Choledochal cysts (CC) are rare congenital dilatation of the extra hepatic common bile duct (though they now include focal cystic dilatation of the intrahepatic bile ducts Caroli Disease), first described by Vater and Ezler in 1723. [1] Historically categorized into three types, choledochal cysts are now classified into five types known as Todani Classification. [2]… Read More Choledochal Cyst
Case An adolescent patient presented for ultrasound with a history of tachycardia and diaphoresis. On ultrasound examination a heterogenous mass was seen medial to the left renal pelvis which was determined to be extra adrenal pheochromocytoma after further investigation. Pheochromocytoma’s are rare adrenal tumors that arise from the medulla (chromaffin cell tumors) derived from the… Read More Pheochromocytoma
Anatomy The Portal Vein is made up three main vessels the Superior and Inferior Mesenteric veins and the Splenic vein. When these three vessels converge they become the Main Portal Vein which enters the Liver via the porta hepatis along with the hepatic artery and common bile duct (cbd exits the liver), aka the Portal… Read More Portal Vein Doppler
IntroductionNutcracker syndrome was first described in the literature by El-Sadr and Mina in 1950 [1]. It is considered a vascular compression disorder akin to May-Thurner syndrome (left iliac vein is compressed by the right iliac artery) and Thoracic outlet syndrome (compression of the vessel of the upper extremity)[2]. In normal anatomy the left renal vein… Read More Nutcracker Phenomenon/Syndrome
biliary sand/microlithiasis precursor to stones cholecystitis, colic, pancreatitis Biliary sludge is a common finding on GB sonography. It is mainly comprised of calcium bilirubinate granules and lesser amounts of cholesterol crystals. It can be asymptomatic. Risk factors are rapid weight loss, gastric surgery, total parenteral nutrition (tpn) in fact you see it quite frequently in… Read More Gallbladder Sludge
Neuroblastoma is the most common extracranial malignant neoplasm in infants and children. It accounts for eight to 10% of all childhood cancers and 15% of cancer related death. The median agent diagnosis is usually 22 months with 30 % of cases being discovered in the first year of life. The tumors arise from the neural… Read More Neuroblastoma
Protocol image sequence (Right side only repeat images on left testis for complete protocol). Transverse Begin in transverse what’s know colloquially as the “twins” view. This view is great for determining quickly symmetry, position and echotexture. With color doppler you can determine whether there is testicular torsion. In cases of undescended testis you can show… Read More Testicular/Scrotal Doppler Protocol
Here is the protocol for the complete renal ultrasound. BLADDER Sagittal With a full bladder begin at midline and take right and left lateral images in sagittal. Measure the bladder wall per protocols or indication. A normal adult bladder can hold about 470 ml of urine or about 2 cups. TRANSVERSE Turning your transducer counter… Read More Renal Ultrasound Complete Protocol
The gallbladder is an oblong pear shaped structure located on the underside of the liver. It is located at the level of the middle hepatic vein aka Cantlie’s line between segments IV and V. The normal distended gallbladder is approximately 7-10 cm in length and 4 cm in diameter. The capacity is usually 50 ml(1.8 fl oz) of bile. The GB is divided into neck, body and fundus, sonographic appearance is anechoic with an echogenic wall.… Read More Gallbladder and Biliary Pathology
Sonographically the liver is usually divided into right and left lobes . However the liver is divided into 8 functional segments with the Couinaud classification (pronounced kwee-NO). Each segment has it’s own vascular and biliary supply. The liver is divided horizontally by the portal veins and vertically by the hepatic veins. Segment I is the caudate lobe.… Read More Couinaud’s Liver Segments
Sonographic Tendencies 