumatic or due to compressive mass/cystTx: Splinting, NSAIDs, US-guided corticosteroid injection, surgical releaseA1 pulley thickness cutoff = 0.62 mm*. Mean normal thickness = 0.5 mm, range with trigger finger 1.1-2.9 mm**. Comparison with asymptomatic side helpfulAdditional findings: Pulley hyperemia, nodular tendon thickening (tendinosis) or tear, buckling of flexor tendon on dynamic imaging, “dark tendon” sign (anisotropic hypoechogenicity due to tendon constriction), synovial sheath effusion (acute), and peri-pulley cyst/cystic degenerationReferences:*Spirig A, Juon B, Banz Y, Rieben R, Vogelin E. Correlation between sonographic and in vivo measurement of A1 pulleys in trigger fingers. Ultrasound Med Biol 2016; 42:1482–1490.**Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, Feydy A, Drapé JL. Sonographic appearance of trigger fingers. J Ultrasound Med. 2008 Oct;27(10):1407-13.Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. J Ultrasound Med. 2019 Dec;38(12):3141-3154.Shohda E, Sheta RA. Misconceptions about trigger finger: a scoping review. Definition, pathophysiology, site of lesion, etiology. Trigger finger solving a maze. Adv Rheumatol. 2024 Jul 11;64(1):53.To learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube Community tab⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or healthcare professional.

In this radiology lecture, we review the ultrasound appearance of hydrosalpinx, pyosalpinx and tubo-ovarian abscess!Key teaching points include:Hydrosalpinx = Fluid-filled, blocked fallopian tubeHydrosalpinx causes: Pelvic inflammatory disease (most common), endometriosis, prior surgery, adhesionsHydrosalpinx US: Thin-walled, tubular structure filled with anechoic simple fluid. Dilated tube may fold upon itself forming tubular C-shaped or S-shaped cystic mass. Incomplete septations commonWith chronic hydrosalpinx, may see “beads-on-a-string” sign: Short, round, 2-3 mm projections seen along inner tubal walls in cross section = Flattened, fibrotic remnants of endosalpingeal folds. Don’t confuse with solid mural nodulesO-RADS US v2022 management of hydrosalpinx = Imaging: None. Clinical: GynecologistPyosalpinx: Inflamed, blocked fallopian tube filled with purulent debris. Indicates pelvic inflammatory diseasePyosalpinx US: Thick-walled tubal structure filled with complex fluid. Like hydrosalpinx, typically conforms to a C or S-shape“Cogwheel” sign of pyosalpinx: Thickened endosalpingeal folds with surrounding tubal wall thickening. Typical of acute tubal inflammationTubal wall hyperemia more common with pyosalpinx than hydrosalpinxTubo-ovarian complex (TOC): With severe salpingo-oophoritis, ovary and tube adhere to each other. Can distinctly identify ovary from tube but cannot separate the two with transducer pressure. Tx: AntibioticsTubo-ovarian abscess (TOA): As pelvic inflammatory disease progresses, complete or near-complete loss of adnexal architecture with pockets of purulent fluid develop. Multiloculated mass with septations, irregular margins, may be bilateral. Tx: Antibiotics, percutaneous drainage, surgeryTo learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube Community tab⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or healthcare professional.

In this radiology lecture, we review the ultrasound appearance of adenomyomatosis of the gallbladder!Key teaching points include:Common cause of benign gallbladder wall thickening seen in up to 9% of patientsIncidence increases with ageUsually asymptomatic, but may be associated with sporadic RUQ painHyperplastic changes of gallbladder wall with mucosal overgrowth. Mucosal herniations protrude into muscular layer forming tiny, bile-filled cystic spaces = Rokitansky-Aschoff sinusesIf large, sinuses may appear as discrete cystic spaces in gallbladder wallCholesterol crystals in sinuses cause comet-tail reverberation artifact: Most common finding and highly specific for adenomyomatosis. Can exaggerate comet-tail with addition of color DopplerThree types: Focal/fundal, segmental/annular and diffuse. Regardless of type, comet-tail artifacts and/or cystic spaces are key to diagnosisFocal/fundal type: Most common. Often exhibits an “ovary on the gallbladder” appearance. Can be confused with a gallbladder mass. High-frequency linear transducer may be helpful to identify morphologySegmental/annular type: Narrows waist of gallbladder yielding a figure 8 or hourglass configuration. Gallstones and/or sludge often form in proximal lumen due to increased stasisIf necessary, MRI helpful for problem solving: T2 hyperintense pearl necklace/string of beads appearance sensitive and specificTo learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Click the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube Community tab⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or follow on social media for bonus teaching material posted throughout the week!Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠This video is for informational purposes only. It does not replace the advice or counsel of a doctor or healthcare professional.

In this radiology lecture, we review the ultrasound appearance of de Quervain’s Tenosynovitis! Key teaching points include: Stenosing tenosynovitis of first extensor compartment tendons = Extensor pollicis brevis (EPB) and abductor pollicis longus (APL) Second most common hand entrapment tendinopathy after trigger finger Most common in middle-aged females Associations include repetitive hand motions, pregnancy, arthritis, and trauma Clinical presentation: Pain with thumb and wrist movement, tenderness and swelling at radial styloid Positive Finkelstein maneuver may be present: Grasp thumb, ulnar deviate hand = Pain over distal radius Ultrasound findings: Increased fluid in EPB/APL tendon sheath (tenosynovitis), hypoechoic, edematous tendon thickening (tendinosis), and thickening of extensor retinaculum (comparison scanning of contralateral thumb helpful) Advanced findings: Impaired tendon movement, tendon tear (anechoic clefts), retinacular and peritendinous hyperemia Don’t confuse normal APL slips with longitudinal tear (“lotus root” sign) Important to identify variant intertendinous septa: Helps to properly guide steroid injection, increased incidence of asymmetric EPB involvement If conservative therapy fails, surgical decompression may be required. More likely when septum present 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://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠⁠ X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠⁠ Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠⁠

In this radiology lecture, we review the contrast-enhanced ultrasound appearance of hepatic hemangioma! Key teaching points include: Microbubble contrast agents are gas-filled microspheres with a lipid or protein shell Sulfur hexafluoride lipid-type A microspheres: Inert gas of six fluoride atoms bound to one sulfur atom, surrounded by a phospholipid shell Similar in size to red blood cells, unique when compared to the molecular sizes of CT and MR imaging contrast agents. Small enough to cross capillary beds, too large to enter interstitial space = Pure intravascular agents, ideal for assessing vascularity and perfusion After IV injection, US contrast agents half-life is about 10 minutes (eliminated via lungs). Multiple injections possible in a single session Contrast-enhanced US (CEUS) has high contrast resolution: Can visualize individual microbubbles and depict a minute amount of flow = Differentiate avascular debris from small solid nodules in complex cysts. Negative predictive value of CEUS in excluding the presence of flow in a lesion is close to 100% CEUS also has high temporal resolution: Effectively eliminates motion artifact, a major source of artifact on CT and especially MRI scans. In elderly or debilitated patients, or when there is any other cause of motion, CEUS may be the contrast-enhanced modality of choice Accuracy and specificity of CEUS for the diagnosis of hepatic hemangioma approaches 100% Mechanical index (MI) = Measure of acoustic power output. At high MI, microbubbles burst. At low MI, microbubbles are preserved and have a nonlinear response to US, unlike other tissues which have a linear response. Allows for creation of a vascular-only image Hemangioma has peripheral discontinuous globular enhancement in arterial phase. Progressive centripetal contrast filling and iso- or hyperenhancement in portal venous and late phase Non-hepatocellular malignancy typically demonstrates early (less than 1 minute) and/or marked washout Hemangioma filling may be partial or complete depending on lesion size To learn more about the Samsung RS85 Prestige ultrasound system, please visit: ⁠⁠⁠⁠⁠⁠⁠⁠https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4⁠⁠⁠⁠⁠⁠⁠⁠ See more impressive visuals by filmmaker and freelance motion graphics artist Nick Shaheen: https://www.instagram.com/nickhshaheen Click the ⁠⁠⁠⁠⁠⁠⁠⁠YouTube Community tab⁠⁠⁠⁠⁠⁠⁠⁠ or follow on social media for bonus teaching material posted throughout the week! Website: ⁠⁠⁠⁠⁠⁠⁠⁠https://radquarters.com/⁠⁠⁠⁠⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠⁠ X (Twitter): ⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠⁠ Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of tennis leg, including medial gastrocnemius and plantaris injury! Key teaching points include: Tennis leg = Injury to muscles of the calf. Tear of myotendinous junction of medial head of gastrocnemius, rupture of plantaris tendon (less common), in isolation or together Classically described in tennis players, but can occur in various athletic activities (running, skiing) with extension of knee and forced dorsiflexion of ankle. Typically seen in middle-aged, active individuals Clinical: Sudden sharp calf pain with associated popping/snapping sensation followed by tenderness and swelling Gastrocnemius & soleus are pennate muscles. Fascicles attach obliquely to a tendon = Aponeuroses with long length of musculotendinous junction. Feathers converging on a single point Triceps surae muscle = Two headed gastrocnemius, soleus and plantaris. Distal continuation of the gastrocnemius and soleus forms the Achilles tendon Distal medial head of gastrocnemius where tapers over soleus = One of most commonly injured calf structures Medial gastrocnemius tear appears as disrupted tendon fibers at aponeurosis with anechoic/hypoechoic fluid or hemorrhage +/- muscle retraction May see retracted muscle fascicles. Hematoma can dissect between and extends into medial gastrocnemius and soleus muscles Tx: Conservative (self-limiting). Surgical fasciotomy if compartment syndrome Plantaris muscle arises from the posterosuperior aspect of lateral femoral condyle near lateral head origin of gastrocnemius muscle. Medially crosses posterior knee joint in oblique fashion Plantaris continues into calf as a long, thin tendon traveling between medial head of gastrocnemius and soleus muscles. Courses distally at medial aspect of Achilles tendon, usually inserts onto calcaneus. Plantaris is absent in up to 20% Plantaris injury/rupture less common than medial head gastrocnemius tear and typically more proximal in calf (at myotendinous junction) 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://radquarters.com/⁠⁠⁠⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠⁠ X (Twitter): ⁠⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠⁠ Reddit: ⁠⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of interstitial ectopic pregnancy! Key teaching points include: Interstitial ectopic pregnancies are rare, occurring in proximal (interstitial) portion of fallopian tube within muscle wall of uterus Much less common than tubal ectopic pregnancy occurring in the more distal ampullary and isthmic portions of fallopian tube Interstitial ectopic pregnancies are important because higher morbidity and mortality due to later presentation and risk of life-threatening hemorrhage Abnormally eccentric gestational sac with thin surrounding myometrium: less than 5 mm myometrial thickness highly suspicious “Interstitial line” sign: Thin echogenic line extending from endometrial cavity to ectopic gestational sac. Thought to represent interstitial portion of tube separating the ectopic pregnancy from the endometrium Medical: Systemic MTX, may also be injected into gestational sac Surgery: Cornual wedge resection when ruptured versus hysterectomy Can be confused with angular pregnancy: Rare, intrauterine pregnancy with implantation eccentrically high at the lateral angle of uterine cavity. More medial than interstitial ectopic pregnancies. No interstitial line sign, and greater than 5 mm thickness of overlying myometrial mantle Angular pregnancy can result in normal pregnancy, but increased risk of miscarriage and uterine rupture. Should be followed closely to ensure growth towards endometrial cavity Angular pregnancy is sometimes referred to as a “cornual pregnancy,” but controversial as earliest use of term cornual pregnancy refers to intrauterine implantations in anomalous unicornuate, bicornuate or septate uteri. To avoid confusion, best to specifically describe whether the gestational sac is intrauterine or ectopic 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://radquarters.com/⁠⁠⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠⁠ X (Twitter): ⁠⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠⁠ Reddit: ⁠⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of ovarian serous cystadenocarcinoma! Key teaching points include: Serous cystadenocarcinoma is the common ovarian malignancy and most common ovarian epithelial tumor High-grade and low-grade types Peak incidence 6th-7th decades Ultrasound appearance: Mixed cystic and solid mass with papillary projections and thick septations Elevated CA-125 in greater than 90% Serous tumors are more commonly bilateral than other tumors Four main categories of ovarian neoplasms: Epithelial (most common), germ cell (second most common), sex cord-stromal and metastases Epithelial ovarian tumors are thought to originate outside the ovary (within fallopian tube or endometrium) and involve ovary secondarily Epithelial ovarian tumor types: Serous, mucinous, endometrioid, clear cell and Brenner 60% of epithelial tumors are benign: Unilocular with thin wall or thin septations (less than 3 mm in thickness) 40% of epithelial tumors are malignant or borderline: Papillary projection (distinctive feature of epithelial tumors) with thick, irregular wall or septations (greater than 3 mm in thickness). Can also present as a large soft tissue mass with necrosis. Advanced findings include peritoneal implants, pelvic wall invasion, adenopathy and ascites 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://radquarters.com/⁠⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠⁠ X (Twitter): ⁠⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠⁠ Reddit: ⁠⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of parathyroid adenoma! Key teaching points include: Benign tumor of the parathyroid glands Most common cause of primary hyperparathyroidism: Elevated serum calcium and parathyroid hormone (PTH) levels Ultrasound: Solid, homogeneous and very hypoechoic. Oval or bean-shaped, long axis oriented craniocaudal. Hypervascular. Majority posterior and inferior to thyroid. Hyperechoic line often separates adenoma from adjacent thyroid. Atypical features: Cystic degeneration, calcification. Tc-99m sestamibi: Radiotracer uptake persisting on delayed 2-hour images. Taken up by both thyroid and parathyroid tissue, but washes out more rapidly from thyroid. Greater than 90% predictive value for preoperative localization of parathyroid adenoma. SPECT aids with anatomic localization Ectopic locations in up to 5%: Lower neck, mediastinum, retrotracheal/retroesophageal, carotid sheath and intrathyroidal (typically more homogeneous than thyroid nodules and have a linear interface with gland) Larger adenomas can be multilobulated “Polar vessel” sign: Enlarged feeding artery or draining vein terminating at parathyroid adenoma 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://radquarters.com/⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠⁠ X (Twitter): ⁠⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠⁠ Reddit: ⁠⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of parotitis in the pediatric population! Key teaching points include: Parotitis = Inflammation of the parotid glands Acute parotitis is usually infectious, most commonly viral Mumps is most common viral cause in children, often bilateral Bacterial parotitis can cause suppurative parotitis seen in premature infants and immunosuppressed children Acute parotitis on US: Enlarged, heterogeneous, hyperemic gland(s) +/- lymphadenopathy Since can be bilateral, comparison scanning essential Bacterial parotitis may be complicated by abscess “Pomegranate sign” may be seen in setting of acute parotitis: Uniform anechoic foci scattered throughout the gland Juvenile recurrent parotitis (JRP) = Recurrent inflammatory parotitis in children of unknown etiology JRP is rare, but second most common cause of parotitis in childhood after mumps JRP often begins between age 3-6, typically resolves spontaneously after puberty Usually idiopathic, JRP can be presenting symptom of Sjogren’s syndrome, lymphoma, and underlying immunodeficiency JRP on US: May be unilateral or bilateral, multiple hypoechoic foci of salivary secretions scattered throughout the gland +/- central calcifications, color Doppler can be normal Additional causes of parotitis: Sialolithiasis/obstruction, autoimmune (Sjogren syndrome, chronic sclerosing sialadenitis), infectious (HIV, TB), and sarcoidosis (rare in children). 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://radquarters.com/⁠⁠⁠ Instagram: ⁠⁠⁠https://www.instagram.com/radquarters/⁠⁠⁠ Facebook: ⁠⁠⁠https://www.facebook.com/radquarters/⁠⁠⁠ X (Twitter): ⁠⁠⁠https://twitter.com/radquarters⁠⁠⁠ Reddit: ⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of sublingual dermoid cyst and explain floor of mouth anatomy! Key teaching points include: The floor of the mouth is a horseshoe-shaped area beneath tongue and in between sides of mandible, inferiorly bounded by mylohyoid muscle, and containing sublingual space (SLS) SLS medial border: Midline genioglossus/geniohyoid muscle complex; SLS inferolateral border: Mylohyoid muscle Anterior margin of hyoglossus muscle projects into posterior SLS Sublingual dermoid cyst is a rare, benign cyst with squamous epithelial lining and contains skin appendages Dermoid and epidermoid cysts are in same family, terminology often used interchangeably, although epidermoid cysts less common and tend to contain fluid contents only Dermoid cyst mean age of presentation late teens to twenties, average age 30 Presents as a slowly enlarging neck mass, may cause dysphagia Often round or oval in shape and homogeneously hypoechoic with punctate echogenic foci May have pathognomonic “sack of marbles” appearance Relationship to mylohyoid is key for surgical planning: Intraoral resection for sublingual (above mylohyoid) location, extraoral approach for submental/submandibular (below mylohyoid) location Most cysts are midline DDx: Suprahyoid thyroglossal duct cyst, ranula (simple and diving), abscess and lymphangioma 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://radquarters.com/⁠⁠ Instagram: ⁠⁠https://www.instagram.com/radquarters/⁠⁠ Facebook: ⁠⁠https://www.facebook.com/radquarters/⁠⁠ X (Twitter): ⁠⁠https://twitter.com/radquarters⁠⁠ Reddit: ⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of carpal tunnel syndrome! Key teaching points include: Most common upper extremity entrapment neuropathy. Results from median nerve compression With carpal tunnel syndrome, see hypoechoic enlargement of the median nerve as enters carpal tunnel with flattening of nerve = Notch sign, also volar bowing of flexor retinaculum Median nerve area: Less than 8 mm2 = Normal; 8-12 mm2 = Borderline; greater than 12 mm2 = Abnormal Most accurate to compare nerve area at proximal pronator quadratus muscle and carpal tunnel: Increase of 2 mm2 or more from proximal to distal = 99% sensitive and 100% specific for carpal tunnel syndrome. Measure inside the echogenic epineurium Bifid median nerve: Normal variant in 15% of population, one trunk may take aberrant course through flexor digitorum superficialis musculature, and often associated with persistent median artery between the two trunks Important to recognize persistent median artery pre-operatively because could be damaged during surgery For diagnosis of carpal tunnel syndrome with bifid median nerve: Combined increase of 4 mm2 or more After carpal tunnel release surgery, median nerve may return to normal diameter or remain enlarged regardless of clinical outcome. Retinaculum may appear thickened or disrupted Carpal tunnel syndrome can be caused by extrinsic compression by a mass, ganglion cyst, or tenosynovitis Reference: Klauser AS, Halpern EJ, De Zordo T, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-177. 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://radquarters.com/⁠⁠ Instagram: ⁠⁠https://www.instagram.com/radquarters/⁠⁠ Facebook: ⁠⁠https://www.facebook.com/radquarters/⁠⁠ X (Twitter): ⁠⁠https://twitter.com/radquarters⁠⁠ Reddit: ⁠⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of ganglion cysts while highlighting relevant wrist ultrasound anatomy! Key teaching points include: Ganglion cysts are viscous, mucin-filled collections lacking a synovial lining Most commonly occur at hand/wrist = Most common wrist mass Location: Dorsum of wrist (60%), frequently adjacent to scapholunate ligament; volar wrist (20%), often between radial artery and flexor carpi radialis tendon; flexor tendon sheath (10%); associated with DIP joint (10%) Grows out of tissues surrounding joint like a balloon on a stalk. May see a pedicle connecting to joint Usually well-defined and multilocular, can be unilocular Hypoechoic to anechoic with posterior acoustic enhancement Noncompressible: Dorsal joint recess and bursal collections will typically collapse with transducer pressure or wrist movement Typically no vascular flow, but septations may have vascularity. May see pulsation artifact from adjacent radial artery Volar cysts can extend towards median nerve and may cause carpal tunnel syndrome May displace or envelop radial artery Tx: Watchful waiting, percutaneous US-guided aspiration and steroid injection, excision Lister’s tubercle is a useful landmark for dorsal wrist anatomy Relevant dorsal extensor tendons (from radial side to ulnar): Compartment 2 = Extensor carpi radialis longus, extensor carpi radialis brevis, Compartment 3 = Extensor pollicis longus (on ulnar side of Lister’s tubercle), Compartment 4 = Extensor digitorum and extensor indicis Flexor carpi radialis overlies the ventral aspect of the scaphoid bone Pisiform and scaphoid bone form the proximal “twin peaks” of the carpal tunnel at the ventral wrist crease Median nerve diameter increase of 2 mm2 or more = Significant compression 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://radquarters.com/⁠ Instagram: ⁠https://www.instagram.com/radquarters/⁠ Facebook: ⁠https://www.facebook.com/radquarters/⁠ Twitter: ⁠https://twitter.com/radquarters⁠ Reddit: ⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

Radiologist Headquarters has a new name: Radquarters! Same high-yield content, but now with a streamlined name that's easier to remember. Click the ⁠YouTube Community tab⁠ or follow on social media for bonus teaching material posted throughout the week! Website: ⁠https://radquarters.com/⁠ Instagram: ⁠https://www.instagram.com/radquarters/⁠ Facebook: ⁠https://www.facebook.com/radquarters/⁠ Twitter: ⁠https://twitter.com/radquarters⁠ Reddit: ⁠⁠https://www.reddit.com/user/radiologistHQ/⁠

In this radiology lecture, we review the ultrasound appearance of acute epididymitis and orchitis! Key teaching points include: Epididymitis = Inflammation of epididymis. Usually bacterial, most commonly due to retrograde ascent from bladder or prostate. Causative infectious agent varies based on age: Adults younger than 35: Neisseria gonorrhoeae, Chlamydia trachomatis (STDs). Adults older than 35: E. coli & other coliform bacteria. Non-infectious causes of epididymitis: Trauma, repetitive activities such as sports (most common causes in males prior to sexual maturity), torsed appendix testis or appendix epididymis, vasculitis, and medications (amiodarone). Presentation: Gradual onset of scrotal pain, swelling & urinary symptoms. Must exclude testicular torsion (usually more acute onset of pain). Epididymitis US findings: Epididymal enlargement, hyperemia, hypoechogenicity. Hyperemia usually precedes grey scale changes. Infection usually spreads from tail to body and head. 20-30% of epididymitis cases have associated orchitis: Scrotal infection typically starts with epididymis then spreads to testis, scrotal sac, or scrotal wall. Orchitis is less common than and usually secondary to epididymitis. Isolated orchitis uncommon, usually viral (mumps). Orchitis US findings: Testicular enlargement, hyperemia and hypoechogenicity. Complications: Scrotal wall inflammation, complicated hydrocele, pyocele (purulent fluid collection with mass effect), abscess (epididymal, testicular, scrotal wall), testicular ischemia and infarct due to obstructed venous outflow (decreased color Doppler testicular blood flow or reversed testicular diastolic arterial flow). 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/⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠https://www.instagram.com/radiologistHQ/⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠https://www.facebook.com/radiologistHeadQuarters/⁠⁠⁠⁠ Twitter: ⁠⁠⁠⁠https://twitter.com/radiologistHQ⁠⁠⁠⁠ Reddit: ⁠⁠⁠⁠https://www.reddit.com/user/radiologistHQ/

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! Website: ⁠⁠⁠https://radiologisthq.com/⁠⁠⁠ Instagram: ⁠⁠⁠https://www.instagram.com/radiologistHQ/⁠⁠⁠ Facebook: ⁠⁠⁠https://www.facebook.com/radiologistHeadQuarters/⁠⁠⁠ Twitter: ⁠⁠⁠https://twitter.com/radiologistHQ⁠⁠⁠ Reddit: ⁠⁠⁠https://www.reddit.com/user/radiologistHQ/

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! Website: ⁠⁠https://radiologisthq.com/⁠⁠ Instagram: ⁠⁠https://www.instagram.com/radiologistHQ/⁠⁠ Facebook: ⁠⁠https://www.facebook.com/radiologistHeadQuarters/⁠⁠ Twitter: ⁠⁠https://twitter.com/radiologistHQ⁠⁠ Reddit: ⁠⁠https://www.reddit.com/user/radiologistHQ/

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! Website: ⁠https://radiologisthq.com/⁠ Instagram: ⁠https://www.instagram.com/radiologistHQ/⁠ Facebook: ⁠https://www.facebook.com/radiologistHeadQuarters/⁠ Twitter: ⁠https://twitter.com/radiologistHQ⁠ Reddit: ⁠https://www.reddit.com/user/radiologistHQ/

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 paralysisn 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/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

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&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! Website: https://radiologisthq.com/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

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/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

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! Website: https://radiologisthq.com/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

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: 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.  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! Website: https://radquarters.com/ Instagram: https://www.instagram.com/radquarters/ Facebook: https://www.facebook.com/radquarters/ Twitter: https://twitter.com/radquarters Reddit: ⁠https://www.reddit.com/user/radiologistHQ/

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! Website: https://radiologisthq.com/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

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! Website: https://radiologisthq.com/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

In this radiology lecture, we review the ultrasound appearance of Achilles tendinosis, partial thickness tears and full thickness tears through four unique cases. Key teaching points include: Achilles tendon is strongest in body. Originates from soleus and gastrocnemius muscles, inserts onto posterior calcaneal tuberosity. Achilles tendon tears = Most common ankle tendon injury. Tendon enlargement greater than 1 cm in AP dimension = Abnormal. Tendinosis appears as fusiform hypoechoic swelling of tendon without fiber disruption with increased blood flow (use power Doppler or microvascular flow). Ultrasound highly sensitive and specific for partial and complete Achilles tears. Partial tear = Hypoechoic/anechoic cleft that disrupts tendon fibers. Full thickness tears = Usually 2-6 cm proximal to calcaneal insertion. Complete tendon fiber disruption and retraction. May see refractive shadowing at tendon stumps. Tendon gap may fill with mixed echogenicity fluid/hemorrhage or portion of adjacent fat pad. Plantaris tendon = Thin tendon at medial aspect of Achilles, may mimic intact Achilles tendon fibers (plantaris usually stays intact with Achilles tear). Dynamic imaging with passive ankle dorsiflexion and plantar flexion helps reveal tendon retraction at tear site. Achilles tendon surrounded by a paratenon as opposed to a true synovial tendon sheath. Paratendinitis = Hypoechoic swelling or anechoic fluid adjacent to tendon. Achilles tendon ossification can occur with prior tendon rupture, surgery, or repetitive microtrauma. Scar tissue in chronic tear can simulate tendon fibers (dynamic maneuvers helpful), and fibrous bridging may occur. 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/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

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! Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Website: https://radiologisthq.com/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

In this video lecture, we review the appearance of the liver on multiphase CT & MRI. A basic approach to image interpretation is presented with pitfalls to avoid. Key points include: The three major liver postcontrast phases include the late hepatic arterial phase, portal venous phase, and delayed/equilibrium phases. The hepatic artery enhances first, followed by the portal veins, then the hepatic veins along with the hepatic parenchyma. An ideal late hepatic arterial phase sequence will have both hepatic artery and portal vein enhancement with no hepatic vein enhancement.  The late hepatic arterial phase occurs at about the same time as the corticomedullary phase, enteric phase, pancreatic phase, and splenic arciform enhancement phase.  The early arterial phase of an angiographic CT is NOT the same as the late hepatic arterial phase of a liver protocol study and may be too early to adequately assess hypervascular liver lesions. “MRI CT” is a handy mnemonic for hypervascular liver metastases, lesions that will be best detected on a hepatic arterial phase series.  Portal venous phase images will have portal vein and hepatic vein enhancement, as well as liver parenchymal enhancement.  Hypovascular hepatic metastases (GI tract, pancreas) are usually best detected on the portal venous phase. Delayed/equilibrium phase images allow detection of intralesional contrast washout and delayed capsular enhancement typical of hepatocellular carcinoma, as well as evaluation of delayed enhancement as seen with hemangiomas and intrahepatic cholangiocarcinoma. CT has better spatial resolution, but MRI has better contrast resolution and is therefore superior to CT in the characterization of liver masses.  Pre- and postcontrast MRI sequences are typically obtained as a special T1 sequence known as a spoiled 3D gradient echo variant with fat saturation. Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Website: https://radiologisthq.com/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/

In this video lecture, we discuss the ultrasound and computed tomography appearance of pelvic inflammatory disease (PID). Topics include: 1) Early findings of PID, including haziness of pelvic fat, salpingitis, oophoritis, and endometritis. 2) Importance of identifying dilated fallopian tubes by the characteristic “C” or “S” shape that they exhibit, as well as the presence of the “cogwheel” sign. 3) Differentiating tubo-ovarian abscess (TOA) from tubo-ovarian complex (TOC), and the associated treatment implications. 4) Delineation of the typical posterior, dependent position of pyosalpinges and TOAs, as well as the associated anterior displacement of the broad ligament/mesosalpinx. Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Website: https://radiologisthq.com/ Instagram: https://www.instagram.com/radiologistHQ/ Facebook: https://www.facebook.com/radiologistHeadQuarters/ Twitter: https://twitter.com/radiologistHQ Reddit: https://www.reddit.com/user/radiologistHQ/