WHAT WE CAN SEE AND WHAT WE CAN NOT ON USGDR.KRISHNA KIRAN MD.DNB.FRCR RADIOLOGIST DRSHAJI`S MRI CALICUT

This talk also includes fallacies/warts of USG apart from good points

Case 1

45 year old male comes with dull pain in both flanks.

Routine urine examination– no RBCs, few crystals.

USG report

He shows you another report done 3 months back.

What to do ..?

Journal of ultrasound in Medicine 2004.

USG NOT ACCURATE IN DETECTING STONES LESS THAN 5 MM

Classical appearance of a calculus on USG

Arcuate artery calcification Milk of calcium

cyst

Angiomyolipoma

Some Ultrasound mimics of calculi

USG IN RENAL CALCULI

FOR Good in detecting

large renal and upper ureteric calculi.

Good in detecting hydronephrosis.

No radiation.

AGAINST Not good in mid and

lower ureteric calculi and small renal calculi.

Chemical analysis not possible.

Operator variation.

Gold standard in detecting renal , ureteric and bladder calculi is CT.

It can detect almost all calculi.

Gives HU values for chemical analysis

Risks are radiation and cost. Hence should be used with caution.

Key points

USG is the preferred modality in initial evaluation of renal/ureteric colic.

Tiny calculi , middle and lower ureteric calculi are not accurately detected.

CT is the gold standard , should be used with caution to avoid excess radiation.

CASE 2

55 year old complains of Bloating sensation in abdomen.

He comes with an USG report.

Criteria for fatty liver on USG

Liver echogenicity exceeds that of right kidney and spleen.

And There is beam attenuation.

What is grading of fatty liver on USG

Grade 1

Grade 2 Grade

3

Does grade 3fatty liver means progression to cirrhosis..?

NO. Not necessarily it is a rough estimate for fat in liver , that`s all

Once fatty liver is found , look for for causes. If no cause is found labelled as NAFLD nonalcoholic fatty liver disease. This affects 10-20% of population. Those with normal liver enzymes can be managed with reduction in weight and lifestyle modification.

Those with persistent elevated liver enzymes are called NASHNonalcoholic steatohepatitis.

Can not be detected on USG at present

Biopsy is recommended to assess inflammation and fibrosis.

Two new techniques promise to fill this gap

Something about fibroscan

A new technique to assess fibrosis of liver.

Employs modified ultrasound probe which assesses velocity of a shear wave created by a vibratory source.

Values of above 12.5kPa are indicative of cirrhosis.

MR elastography promises to detect fibrosis and inflammation noninvasively.

Key points

USG is sensitive in detecting fatty liver.

It can not detect liver inflammation and early fibrosis.

Liver biopsy is currently gold standard for nonalcoholic steatohepatitis.

New noninvasive techniques are promising.

Case 3

A 10 year old child has recurrent abdominal pain.

USG report shows

? SIGNIFICANT ? MESENTERIC ADENITIS

EALN– enlarged abdominal lymph node Journal of ultrasound in

medicine 2007

It is normal to find small nodes in children.

Lymph nodes should show , minimum or short axis diameter at least 10 mm to be significant or to be called mesenteric adenitis.

Case 425 year old male with recurrent RIF pain

appendicitis

How accurate is Ultrasound or is it necessary..? Sensitivity of USG is about 70% in

detecting appendicitis. Main use is to rule out alternative

diagnosis.

Is there a modality 100% accurate in acute appendicitis Abdominal CT is 100% sensitive in

acute appendicitis.

Summary--

But if not done and interpreted properly..

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