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Showing posts with label Doppler. Show all posts
Showing posts with label Doppler. Show all posts

Case 115: Acute Epididymo-orchitis || Ultrasound || Doppler

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Clinical Features:

A 63-year-old male patient came with right hemiscrotal painful swelling.


Ultrasound Features:

- Swollen & hypoechoic right testis & epididymis with increased vascularity on Doppler.

- Right sided mild hydrocele.


Remember:

Any focal heterogeneous area in a case of acute epididymo-orchitis should be assessed carefully with Doppler to exclude abscess.


Ultrasound Diagnosis:

Right sided acute epididymo-orchitis with reactionary hydrocele.


Ultrasound Images:









Right sided acute epididymo-orchitis with reactionary hydrocele






Right testis & epididymis on 3D images


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link







Case 83: Hyperthyroidism | Thyrotoxicosis || Doppler

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Clinical Features:

A 35-year-old female patient came with 

- Midline neck swelling

- Weight loss

- Diarrhoea


Ultrasound Features:

- Diffusely enlarged thyroid gland with heterogeneous echotexture.

- Grossly increased parenchymal vascularity forming the ‘Thyroid Inferno’ as well as grossly increased flow velocities in bilateral thyroid arteries.


Ultrasound Diagnosis:

Hyperthyroid Goitre


Ultrasound Images:



Diffuse thyromegaly with heterogeneous parenchyma


Thickened isthmus with high parenchymal vascularity


Enlarged inhomogeneous right lobe


Enlarged inhomogeneous left lobe


Very high flow velocities in the right inferior thyroid artery 


Very high flow velocities in the right superior thyroid artery 


Very high flow velocities in the left inferior thyroid artery 


Very high flow velocities in the left superior thyroid artery 


Increased parenchymal vascularity 


Thyroid Inferno


Normal right submandibular gland


Normal left submandibular gland


YouTube Link:

















Case 47: Facial Hemangioma || Ultrasound || Doppler

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Clinical Features:

A 23 years old female patient came with a left cheek swelling.


Ultrasound Features:

- A well-defined oval slightly lobulated hypoechoic mass of heterogeneous echotexture with multiple internal cystic spaces is noted within the muscular compartment of the left cheek, just medial to the medial border of the left parotid gland.
- No extension beneath the muscular compartment.
- Color Doppler shows, weak vascular flow signals of predominantly venous origin.
- Supplying artery arising from adjacent facial vessel show moderate impedance flow (RI: 0.7).


Remember:

- According to newer nomenclature (ISSVA classification of vascular anomalies), these lesions are merely known as slow flow venous malformations.
- It is probably helpful to include the word 'hemangioma' in reports as this term is most familiar to many clinicians.


Ultrasound Images:


Fig: Well-defined, oval, slightly lobulated, hypoechoic mass of heterogeneous echotexture with multiple internal cystic spaces is noted within the muscular compartment of the left cheek, just medial to the medial border of the left parotid gland suggesting hemangioma.


Fig: Well-defined, oval, slightly lobulated, hypoechoic mass of heterogeneous echotexture with multiple internal cystic spaces is noted within the muscular compartment of the left cheek, just medial to the medial border of the left parotid gland suggesting hemangioma.


Fig: Internal venous flow signal on color Doppler


Fig: Hemangioma in relation to left parotid gland


Fig: Feeding artery waveform (RI: 0.7)


Fig: Internal venous flow

YouTube Video Link:


https://youtu.be/gWjlJVEWzm8


Case 42: Scrotal Foreign Body Granuloma || Ultrasound

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Clinical Features:

A 33 years old male patient came with left hemiscrotal painful swelling.


Ultrasound Features:

- A well-defined linear echogenic structure is noted about 8.5mm deep to the skin surface of the bottom of the left hemiscrotum.

- Irregular hypoechoic area is noted surrounding the echogenic focus.

- Color Doppler shows increased vascularity within the hypoechoic area.

- No testicular or epididymal abnormality.


Remember:

- In case of genital part lesions, patient history may not be always satisfactory.
- What you see may become more important than what you hear.


Ultrasound Images:


Fig: Echogenic linear foreign body with surrounding hypoechoic granuloma


Fig: Echogenic linear foreign body with surrounding hypoechoic granuloma


Fig: Foreign body is 8.5mm deep to scrotal skin surface. Doppler shows increased vascularity within & towards the granuloma


Fig: Foreign body is of 6.7mm length & 0.3mm width. Doppler shows increased vascularity within & towards the granuloma.


Fig: Color Doppler shows low impedance flow supplying the granuloma.



YouTube Video Link:



https://youtu.be/4O_br21_jeE






Case 40: Chronic Venous Insufficiency - Varicose Veins - Venous Thrombosis

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Clinical Features:

A 52 years old male patient came with

- Left leg pain

- Dilated superficial veins with overlying skin discoloration


Ultrasound Features:

- Bilateral severely incompetent sapheno-femoral & sapheno-popliteal junctions along with dilated incompetent left leg perforators suggest chronic venous insufficiency.

- Dilated & tortuous superficial veins along both long & short saphenous territories of the left lower limb, more prominent below the knee indicate varicose veins.

- Heterogeneous low-level echoes within a dilated tortuous, non-compressible posterior thigh tributary of the left long saphenous vein suggest venous thrombosis. 

- No deep venous thrombosis.

- Prominent left inguinal lymph nodes.


Remember:

In case of long-standing varicose veins, thrombus within superficial & deep veins is not uncommon.


Ultrasound Images:

 

Fig: Severely incompetent right sapheno-femoral junction


Fig: Severely incompetent right sapheno-popliteal junction


Fig: Severely incompetent left sapheno-femoral junction


Fig: Severely incompetent left sapheno-popliteal junction


Fig: Left Long saphenous vein


Fig: Left Long saphenous vein


Fig: Dilated left leg perforator vein


Fig: Incompetent left leg perforator vein with bidirectional flow


Fig: Varicose veins along the left leg short saphenous territory 


Fig: Dilated left leg short saphenous vein


Fig: Lt: Varicose veins along the left leg short saphenous territory
Rt: Posterior thigh varicose vein with thrombus


Fig: Left leg varicose veins along the long saphenous territory


Fig: Left posterior thigh varicose veins with thrombi


Fig: Left posterior thigh varicose vein, a tributary of LSV with thrombi


Fig: Left posterior thigh varicose vein, a tributary of LSV with thrombi


Fig: Left posterior thigh varicose vein, a tributary of LSV with thrombi



YouTube Video Link:



https://youtu.be/mAKkOSCWFv0