Dr Arun Gupta Director imaging

Dr Rakhee gupta Dr Vinayak Mittal Dr Niharika MahajanDr Gaurav SharmaDr Ritesh Mahajan

ADVANCED USG

LOUNGE

ULTRASOUND IMAGE GALLARY INTRACAPSULAR RUPTURE OF BREAST

IMPLANT . STRANGULATED UMBILICAL HERNIA DIVERTICULITIS. AGGRESSIVE PERIOSTEAL REACTION ON

USG . ECTOPIC FETAL KIDNEY. EJACULATORY DUCT CYST.

BREAST IMPLANT RUPTURE( INTRACAPSULAR)

STEP LADDER SIGNON ULTRASOUND IN CASE OF

INTRACAPSULAR BREAST IMPLANT RUPTURE

Breast implant ruptures are a recognized complication of a breast implant. It can be intra- or extracapsular.Pathology

After implantation of a silicone or saline breast implant, a fibrous capsule (scar) forms around the implant shell. Implant ruptures may be intracapsular(~85%) or extracapsular (~15%) .

Intracapsular ruptureAn intracapsular rupture occurs when the shell of the implant ruptures but the fibrous capsule formed by the breast remains intact. Silicone does not freely extravasate.This makes it difficult to detect on clinical exam or mammography. Intracapsular rupture is best seen on MRI.

Extracapsular ruptureAn extracapsular rupture can lead to a change in the implant contour and may be detected on clinical examination or mammography. An extracapsular rupture implies intracapsular rupture as well.

The stepladder sign is a sonographic sign indicating an intra-capsular breast implant rupture. It is considered the most reliable ultrasonographic finding in silicone gel breast implant intra-capsular rupture. It is identified as multiple, discontinuous, parallel, linear echoes in the lumen, and is analogous to the linguine sign at MRI.

Normal Contour/ core Of the implant

Multiple, discontinuous, parallel, linear echoes in the lumen of the

breast implant

STRANGULATED UMBILICAL HERNIA

There is a mechanical bowel obstruction associated with the hernia and/or if there is evidence of strangulation, i.e. constriction to the vascular supply of the hernial sac contents at the level of the neck. In this case there is apparent inflammation in the herniated fat strongly suggesting that strangulation is present.

Hernia sac with gut as content • Mural edema appreciated in

gut .• Inflammation in the sac

contents appreciated • Sac contents are irreducible

on probe insinuation

PERIOSTEAL REACTION ON USG ( AGGRESSIVE)

Periosteal reaction, also known as a periostitis/periosteitis, is a non specific radiographic finding that occurs with periosteal irritation. Periosteal reactions may be broadly characterized as benign or aggressive, or more specifically broken down by pattern.

Benign periosteal reactionLow-grade chronic irritation allows time for the formation of normal or near-normal cortex. The cortex will be thick and dense and have a wavy or uniform appearance.Benign periosteal reactions can be seen in callus formation in a fracture or with slowly growing tumours.

Aggressive periosteal reactionRapid irritative processes do not allow the periosteum time to lay down and consolidate new bone to form normal cortex. The cortex may appear lamellated, amorphous, or sunburst-like.Aggressive periosteal reactions can not only be seen with malignant tumours, but also with more benign processes like infection , eosiophilic granuloma , ABC , osteoid osteoma and trauma .

Cortical break

PERIOSTEAL REACTION Interrupted / onion skin type

Periosteal reaction ( aggressive)

DIVERTICULITIS

Diverticulitis is one of the presentations of diverticular disease and is most often a complication of colonic diverticulosis.

On imaging, a non-complicated diverticulitis is characterised by a focal fat stranding adjacent to a colonic diverticulum, usually the sigmoid. A small amount of extraluminal fluid and gas locules may be present. 

DIVERTICULAAPPRECIATED AS OUTPOUCHING WITH ASSOCIATED REACTIONARY INFLAMMATORY STRANDING SEEN AS INCREASED ECHOGENICITY OF THE ADJACENT PERIDIVERTICULAR FAT PLANES .

FETAL PELVIC KIDNEY

FETAL PELVIC KIDNEY

Fetal kidneys Migrate to renal fossa after

crossing the Arterial fork formed from the

Umbilical arteries .Sometimes these kidneys

fail to Cross this arterial fork

And remain in pelvis only close to

Common iliac arteries . This process of ascent is

completed by 10wks Hence diagnosis of the

fetal pelvic kidney Can be made as early as in

first trimester also .

EJACULATORY DUCT ECTASIA

DILATED EJACULATORY DUCT

REFERENCE

DIAGNOSTICULTRASOUNDFOURTH EDITIONCarol M. Rumack, MD, FACRJ. William Charboneau, MD, FACRDeborah Levine, MD, FACR

Ultrasound of CongenitalFetal AnomaliesDifferential Diagnosis and Prognostic IndicatorsDario Paladini MDHead, Fetal Cardiology UnitDepartment of Obstetrics and GynecologyUniversity Federico II of NaplesNaplesItalyPaolo Volpe MDHead, Fetal Medicine UnitDepartment of Obstetrics and GynecologyHospital Di VenereBari