Leaking Abdominal Aortic Aneurysm

LEAKING ABDOMINAL AORTIC ANEURYSM WITH MURAL THROMBUS

An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall. 

As blood passes through the weakened blood vessel,
 the blood pressure causes it to bulge outwards like a balloon.
(image of leaking abdominal aortic aneurysm measuring 9.5x5.6cms with thrombus in long scan)

The abdominal aorta is the largest blood vessel in the body.
 It is roughly the width of a garden hose.
 It transports oxygen-rich blood away from the heart to the rest of the body.

It runs in a straight line down from the heart, through the chest and abdomen before branching off into a network of smaller blood vessels.

 A ruptured abdominal aortic aneurysm can cause massive internal bleeding, which is usually fatal. Four out of five people with a ruptured aortic aneurysm will die as a result.

The most common symptom of a ruptured aortic aneurysm is 

sudden and severe pain in the abdomen.

TRANS SONOGRAM OF ABDOMINAL AORTA SHOWS  MURAL THROMBUS.

. Ultrasonography usually gives a clear picture of the size of an aneurysm.
 Ultrasound has about 98% accuracy in measuring the size of the aneurysm and is safe and noninvasive.The aortic wall has three layers, the tunica adventitia, tunica media, and tunica intima. The layers add strength to the aorta as well as elasticity to tolerate changes in blood pressure. Chronically increased blood pressure causes the media layer to break down and leads to the continuous, slow dilation of the aorta.

LEAKING ABDOMINAL AORTIC ANEURYSM-

Most abdominal aortic aneurysms produce no symptoms and are discovered incidentally when an imaging test of the abdomen  is performed. 

They can also be detected by physical examination when the health care professional feels the 

abdomen and listens for a bruit, the sound made by turbulent blood flow.

Pain is the most common symptom when the aneurysm expands or ruptures.

 It often begins in the central abdomen and radiates to the back or flank. 

Other symptoms can occur depending upon where the aneurysm is located in the aorta and whether nearby structures are affected.

Abdominal aortic aneurysms can remain asymptomatic or produce minimal symptoms for years. 

LEAKING ABDOMINAL AORTIC ANEURYSM INTO THE RETROPERITONEAL SPACE WITH MASSIVE ACUTE INFLAMMATORY REACTION ..
Rapidly expanding abdominal aneurysm can cause sudden onset of severe, steady, and worsening middle abdominal and back or flank pain. Rupture of an abdominal aortic aneurysm can be catastrophic, even lethal, and is associated with abdominal distension,
 a pulsating abdominal mass, due to massive blood loss.

HR MSK US-Shoulder joint.--Rotator cuff injuries and degenerative changes

SUB DELTOID BURSITIS AND BICEPS TENOSYNOVITIS

TENOSYNOVITIS OF THE  BICEPS TENDON.

INFLAMMED SYNOVIAL SHEATH WITH COMMUNICATEING TO THE JOINT SPACE.

BILATERAL CHRONIC DIFFUSE NON COMPRESSIBLE THICKENING  OF

THE BICEPS TENDON SYNOVIAL SHEATH..

BILATERAL SUPRASPINATUS  SYNOVIAL HYPERTROPHY

TRANS SCAN OF SHOULDER SHOWS HETEROGENOUS ANECHOIC

SUB ACROMIAL SUB DELTOID BURSA FILLED WITH FLUID.

BURSITIS-
THERE IS MARKED IRREGULAR SYNOVIAL LINING WITH MULTIPLE INTERNAL ECHOES IDENTIFIED WITHIN THE FLUID.THESE INTERNAL ECHOES CORRESPONDS TO PANNUS ,BLOOD OR RICE BODIES
(free corpuscles of synovial origin with a cartilage like appearence)

MSK-HRUS--Achilles tendon rupture

The Achilles tendon is the largest and strongest tendon in the human body, and it is formed from tendinous contributions of the gastrocnemius and soleus muscles. Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute severe pain and loss of plantar flexion power in the foot..

As the strongest tendon of the human body, the Achilles tendon originates from the soleus and gastrocnemius muscles, and inserts onto the posterior calcaneal tuberosity. The tendon is surrounded by a paratenon rather than a synovial sheath. 

  Dynamic evaluation.

 Dynamic imaging is important in evaluation of Achilles tendon tears since hemorrhage, fluid, debris, or scar tissue may fill the gap between torn tendon ends. 

·         Full-thickness tear: 

This disorder is characterized by complete tendon fiber disruption and tendon retraction. 

Sonography is an efficient and accurate way to assess the Achilles tendon. Advantages of sonographic evaluation include cost,

 widely available equipment, ease of contralateral comparison, 

and the ability to image during joint motion.

Tube within Tube-Ultrasonographic appearence of ascaris lumbricoides in small bowel

Hrsg image of fluid filled small bowel loops

 

Hrsg image of small bowel showing ascaris in transverse view

Ascaris lumbricoides in the gastrointestinal  tract has various features.

 Sonographic examination in the diagnosis of ascaridiasis has a high value.

The conventional method of diagnosing ascariasis is by testing the stool for the presence of the eggs.
 When there are atypical abdominal symptoms in association with a vague abdominal mass, a routine ultrasound scan using the common 3-3.5 MHz probe yields no definite findings to diagnose intestinal ascariasis.
 If a high frequency probe of -10-12 MHz is used instead, intestinal ascariasis could be definitely established.
 This case illustrates a typical worm mass diagnosed with the help of a high frequency probe.

 .

Roundworm infestation, one of the most common helminthic diseases worldwide, is caused by Ascaris lumbricoides, one of the largest parasites that infests the human bowel.
 A lumbricoides is virtually universal at some stage of childhood in semitropical and tropical regions. 

Hrsg image of small bowel showing ascaris in longitudinal view

A longitudinal section of a segment of the Ascaris lumbricoides shows the tubular shadow with brighter parallel walls (strip sign), marked by the arrows. 

The core is hypoechoic (inner tube sign). The patient's bowel walls are also identifiable.

Polypoid Lessions in the gall bladder

polypoid lesions of the gallbladder  are defined as masses protruding from
 the mucosal surface of the gallbladder.

polypoid lessions in the gall bladder can be benign or malignant.
polypoid lessions in the gall bladder are usually diagnosed with ultrasonography as nonshadowing, fixed, solid masses

 Symptoms are unusual unless other abnormalities, such as stones, are present.

 The widespread use of US in patients with suspected gallstones and screening for other abdominal diseases has increased the detection rate of polypoid lessions in the gall bladder.

Ultrasound images in acute scrotum--Torsion Testis

Diagnostic imaging, particularly Doppler ultrasonography, plays an important role in the assessment of the patient with acute scrotal pain and swelling.

                  The affected testes was removed and found to be gangrenous

Testicular torsion, also termed torsion of the spermatic cord, is a relatively common and potentially devastating acute condition due to obstruction of the arterial blood supply to the testis.Fortunately, this entity is relatively well known, and it usually occurs with enough discomfort to lead to its diagnosis and subsequent testicular salvage
. However, atypical presentations of testicular torsion, delayed recognition of the condition, and its confusion with other causes of acute scrotum can potentially delay diagnosis and lead to testicular necrosis necessitating orchiectomy

The -"Whirl pool sign"-or-"snail sign" is also seen in the testes, caused by swollen testes  and twisted, bulky spermatic cord .
These ultrasound images suggest torsion of the Right testes.

The whirl pool sign-"snail sign" is also seen in twisted, bulky spermatic cord
(body and head of snail). 

ultrasonography with color and power Doppler imaging has emerged as the primary imaging modality for the diagnosis of testicular torsion.It not only helps in corroborating the diagnosis by alteration of testicular echotexture but also provides valuable information on vascular perfusion of the testis. In addition, sonographic findings frequently allow other diagnoses to be made in those patients presenting with an acute scrotum who do not have torsion..

Prior to the development of high resolution, real-time ultrasonography coupled with sensitive color Doppler, nuclear scintigraphy was the mainstay of tests available to evaluate the acute scrotum. 

Given associated radiation, less widespread availability, limited ancillary information, and the accuracy of color Doppler imaging, scrotal scintigraphy is no longer used as frequently

..

Information about the role of MRI in the diagnosis of torsion is limited. 

Although MRI is likely to be highly sensitive..

 However, with its limited availability, particularly at night, and its cost, MRI is unlikely to become a front-line examination for the patient presenting with acute scrotal pain.

Limitations of techniques

Color Doppler ultrasonography is highly
 operator dependent.

 In the diagnosis of testicular torsion, gray-scale findings are combined with dynamic flow information. Inaccurate results may be obtained in the prepubertal patient with small testicular volume or in cases with multiple imaging and Doppler artifacts. Such imaging artifacts may result from inappropriate gain settings and the non-use of slow-flow techniques..

Thyroid Gland Images in Acute Thyroiditis

Thyroiditis is a generic term including an array of clinical entities affecting the thyroid gland.

The thyroiditis may present infectious, autoimmune, traumatic, postradiotherapy, drugs use, and other etiopathogenies.

Heterogenous goitre with parenchymal micronodules,poorly defined hypoechoic areas permiated by fibrous echogenic layers giving a gland a psuedolobular appearece.

Doppler mapping showing a  diffuse hypervascularization pattern