Differential Diagnosis in Ultrasound Satish K Bhargava, Sumeet Bhargava
INDEX
Page numbers followed by f refer to figure.
A
Abdomen 37
Abdominal disease 8
Abdominal pathology 149, 151
Abdominal tuberculosis 105f, 142f
case of 106f
Abdominal wall
abscess 71f
anterior 72
defect 284
masses 70
common 70
uncommon 71
Abortion 264
complete 264
incomplete 248, 248f, 264
missed 265f
threatened 264
Abscess 47, 49, 52f, 70, 92f, 110f, 156, 157, 206, 208
amebic 51
epididymal 157f
hepatic 76
iliopsoas 184f
intraperitoneal 145
mediastinal 10
multiple 29f
pyogenic 51, 84, 85
renal 77
scrotal 149f
subperiosteal 206
subphrenic 11, 78, 78f
Acalculus cholecystitis 68
Acardiac parabiotic twin 270
Acetabular roofline 181, 182f
Acetabulum labrum 181
Achalasia
primary 98
secondary 98
Achondrogenesis 268, 275, 276
Achondroplasia 276
Acinar cell tumor 93
Acquired immunodeficiency syndrome 41
Acrania 279
Actinomycosis 103
Acute respiratory distress syndrome 8
Addison's disease 140
Adenocarcinoma 93, 103, 131, 133, 137, 163
colon 81f, 113
colon, case of 88f
mucinous 43
of pyloric antrum 100f
pancreatic 43
Adenofibrolipoma 175
Adenoid cystic tumor 206
Adenoma 14, 41, 93, 97, 121, 137
adrenal 137, 137f
nephrogenic 130
papillary 63
pleomorphic 28f, 200, 206
Adenomatous nodule 14, 16f
Adenomyomatosis 63, 63f, 64
Adenomyosis 236, 246
focal 239f
Adenopathy
hilar 1
mesenteric 144f
Adenosis, sclerosing 169
Adhesions 254
Adnexal lesions, bilateral 237
Adnexal mass 230, 236, 250, 266
cystic 232
Adnexal tenderness 266
Adrenal calcifications 140
Adrenal cortex, layers of 139
Adrenal gland 136, 139f
bilateral large 136
Adrenal hyperplasia, congenital 136
Adrenal masses
cystic 140
large solid 139
lesion 137f
unilateral 137
Adrenocarcinomas 139
Agenesis 195
renal 272
Agyria 282
Alkaptonuria 188
Alobar holoprosencephaly 210, 211, 214
Alpha thalassemia 268
Amebic abscess, large 52
Amniotic band 284
syndrome 277, 278
Amniotic fluid assessment 259
Amniotic sacs 269f
Amorphous mass 280
Amyloid arthropathy 177
Amyloidosis 188
Amyotropic lateral sclerosis 11
Anaplastic carcinoma thyroid 21f
Anechoic retroperitoneal cyst 115f
Anemia 268
maternal severe 255
severe 268
Anencephaly 279
Aneurysm 176, 207
dissecting 79f
Angioma, cutaneous 196
Angiomyolipoma 120, 121, 123
Angiosarcoma 86, 89, 168
Annular pancreas 102
Anomalous pulmonary venous return 287
Anophthalmia 195, 256
Anorectal malformation 228
Aorta
aneurysm of 10
coarctation of 258, 288
ipsilateral location of 288
Apert's syndrome 207, 276
Appendiceal perforation 108
Appendicitis 106
acute 80, 80f
case of 110f, 111
differential diagnosis of 108
Appendicolith 80, 111f
Appendicular lump 108, 111
Appendix, mucocele of 109f
Aqueductal stenosis 211, 282
congenital 212
Arachnoid cyst 208, 215, 225f, 282
Arnold-Chiari malformation 212f, 280
Arrhythmias 288
Artefactual masses 74
Arterial bypass grafts, subcutaneous 73
Arterioarterial anastomosis 270
Arteriovascular malformations 207
Arteriovenous malformation 120, 201, 217
Artery
sign, prominent feeding 112
umbilical 256
Arthritis
infective 178
inflammatory 176
pyogenic 179f
septic 176, 177
Arthropathy
crystal-induced 177
hemophilic 177
Articular cartilage calcification, causes of 188
Ascaris lumbricoides 70
Ascending colon, thickening of 105f
Ascites 4, 11, 142f
outlining bowel loops 143f
Asphyxia 219
Asphyxiating thoracic dystrophy 268
Asplenia 288
syndrome 83
Asteroid hyalosis 197
Atherosclerotic plaque 33f
Atresia
bronchial 262
laryngeal 262
Atrial septal defects 286
Atrioventricular septal defects 256, 286
Atrophy 208
Autoimmune disorders 25
Autosomal dominant 120, 278
Avascular necrosis 176
B
Baker's cyst 176
Banana sign 280
Bardet retinal dystrophy 272
Baum's bumps 191
Beak sign 112
Bear's criteria 120
Beckwith-Wiedemann syndrome 272
Benign tumors 30, 47, 241
cystadenoma 241
cystic teratoma 241
hemangioma 30
lipoma 31
nerve tumors 31
Bertin
hypertrophied column of 117, 117f
prominent septum of 117
Bile duct
common 56f, 67f, 70f
hamartoma 49, 50, 69
malignancy 69
Biliary cyst
adenoma 49, 54
congenital 66
Biloma 49, 64, 70f
Bladder
contour and caliber abnormality 133
diverticulum 233
masses 236
mucosae herniate 233
outlet obstruction 130, 132, 133, 164f, 274f
case of 133f
wall
hypertrophy 133f
thickening 130
Blighted ovum 265
Blood clot 123
Blunt abdominal trauma 55f
Bochdalek hernia 262
Bone
cysts, aneurysmal 206
dysplasias 258
tumor 283
Bony fragments 176
Bowel
and colon, small 102
complications 285
loops, adherent 242
masses 236
thickening 104f
Bowman's layer 189
Brachial cyst 28f
Brachycephaly 258
Bradycardia 260, 288
Brain
abscess 216
destructive lesions of 210
Branchial cyst 28
Breast 166
abscess 167, 168f
space-occupying lesion 168f
anatomy 166f
anechoic lesion 168f
carcinoma 43, 174f
chronic abscess 167f
ductal ectasia in 170f
fibroadenoma 173f
fibrocystic disease of 172f
lipoma in 171f
metastatic 48f
neoplasm, benign 169f
parenchyma 166f
prosthesis 171
simple cyst in 167f
ultrasound 166
Brenner tumor 236
Bromobenzyl cyanide 193
Brucellosis 45
Bruch's membrane 189, 196
Bulky lacrimal glands 205
Bull's eye 45, 47
C
Calcium pyrophosphate dehydrate deposition disease 188
Calculus
cholecystitis, acute 62
renal 123
Caliceal calculus, multiple 126f
Caliectasis, focal 125f
Campomelic dysplasia 275
Cancer, endometrial 247
Candida forming fungal balls 118
Candidiasis 41, 45, 87
Carcinoid 142
fibrotic reaction of 142
Carcinoma 14
adenosquamous 93
anaplastic carcinoma thyroid 20
cervix 245f
colon 104f
colorectal 43
cortical 139
endometrial 236, 246, 253, 254
endometrioid 236
esophageal 97
follicular 19
gastric 98
intracystic 167, 172
maxilla 206
medullary thyroid 20
mucoepidermoid 28
pancreatic 70
papillary 19, 24
stomach, case of 99f
Carcinomatosis 145
Cardiac failure, congestive 41
Cardiosplenic syndromes 288
Caroli's disease 49, 50, 69
Caroticocavernous fistula 192, 193, 200, 207
Carotid artery, common 15, 26f
Carpenter's syndrome 276
Cartilage convexity, development of 182
Cataract 196
case of 205
Caudal regression syndrome 223, 228, 283
Cavum
excavatum 276
septi pellucidi 216f
septum pellucidum 216
vergae 216, 216f
Cecum 103, 103f
Celiac artery 92
Cell implantation, malignant 9
Cellular lining 85
Central nervous system 218
Central retinal artery 192
occlusion 192
Central retinal vein occlusion 192
Cephalocele 207, 280
Cerebellum 210
Cerebral
edema 220
hemorrhage 218
Cerebritis 220
Cerebrospinal fluid 210
post-traumatic leakage of 223
Cerebrovascular complications 222
Cervical
carcinoma 246, 254
esophagus, tumor of 32
fibroid 244f
lymph nodes
enlarged 19
levels 33
multiple enlarged 36
posterior 34f
lymphadenopathy 33
features of 33
phlegmon 29
stenosis 254
Cesarean scar 72
Chemodectoma, malignant 32
Chest 1
film, lateral 3
wall 1
cold abscess 188f
muscle, worm in 187f
Chiari malformation 214, 280f
Chloroacetophenone 56f, 193
Cholangiocarcinoma, hilar 57f, 68
Cholangitis 46
sclerosing 39, 113
Cholecystitis 45, 46
acute 46f, 76
chronic 60
gangrenous 63, 64
signs of chronic 61f
Choledochal cyst 66, 69
types of 67f
Choledocholithiasis 70
Cholelithiasis 64f
Cholesterol
crystals 85
polyps 64
Chorioangioma 269
Choriocarcinoma 43, 159, 250, 266
Chorionic villi 251
Choristoma 196
Choroid
detachment 204f
disease of 199
plexus
cyst 208, 215, 282, 283
enlarged 222
papilloma 209, 220
prominent 209
tumor 222
Choroidal
detachment 194
differential diagnosis 199
excavation 196
hemangioma 192, 196
melanoma 192, 196, 204f
osteoma 196
Chromosomal abnormality 268, 285
ultrasound signs of 256
Chromosomal defect 277
Ciliary artery occlusion 192
Cirrhosis 4, 37
biliary 39
case of 38f
classified 38
etiology 38
portal vein wall 38f
sonographic findings of 39
Cisterna magna, abnormal 280
Classical hydatid cyst 53f
Claw sign 112
Cleft
bilateral 215
lip 256, 277, 279
palate 256, 277, 278
unilateral 215
Clinodactyly 256
Cloacal defects 284
Cloacal exstrophy 284
Clonorchis sinensis 70
Coat's disease 199
Coffin-Lowry syndrome 276
Colitis 76
Collagen vascular disease 8
Colloid goiter 17f, 35
Colpocephaly 208, 214
Conjoined twins 270
Connective tissue tumor 93
Cord
atrophy 229
laceration 229
Cornea 189
layers of 191
Corpus callosum, agenesis of 215, 257, 282
Corpus luteal cyst 236
ovary sign of 240f
Cortical sac 127f
Corticosteroids, endogenous 37
Craniopharyngioma 282
Cranioschisis 280
Craniosynostosis syndromes 275277
Crohn's disease 104, 113
Crouzon's syndrome 207, 276, 277
Cryptophthalmos 195
Crystal deposition 176
Cubitus valgus 258
Cul-de-sac
free fluid in 230
posterior 230, 231
Curvilinear hyperechoic scar 175
Cyclophosphamide cystitis 130, 131
Cyclopia 256, 281
Cyst
adrenal 140
benign 156, 206
bronchogenic 10
congenital 10
cortical 119
epidermoid 83, 84, 154, 156, 157, 201f
epididymal 160
epithelial 140
extrarenal 120
filarial 168
follicular 236
functional 232
hemorrhagic 230, 234, 236, 237f
hepatic 49
in testis 157
infected 48f, 167
interhemispheric 208
leptomeningeal 208, 218
mesenteric 145, 145f, 233
neuroenteric 10, 283
oil 167, 173
peribiliary 49, 50, 69
pericardial 10
popliteal 176
porencephalic 208, 210, 211
post-traumatic 218
renal 117
cortical 257
retention 91, 162
retroperitoneal 116
subependymal 208, 215
testicular 156f
umbilical 72, 72f
vitreous 206
with debris 91
with solid 91
Cystadenocarcinoma 49, 54, 56, 68, 236, 241f, 242
Cystadenoma 56, 58, 235, 236
mucinous 243f
serous 237f, 241f
Cystic adenomatoid malformation, pulmonary 262
Cystic degeneration 10, 16f
Cystic disease, uremia associated 120
Cystic dysplasia 154, 156, 157
familial 118
hereditary 118
Cystic lesion
hypoechoic 145f
infective 216
Cystic nephroma
benign 121
multilocular 119, 120, 121
Cystic pancreatic masses, differential diagnosis of 91
Cystic renal disease 272
differential diagnosis of 118
Cystic teratoma, mature 10
Cysticercosis 198f, 206
Cysticercus 73f
cyst 72
Cystitis
cystica 132
glandularis 132
Cytomegalovirus 136, 215, 220, 221
D
Dacryoadenitis 205
Dandy-Walker
cyst 281, 281f
malformation 208, 282
syndrome 213f, 214
Daughter cysts, multiple 54
De Quervain's thyroiditis 19f
Debris 85
Dermal sinus 228
Dermoid 207, 240f
cyst 238, 242f
mesenteric 145
Descemet's membrane 189
Diabetes 37
mellitus 154
maternal 255, 285
Diabetic retinopathy 192, 200
Diaphragm
bilateral 10
eventration of 12, 263
part of 13
unilateral 11
Diaphragmatic hernias, congenital 262
Diastematomyelia 223, 225, 226f, 283
Diastrophic dysplasia 275
Dichorionic diamniotic twins 269f
Diffuse toxic goiter 19
case of 18f
DiGeorge syndrome 275, 276
Dilated fluid-filled jejunal loops 102f
Dilated small bowel 102
loop 106f
Distal small bowel obstruction 102
Distal ureters, dilated 233
Diverticular disease 106
Diverticulitis 76, 142
Dorsal dermal sinus 223, 225
Dorsal interhemispheric cyst 215
Double outlet right ventricle 256, 287
Down's syndrome 101
Dromedary hump 117
Duct
ectasia 170
dilated 170
Ductal carcinoma
in situ 170
invasive 170, 173
Ductal dilatation 170
Ductal ectasia, mucinous 92
Dumb-bell masses, solid 264
Duodenal atresia 256
Duodenum 101
dilatation of 101
mechanical obstruction 101
Dysgerminoma 243
Dysostosis, acrofacial 279
Dysplasia
craniofrontonasal 276, 277
fibrous 206
frontal 276, 278
renal 256
cystic 118
thanatophoric 268, 276
Dysraphic defect, large 225f
E
Ears, malformed 279
Ebstein anomaly 286
Echinococcal cyst 140
Echinococcus granulosus 43, 51
Echogenic fetal kidneys, differential diagnosis of 271
Ectodermal dysplasia syndrome 277
Ectopia cordis 288
Ectopia lentis 196
Edema
placental 267
subcutaneous 186f, 267
subserosal 68
Egg shell-like calcification 22
Ejaculatory duct
calculi 154
cyst 163
dilatation, bilateral 163f
obstruction 162
prominent 164
Embedded organ sign 112
Emboli, pulmonary 8
Embryonal cell carcinoma 153, 158
Empyema 3, 208, 217, 222
subdural 209f
Encephalocele
frontal 276
paramedian 278
Encephalomalacia, cystic 208, 211
Endodermal sinus 158
tumor 153, 158, 243
Endometrial cavity 253f
Endometrial hyperplasia 236, 247, 251
causes 251
ultrasound 251
Endometrial polyp 247, 251, 251f253f
feeding vessel sign of 253f
Endometrioma 72, 234, 236, 237, 238f
Endometriosis 132, 254f
Endometritis 254
Endometrium 80
hyperplastic 230f
thickened 247
Endophthalmitis 192, 197
Entamoeba histolytica 51
Enteric cyst 264
Ependymoma 220
Epididymal tubules, dilated 160
Epididymis 156
chronic 150f
cystic lesion in head of 150f
enlargement of 161
region of head of 160f
Epididymitis 149, 160f
chronic 151, 161
thickened 150
Epigastrium
differential diagnosis for 75
transverse scan of 92f
Episcleritis 202
Epithelioma, bronchial 32
Epithelium 189
Escherichia coli 222
Esophageal duplication cyst 10
Esophagus 97
Ethyl iodoacetate 193
Extracapsular nodal spread 33
Extraocular muscles, lesions of 202
Exudative pleural effusion, causes of 6
Eye, vertical section of 191f
Eyeball 189
evaluation of 191
lesions of 202
vascular layer of 189
F
Fallopian tube 231f
carcinoma of 236, 240
dilated 255f
Fasciola hepatica 70
Fat
fluid levels 113
necrosis 169, 173
Fatty infiltration 37
focal 38f, 41
Fatty metamorphosis 43
Femur head 182, 183f
Fetal
abdominal wall defects 283
anemia 255
arrhythmias 285
calcification, intra-abdominal 260, 261
cardiac failure 283
central nervous system 279
echocardiogram, indications for 285
head, neck and face 275
hydronephrosis 272
hydrops 255, 285
limb body wall 284
lobulations 117
thoracic abnormalities, differential diagnosis of 262, 263
Fibrillation 260
Fibrin balls 8, 9
Fibroadenolipomas 171
Fibroadenoma 169, 169f, 172, 172f
juvenile 169, 173
Fibroid 236
uterus 243f
Fibroma 13, 98, 288
nonossifying 206
pleural 8, 9
Fibromatosis 142
Fibrosis 41
retroperitoneal 113
scar 175
secondary 99
Fibrous histiocytoma
benign 193
malignant 86, 113
Fibrous septae 222
Fine-needle aspiration cytology 18f, 74f, 82f, 169f, 174, 201f
Floating aorta sign 82
Fluid
debris level 146f, 235f
distended bowel 233
endometrial 254
filled bowel, wall of 97
Follicular adenoma 24f
case of 20f
Fraser syndrome 272
Fuchs spots 196
Fungal infection 118
G
Galactocele 168
Galen aneurysm, vein of 282
Galen malformation, vein of 208, 211, 217
Gallbladder 39f
adenomyomatosis of 63f
anterior wall of 65f
carcinoma 6264
dilatation 62
mass 64f
neck mass 58f, 64f
perforation 61f, 62, 68
polyp, evidence of 65
thickening 40
focal 63
tumefactive sludge in 66f
wall
posterior 61
thickened 68f
varices 63
Gallstone 46
with acoustic shadowing 65f
with intrahepatic dilatation 69f
Gamna-Gandy nodules 89, 90
Ganglion cysts 176
Ganglioneuroma 31, 139, 140
Gartner duct cyst 255
Gastric
dilatation 99, 101
gas in stomach wall 100
mechanical obstruction 99
paralytic ileus 100
diverticulum 140
emphysema, interstitial 100
fundus 140
lymphoma 98
wall
hypertrophic 101f
thickening of 98
Gastrinoma 93, 95
Gastritis
emphysematous 100
granulomatous 99
Gastrocnemio-semimembranosus bursa 176
Gastroesophageal junction 98f
Gastrointestinal
abnormality 268
tract 97, 196
ultrasound differential diagnosis of 97
Gastropleuroschisis 278
Gastroschisis 283, 284
Gaucher's disease 86, 87
Genetic
disorders 268
syndrome 275
Genital tract
calcification, extratesticular male 154
obstructed 232
Genitalia, malformation of 284
Genitourinary
abnormality 282
system 272
Germ cell
origin, benign tumors of 157
tumors 113, 151, 153, 158, 236
differentiating features of 159
malignant 243
mixed 159
necrotic 235
Germinal matrix hemorrhage 218, 218f
Gestation
ectopic 233
sac 265
Gestational sac, anembryonic 265f
Gestational trophoblastic
disease 248, 265, 266
neoplasia 258
Ghost artifact 74
Giant fibroadenoma 169, 173
large mass 169f
Gland, adrenal 138
Glandular enlargement, diffuse 17
Gliding sign 8
Glioblastoma 282
Glioma 200, 202
Gliotic white matter 210
Glomerulonephritis, acute 4
Glucogenoma 93
Glycogen storage disease 37
Goldenhar syndrome 275
Gonadal stromal tumor 153
Gout 188
Granuloma 89, 206
healed 44f
Granulosa cell tumor 154
Graves' disease 19, 192, 201, 202, 206
Great arteries, transposition of 287
Gut atresias 256
Gynecomastia 172
H
Haemophilus influenzae 222
Hair tufts 223
Halo, absence of 16
Hamartoma 86, 168, 171, 175
subependymal 282
Hamartomatous lesions 140
Hansemann's giant cells 118
Harada's disease 199
Hashimoto's thyroiditis 19
case of 19
Head
complete dislocation of 183f
femur development of 178
meningocele of 281f
Heart
disease, congenital 279, 282
univentricle 286
Hemangioendothelioma 260, 261
Hemangioma 41, 42, 55, 86, 92, 98, 131, 132, 139, 141, 168, 187f, 205, 206, 260
capillary 200, 201
cardiac 288
cavernous 42, 47, 49, 92, 200
giant cavernous 55
retinal capillary 192
tip of nose 187f
Hemangiothelioma 31f
Hematocolpos 232f
Hematohydrocolpos 244
Hematoma 49, 70, 84, 151, 175, 202, 206, 230, 233
acute 175
chronic 218
intraparenchymal 84
perisplenic 84f
Hematometra 232f, 255f
Hematometrocolpos 244f
Hematopoiesis, extramedullary 116
Hematosalpinx 255f
Hemifacial microsomia 275
Hemochromatosis 39, 188
Hemorrhage
adrenal 77, 136
intracranial 209, 209f, 218
intraocular 192
intraparenchymal 219
intraventricular 209, 210f, 219, 222
placental 257f
splenic 80
subarachnoid 219
subchorionic 262
subependymal 218, 219
subhyaloid 197, 198
vitreous 194, 198, 200, 201f
Hemothorax 3
Henoch-Schönlein purpura 149, 151
Hepatic adenoma 47, 56
presence of 42f
Hepatic dysfunction 62
Hepatic hematoma 42f
Hepatic laceration 55f
Hepatic metastasis 3f
patterns of 58
Hepatic parenchyma 38f
Hepatitis 37, 39
acute 40f, 76
alcoholic 37, 39
chronic 37, 39
granulomatous 37, 39
Hepatobiliary system 37
Hepatoblastoma 260262
Hepatocellular carcinoma 48, 49, 55, 56, 58, 58f
Hepatoduodenal ligament, echogenic fat in 66
Hepatoma 41, 42, 45
Hepatorenal pouch 142
Hernia 71
diaphragmatic 12, 12f, 268
evidence of 72f
type of 71
Herniated sac 225f
Herpes simplex 221
Heterogeneous echotexture 122f
lesion of 43
Heterogeneous mass 139f, 229
solid 138f
Hilar lip 117
Hilum, splenic 96
Hip
abnormal 179, 182
congenital dislocation of 180
coronal sonography 182f
dysplasia, classification of 181
joint 185f
pediatric 178
Hippel-Lindau disease 199
Histiocytoma, fibrous 141
Hodgkin's disease 10
Hodgkin's lymphoma 49, 88, 202
Holoprosencephaly 208, 214, 214f, 256, 277, 281
Homozygous alpha thalassemia 255
Horseshoe kidney 116, 258
Human chorionic gonadotropin 159, 248
Hurler's syndrome 276
Hyaloid artery, persistent 206
Hydatid 175, 206
cyst 49, 53f, 118f, 167
parenchyma like 1
disease 51
infected 53f
sand 85f
splenic 85
Hydatidiform mole 248
complete 267
early 250f
partial 267f
Hydranencephaly 208, 210, 211, 282
Hydrocele 149f, 155f, 160f
acute 149
gross 155f
Hydrocephalus 208, 210, 211, 215f, 219, 222
causes of 211, 213
diagnosis of 212
imaging after development of 219
Hydrolethalus syndrome 275, 276
Hydromyelia 223, 224f, 227
Hydronephrosis 126f, 283
intrauterine 273
moderate 124f
Hydropneumothorax 4, 7f
Hydrops
fetal 267
immune 267
nonimmune 256, 258, 267
Hydrosalpinx 81, 236, 239
Hydrothorax 256
Hydroureteronephrosis 274
Hygroma, cystic 28, 256, 258, 262, 264, 268, 270, 281f
Hyperechoic
lesion 168, 249f
metastasis 59, 59f
nodule 22
renal nodules, differential diagnosis of 123
splenic lesion 89
Hyperlipidemia 37
Hyperparathyroidism 188
Hyperplasia 136
cystic endometrial 249f
Hyperplastic
adenomatous nodule 14
nodule 15f
Hypertelorism 276
syndromes with 276
Hypertrophy
compensatory 117
iliopsoas 133, 135
Hypervascular masses 112
Hyphema 193
Hypochondrium, differential diagnosis for 75
Hypoechogenicity, periportal 46
Hypoechoic
deposits, multiple 48
lesions 30f, 48, 150, 163
multiple 30f, 88f
solid 114f
nodular lesions, multiple 82f
renal sinus, differential diagnosis of 123
solid mass 74, 107f
lesion 7f
space occupying lesion 4f, 12f
Hypogastrium, differential diagnosis in 76
Hypoplasia 282
pulmonary 262, 263
Hypoproteinemia, severe 268
I
Iliac artery aneurysm 133
Iliac fossa 108, 114f
transverse scans of 108
Iliac line 182
Iliac region, differential diagnosis in 76
Iliac vein varices 133
Infarct, cystic degeneration of 83
Infarction, pulmonary 8
Inflammatory mass
chronic 96f
in ovary 236f
Inguinal canal 73f, 154f
Inguinal hernia, case of 155f
Iniencephaly 280
Injury, spinal trauma mode of 229
Insulinoma 93, 95
Interbowel loop fluid 106f, 143f
Interstitial line sign 266
Interventricular septum 286, 287
Intrahepatic bile ducts, dilated 68f
Intrahepatic biliary
calculi 69
dilatation, differential diagnosis of 68
radicals 38f
dilated 70f
Intrahepatic neoplasm 68
Intranodal blood flow pattern 14
Intraocular
structures, evaluation of 190
tumors, evaluation of 191
Intraorbital
calcification, differential diagnosis of 207
fat 206
Intrauterine
growth restriction 256
infections 255
Intussusception 77
evidence of 107f
Iridocyclitis 192
Iris 189
Ischemia 220
Islet cell tumor 91
nonfunctioning 96
Isoechoic nodule 23
J
Jeune's syndrome 272
Joint
capsule 178, 181
effusion 178
neuropathic 176
Juxtaportal intrahepatic mass 69
K
Kaposi's sarcoma 43, 45
Keratoconjunctivitis sicca 25
Kidney
cystic dysplasia of 279
medullary sponge 119, 120
multicystic dysplastic 118, 120
multilocular nephroma of 120
Klatskin tumor 68
Klippel-Trenaunay-Weber syndrome 86
Knee
joint 185
effusion 184f
synovitis of 185
Koch's abdomen, case of 144f
L
Lacrimal gland
carcinoma 207
lesions of 205
Lamina propria 131
Larsen syndrome 276
Laurence-Moon-Biedl syndrome 272
Legg-Calvé Perthes disease 179, 180
Leiomyomatosis peritonealis disseminated 147
Leiomyosarcoma 104, 113, 141, 246
Lemon sign 280
Lens 190
disease of 196
dislocation 197
Leptomyelolipoma 226, 227, 228
Lesions
anechoic 208
appendiceal 108
cystic 13f, 98, 167, 208
malignant 173
sclerosing 171
solid 209
Lesser sac posterior 147
Leukemia 45, 121
Leukomalacia
periventricular 211, 219, 220
subcortical 220
Leydig cell tumor 153
Limb
amputation defects 278
body wall complex 284
defects 284
reduction defects 279
Limbus 189
Linitis plastica, case of 99f
Lipodystrophy 142
Lipoleiomyoma 244
Lipoma 41, 141, 171, 283
intradural 226f, 227
intraspinal 227, 228
Lipomatosis, diffuse infiltrative 142, 148
Lipomeningocele 228
Lipomyelocele 226
Lipomyelomeningocele 223, 224
Lipomyeloschisis 228
Liposarcoma 32, 142
Lissencephaly 282
Listeria 222
Liver 47, 52f
abscess
amebic 12f
information 47f
multiple 51
cyst 50f
cystic lesions of 49
echogenicity of 37
focal hypoechoic lesions 47
focal nodular hyperplasia lesion in 41f
generalized decrease in echogenicity of 40
hematoma 55
in transverse scan 11f
left lobe of 147
lesions, differential diagnosis of 37
mass 12
isoechoic 49, 58f
multiple hydatid cysts in 54f
right lobe of 42f, 45f, 48f, 59f
shadowing lesions of 43
subcostal scan of 53f
target lesion of 45
transabdominal scan of 57f, 64f
Lobar holoprosencephaly, sonographic findings in 214
Lumbar quadrants, differential diagnosis for 75
Lumbosacral
region 228f
spine 224
vertebrae 224f
Lung
abscess 4f
carcinoma 43
collapse 1
hydatid 2f
lesions 13
normal 1
parenchyma 1
right lower lobe of 2f
scan, pleural 7f
tumor 1
primary 11
Lymph nodes 73, 82f, 99f, 104
intramammary 169
lymphomatous 82
mass, conglomerate 113f
metastasis to 10
metastatic 34f
multiple matted 29f
necrotic mesenteric 143f
submental 33
Lymphadenopathy 112
abdominal 81
mediastinal 9
retroperitoneal 140
Lymphangioma 10, 86, 92, 98, 116, 200, 201, 206, 264
cystic 29f
Lymphatic
obstruction, malignant 46
periportal 46
Lymphocele 146, 116, 168, 233
Lymphoma 9, 14, 43, 45, 91, 103, 104, 112, 133, 135137, 141, 142, 146, 170, 174, 200, 206, 283
case of 113f
M
Macroglossia 276
Macronodular cirrhosis 39
Malakoplakia 130, 132
renal 118
Malformations, congenital and developmental 214
Malignant disease 8
Malignant infiltration, diffuse 40
Malignant ovarian
lesions, ultrasound features of 242
mass 242f
neoplasm 242
Mammilopontine distance 211
Mandible, radicular cyst of 186
Masses
cystic 280
hypoechoic 82f
pleural 3, 8
pulmonary 3f
renal 120
Mastitis 171, 171f
Matted bowel loop 102f
Meckel-Gruber's syndrome 280
Meconium peritonitis 144, 146, 148f, 151, 260, 261, 268
Median cleft syndrome 276
Mediastinum 1
anterior 1
cystic mass of 10
vascular lesions of 10
Mediterranean fever, familial 149
Medullary carcinoma 21f, 170
case of 21f
Medullary granulomatous masses 118
Megacisterna magna 208, 215, 256
Megaureter 272
Melanoma 202
malignant 86
Ménétrier's disease 99
Meningioma 202, 207
Meningitis 222
Meningocele
herniation, posterior 225f
lateral 10
posterior 223
simple posterior 225
Mesenteric artery
superior 80, 81f, 93
syndrome, superior 102
Mesenteric dermoid tumors 146
Mesenteric lymph nodes
enlarged 143f
isolated 147
multiple enlarged 148, 148f
Mesenteric masses 141
Mesenteric thickening 141f
ascites 104
Mesenteric vein, superior 80f, 102
Mesoblastic nephroma 120, 121
Mesothelioma 145, 146
cystic 144, 146
malignant 8
peritoneal 142
pleural 9
Metastasis 8, 43, 45, 88, 103, 104, 136, 147, 170, 174, 202
cystic 55, 59
echopoor 58, 59f
hypoechoic mass 137f
Metastatic lesions 54f
cystic 60f
different types of 58
Michaelis-Gutmann inclusion bodies 118
Microabscess 84
Microcalcification, presence of 16
Micrognathia 257, 279
differential diagnosis of 275
Microlithiasis, isolated 152
Midface syndromes 275
Miliary tuberculosis 85, 86, 88
Miller's syndrome 275, 278, 279
Mirizzi's syndrome 69
Mohr's syndrome 275, 278, 279
Molar placenta 257
Mondor's disease 171
Monochorionic twin syndromes 270
Morgagni hernia 263
Mucocele 206
Mucoepidermoid tumor 206
Müllerian cyst 162
Multicystic dysplastic kidney 274f
Multinodular parenchymal pattern, heterogeneous 21f
Mural nodule 242
Musculoskeletal system 176
Mustard gas 193
Myasthenia gravis 11
Mycobacterium
avium intracellulare 85
tuberculosis 85
Myelocele 224, 280
Myelocystocele 223, 224, 283
Myelofibrosis 90
Myelolipoma 137, 139
adrenal 139
Myelomeningocele 223, 224, 257
anterior 283
Myotonic dystrophy 268
N
Neck
abnormality 268
lesions 14
Neonatal
and infant brain 208
spinal canal, indications for ultrasound of 223
Neoplasm 12
cystic 84
Neoplastic lesions 233
Nephrocalcinosis 124
Nephrotic syndrome 4
congenital 268
Nerve root tumors 10
Neural arches 224f
Neural tissue, part of 224
Neural tumors 141
Neurilemmoma 176
malignant 193
Neurinomas 31
Neuroblastoma 138, 138f, 139, 262, 264, 282, 283
metastatic 260
Neurocysticercosis, intraocular 206
Neurofibroma 31, 206
Neurofibromatosis 207
Neurogenic bladder 130, 132
Neuromuscular disorders 11
Nodal disease, criteria for assessing 81
Nodular
goiter 18f
hyperplasia, focal 41
Nodule
benign 22
hypoechoic 22
metastatic 63, 64
pleural 3
Non-Hodgkin's lymphoma 74, 88
Nonskin covered back mass 223
Noonan's syndrome 276
Nuchal
fold 285
thickening 256
translucency 256, 285
O
Obesity 11
Obstruction, intrahepatic 70
Obstructive uropathy, signs of 126f
Ocular inflammatory diseases 199
Ocular tumors, common 195
Oligohydramnios 258, 259, 260
Omental
cyst 147, 233
infarction 78
sarcoma, evidence of 143f
Omentum, thickened 103f
Omphalocele 256, 283, 284
Oncocytoma 121, 123
Oophoritis 236
Ophthalmic vein, superior 201f
Optic nerve 190
avulsion 192, 194
head, disease of 200
lesions of 202
Ora serrata 189
Orbit 189, 190
vertical section of 191f
Orbital
cellulitis 206
color Doppler 192
cyst 195
cysticercosis 195, 202f
diseases, sonological features of 193
hemorrhage 195
lesions, sonographic classification of 200
muscle enlargement, differential diagnosis of 201
pathology 200
trauma 192
sonoanatomy and technique 190
indications 190
systematic evaluation 191
ultrasound technique 191
trauma 192, 193
Orchitis 149
Ormond's disease 113
Orofacial digital syndrome 279
Osteochondromatosis, synovial 177
Osteomyelitis 185f
Otocraniofacial syndromes 275
Ovarian
carcinoma 43
cyst 233
adenoma 233
functional 239f
hemorrhagic 238f
large 240
dermoid 235f, 242f
enlargement 232
lesions 234
malignancy 242f
mass, cystic 236
stimulation, case of 238
torsion 236, 239
tumors 236
benign 241
malignant 241
Ovary
cystadenocarcinoma of 243f
endometriotic cyst in 239f
massive edema of 238
P
Pancreas 91
cystic
mass 96f
tumors of 91
diffuse fatty, infiltration of 95f
enlargement of 78
head of 94, 95f
Pancreatic masses, inflammatory 93, 95
Pancreaticoblastoma 93
Pancreatitis 78, 142
Panuveitis 192
Papillary carcinoma, case of 20f
Papillary tumors, intraductal 91
Papilloma 97, 173
intracystic 167
Paraganglioma 131, 132
Paralysis, diaphragmatic 11
Paralytic ileus 102, 103
Paranasal sinus malignancy 200
Paraovarian cyst 232, 236, 238
Parasites, biliary 70
Parasitic
cyst 84, 85
infection 118
infestation 72
Paratubal cyst 238
Parenchyma
homogeneous 15f
hyperplasia of 117
pulmonary 7f
Parotid gland 28f
enlarged 30f
Paroxysmal nocturnal hemoglobinuria 41
Patau's syndrome 272
Peak systolic velocities 192
Pediatric
neoplasm, solid 93
testicular masses 157
Pelvic
abscess 145f, 146f, 230, 231, 234f
hematoma 133, 135, 235f
inflammatory disease 80, 230
case of 78f
lipomatosis 133
malignancies 131
masses
cystic 232
solid 236
nodes 135
tumors 112
Pelvicalyceal system, dilatation of 126f
Pelvis 123, 141f, 142f
renal 127f
transverse scan of 232f, 243f
Pelviureteric junction obstruction 125f, 272, 273, 273f
Pena-Shokeir syndrome 268, 275
Pericholecystic fluid 62, 68
differential diagnosis of 68
Pericholecystic inflammation, signs of 66
Perichondrium unite 181
Perinodal blood flow 14
Periovarian inflammation 81, 231
Peripancreatic collaterals 92f
Peripheral nerve sheath 192
Peritoneal
cavity 145f
duplication cyst 107f
with internal septae 144f
dialysis 4
inclusion cyst 148, 233
lesions, solid 145
masses 141
Perthes' disease 180f
Pfeiffer syndrome 276, 277
Phantom sign 112
Pheochromocytoma 136, 137, 138, 138f, 139, 140
large 139f
Phleboliths 207
Phrenic nerve paralysis 11
Phthisis bulbi 194
Phylloides tumor 173
Pierre Robin syndrome 275
Placental cotyledon, single 270
Placode 224
Pleural disease, drug-related 8
Pleural effusion 3f, 4, 6f, 8f, 262, 267
and ascites outlining diaphragm 5f
and collapsed lung 6f
superior to diaphragm 5f
Plexiform neurofibroma 201
Pneumobilia echogenic foci 46f
Pneumocystis 123
carinii infection 84, 85
Pneumothoraces 4
Polycystic
kidney disease 69, 119, 119f, 120, 240f, 268
infantile autosomal recessive 120
liver 50f
ovarian disease 239
renal disease 50
Polydactyly 257, 282
Polyhydramnios 258, 260, 285
Polypoidal mass 130f
Polysplenia 288
syndrome 83
Popliteal fossa, cystic mass in 176
Portal hypertension, noncirrhotic 46
Postmeningitis hydrocephalus 222f
Post-vasectomy changes 161
Pott's spine 116
Pouch of Douglas 230f
Pregnancy
and lactation, late 175
anembryonic 265
ectopic 230, 230f, 231f, 234, 248, 250f, 258, 265, 266, 266f
first trimester 264
intrauterine 244, 247, 248, 248f, 258
loss, first trimester 270
molar 266
multifetal 269
ruptured ectopic 230
test 258
Prephthitic eyeball 194
Pressure, intra-articular 179
Primitive gonadal stroma, tumor of 154
Proliferative disease 248
Prostastitis, chronic 154
Prostate 162
abscess 164
acute 165
advanced carcinoma of 164f
calcification 165, 165f
carcinoma 163f, 164f
chronic 165
cyst
differential diagnosis of 162
simple 165
dysplasia 165
midline cyst in 162f
retention cysts cluster of 164
tissue, normal 164
Prostatic hyperplasia, benign 164
Prostatic hypertrophy, benign 162, 162f
Prostatitis, granulomatous 163, 165
Protruding tongue 256
Prune-Belly syndrome 260, 268
Pseudoachalasia 98
Pseudoaneurysm 73, 92
Pseudoangiomatous stromal hyperplasia 169, 173
Pseudocyst 92, 140
pancreatic 10, 84, 86, 92f, 116, 147
paracardiac 144
Pseudogestation sac 266
Pseudokidney sign 103, 104f
Pseudolithiasis, drug-induced 63f
Pseudomasses
adrenal 140
differential diagnosis of 116
Pseudomembranous colitis 106
Pseudomyxoma peritonei 144, 147
Pseudostaphyloma 200
Pseudotumor 117, 202
inflammatory 86
pleural 8
renal 117
Psoas abscess 114f, 115f, 116
Ptotic kidney 116
Pulsatile proptosis, differential diagnosis of 207
Pyelonephritis
acute 125f
case of 127f
xanthogranulomatous 118
Pyloric stenosis
hypertrophic 101f
infantile hypertrophic 100f
Pyogenic cholangitis, recurrent 45, 46
Pyometra 244
Pyonephrosis
secondary 127f
stone 123
Pyosalpinx 81
Q
Quadrants, division of 75f
R
Radial scar 169
Radiation cystitis 130, 132
Rectal endosonography, role of 111
Rectus abdominis muscles 71f
Reflux nephropathy 117
Renal cell carcinoma 43, 118f, 119, 121, 122, 123f
mass 122f
presence of 122f
Rendu-Osler-Weber syndrome 217
Reninoma 120
Retina 190
disease of 198
Retinal detachment 194, 203, 204
Retinoblastoma 195, 202, 203, 203f
Retractile mesenteritis 142
Retroperitoneum 112
Retrotumoral attenuation 170
Rhabdomyoma 288
Rhabdomyosarcoma 32, 131, 201
Rhadomyoma 205
Rhesus isoimmunization 255
Rheumatoid arthritis 8, 177, 188
Rib
fracture 8
with distal shadowing 1f
Riedel's lobe 37f
Riedel's struma 113
Robert's syndrome 275, 278
Robinson syndrome 276
Rocker bottom feet 256
Rotator cuff 177f
Roundness index 33
Rubella 220, 221
clinical features 221
ultrasonography 221
Russell silver syndrome 276
S
Sacral meningocele, anterior 223, 227
Saethre-Chotzen syndrome 277
Salivary gland, enlargement of 25
Sandwich sign 81f
Sarcoidosis 9, 86, 87, 152, 154, 188, 206
Sarcoma 91, 170, 175, 205
botryoides 131
osteogenic 13
retroperitoneal 114f
Scalp edema 280
Scar granuloma 169, 175
Schistosomiasis 45, 130, 131, 151
Schizencephaly 208, 214, 282
Schwannomas 31
Sclera 189
Scleral injury 194
Scleritis 202
Sclerocornea, disease of 199
Scoliosis, thoracolumbar 276
Scrotal
calcification, differential diagnosis of 151
edema, idiopathic 149, 150
fat necrosis 149
gas, differential diagnosis of 152
masses, differential diagnosis of 153
pearls 151, 152
sac 153f, 155f
calcification in 152f
tubercular collection in 151
Scrotolith 151f
Scrotum 149
differential diagnosis of 149
Sebaceous cysts 167
Seckel syndrome 275
Semilobar holoprosencephaly 208
sonographic findings in 214
Seminal vesicles
absent 163f
cyst 133, 163
normal 163f
Seminiferous tubules 150
Seminoma 158
testis 154f
tumors 159
Sepsis 63
Septate uterus 245f
Septic emboli 45
Seroma 71
Serpentine sonolucencies transgress 63
Serpiginous tortuous hypoechoic vascular structures 207
Sertoli's cell tumor 151, 153
Sex cord tumors 236
Short rib polydactyly syndrome 272
Shoulder joint cavity 184f
Sialadenitis
acute 25
chronic 25
Sialolithiasis 26
Sickle cell anemia 199
Sigmoid colon 76
Silhouette sign 82
Silicon granulomas 175
Simple cyst 156
Sinonasal malignancies 206
Sinus of Valsalva, aneurysm of 10
Sinusoidal dilatation 43
Situs inversus 80
Sjögren's syndrome 25
Skeletal dysplasias 275, 276
Skin covered back mass 223
Soft splenic calcification 90f
Soft tissue
nodule causes of 188
sarcomas 121
tumors 236
Solid masses, differential diagnosis of 112
Solitary thyroid nodule 15f
Somatostatinoma 96
Sonopathology 192
Space-occupying lesion 92f, 93f, 282
Sperm granuloma 160
Spermatocele 160, 160f
Sphenoid wing dysplasia 207
Spill meconium 146
Spina bifida 280, 283
aperta 223, 224
cystica 223, 224
with meningocele 227f, 281f
Spinal childhood tumors 229
Spinal cord, area of clefting 226f
Spinal defect 280
Spinal dysraphism 223, 227, 284
occult 223, 225, 228
overt 223
Spinal lipoma 223, 226
Spinal trauma 223, 229
etiology 229
Spleen 83
abscess 79
absence of 288
cystic, lesion of 83
cystic neoplasm 86
epidermoid cyst 84
infection or inflammation 85
post-traumatic 85
vascular 84
multiple hydatid cysts in 85f
star-sky 89
traumatic fragmentation of 83
Splenic
abscess, case of 84
infarction 86, 87
laceration 83, 84
lesion, solid 86
parenchyma, abscess in 84
vein 85
Splenoma 86
Splenomegaly 85, 87, 90
Split notochord 227
syndrome 223
Squamous cell carcinoma 121, 130, 133
Squamous tumors, small 97
Staghorn calculus 127f
Staphyloma 199
posterior 205f
Stenosis 260
Sternocleidomastoid muscle 28
Stewart's classification 275
Stomach 98
Stroma 189
Stromal tumors 159
Sturge-Weber syndrome 196
Subarachnoid space 217
Subcutaneous fat 225f
Submandibular gland, transverse scan of 25f
Submucosa, disease of 131
Submucosal fibroid 244f
Subretinal fluid 194, 199
Sunray spiculation 44
Supraspinatus tendon 187f
Swelling, diffuse 220
Synovitis, proliferative 185f
Systemic lupus erythematosus 8
T
Tachycardia 260
Taenia solium 72
Target lesion 104f
Target sign 103
Taussig-Bing syndrome 287
Teeth, apical cyst of 186f
Tendinitis, signs of 177
Tendo-Achiles chronic, partial rupture of 184f
Tendon tears 177
Tenosynovitis 185f
Teratocarcinoma 156
gonadoblastoma 151
Teratogen exposure 285
Teratoma 113, 151, 158, 260, 262, 282, 288
cystic 91, 236
sacrococcygeal 282
Testicular
appendages, torsion of 149
calcification 151, 152f
lesions, cystic 156
malignancy 153f
metastasis 159
microlithiasis 151
torsion 149
trauma 149, 150
Testis 150, 156
Tethered cord 228
causes of 228
risk factors for 228
Tetralogy of Fallot 287
Thalamus 210
Theca cell tumor 154
Theca lutein cyst 232, 237, 250
Thickened placenta 255, 255f
differential diagnosis of 255
Thoracic meningocele, lateral 223, 227
Thoracic tumor 268
Thorax abnormality 268
Thymic cyst 10
Thymic enlargement 262
Thyroglossal cyst 28
Thyroid 14
calcification 22
colloid nodule of 23f
disease, diffuse 17
function tests, abnormal 206
gland, heteroechoic enlarged 19f
inferno 19
isthmus of 15f
left lobe of 23f
multinodular goiter, nodule in 22f
nodule
benign 16, 17
cystic 23
degeneration in 24f
differential diagnosis on 22
malignant 16, 17
with internal calcification 24f
Tissue inhomogeneity 193
Tortuous brachiocephalic artery 10
Toxocara infection 195
Toxoplasma 261
Toxoplasmosis 136, 220, 221
Transabdominal
scan 57f
sonography 248
Transient uterine contraction 244
Transitional cell
carcinoma 121, 121f, 128f, 130, 130f, 133
papilloma 130
Transudative pleural effusion, causes of 4
Transvaginal sonography 248
Traumatic cystic lesions 218
Treacher-Collins syndrome 275
Trilobed lung, bilateral 288
Triploidy 255, 257
Triradiate cartilage 183f
Trophoblastic
disease 247
invasive 246
neoplasia, persistent 266
tumor, placental site 251, 266
Truncus arteriosus, persistent 287
Tubal lesions 232
Tubercular
abdomen 105f
abscess, multiple 29f
arthritis, right hip 179f
epididymitis 161f
epididymo-orchitis 150f
lymphadenopathy 82f
peritonitis 106f
case of 143f
thickened omentum 144f
tubo-ovarian mass 232f
Tuberculosis 9, 103, 131, 142
peritoneal 144, 147
renal 129
Tuberculous pleural effusion 7f
Tubo-ovarian
abscess 81, 81f, 231, 235, 235f, 238
complex 231
mass 231f
Tubular ectasia 154, 156, 157
Tubular structures, multiple 69f
Tumefactive sludge 63, 65
Tumors 74, 220, 229
benign submandibular 26f
cardiac 288
cystic
change in 162
spindle-shaped 144
desmoid 74, 141, 142, 145
endometrioid 243
epithelial 93, 97
esophageal 97
extradural 229
lipomas 74
malignant 32, 47
metastasis 74
metastatic 243
neuroendocrine 43
neurofibromas 74
neuromas 74
occult primary 159
pancreatic 140
pleural 8
renal 117
retroperitoneal 112
sacrococcygeal 229
thrombus in portal vein 49f
Tunica albuginea cyst 154, 156, 157
Turner's syndrome 258
Twin
and multifetal pregnancy, complications of 270
embolization syndrome 270
peak sign 269
pregnancy 257f, 269
case of 269
transfusion syndrome 270
Typhlitis, amebic 103
U
Umbilical region, differential diagnosis for 76
Undescended testicles 72
Unilocular cystic lesion 238
Urachal cyst 72, 134f
Ureter, ectopic 274
Ureterocele, ectopic 274f
Urethra, dilated posterior 272f
Urethral atresia 260
Urethral diverticulae 255
Urethral valve, posterior 260
Uric acid, calcium precipitates 176
Urinary bladder 130, 146f, 237f
clot in 130f
hemangiomatous lesion 131f
multifocal carcinoma 131
polypoidal mass from anterior wall 132f
posterior wall of 130f, 134, 234f
transitional cell carcinoma of 131f
walls of 130f
Urinary tract
abnormality 268
obstruction 4
Urinoma 116, 119f, 233
Uterine
cavity 253f, 255f
endometrium 247f
enlargement, diffuse 246
fibroids 243, 244f
fundus 238
lesions 234
masses 243
adenomyosis 246
benign 243
cervical carcinoma 246
focal myometrial contraction 246
leiomyoma 246
leiomyosarcoma 246
lipoleiomyoma 246
malignant 246
rudimentary horn of bicornuate uterus 246
synechia 254f
Uterus
adenomyoma of 245
foreign body in 254f
obstructed 232
peritoneal surfaces of 148
small lipoma of 245f
Utricle cyst 162
Uveal melanoma 196
Uveal tract 189
Uveitis 202
V
Vaginal lesions detected on ultrasound 255
Vanishing twin syndrome 265
Varicocele 73, 152f
Vascular
abnormalities 171
aneurysms 92
disease 192
extratesticular mass 150f
lesions 217
malformations and aneurysm 118
masses 73
Vein of Galen, aneurysm of 217f
Vena cava
bilateral superior 288
inferior 12f, 115f
superior 4
Venous thrombosis 269
Venovenous placental anastomosis 270
Ventral wall defect, large 284
Ventricular septal defect 286
Ventriculoarterial discordance 287
Ventriculomegaly 208, 211
Vermian agenesis 282
Vertebral body 228f
Vesical calculus 134f
Vesicocervical fistula 268f
Vesicoureteric junction 272
obstruction 272, 273
Vesicoureteric reflux 272, 274, 275f
jet 273f
Vessel
encasement 14
tear, cause of 198
Villous hyperplasia 63
Vipoma 96
Viral hepatitis 39f, 46
Vitreous humor, evaluation of 191
Volvulus 99
malrotation with 102
von Hippel-Lindau disease 91
von Meyenburg complex 49, 50
W
Wall-echo-shadow sign 61
Wandering spleen 83
Wegener's granulomatosis 201
Wharton's duct 26f
Wilms' tumor 13, 119, 121123
Wilson's disease 39, 188
Wolman's disease 137
Wyburn-Mason syndrome 217
X
Xerostomia 25
Y
Yolk sac 265, 265f
tumor 153, 156, 158
Z
Zellweger syndrome 215, 272
×
Chapter Notes

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ChestCHAPTER 1

 
1.1 CHEST OVERVIEW
Ultrasound (US) is a noninvasive, relatively inexpensive and most rewarding imaging modality, carries no radiation burden, but not much exploited for evaluation of chest disease because of basic (inherent) properties of US waves not to pass through bony cage and air-filled lungs. However, over a couple of years, US has emerged as a useful tool in evaluating wide range of perplexing clinical problems of chest due to presence of fluid in pleural space, consolidating or atelectatic lung or even tumor, provide window for US to penetrate and this has helped in diagnosis of certain conditions or limit the differential diagnosis (DD) of conditions under consideration.
  1. Chest wall (Fig. 1.1.1): It has helped in diagnosing soft tissue abscesses, masses, osteomyelitis, rib tumors and even fracture where plain X-ray gives only soft tissue swelling or obliteration of costophrenic angle (may be due to pleural fluid or sometimes by rib tumor) and also where rib erosion is due to underlying carcinoma. Sometimes, when clinically mass is suspected with fractures, US can be used as a first modality particularly in children to avoid radiation by getting an X-ray chest.
  2. Mediastinum: Anterior mediastinum can be very well-evaluated by US through suprasternal route by elevating shoulders and extending the neck. This will avoid structures particularly thymus in children. Even paratracheal and hilar adenopathy can be diagnosed especially in tubercular patients where it is not only helpful in diagnosis but also in follow-up when child is on antitubercular therapy, thus avoiding unnecessary radiation and getting repeated X-rays.
    zoom view
    Fig. 1.1.1: Normal lung as seen in transverse section. Ribs with distal shadowing are shown with intercostal muscles. The lung pleural interface is seen as an echogenic line.
  3. Lung parenchyma: It is also helpful in differentiating cystic lesions of the lung parenchyma like hydatid cyst (Fig. 1.1.2) consolidation (Figs. 1.1.3 to 1.1.5), collapse and tumor of lung. Also differentiates a tumor and pleural fluid/consolidation above the diaphragm from (subpulmonic effusion) below the diaphragm.
  4. Pleura: US is a good modality to differentiate pleural lesions from parenchymal ones.2
    zoom view
    Fig. 1.1.2: Lung hydatid seen as anechoic cystic lesion in transverse scan of lung. (SOL: space occupying lesion; RT: right)
    zoom view
    Fig. 1.1.3: Consolidation—seen as a homogeneous hypoechoic lesion with air bronchogram in right lower lobe of lung.
    zoom view
    Figs. 1.1.4A and B: US scans showing consolidation with cavitation in lower lobe. (M: mass)
    zoom view
    Figs. 1.1.5A and B: US scans show lobar consolidation with presence of color flow on color Doppler flow imaging (CDFI). (M: mass)
    3
    It is also helpful in diagnosing minimal amount of fluid in pleural cavity, even 5–10 mL of fluid, thus avoiding need of lateral decubitus film/lateral chest film.
    1. It also gives the etiology of pleural fluid due to its appearance as anechoic, hypoechoic, echogenic, presence of debris, nodules and types of septa.
    2. Anechoic—all transudates are anechoic, however, all anechoic collections are not transudates. About one-third of exudative collection tends to be anechoic in the beginning.
    3. Hypoechoic—Usually exudative effusions, empyema and later stages of hemothorax.
    4. Echogenic—Hemothorax or empyema.
    5. Debris—Represents settled down pus cell, blood cells, etc.
    6. Septations—Usually represent process of loculation and fibrosis occurring in pleural effusion. Thin clean septa with no or very minimal debris—tubercular pleural effusion. However, thick, shaggy irregular septations with debris—pyogenic effusion.
    7. Pleural nodule/masses (Figs. 1.1.6A to C), represent meso-thelioma, metastatic nodule and tuberculomata. In addition to characteristics septations the thickness of parietal pleura and combined (parietal + visceral) also give etiological diagnosis. As tubercular pleural effusion-parietal pleural thickness varies 2–8 mm and combined pleural varies from 4–10 mm. In pyogenic pleural effusion, parietal pleural thickness varies from 5–22 mm and combined 8–27 mm. In hemothoraces (post-traumatic) thick irregular mantle of pleura around hypoechoic pleural collection is seen, pleural thickness varies from 12–18 mm.
      Pleural effusion v/s ascites: Bare area sign—if fluid interface is abutting the bare area of liver than it is pleural effusion and if it is not than it is ascites.
      Diaphragmatic crus sign—pleural effusion is posterolateral and superior to crus of diaphragm while ascites is anteromedial and inferior to crus of diaphragm.
  5. Intervention: US is very helpful in fine needle aspiration biopsy, pleural tapping, guided pleural aspiration and tube placement.
  6. ICU: US is very helpful in critically ill-patients that is trauma and ICU-needs serial X-rays to see day-to-day changes in lesions like consolidation and lung abscess (Fig. 1.1.7), particularly when there is inability to position the patient as required and usually substandard quality of X-rays.
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Figs. 1.1.6A to C: US scans show pulmonary mass with color flow associated with mild pleural effusion causing compression atelectasis of underlying parenchyma and hepatic metastases. (M: mass)
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Limitations
  • Pneumothoraces/hydropneumothorax
  • Limited information about mediastinum, hilar and proximal airways
    • Limited information of the underlying lung parenchyma in the setting of complex pleural and lung parenchymal disease.
    • No preferred for complicated interventional procedures, such as empyema drainage with a pigtail catheter or biopsy of pleural masses.
  • Restricted field of view
  • Familiarity of clinician
  • Operator dependent.
 
Other Advantages
  • Lower cost
  • Increase flexibility
  • No radiation
  • Good guidance tool
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    Fig. 1.1.7: Lung abscess—a large predominantly hypoechoic space-occupying lesion (SOL) with internal septae and posterior enhancement is seen in lower lobe of right lung. Aspiration revealed pus Inversion of diaphragm is seen.
  • Repeated evaluation with no radiation cost
    • Portability in ICU settings
    • Better in differentiating pleural effusion from pleural thickening
    • More sensitive than X-ray in differentiating pleural fluid from consolidation
    • Ultrasound guidance is associated with a reduced risk of pneumothorax during thoracentesis.
Ability to detect abdominal lesions associated with causative of chest lesion as liver abscesses leading to pleural effusion.
 
1.2 PLEURAL EFFUSION
Pleural effusion can be transudative or exudative.
Signs of pleural fluid on USG:
Transudative effusion: Pleural (fluid) that changes shape with respiration.
Exudative effusion:
  • Fluid with floating echodensities
  • Septations—thick and shaggy (Figs. 1.2.1A to C)
  • Fibrin strands
  • May be anechoic fluid
  • Echogenic fluid (Fig. 1.2.2)
  • Pleural nodules
  • Thickened pleura.
 
Causes of Transudative Pleural Effusion
  1. Increased hydrostatic pressure
    • Congestive heart failure
    • Superior vena cava (SVC) obstruction
    • Constrictive pericarditis.
  2. Decreased osmotic pressure
    • Cirrhosis with ascites
    • Peritoneal dialysis
    • Acute glomerulonephritis
    • Nephrotic syndrome
    • Urinary tract obstruction5
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      Figs. 1.2.1A to C: (A) Pleural effusion superior to the diaphragm; (B) Pleural effusion and ascites outlining the diaphragm; (C) Ascites only. Irregular outline of the gut is seen due to ascites. (L: liver)
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      Fig. 1.2.2: Longitudinal intercostal view in a patient with pleural effusion showing echogenic surface of visceral and parietal pleura.
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    • Hypoalbuminemia
    • Overhydration
    • Hypothyroidism.
 
Causes of Exudative Pleural Effusion (Figs. 1.2.3 to 1.2.10)
  1. Infection
    • Parapneumonic effusion
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      Fig. 1.2.3: Longitudinal intercostal view—pleural effusion and collapsed lung showing echogenic gas-filled bronchus (arrow) within the collapsed lung.
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      Fig. 1.2.4: Loculated multiseptated fluid collection seen in the pleural cavity with associated pleural thickening.
    • Empyema (see Fig. 1.1.7)
    • Tuberculosis
    • Fungi (nocardia, actinomycosis).
  2. Neoplasm
    • Pleural metastasis
    • Pleural mesothelioma
    • Bronchogenic carcinoma
    • Lymphoma.
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      Fig. 1.2.5: Multiseptated fluid collection seen in right pleural cavity in the case of infected pleural effusion.
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      Fig. 1.2.6: Thickened pleura seen along with pleural effusion.
      7
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      Fig. 1.2.7: A predominantly hypoechoic solid mass lesion seen in right lower lobe (LL) of lung.
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      Fig. 1.2.8: US scans show hydropneumothorax with compression atelectasis of underlying pulmonary parenchyma. (PLS: pleural lung scan)
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      Fig. 1.2.9: US scan shows tuberculous pleural effusion with pleural thickening. (PLE: pleural effusion)
      8
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      Fig. 1.2.10: US scans show presence of organizing pleural effusion (PLE).
  3. Vascular
    • Pulmonary emboli.
  4. Collagen vascular disease
    • Systemic lupus erythematosus (SLE)
    • Rheumatoid arthritis.
  5. Abdominal disease
    • Subphrenic abscess
    • Pancreatitis.
  6. Trauma
    • Hydrothorax.
  7. Miscellaneous
    • Drug induced effusion
      • Uremia
      • Hypothyroidism
      • Acute respiratory distress syndrome (ARDS).
 
1.3 PLEURAL PLAQUE
Common causes of pleural plaque includes:
  • Pneumonia
  • Asbestos exposure
  • Pulmonary infarction
  • Trauma
  • Chemical pleurodesis
  • Drug-related pleural disease.
Plaques resulting from asbestos exposure are usually confined to the parietal pleura. Ultrasound demonstrates pleural plaques as smooth, elliptical, hypoechoic pleural thickening.
Visceral pleural plaques are differentiated from parietal pleura by observing the ‘gliding sign’ during respiration.
Calcified pleural plaques are irregular, echogenic and produce acoustic shadowing and comet tail artifact.
Differential diagnosis to be considered while diagnosing pleural plaques:
  • Diffuse pleural thickening
  • Extrapleural fat
  • Pleural tumors
  • Pleural pseudotumors
  • Rib fracture.
 
1.4 PLEURAL MASSES
  1. Loculated pleural effusion
  2. Metastasis
  3. Malignant mesothelioma
  4. Pleural fibroma
  5. Fibrin balls.
 
Loculated Pleural Effusion
Anechoic collection seen within the pleural cavity.
 
Metastasis
Pleural effusion associated with malignant disease may result from:9
  • Malignant cell implantation on the pleura (common causes: lung, breast and GIT cancers)
  • Obstruction of pleura or pulmonary lymphatics (common causes: lymphoma, breast cancer)
  • Obstruction of pulmonary veins usually by lung cancers
  • Malignant cells shed freely into pleural space
  • Obstruction of thoracic ducts, resulting in chylous effusion (usually due to lymphoma).
Sonographic findings favoring malignant etiology.
  • Solid nodules in the pleural space
  • Circumferential pleural thickening
  • Nodular pleural thickening or >1 cm pleural thickening
  • Pleural thickening involving the mediastinal pleura.
 
Pleural Mesothelioma
Malignant mesothelioma is a rare and usually fatal pleural tumors associated with asbestos exposure.
 
Imaging Findings
Diffuse pleural thickening, often nodular and irregular (86%).
  • Calcification in pleura (74%)
  • Focal pleural mass (25%).
Rib destruction occurs with advanced disease.
 
Pleural Fibroma (Local Benign Mesothelioma)
A smooth lobular mass, 2–15 cm diameter arising more frequently from the visceral pleura.
  • Pedunculated mass changes shape with respiration (30–50%)
  • Forms an obtuse angle with the chest wall.
 
Fibrin Balls
These develop in serofibrinous pleural effusion and become visible following absorption of fluid.
  • Small and tend to be situated near the lung base.
  • May disappear spontaneously or remain unchanged for many years.
 
1.5 MEDIASTINAL LYMPHADENOPATHY
Tuberculosis
Sarcoidosis
Lymphoma
Unilateral
Bilateral
Bilateral
Symmetric
Asymmetric
Right paratracheal and tracheobronchial nodes are most commonly involved
Bilateral hilar with or without right paratracheal, aortopulmonary window lymphadenopathy
Superior mediastinum most common site with or without unilateral or bilateral hilar nodes
  • Mediastinal lymph node (LN) with or without hilar LN-unusual
  • Characteristic involvement of bronchopulmonary nodes, than hilar nodes
In non-Hodgkin lymphoma (NHL) involvement of other nodal groups (cardiophrenic, posterior media stinal) also seen more commonly
Low attenuation
Isodense
Isodense
Mild homogeneous enhancement to rim enhancement
Homogeneous mild to moderate enhancement
Mild homogeneous enhancement
May show calcification
May show rim calcification
Calcification unusual without treatment
More likely to be confluent
Discrete
May be confluent with large nodal masses
Usually discrete
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1.6 VASCULAR LESIONS OF MEDIASTINUM
Ultrasound is an excellent, noninvasive method of diagnosing masses of vascular origin in the mediastinum.
Vascular nature of a suspected mass can be confirmed by ultrasound using imaging supplemented by color flow and spectral Doppler effect:
  • Tortuous brachiocephalic artery
  • Aneurysm of the aorta
  • Aneurysm of the sinus of Valsalva
  • Right-sided aortic arch
  • Double aortic arch
  • Dilated superior vena cava.
 
1.7 CYSTIC MASSES OF MEDIASTINUM
  1. Congenital cyst (Benign)
    • Bronchogenic cyst
    • Pericardial cyst
    • Esophageal duplication cyst
    • Neuroenteric cyst
    • Thymic cyst.
  2. Mature cystic teratoma
  3. Meningocele (Lateral)
  4. Lymphangioma
  5. Cystic degeneration
    • Hodgkin's disease
    • Metastasis to lymph nodes
    • Nerve root tumors
  6. Mediastinal abscess
  7. Pancreatic pseudocyst.
Ultrasonography can be useful in evaluating a mass adjacent to pleural surface or cardiophrenic angle. At US, the benign cysts typically appear as anechoic thin-walled masses with increased through transmission.
  • Ultrasound is used to characterize wall thickness, septations, vascularity, appearance of internal fluid, location and relationship to adjacent structures.
Pericardial cyst-results from aberrations in the formation of celomic cavities. Pericardial cysts are invariably connected to the pericardium but only a few cases unable to show communication with the pericardial sac. Thus ultrasound can help in detecting the pericardial involvement.
The majority of pericardial cysts arise in anterior cardiophrenic, more commonly on the right side. Occasionally cysts are pedunculated.
 
Mature Cystic Teratoma
These are cystic tumors composed of well-differentiated derivations from at least two of the three germ layers.
Majority of dermoid cysts are in the anterior mediastinum.
Most cystic teratoma are multilocular but unilocular cystic lesions also occur.
They may contain four types of tissues-including fluid, fat, soft tissues, calcium but fluid containing cystic component are usually prominent.
A fat fluid level within the mass is highly specific finding but is seen less frequently.
 
Cystic Degeneration
Many tumors and lymph nodes can undergo cystic degeneration and demonstrate mixed solid and cystic elements. If degeneration is extensive, the appearance of the lesion is indistinguishable from those of a congenital cyst. Cystic degeneration of a solid mass is more likely to occur after radiation therapy or chemotherapy but may be seen prior to treatment.
  • A mediastinal abscess or pancreatic pseudocyst appears as a fluid containing mediastinal cystic mass, but clinical features usually permit differentiation from true cysts or neoplasms.
 
1.8 DIAPHRAGM
Bilateral diaphragmatic elevation
  1. Shallow inspiration (most common).11
  2. Abdominal cause (USG useful by showing fluid, fetus or an abdominal mass as the cause)
    1. Obesity
    2. Pregnancy
    3. Ascites
    4. Any large abdominal mass.
  3. Pulmonary causes—USG little use
    1. Chext X-ray/CT required making the diagnosis.
  4. Neuromuscular disorders
    1. Myasthenia gravis—chest CT may show thymoma.
    2. Amyotropic lateral sclerosis—USG is of little use.
      • MRI required for diagnosis.
 
Unilateral Diaphragmatic Elevation
 
Subpulmonic Pleural Effusion
  • Ultrasound confirmatory
  • Shows the presence of fluid is pleural cavity with normal relative position of both domes of diaphragm.
 
Pulmonary Causes
  • USG may show the presence of elevation of one dome of diaphragm may be due to liver lesions also (Figs. 1.8.1 and 1.8.2) as compared to other dome. However, underlying lung is usually not evaluated by ultrasound
  • Chest X-ray/CT will confirm the cause for diaphragmatic elevation and relation to diaphragm with other structures.
 
Phrenic Nerve Paralysis (Diaphragmatic Paralysis)
  • May occur due to:
    • Primary lung tumor
    • Malignant mediastinal
    • Iatrogenic
    • Idiopathic.
  • Diagnosis is made on USG by observing the absent or paradoxical movement on the affected side with usual or exaggerated excursion on the opposite side. Paradoxical movement can be elicited by the coughing or sniffing tests.
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Fig. 1.8.1: Liver in transverse scan—right lobe of liver. (Ao: aorta; IVC: inferior vena cava; PV: portal vein)
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Fig. 1.8.2: Longitudinal image showing the various relation along the anteroposterior extent of the diaphragm on right side.
 
Abdominal Causes
  • Subphrenic abscesses
    • In appropriate clinical setting usually history of surgery
    • USG shows—elevated hemidiaphragm
  • Reduced or absent movement of the ipsilateral diaphragm
    • Subdiaphragmatic anechoic or hypoechoic collection12
    • Usually ipsilateral pleural effusion present
  • Liver mass: Tumor, echinococcal cyst, abscess
  • Distended stomach or colon
  • Interposition of colon.
 
Diaphragmatic Hernia (Fig. 1.8.3)
  • USG may show the discontinuity of the dome of diaphragm
  • Bowel, spleen, kidney may be visualized inside thorax above dome of diaphragm
  • Contralateral displacement of heart is visualized
  • In congenital diaphragmatic hernia, polyhydramnios may be associated after 25 weeks.
 
Eventration of Diaphragm
  • Complete—more commonly on left
  • Partial—more commonly on right
  • Complete eventration of diaphragm can be diagnosed by ultrasound
  • Ultrasound in focal eventration shows evidence of typical focal diaphragmatic bulge filled by liver (Figs. 1.8.4 and 1.8.5).
 
Diaphragmatic Rupture
  • Traumatic—blunt or penetrating trauma
  • Infection—ruptured amebic liver abscess
  • In post-traumatic rupture in large, usually over 10 cm, defects ultrasound may detect—disruption of diaphragmatic echoes. Herniation of abdominal viscera into thorax-associated pleural effusion. Sometimes, small diaphragmatic rents may be difficult to detect, but due to availability of high frequency transducers, it is now possible to detect small disruption of diaphragmatic contour.
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Fig. 1.8.3: Diaphragmatic hiatus for inferior vena cava (IVC), esophagus and aorta. (PE: pleural effusion)
 
Neoplasms
  • Very rarely diaphragmatic neoplasms
  • Primary—various types of sarcomas
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    Fig. 1.8.4: Amebic liver abscess—a hypoechoic space-occupying lesion (SOL) is seen in the posterosuperior aspect of liver with evidence of posterior enhancement. It is extending into subdiaphragmatic space.
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    Fig. 1.8.5: Subdiaphragmatic collection—fluid collections with multiple internal septae is seen below the diaphragm.
    13
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    Fig. 1.8.6: Cystic lesion with internal membrane and daughter cyst in the lower lobe of right lung.
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    Fig. 1.8.7: Cystic lesion with internal membranes in the lower lobe of right lung with minimal subdiaphragmatic fluid. (PL: pleura; LIV: liver)
  • Various lung lesions like hydatid (Figs. 1.8.6 and 1.8.7)
  • Fibroma
  • Secondary—local invasion by adjacent pleural, peritoneal, thoracic and abdominal wall malignancies
  • Distant metastasis from bronchogenic or ovarian carcinoma
  • Wilms’ tumor and osteogenic sarcoma are less
  • More common on left side, due to protective effect of liver on right side
  • Part of diaphragm or entire diaphragm may be affected
  • May occur due to large pleural effusion or neoplasm, pushing the diaphragm downwards (Figs. 1.8.8 and 1.8.9)
  • May show little or asynchronous motion with respiration.
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Fig. 1.8.8: Transverse view—a large pleural effusion inverting the diaphragm can look like a large cyst. (L: liver; K: kidney)
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Fig. 1.8.9: Free-fluid seen in right pleural cavity with collapsed lung inside—note the inverted diaphragm.
Ultrasound should be the primary imaging modality to see for the cause of elevated diaphragm. In helps to give an etiology at many instances and could narrow down the differential diagnosis in others.