APPENDICITIS WITH PERFORATION AT TIP

ULTRASOUND EVALUATION OF APPENDICITIS WITH PERFORATION AT TIP

Clinicals- F/70y with pain RIF

Fig1- High resolution ultrasound scan of RIF shows thick walled tubulo target like gut Lesion consistent with inflamed appendix . A small breach is seen in mural continuity at tip with perifocal small amount of fluid and inflamed fat ( arrows) - s/o perforation.

Fig 2- HRSG scan of RIF shows inflamed appendix in longitudinal plane with small amount of fluid & fat reaction at tip ( indicative of perforation)

MOREL LAVALLEE LESION ON ULTRASOUND

" MOREL LAVALLEE LESION"

Clinicals - H/O trauma 

- Painful swelling anterior aspect of knee 

 Fig 1- Sagittal Extended field of view image anterior aspect of knee joint showing well defined area of  fluid collection in subcutaneous  fat plane with few thin septas & fat lobules . The lesion is extending above and below knee joint .

Fig 2- High resolution US scan anterior aspect knee joint showing fluid , thin floating septas & echogenic fat lobules with in superficial fascia & subcutaneous plane . The findings are consistent with "Morel Lavallee Lesion "

MOREL LAVALLEE LESION -  It is due to  closed degloving soft tissue injury associated with trauma . In this lesion skin & subcutaneous fat abruptly separate from underlying deep fascia forming a hemolymphatic mass . Thigh at greater trochanteric area is the most common site .

ULTRASOUND CHEST- Empyema thoracis & Enlarged Thymus

ENCYSTED /LOCULATED INFECTED PLEURAL EFFUSION [ EMPYEMA THORACIS]

Fig 1- Utrasound image of left side chest showing  thick walled loculated pleural effusion with internal echos and septas  - indicative of empyema .

Fig 2- CXR PA of the same case showing homogeneous opacity left mid and lower zone with smooth upper margin  . The opacity is obscuring cardiac and dome outline .

D/D - 1) Consolidation - point against - absent air bronchograms

2)- Pleural effusion  - point against - no mass effect - this can be explained as it is loculated empyema 

USG OF ENLARGED THYMUS 

CXR: Shows upper mediastinal widening

USG scan(chest, left parmedian TS view) of the same pediatric case: Shows enlarged thymus as well defined soft tissue mass in the region of superior mediastinum retrosternal space. 

USG scan(chest, left parmedian LS view) of the same pediatric case: Shows enlarged thymus as well defined soft tissue mass in the region of superior mediastinum retrosternal space, antero-superior to heart and great vessels.