l 3diagnostic Ultrasonography

8/12/2019 l 3diagnostic Ultrasonography

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DIAGNOSTICULTRASONOGRAPHY

CHAPTER 23


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PRINCIPLES OF ULTRASOUND

Sound waves are generated by theTRANSDUCER- the gizmo holding apiezoelectric crystal that changes

electrical current into sound waves andvice versa.

Sound waves are generated, reflected offof tissues and echo back, and arepicked up by the transducer(piezoelectric crystal) and converted to

electrical activity.


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PRINCIPLES OF ULTRASOUND

The image that is generated isdependent upon the time it takesthe sound waves to return to thetransducer.

The return time is a reflection of the

distance the tissue is from thetransducer and the degree to whichthe sound waves are reflected by

that tissue (organ vs. bone vs. fatvs. fluid .


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HAZARDS OF DIAGNOSTIC

ULTRASOUND

In short, for diagnostic ultrasound,there are none.

Ultrasound for longer periods oftime than are used in diagnosticultrasound can generate sufficientheat as to be harmful.

And in higher frequencies(>100,000 Hz) can causecavitation.


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METHODS OF UULTRASOUND

1) PULSE-ECHO

2) DOPPLER


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PULSE-ECHO METHOD

2 TYPES:

1) A MODE -amplitude modulation echoes

are displayed in graphic form, such as in anechocardiogram.

2) B MODE - brightness modulation echoesare displayed as different intensities of

brightness, giving a 2-dimensional cross-sectional image (picture, if you will). Can bestatic or dynamic (real-time).


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DOPPLER METHOD

Sound waves bounced off of differentobjects have different frequencies.

With doppler ultrasound, these different

frequencies are transformed into audiblesounds, of different frequency.

The different frequencies can also bemapped to give a visual representation as

well as an audible one.


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DOPPLER METHOD

USES

Flow through arteries and veins- to assesspatency of arterial grafts, obstruction to

flow by thrombi, atherosclerosis, etc.-arterial flow can often be heard in caseswhere it can not be palpated.

Opening and closing of cardiac valves

and flow through them- valvular stenosis,regurg.


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DOPPLER METHOD

OBSTETRICAL USES

Doppler stethoscope- to detect a fetalheart beat episodically, or continuously as

in labor.

Assessment of placental function / fetalgrowth evaluates flow through theumbilical artery and vein, looks for

differentials in flow


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DOPPLER METHOD

COLOR FLOW IMAGING

A type of doppler study.

Asseses whether blood flow is laminar (the

usual way) or turbulent (the abnormal way). Useful in: cardiac valvular regurgitation;

identification of a false lumen in aorticdissection; congenital heart defects such as

patent ductus arteriosus, atrial and venticularseptal defects, which would appear as turbulentflow.


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DOPPLER METHOD

DUPLEX SCANNING

Uses both real-time imaging and dopplerflow together.

Useful in evaluating a variety of vascularproblems: aneurysms, atherosceroticplaques.


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APPLICATIONS OF ULTRASOUND

CEREBRAL CIRCULATION

CAROTID ARTERY

GYNECOLOGIC / OBSTETRIC

TRANSVAGINAL / TRANSABDOMINAL TRANSRECTAL / TRANSTHORACIC /

TRANSESOPHAGEAL

STRESS ECHOCARDIOGRAM

ECHOENCEPHALOGRAM

BREAST

BLADDER


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CEREBRAL CIRCULATION

Measures blood flow in the cerebralcirculation, particularly in the:

1) Middle, anterior, and posterior cerebral

arteries.

2) Distal internal carotid.

3) Basilar artery.

Often combined with doppler duplexultrasound and arteriography.


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CAROTID ARTERY SCANS

Atherosclerosis is associated withthickening of the intima of the artery.

Risk of cardiovascular disease and stroke

is proportional to the thickness of theintima, which is a reflection of the degreeof atherosclerosis.

Useful for screening both symptomatic

patients who may need surgicalintervention and asymptomatic patientswho may need prevntive measures.


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GYNECOLOGIC ULTRASOUND

Uterus-size, shape (bicornuate),presence of masses within (fibroids,neoplasms).

Ovary-presence of masses, cysts,neoplasms.

Tubes-hydrosalpinx, pyosalpinx in

PID, ectopic pregnancy.


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BENIGN CYSTIC TERATOMA

RIGHT

OVARY
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ECTOPIC PREGNANCY

UTERUS:

SOLID MASS WITHIN

NO GESTATIONAL SAC
http://rad.usuhs.mil/medpix/parent.php3?mode=pt&pt_id=8523&imid=25036&quiz=no&th=-1


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ECTOPIC PREGNANCY

ADNEXA:

CYSTIC MASS,BETA HCG 17,000


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COLOR DOPPLER (FLOW)STUDY

INCREASED

FLOW

ECTOPIC PREGNANCY
http://rad.usuhs.mil/medpix/medpix.html?mode=pt&pt_id=4330&imid=10305&quiz=no&th=-1


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TWIN GESTATION
http://rad.usuhs.mil/medpix/medpix.html?mode=pt&pt_id=7847&imid=22184&quiz=no&th=


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OB (FETAL) ULTRASOUND

26 WEEK FETUS:

CONGENITAL

POLYCYSTIC

KIDNEYS


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23 YOF AT 20 WEEKS GESTATION

FETAL HYDROTHORAX (BILATERAL PLEURAL EFFUSIONS) AND

ASCITES, C/W HYDROPS FETALIS


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23 YOF AT 20 WEEKS GESTATION

FETAL HYDROTHORAX (BILATERAL PLEURAL EFFUSIONS) AND

ASCITES, C/W HYDROPS FETALIS


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OLIGOHYDRAMNIOS
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OB SCAN - OMPHALOCOEL


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PLAIN FILM - OMPHALOCOEL


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TRANSVAGINAL ULTRASOUND

Transducer placed in the vagina.

USEFUL FOR:

Evaluation of follicular development,

ovulation.

Ruling out ectopic pregnancy.

Evaluation of endometrial thickness inthe assessment of post-menopausalbleeding, need for biopsy.

Incompetent cervix.


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BICORNUATE UTERUS


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SAME BICORNUATE UTERUS

GESTATIONAL SAC


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SAME BICORNUATE UTERUS

OTHER HORN

FLUID-FILLED

ONLY


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TRANSVAGINAL SCAN

UTERUS:

COMPLEX, CYSTICMASS WITHIN THE

UTERUS

DDx

CYSTIC POLYP,

ENDOMETRIAL Ca,ENDOMETRIAL

HYPERPLASIA


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TRANSVAGINAL SCAN

On this image performed during sonohysterography,

two masses, one polypoid and another more broad-based,

extending from the endometrial lining are evident.


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ULTRASOUND LEFT OVARY

HEMORRHAGIC CYST


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SAME PATIENT

HEMORRHAGIC CYST RESOLVED


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ABDOMINAL ULTRASOUND

Often the 1sttest used to evaluateabdominal pathology (or 2nd, behind aKUB).

Or complementary to other studies suchas radionuclide studies, CT, MRI, X-Ray/Contrast studies, etc. No radiation,cheaper.

Needle-guided biopsies, paracentesis. Examples: appendicitis, cholelithiasis,

aortic aneurysms, cysts / masses /tumors / abscesses / ascites.
http://rad.usuhs.mil/medpix/parent.php3?mode=single&recnum=2287


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CHOLECYSTITIS

GALLBLADDER:

GALLSTONE,WALL THICKENING
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SAME PATIENT

COMMON BILE DUCT ENLARGED


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ABDOMINAL SONOGRAM

A thickened gall bladder wall is noted, with some pericholecystic fluid

and shadowing echogenic foci likely representing stones


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TRANSRECTAL ULTRASOUND

Primarily for evaluation of the prostate-size, shape, etc., to evaluate for BPH,prostate cancer.

Used after evaluation by DRE (digitalrectal exam) and PSA (prostate-specificantigen).

Used in needle-guided biopsies,implantation of radioactive seeds fortreatment of malignancy of the prostate.


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TRANSTHORACIC

ECHOCARDIOGAPHY

USEFUL IN THE EVALUATION OF

Valvular defects, chamber size.

Structural abnormalities- patent ductus, atrial

and ventricular septal defects. Pleural effusion, cardiac tamponade.

Color imaging can detect flow laminar vs.turbulent.

Some changes in coronary flow. ECG sometimes done simultaneously.


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TRANSESOPHAGEAL ULTRASOUND

Generates an image unimpeded by thelungs and chest-wall structures.

Especially good visualization of the left

atrium and aortic root. Examples: infective endocarditis, aortic

dissection, cardiac origin of an arterialembolus such as atrial fib. much better

than TTE. RISKS: bleeding, aspiration, perforation,

arrhythmias.


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ECHOENCEPHALOGRAM

Ultrasound can not penetrate bone.

Limited use in the adult.

This modality is most useful for imaging

the newborn as the skull (sutures) havenot completely fused.

Useful for evaluating: mostly, things thatshift the midline, hydrocephalus, size of

the cerebral ventricles, intracranialhemorrhage in the newborn.


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ECHOENCEPHALOGRAM

ANEURYSM OF THE VEIN OF GALEN,

WHICH IS REALLY AN A-V FISTULA


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SAME PATIENT - ANGIOGRAM


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1 DAY OLD INFANT W/ HEART

FAILURE


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FAILURE

Head ultrasound shows a cystic mass, posterior to the

third ventricle. The mass is continuous with the dilated straight sinus.


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FAILURE

Doppler examination shows pulsatile high flow in the cystic mass.


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THORACIC SONOGRAMS

Limited utility due to the lack ofpenetration of ultrasound by air.

Can detect pleural fluid, abscess,malposition of the diaphragm.


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ULTRASOUND OF THE BREAST

Usually done adjunctively with or as a follow-upto mammography.

Differentiates between solid and cystic lesions.

Helpful in women w/ dense breasts as glandulartissue and malignancy both show up white onmammogram. On ultrasound, malignancyappears black.

Used to guide needle biopsy and to place asurgical clip to mark the area for futuretreatment.


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MAMMOGRAM

PALPABLE MASS
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BREAST ULTRASOUND

PALPABLE MASS,

CYSTIC ON

ULTRASOUND


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BONE SONOGRAMS

Primary use is as a screening toolfor osteoporosis, looking at theheel, as healthy bone echoes sound

waves faster than does osteoporoticbone.

Also used for congenital hip

dysplasia (dislocation).


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BLADDER ULTRASOUND

Used to determine volume of urine.

Main purpose is to determine urinevolume without having tocatheterize the bladder, avoidingthe risk of infection.

Image of the bladder is matched to

an image on the screencorresponding to a pre-calculatedvolume.


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Compression U/S - LLE: Noncompressibility of common femoral vein with

echogenic thrombus within the vein lumen consistent with chronic DVT.


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18 YOM W/ TESTICULAR MASS


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18 YOM W/ TESTICULAR MASS

EPIDERMOID CYST OF THE TESTICLE


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ULTRASOUND-GUIDED NEEDLE

BIOPSY OF THE LIVER

l 3diagnostic Ultrasonography

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