Ultrasonography

DR C.S.SINGH DEPARTMENT OF RADIO-DIAGNOSIS AIMST UNIVERSITY

History
Ability of bats to navigate accurately in the dark Lazzaro Spallanzani -1794 Other uses-1)under water echo used by submarine to detect war ships-wartime 2) ultrasonic metal flaw detectors 3)ultrasonic therapy-heat effect 4)trawlers to detect fish

What is ultrasound?

High frequency sound wave over 20kHz Non ionising Soft tissue imaging

Mechanism -Ultrasound Generators

Ultrasound is produced by mechanical movements(oscillations) of a piezoelectric crystal exited by electrical pulses. several crystals are arranged together to form a transducer Transducer acts as a transmitter and receiver. Image is formed by the reverse of the process used to create sound waves i.e. returning echoes are converted to electrical signals by the same crystal

Piezoelectric crystal

Quartz Lead zirconate titanate

Different modes of ultrasound

A mode: echoes are shown as a peak B mode: brightness Real time: Multiple B mode images seen in rapid sequence. M mode: Displays motion. Used for cardiac ultrasound.

A scan

A-amplitude Each layer of tissue produces a different reflection The A-scan provides data on the length of the eye which is a major determinant in common sight disorders

a = cornea spike b = anterior lens spike c = posterior lens spike d = retinal spike e = orbital spike

B scan

B- brightness Largest amplitude gives rise to brightest spot

Types of probes

ADVANTAGES
No ionising radiation

Safe in pregnancy No known side effects Cheap Portable Minimal preparation of patients Non invasive and painless Direct vision for biopsy

Disadvantages

Resolution of images is limited Ultrasound is reflected very strongly when passing from tissue to gas and vice versa Does not pass well through bone

Disadvantages

Excessive bowel gas scatters the beam Obese and kyphotic patients Operator dependent Fasting Full bladder

Major applications

Abdomen Pelvis Vascular Small parts Musculoskeletal Neonatal brain

Special applications

Guide needle aspiration Biopsy of masses Endoluminal probes provide high resolution images, eg: TVS, TRUS, TES (for heart and aorta.)

Terminology

Anechoic- absence of echoes [clear cyst, UB] Hypoechoic- less echoes [darker] than the surrounding tissue. Hyperechoic- more echoes [brighter] than surrounding tissue.

Ultrasound gel

Applied to the body to eliminate pockets of air between the skin and the transducer

ABDOMINAL USG

Abdominal pain or palpable mass Acute cholecystitis Gallstones Cirrhosis of liver Pancreatitis Retroperitoneum

ABDOMINAL USG

Tapping of ascitic fluid Localize postop. collections Drain collections

Hepatobiliary system

Liver

Gall bladder

Liver masses

Hemangioma

Metastasis

Cholelithiasis

Complicated cholecystitis

Obstructive jaundice

Dilated IHBR

Cholangiocarcinoma

Renal system

Renal colic Hematuria Palpable mass UTI Anomalies Obstruction

Chronic renal failure

Normal kidney

Chronic renal failure

Renal calculi

Hydronephrosis

Dilated calyces

UVJ calculus

CHEST

Pleural effusion Pericardial effusion Drainage Biopsy

Pleural effusion

Transudate

Exudate

PAEDIATRIC

Cranial ultrasound Intussusception Congenital hypertrophic pyloric stenosis Midgut malrotation Developmental dysplasia of the hip Palpable mass

Cranial ultrasound

Normal

Aqueductal stenosis

Subependymal haemorrhage

Coronal section

Parasagittal

SMALL PARTS

Testicular torsion Epididymitis Thyroid- differentiate MNG from diffuse enlargement. Eye: retinal detachment, vitreous haemorrhage Breast-cystic or solid.

Acute epididymo-orchitis

Testes

Hematocele

Thyroid nodule

Normal

Thyroid inferno

Hyperthyroidism

Breast carcinoma

Venous doppler

Venous doppler to rule out DVT Incompetent valves in varicose veins

Arterial doppler

Peripheral arterial disease Arterial occlusion Carotid artery stenosis Renal artey stenosis Aneurysm

Obstetrics
1. 2. 3. 4. 5.

Early pregnancy to confirm intrauterine pregnancy and exclude ectopic. Detect viable fetus at 7wks gestation Missed abortions, retained products. In later pregnancy to assess growth and exclude anomalies. USG guided interventions .-eg. amniocentesis, chorionic villous biopsy, intrauterine fetal transfusion.

Transvaginal scan

Early gestation

1st trimester- crown rump length

Biparietal diameter [BPD]

2nd trimester

Femur length

3rd trimester

Ovarian pregnancy

Anencephaly

Absence of brain and cranial vault. Failure of neural tube to close at its cephalad end. Occurs between 2nd-3rd week of development. Associated anomalies are spinal defects and polyhydramnios.

Anencephaly

Double bubble sign

Dilated stomach and duodenal cap

DOUBLE BUBBLE SIGN

Suggests fetal duodenal obstruction. Causes: Duodenal atresia, duodenal stenosis, annular pancreas, Ladds bands, volvulus.

UMBILICAL CORD

3 vessel cord.(2 arteries,1 vein) Single umbilical artery is seen in 0-2%1.1% of deliveries. Associated abnormalities; cardiac defects, hydrocephalus, omphalocele, diaphragmatic hernias.

3 cord vessel

2 arteries and 1 vein

2 vessel cord

Types of placenta previa

Complete placenta previa

INCOMPETENT CERVICAL OS

Painless 2nd trimester abortions. Cervix length <3cm, gaping internal os, funneling of membranes into endocervical canal.

Incompetent os

Musculoskeletal

Congenital dysplasia of the hip Joint effusions Hemangioma Nerve sheath tumours Soft tissue sarcomas Superficial metastasis

Indications

Popliteal cyst Ganglion cyst Abscess Tendon rupture

Hip joint

Tendon Rupture

Abscess

Popleteal cyst

Ganglion

ECHO TTE and TEE

Assess velocity of blood flow Assess cardiac valve and function Motion of the ventricular wall Hypertrophic cardiomyopathy (TTE-trans thoracic TEE-Trans esophageal)
VSD