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. 

TRANSPERINEAL US SCAN DEPICTING ANAL FISTULA WITH PERIANAL ABSCESS

CASE  1- 

CLINICAL PROFILE  - A young female c/o pain during defecation  & some pus discharge per rectum 

EXAMINATION - High resolution transperineal USG  

Fig -1 , High resolution trans perineal US scan  showing  anal canal [ AC] in transverse plane with  hypoechoic fistula track at about 11 o' clock position  continuous with irregular right lateral perianal abscess .


                                                                    CASE 2

Fig 2 - High resolution trans perineal US scan  of another case showing  anal canal [ AC] in transverse plane with  hypoechoic fistula track at about 1 o' clock position  continuous with irregular left  lateral perianal abscess . 

SOFT TISSUE ULTRASOUND

                                      MYOCYSTICERCOSIS

CASE 1 -  A  case with small tender swelling right pectoral region

Fig 1-  High resolution US scan of right pectoral region shows a well defined rounded cystic lesion within pectoralis major  muscle with eccentric echogenic nidus - consistent with myocysticercosisi [ vesicular stage ] with subtle hypoechoic halo/edema around .  


                                                                CASE 2
 A young female presented with small  slightly painful nodule left breast

Fig 1 - High resolution US image of left breast showing a well defined round to oval slightly thick walled cystic lesion with eccentric echogenic mural nodule  , the findings are consistent with cysticercosis 

Fig 2- High resolution US & Elastography image of the breast cysticercus cyst   , with classical BGR pattern seen on elastography  

ULTRASOUND IN RIGHT ILIAC FOSSA PATHOLOGIES

ULTRASOUND IN POST APPENDECTOMY FECAL FISTULA


CASE - A case with RIF discharging  lesion . H/O -  appendectomy a month back .

 Fig 1 - High resolution right iliac fossa US scan - shows a well defined hypoechoic track like lesion with central echogenicitis [ arrows ] indicative of air foci extending from cecal area to open externally through abdominal wall, s/o fecal fistula.  The lumen of lesion is connected with lumen of cecum.  

TESTICULAR DOPPLER ; VARICOCELES - COLOR & SPECTRAL DOPPLER

CASE - A young man with mild left hemiscrotal swelling and dull ache !

Fig 1- Color doppler scrotal scan showing dilated & tortuous venous vessels  [ structures with red & blue color filled signals]

Fig 2- Spectral doppler display of scrotal veins showing blood flow augmentation & reversal [ paired arrows]on valsalva maneuver , and return to normal spectrum post release .  

OCULAR USG

Fig 1 - Ocular cysticercosis ;  High resolution ocular USG scan depicting a well defined ring lesion posteromedial aspect of eye ball ,consistent with cysticercus cyst [ vesicular stage ] with eccentric echogenic nidus[scolex] .  Retinal detachment is also evident.
[ Image courtesy: Dr  Ajay Khandelwal , Alwar -Raj, India ]

DUODENAL USG

Duodenal ulcer disease 

CASE 1

Fig 1 - Upper abdominal / right paramedian transverse & oblique high resolution US images shows a focal area of mucosal defect consistent with ulcer crater in first part of duodenum. The lesion depicts some air foci in it with underlying hypoechoic muscularis  propria thickening .


                                                              CASE 2

A young man with h/o chronic upper abdominal pain & occassional vomiting

Fig 1- upper abdominal TS & oblique US scan shows small hyperechoic area of ulcer crater along anterior dudenal wall with air foci within [ arrows]  . Adjacent hypoechoic muscle layer thickening
also noted .

Fig 2 - Upper GI endoscopy of the same case shows a large duodenal ulcer [ blue arrows]

                                                           
                                                                 CASE 3 
CLINICALS -  A young lady c/o pain upper abdomen since 15 to 20 days , with occ vomiting .

Fig 1- Epigastric USscan depicting duodenum in transversa plane with echogenic mural lesion consistent with ulcer crater [ arrow]