ADVANCED USG LOUNGE SPIRAL CT / MRI CENTRE CHANDIGARH

1. • SONO ELASTOGRAPHY
(FREE HAND ELASTOGRAPHY AN
OVERVIEW)
•CLITOROMEGALY
•RANULA
•CAPILLARY MALFORMATION
•DIASTEAMATOMYELIA
•FOREIGN BODY IN KNEE
DR ARUN GUPTA
DIRECTOR IMAGING
DR RAKHEE GUPTA
DR VINAYAK MITTAL
DR NIHARIKA MAHAJAN
DR GAURAV SHARMA
DR RITESH MAHAJAN

2. SONOELASTOGRAPHY
Sonoelastography aims to
determine the normal from
the hard lesion. Certain
pathological conditions, such
as malignant tumours, cause
changes in the tissue's
mechanical stiffness.
Normal tissue would show
more movement than the
stiffer pathological regions.
Benign tumors could be
distinguished from the
malignant ones due to their
different but uniform elastic
properties, and these results
are better highlighted if the
strain on the tissue is rapidly
changing.

3. CELLULAR
FIBROADENOMA
2D IMAGE
AND
SONOELSATOGRAPHY
IMAGE IS OF SAME
SIZE AND THIS IS S/O
BENIGN NATURE OF
THE LESION TSUKUBA
ELASTICITY SCORE OF
TWO IS SUPPORTIVE
OF BENIGN NATURE OF
THE LESION.

4. 2D IMAGE AND
SONOELASTOGRAPHY IMAGE
SHOWS LESION HAVING
SAME DIMENSIONS.
MOSAIC PATTERN OF GREEN
AND BLUE IS S/O
PREDOMINANTLY
ELASTIC LESION ( TSUKUBA
SCORE OF TWO)( BOTH
FEATURES S/O BENIGN
LESION) .

5. LYMPHEDEMA BREAST
( DIFFUSE IN DISTRIBUTION
ALONG THE
TRACT SITE)
BGR SIGN ( BLUE / GREEN / RED
SIGN ) IS TYPICALLY SEEN IN
BENIGN LESIONS.
ARTIFACTUAL BLUE/ GREEN /
RED DISTRIBUTION IS
APPRECIATED IN CYSTIC IN
NATURE LESIONS AND IS
ATTRIBUTED SCORE ONE
( ITALIAN SCORE PATTERN).
.

6. PROSTATE
OUTER GLANDULAR TISSUE IS
RELATIVELY RED ( SOFT ) .
NO ABERRANT FOCUS OF FRANK
BLUE COLOR APPRECIATED
IN THE CORE OF THE PROSTATE

7. HAEMANGIOENDOTHELIOMA
MOSIAC PATTERN ON
ELASTOGRAPHY IS S/O
TSUKUBA SCORE TWO
BENIGN ETIOLOGY.

8. STRAIN ELASTOGRAPHY OF THE
LYMPHNODE : CORE HAS RED COLOR
S/O ELASTIC CORE WITH PERIPHERY
HAVING HUE OF GREEN COLOR ( S/O
BENIGN ETIOLOGY OF THE
LYMPHNODE ENLARGEMENT .
Focal lesions in breast with MOSIAC
PATTERN OF COLOR ON
ELASTOGRAPHY corroborative with
Tsukuba score of two . ( S/O BENIGN
ETIOLOGY ) .

9. STRAIN ELASTOGRAPHY
OF RT SIDE
SUBMANDIBULAR
GLAND WITH
EVIDENT
SIALOLITHIASIS . The
gland per se has MOSIAC
PATTERN of core ( CASE
OF SIALODENITIS ) .

10. FOREIGN BODY IN KNEE
POST TKR
60 YR OLD FEMALE WITH SWELLING LEFT KNEE .
• PIN PRICK SENSATION IN THE LEFT KNEE LATERAL
• COMPARTMENT .
• USG DONE : TRAMTRACK LINEAR ECHOGENIC FOCUS
APPRECIATED IN LEFT KNEE LATERAL ASPECT OF THE
JOINT SPACE .

11. TRAM TRACK LINEAR
ECHOGENIC FOCUS APPRECIATED
IN JOINT SPACE ( LATERAL ASPECT )

12. Ranulas are a rare benign acquired cystic lesion that occur
at the floor of mouth .Ranulas arise either spontaneously
or as a result of trauma to the floor of mouth, including
surgery. They result from obstruction of a sublingual
gland or adjacent minor salivary gland with resultant
formation of a mucous retention cyst A ranula can be
classified based on its extent:
simple ranula: confined to the sublingual space
plunging ranula (also known as diving ranula or cervical
ranula): extends into thesubmandibular space
USG DONE WITH ENDOCAVITARY PROBE AND LINEAR PROBE
MOST IMPORTANT ASPECT IIN RANULA IMAGING IS TO DEMONSTRATE
CONNECTION OF LESION WITH SUB LINGUAL SPACE .

13. RANULA
THIN WALLED HOMOGENOUS
UNILOCULAR CYSTIC LESION
PRESENT IN SUBLINIGAL
SPACE . THE WALL OF
RANULA HAS NO
EPITHELIUM
AND WALL IS MADE OF
ONLY CONDENSATION OF
THE CONECTIVE TISSUE
( REACTIONARY
INFLAMMATION TO THE
SECRETIONS OF THE
SALIVARY GLAND.
 USG DONE WITH ENDOCAVITARY PROBE
AND LINEAR PROBE

14. Vascular malformations and
tumours are a heterogeneous
group of lesions that may affect
the arterial, capillary, venous or
lymphatic system or any
combination thereof.
SLOW FLOW DOPPLER
SETTINGS WERE USED
AND NEAR SUPERFICIAL
VASCULAR MALFORMATION
APPRECIATED .

15. Slow flow vascular malformations capillary malformation (CM)
are
• Port-wine stain
• Capillary telangiectasia
• capillary telangiectasia of the brain
• Angiokeratoma

16. TRANS PERINEAL USG DONE
IN NEWBORN BABY
The typical clitoris is defined as having a cross
wise width of 3 to 4 mm (0.12 - 0.16 inches)
and a lengthwise width of 4 to 5 mm
(0.20 inches). On the other hand, in
Obstetrics and Gynecology medical literature,
a frequent definition of clitoromegaly is when
there is a clitoral index (product of lengthwise
and crosswise widths) of greater
than 35 mm2(0.05 inches2).

17. Clitoromegaly is a
rare condition and
can be either present
by birth
or acquired later in
life. If present at
birth,Congenital
adrenal hyperplasia
be one of the causes,
since in this
condition
the adrenal gland of
the female fetus
produces additional
androgens and the
newborn baby has
ambiguous genitalia
which are not clearly
male or female.

18. VIDEO OF THE SAME CASE
Diastematomyelia, also known as
a split cord malformation, refers to
a type of SPINAL
DYSRAPHISM(spina bifida occulta)
when there is a longitudinal split in
the spinal cord.

19. ONLY TWO PARALLEL
ECHOGENIC FOCI ARE APPRECIATED
IN THE LINE OF THE SPINE IN THE
DORSOLUMBAR REGION .
ON CORONAL SCAN THERE IS INCREASED
INTERPEDICULAR DISTANCE
IN THIS REGION WITH E/O
DIASTEMATOMYELIA .

20. DIAGNOSTIC
ULTRASOUND
FOURTH EDITION
Carol M. Rumack, MD, FACR
J. William Charboneau, MD, FACR
Deborah Levine, MD, FACR