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The Peritoneum

Summary of Key Points Ultrasound has a role in peritoneal imaging. Success is dependent on operator awareness and thorough technique. Inclusion of transvaginal scan in women will greatly improve accuracy. Ultrasound is excellent for detecting and characterizing peritoneal fluid. Ultrasound is very useful for detecting and characterizing neoplastic and inflammatory peritoneal disease. Ultrasound is often the modality of choice to guide paracentesis and biopsy of peritoneal…

Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall

Summary of Key Points Dynamic ultrasound is the key examination for assessing the groin or anterior abdominal wall pain. Dynamic components of the examination include Valsalva and compression maneuvers and scanning in both supine and upright positions. Dynamic sonography enables clinicians to determine hernia type, size, contents, reducibility, and tenderness. Evaluation of groin pain in athletes is frequently more complex than in nonathletes because of associated…

The Retroperitoneum

Summary of Key Points If an abdominal aortic aneurysm progresses to rupture, survival is very unlikely. If discovered before rupture, survival is highly likely. Most aneurysms are fusiform, which makes them readily diagnosable with ultrasound. Clinicians must also be aware of related entities that are more difficult to diagnose with ultrasound, including eccentric aneurysms, pseudoaneurysms, and penetrating ulcers. Ultrasound is not an appropriate method for the…

The Adrenal Glands

Summary Key Points The adrenal glands are responsible for maintaining homeostasis and regulating hormonal production and secretion within the body. The adrenal cortex is comprised of the zona glomerulosa, fasciculata, and reticularis, which are responsible for aldosterone, glucocorticoid, and androgen regulation, respectively. The adrenal medulla regulates catecholamines. Sonographic visualization of the right adrenal gland is best through a transverse oblique and coronal view, using the liver…

The Prostate and Transrectal Ultrasound

Summary of Key Points Prostate cancer is a significant health problem and its management is changing rapidly. Currently, transrectal ultrasound (TRUS) with biopsy is the primary modality to diagnose prostate cancer. New modalities including multiparametric magnetic resonance imaging and biomarkers are being introduced for prostate cancer assessment. Understanding of prostate cancer has evolved with recognition of aggressive and indolent forms, which are managed differently. Screening for…

The Kidney and Urinary Tract

Summary of Key Points Renal ultrasound is the screening modality of choice for the initial evaluation of renal insufficiency. Relevant imaging markers include parenchymal echogenicity, renal length, and collecting system dilatation. The primary role for ultrasound in the evaluation of renal masses is to differentiate between cystic and solid lesions, although an appropriate differential diagnosis may be given based on clinical history and cyst complexity. Echogenic…

The Gastrointestinal Tract

Summary of Key Points High-resolution ultrasound allows for excellent depiction of the bowel, including the normal multilayered appearance of the bowel wall and many pathologic features. Ultrasound is a safe, objective, and accurate method for measuring the severity of inflammatory activity in inflammatory bowel disease, an essential requirement considering the young population most often affected by this chronic and often debilitating disease. Contrast-enhanced ultrasound is an…

The Pancreas

Summary of Key Points Knowledge of a few key scanning techniques will optimize imaging of the entire pancreas. Understanding of the embryologic development, normal anatomy, and anatomic variants of the pancreas aids in detection and characterization of disease. Ultrasound plays an important role in assessment of acute and chronic pancreatitis, allowing for detection of gallstones, bile duct dilation, and guiding aspiration and drainage when needed. Computed…

The Biliary Tree and Gallbladder

Summary of Key Points Ultrasound should be the first imaging modality used in the evaluation of the patients with potential disease of the biliary tree. Awareness of various scanning techniques and use of harmonic and compound imaging improve visualization of various diseases affecting the biliary tree. Stones in the intrahepatic and extrahepatic biliary tree can be easily overlooked; familiarity with their appearance and a high index…

The Spleen

Summary of Key Points Ultrasound can be used to diagnose or exclude splenic abnormalities, but computed tomography and/or magnetic resonance imaging may be needed in indeterminate cases. There is no single upper limit of normal for spleen size, since size varies with patient sex, weight, and height. Use of a strict 12-cm upper limit of normal for the spleen will lead to overdiagnosis of splenomegaly. The…

The Liver

Summary of Key Points The liver is an ideal organ for sonographic evaluation based on its large size, homogeneous parenchyma, and location high in the abdomen with access provided from both a subcostal and an intercostal approach. Standard ultrasound with real-time gray-scale morphologic assessment and Doppler evaluation of the liver vasculature is augmented by newer techniques of contrast-enhanced ultrasound and elastography. Fatty liver is considered an…

Contrast Agents for Ultrasound

Summary of Key Points After more than 20 years of development and a somewhat hesitant start, microbubbles have finally come of age as a contrast agent for ultrasound. The principal requirements for an ultrasound contrast agent are that it should be easily introducible into the vascular system, be stable for the duration of the diagnostic examination, have low toxicity, and modify one or more acoustic properties…

Biologic Effects and Safety

Summary of Key Points Clinical ultrasound has been found to be an effective imaging modality with an excellent safety profile when used appropriately. Ultrasound can produce physical effects, which should be understood as part of the benefit-versus-risk assessment as with any medical procedure. The thermal index (TI) and mechanical index (MI) provide feedback to the user and should be minimized while obtaining the requisite medical benefit…

Physics of Ultrasound

Summary of Key Points Quality imaging requires an understanding of basic acoustic principles. Image interpretation requires recognition and understanding of common artifacts. Special modes of operation, including harmonic imaging, compounding, elastography, and Doppler, expand the capabilities of conventional gray-scale imaging. Knowledge of mechanical and thermal bioeffects of ultrasound is necessary for prudent use. High-intensity focused ultrasound has potential therapeutic applications. All diagnostic ultrasound applications are based…

Classic Signs and Findings in Musculoskeletal Radiology

Condition Absent in posterior dislocation of the shoulder Name of Sign Half-moon sign Description The medial humeral head normally overlaps the posterior glenoid rim on a standard anteroposterior (AP) shoulder radiograph in external rotation, an appearance resembling a half-moon. When a patient has a posterior shoulder dislocation, there is often no overlap (rim sign). Reference Schild H, Muller HA, Klose K: The halfmoon sign. Australas Radiol…

Diseases with Names

A few examples of these are shown here, and the full listing is available online. A Aarskog Syndrome Aarskog syndrome is an extremely rare genetic disorder marked by stunted growth that may not become obvious until the child is about 3 years of age, and also by broad facial abnormalities, musculoskeletal and genital anomalies, and mild mental retardation. Aarskog D. A familial syndrome of short stature…

Fractures with Names

Abstract In general, an eponym can be considered the proper name of the first person or persons describing an anatomical structure, a classification system, a disease, a fracture, a surgical technique, an instrument, and so on. It is believed that the use of eponyms tends to cause confusion and should be avoided. A clear example of this is the Colles fracture, a name applied to many…

Orthopedic Devices

Abstract Plates and Screws Blade Plate and Screws Indications: subtrochanteric and supracondylar femoral fractures ( Fig. 1 ) as well as femoral osteotomies Angled plate configuration Reconstruction Plate Indications: pelvic ( Fig. 2 ) and calcaneal ( Fig. 3 ) fractures Malleable plate that can be appropriately sized and configured for stabilization of fractures with complex bony surfaces Buttress Plate and Screws Also known as periarticular…

Measurements Most Frequently Used in Orthopedic Imaging

Abstract Measuring distances and angles is an important task in daily orthopedic practice. Radiologic measurements are the key to diagnosing certain injuries and defining their prognosis, and they often have a decisive impact on treatment. Radiologic measurements can be used in orthopedics to diagnose certain injuries or to assess progression in some diseases, in particular chronic ones. After a fracture, measurements are useful to quantify displacement…

Ultrasound Procedures

Abstract Indications Ultrasound guidance is the optimum technique for placing needles into soft tissue structures when they are well visualized using this imaging method. In broad terms, ultrasound is used for injections and biopsies, but both the structures to be punctured and those that must be avoided should be visible. Ultrasound imaging has particularly good resolution within the first 5 to 10 cm of soft tissue. Sound…