• SONO ELASTOGRAPHY (FREE HAND ELASTOGRAPHY AN

OVERVIEW)•CLITOROMEGALY•RANULA •CAPILLARY MALFORMATION•DIASTEAMATOMYELIA•FOREIGN BODY IN KNEE

DR ARUN GUPTA DIRECTOR IMAGING

DR RAKHEE GUPTADR VINAYAK MITTALDR NIHARIKA MAHAJANDR GAURAV SHARMADR RITESH MAHAJAN

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.

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.

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) .

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)..

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

HAEMANGIOENDOTHELIOMA

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

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 THELYMPHNODE ENLARGEMENT .

Focal lesions in breast with MOSIAC PATTERN OF COLOR ON ELASTOGRAPHY corroborative with Tsukuba score of two . ( S/O BENIGN ETIOLOGY ) .

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

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 .

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

RANULA 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 spaceplunging 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 .

RANULA

THIN WALLED HOMOGENOUS UNILOCULAR CYSTIC LESIONPRESENT 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

CAPILLARY MALFORMATION

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 .

Slow flow vascular malformations capillary malformation (CM) are

• Port-wine stain• Capillary telangiectasia

• capillary telangiectasia of the brain• Angiokeratoma

CLITOROMEGALY/ MACROCLITORIS

TRANS PERINEAL USG DONEIN 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).

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.

dsm_4.aviVIDEO 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.

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 .

REFERENCEDIAGNOSTICULTRASOUNDFOURTH EDITIONCarol M. Rumack, MD, FACRJ. William Charboneau, MD, FACRDeborah Levine, MD, FACR