Gandikota Girish

Sonography of Inguinal Region Hernias

OBJECTIVE The purpose of this article is to describe the anatomy of the inguinal region in a way that is useful for sonographic diagnosis of inguinal region hernias, and to illustrate the sonographic appearance of this anatomy. We show sonographic techniques for evaluating inguinal, femoral, and spigelian hernias and include surgically proven examples. CONCLUSION Understanding healthy inguinal anatomy is essential for diagnosing inguinal region hernias. Sonography can diagnose and differentiate between various inguinal region hernias.

Radiographic Evaluation of Arthritis: Inflammatory Conditions

In the presence of joint space narrowing, it is important to differentiate inflammatory from degenerative conditions. Joint inflammation is characterized by bone erosions, osteopenia, soft-tissue swelling, and uniform joint space loss. Inflammation of a single joint should raise concern for infection. Multiple joint inflammation in a proximal distribution in the hands or feet without bone proliferation suggests rheumatoid arthritis. Multiple joint inflammation in a distal distribution in the hands or feet with bone proliferation suggests a seronegative spondyloarthropathy, such as psoriatic arthritis, reactive arthritis, or ankylosing spondylitis.

Ultrasound of the Shoulder: Asymptomatic Findings in Men

OBJECTIVE The purpose of this study was to examine the range and prevalence of asymp tomatic findings at sonography of the shoulder. MATERIALS AND METHODS The study sample comprised 51 consecutively enrolled subjects who had no symptoms in either shoulder. Ultrasound of one shoulder per patient was performed by a musculoskeletal sonographer according to a defined protocol that included imaging of the rotator cuff, tendon of the long head of the biceps brachii muscle, subacromial-subdeltoid bursa, acromioclavicular joint, and posterior labrum. The shoulder imaged was determined at random. The 51 scans were retrospectively analyzed by three fellowship-trained musculoskeletal radiologists in consensus, and pathologic findings were recorded. Subtle or questionable findings of mild tendinosis, bursal prominence, and mild osteoarthritis were not recorded. RESULTS Twenty-five right and 26 left shoulders were imaged. The subject age range was 40-70 years. Ultrasound showed subacromial-subdeltoid bursal thickening in 78% (40/51) of the subjects, acromioclavicular joint osteoarthritis in 65% (33/51), supraspinatus tendinosis in 39% (20/51), subscapularis tendinosis in 25% (13/51), partial-thickness tear of the bursal side of the supraspinatus tendon in 22% (11/51), and posterior glenoid labral abnormality in 14% (7/51). All other findings had a prevalence of 10% or less. CONCLUSION Asymptomatic shoulder abnormalities were found in 96% of the subjects. The most common were subacromial-subdeltoid bursal thickening, acromioclavicular joint osteoarthritis, and supraspinatus tendinosis. Ultrasound findings should be interpreted closely with clinical findings to determine the cause of symptoms.

Radiographic Evaluation of Arthritis: Degenerative Joint Disease and Variations

In the presence of joint space narrowing, it is important to differentiate inflammatory from degenerative conditions. The presence of osteophytes, bone sclerosis, and subchondral cysts and the absence of inflammatory features such as erosions suggest osteoarthritis. Typical osteoarthritis involves specific joints at a particular patient age. When osteoarthritis involves an atypical joint, occurs at an early age, or has an unusual radiographic appearance, then other causes for cartilage destruction should be considered, such as trauma, crystal deposition, neuropathic joint, and hemophilia. There are several types of arthritis, such as juvenile chronic arthritis and gouty arthritis, that may have a variable appearance compared with that of other common inflammatory arthritides.

Sonography of Morel-Lavallée Lesions

Objective. The purpose of this series was to retrospectively characterize the sonographic appearance of posttraumatic Morel‐Lavallée lesions. Methods. After Institutional Review Board approval was obtained, a search of the radiology information system database with correlation to medical records identified 21 posttraumatic fluid collections of the hip and thigh in 15 patients. Sonographic images were retrospectively reviewed by 1 author to characterize the echogenicity, homogeneity, shape, margins, location, compressibility, and vascularity of the fluid collection. Results were correlated with the age of the fluid collection and aspiration results where possible. Results. All fluid collections (21/21) were located between the deep fat and fascia, with a shape that was fusiform in 12 (60%) of 20, flat in 5 (25%), and lobular in 3 (15%) (shape not determined in 1 case). Regarding echogenicity, 15 (71%) of the 21 collections were hypoechoic, and 6 (29%) were anechoic; 13 (62%) were heterogeneous, and 8 (38%) were homogeneous. The lobular fluid collections were all less than 2 weeks of age, and the flat fluid collections were all greater than 6 months of age. All homogeneous fluid collections were greater than 8 months of age. There was no relationship between the age of a fluid collection and its echogenicity. Conclusions. Morel‐Lavallée lesions had a variable appearance, being more homogeneous and flat or fusiform in shape with a well‐defined margin as the lesions aged. All Morel‐Lavallée lesions were hypoechoic or anechoic, compressible, and located between the deep fat and overlying fascia.

Photoacoustic and ultrasound dual-modality imaging of human peripheral joints

Abstract. A photoacoustic (PA) and ultrasound (US) dual modality system, for imaging human peripheral joints, is introduced. The system utilizes a commercial US unit for both US control imaging and PA signal acquisition. Preliminary in vivo evaluation of the system, on normal volunteers, revealed that this system can recover both the structural and functional information of intra- and extra-articular tissues. Confirmed by the control US images, the system, on the PA mode, can differentiate tendon from surrounding soft tissue based on the endogenous optical contrast. Presenting both morphological and pathological information in joint, this system holds promise for diagnosis and characterization of inflammatory joint diseases such as rheumatoid arthritis.

Advanced Imaging in Gout

OBJECTIVE The purpose of this article is to describe the role of advanced imaging using ultrasound, CT, and MRI in the assessment and diagnosis of gout. CONCLUSION Dual-energy CT can quantitatively identify monosodium urate crystal deposits with high sensitivity and specificity within joints, tendons, and periarticular soft tissues. There are several characteristic ultrasound imaging findings, which include visualization of echogenic monosodium urate crystal deposition, tophus, and adjacent erosions. MRI is sensitive in showing soft-tissue and osseous abnormalities of gout, although the imaging findings are not specific. Gout commonly involves specific joints and anatomic structures, and knowledge of these sites and imaging appearances are clues to the correct diagnosis.

Characteristic Locations of Inguinal Region and Anterior Abdominal Wall Hernias: Sonographic Appearances and Identification of Clinical Pitfalls

OBJECTIVE The purpose of this article is to show the typical locations of anterior abdominal wall and inguinal region hernias and to illustrate their sonographic appearances and describe pitfalls in clinical diagnosis of hernias that may be resolved with sonography. CONCLUSION Awareness of the expected locations of anterior abdominal wall hernias and potential clinical pitfalls allows an accurate diagnosis of a hernia and helps in differentiating a hernia from other abnormalities.

Sonography of wrist ganglion cysts : Variable and noncystic appearances

In our clinical practice, we have noted wrist ganglion cysts that do not fulfill the criteria for simple cysts. This study retrospectively evaluated the sonographic features of wrist ganglia.

Imaging Appearances in Gout

Gout is an ancient disease. Last decade has brought about significant advancement in imaging technology and real scientific growth in the understanding of the pathophysiology of gout, leading to the availability of multiple effective noninvasive diagnostic imaging options for gout and treatment options fighting inflammation and controlling urate levels. Despite this, gout is still being sub-optimally treated, often by nonspecialists. Increased awareness of optimal treatment options and an increasing role of ultrasound and dual energy computed tomography (DECT) in the diagnosis and management of gout are expected to transform the management of gout and limit its morbidity. DECT gives an accurate assessment of the distribution of the deposited monosodium urate (MSU) crystals in gout and quantifies them. The presence of a combination of the ultrasound findings of an effusion, tophus, erosion and the double contour sign in conjunction with clinical presentation may be able to obviate the need for intervention and joint aspiration in a certain case population for the diagnosis of gout. The purpose of this paper is to review imaging appearances of gout and its clinical applications.