Learning Imaging Series Editors: P.R. Ros • A. Luna • R. Ribes

Jose Luís del Cura • Pedro Seguí Carlos Nicolau (Editors)

Learning Ultrasound Imaging

JOSE LUÍS DEL CURA Servicio de Radiodiagnóstico Hospital de Basurto Bilbao Spain

CARLOS NICOLAU Servicio de Radiodiagnóstico (CDIC) Hospital Clinic Barcelona Spain

PEDRO SEGUÍ Servicio de Radiodiagnóstico Hospital Universitario Reina Sofía Córdoba Spain

ISBN 978-3-642-30585-6

ISBN 978-3-642-30586-3 (eBook)

DOI 10.1007/978-3-642-30586-3 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2012950865 © Springer-Verlag Berlin Heidelberg 2012 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

Contents

1

Abdominal Ultrasound CARLOS NICOLAU, PEDRO SEGUÍ, JOSE LUÍS DEL CURA, BLANCA PAÑO Case 1: Case 2: Case 3: Case 4: Case 5:

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Acute Cholecystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gallbladder Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . Gallbladder Adenomyomatosis . . . . . . . . . . . . . . . . . . Hepatic Metastases of Breast Carcinoma in Hepatic Steatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 6: Hepatic Hydatid Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . Case 7: Littoral-Cell Angioma of the Spleen . . . . . . . . . . . . . . Case 8: Mesenteric Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . Case 9: Mesenteric Metastases of Seminoma . . . . . . . . . . . . . Case 10: Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 11: Acute Colonic Diverticulitis . . . . . . . . . . . . . . . . . . . . Case 12: Anal Abscess and Fistula . . . . . . . . . . . . . . . . . . . . . . . Case 13: Ascites and Peritoneal Metastases of Colon Carcinoma . . . . . . . . . . . . . . . . . Case 14: Abdominal Wall Endometriosis . . . . . . . . . . . . . . . . . Case 15: Abdominal Wall Hernia . . . . . . . . . . . . . . . . . . . . . . . . Case 16: Renal Angiomyolipoma . . . . . . . . . . . . . . . . . . . . . . . . Case 17: Renal Cortical Necrosis . . . . . . . . . . . . . . . . . . . . . . . . Case 18: Nephrocalcinosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 19: Ureteral Lithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 20: Ureterocele . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 21: Bladder Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 42 44 48

Woman’s Imaging JOSE LUÍS DEL CURA, PEDRO SEGUÍ, ROSA ZABALA, MARTÍN VELASCO, GORANE SANTAMARÍA, XAVIER BARGALLÓ, ENRIQUE REMARTÍNEZ, CARMEN KRAEMER Female Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 1: Ovarian Functional Cysts. . . . . . . . . . . . . . . . . . . . . . . Case 2: Ovarian Teratoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 3: Ovarian Torsion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 4: Uterine Leiomyoma . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 5: Leiomyoma of the Fallopian Tube . . . . . . . . . . . . . . . Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 6: Diabetic Mastopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 7: Intracystic Papillary Carcinoma of the Breast . . . . . Case 8: Borderline Phyllodes Tumor . . . . . . . . . . . . . . . . . . . . Case 9: Nonpuerperal Breast Abscess . . . . . . . . . . . . . . . . . . .

52 52 54 56 60 62 64 64 66 68 72

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Contents

Obstetric Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 10: Extralobar Infradiaphragmatic Pulmonary Sequestration . . . . . . . . . . . . . . . . . . . . . . Case 11: Hypoplastic Left Heart Syndrome . . . . . . . . . . . . . . . Case 12: Branchio-Oto-Renal Syndrome. . . . . . . . . . . . . . . . . . Case 13: OEIS Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 14: Exencephaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

74 74 76 78 80 84 88

Musculoskeletal Ultrasound ANGEL BUENO, JOSE MARTEL, ANA SANZ Case 1:

Gastrocnemius Muscle Tear and Thrombosis of the Gastrocnemius Veins . . . . . . . . . . . . . . . . . . . . . Case 2: Achilles Tendon Rupture . . . . . . . . . . . . . . . . . . . . . . . Case 3: Myositis Ossificans . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 4: Morel-Lavallée Lesion. . . . . . . . . . . . . . . . . . . . . . . . . . Case 5: Primary Hydatid Cyst of the Skeletal Muscle . . . . . . Case 6: Massive Rotator Cuff Tear . . . . . . . . . . . . . . . . . . . . . . Case 7: Hand Angiomyoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 8: Giant Cell Tumor of the Tendon Sheath. . . . . . . . . . . Case 9: Subungual Glomus Tumor . . . . . . . . . . . . . . . . . . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

90 92 94 96 98 100 102 104 106 108

Small Parts PEDRO SEGUÍ, ELENA ELIZAGARAY, CARLOS NICOLAU, XIMENA WORTSMAN, ROSA ZABALA, JOSE LUÍS DEL CURA, MONTSERRAT DOMINGO Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 1: Hodgkin’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 2: Papillary Thyroid Carcinoma . . . . . . . . . . . . . . . . . . . Case 3: Medullary Thyroid Carcinoma . . . . . . . . . . . . . . . . . . Face . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 4: Pleomorphic Adenoma of Parotid Gland . . . . . . . . . Case 5: Warthin’s Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 6: Lymphoma of the Parotid Gland . . . . . . . . . . . . . . . . Case 7: Mucoepidermoid Carcinoma of the Submaxillary Gland . . . . . . . . . . . . . . . . . . . . . . Orbit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 8: Retinal Detachment . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 9: Vitreous Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . Case 10: Choroidal Detachment . . . . . . . . . . . . . . . . . . . . . . . . . Case 11: Optic Disc Drusen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 12: Choroidal Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . Testis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 13: Testicular Microlithiasis . . . . . . . . . . . . . . . . . . . . . . . . Case 14: Testicular Non-seminomatous Germ Cell Tumor . . Case 15: Testicular Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 16: Epididymo-orchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . .

110 110 114 116 118 118 120 122 124 126 126 128 130 132 134 136 136 140 142 144

Contents

Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 17: Hemangioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 18: Pilomatrixoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 19: Basal Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . Case 20: Plantar Wart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5

Infantile Hypertrophic Pyloric Stenosis . . . . . . . . . . Ileocolic Intussusception . . . . . . . . . . . . . . . . . . . . . . . Enteric Duplication . . . . . . . . . . . . . . . . . . . . . . . . . . . . Neutropenic Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . Partial Absence of Septum Pellucidum and Intracranial Hemorrhage . . . . . . . . . . . . . . . . . . . Case 6: Lymphatic Malformation . . . . . . . . . . . . . . . . . . . . . . . Case 7: Developmental Dysplasia of the Hip . . . . . . . . . . . . . Case 8: Subperiosteal and Intraosseous Abscesses . . . . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

170 172 174 176 178 180 182 184 186

Vascular BLANCA PAÑO, PEDRO SEGUÍ Case 1: Carotid Artery Stenosis . . . . . . . . . . . . . . . . . . . . . . . . Case 2: Carotid Artery Dissection . . . . . . . . . . . . . . . . . . . . . . Case 3: Carotid Intrastent Stenosis . . . . . . . . . . . . . . . . . . . . . Case 4: Temporal Arteritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 5: Deep Venous Thrombosis . . . . . . . . . . . . . . . . . . . . . . Case 6: Femoral Artery Pseudoaneurysm . . . . . . . . . . . . . . . . Case 7: Renal Artery Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . Case 8: Portal Vein Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

160 162 164 166 168

Pediatrics FERMÍN SÁEZ, ELENA ELIZAGARAY, JOSÉ MARTEL Case 1: Case 2: Case 3: Case 4: Case 5:

7

148 148 150 152 154 156

Thorax ROSA ZABALA, JOSE LUÍS DEL CURA Case 1: Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 2: Pulmonary Hydatid Cyst . . . . . . . . . . . . . . . . . . . . . . . Case 3: Pleural Rhabdomyosarcoma . . . . . . . . . . . . . . . . . . . . Case 4: Supraclavicular Schwannoma . . . . . . . . . . . . . . . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6

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188 192 196 198 200 202 204 208 212

Contrast Ultrasound TERESA FONTANILLA, CARLOS NICOLAU, JAVIER MINAYA, RAFAEL PÉREZ-ARANGÜENA, BLANCA PAÑO Case 1: Case 2: Case 3: Case 4:

Hepatic Hemangioma. . . . . . . . . . . . . . . . . . . . . . . . . . Hepatic Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hepatocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Focal Nodular Hyperplasia . . . . . . . . . . . . . . . . . . . . .

214 216 218 220

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Contents

Case 5: Renal Abscess in Complicated Acute Pyelonephritis . . . Case 6: Cystic Renal Cell Carcinoma . . . . . . . . . . . . . . . . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

222 224 226

Interventional Ultrasound JOSE LUÍS DEL CURA, ROSA ZABALA, IGONE KORTA Case 1: Case 2: Case 3:

Percutaneous Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . Drainage of a Hepatic Abscess . . . . . . . . . . . . . . . . . . Percutaneous Treatment of Severe Acute Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 4: Percutaneous Treatment of Severe Acute Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 5: Pleural Drainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case 6: Treatment of Shoulder Calcific Tendinitis . . . . . . . . . Case 7: Percutaneous Treatment of Paralabral Cyst . . . . . . . Case 8: Percutaneous Treatment of Pseudoaneurysms . . . . . Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

228 230 232 234 236 238 240 242 244

Contributors

Xavier Bargalló Servicio de Radiodiagnóstico (CDIC) Hospital Clinic Barcelona Spain

Teresa Fontanilla Servicio de Radiodiagnóstico Hospital Universitario Puerta de Hierro Majadahonda Spain

Angel Bueno Diagnóstico por Imagen Hospital Universitario Fundación Alcorcón Alcorcón Spain

Igone Korta Servicio de Radiodiagnóstico Hospital Basurto Bilbao Spain

Jose Luís del Cura Servicio de Radiodiagnóstico Hospital Basurto Bilbao Spain Montserrat Domingo Servicio de Radiodiagnóstico (CDIC) Hospital Clinic Barcelona Spain Elena Elizagaray Servicio de Radiodiagnóstico Hospital Basurto Bilbao Spain Simona Espejo Servicio de Radiodiagnóstico Hospital Universitario Reina Sofía Córdoba Spain

Carmen Kraemer Departamento de Enfermería Universidad de Granada Granada Spain Jose Martel Diagnóstico por Imagen Hospital Universitario Fundación Alcorcón Alcorcón Spain Javier Minaya Servicio de Radiodiagnóstico Hospital Universitario Puerta de Hierro Majadahonda Spain Carlos Nicolau Servicio de Radiodiagnóstico (CDIC) Hospital Clinic Barcelona Spain

x

Contributors

Blanca Paño Servicio de Radiodiagnóstico (CDIC) Hospital Clinic Barcelona Spain

Ana Sanz Diagnóstico por Imagen Hospital Universitario Fundación Alcorcón Alcorcón Spain

Rafael Pérez-Arangüena Servicio de Radiodiagnóstico Hospital Universitario Puerta de Hierro Majadahonda Spain

Pedro Seguí Servicio de Radiodiagnóstico Hospital Universitario Reina Sofía Cordoba Spain

Enrique Remartínez Departamento de Radiología Hospital General de Melilla Melilla Spain Fermín Sáez Servicio de Radiodiagnóstico Hospital Cruces Baracaldo Spain Gorane Santamaría Servicio de Radiodiagnóstico (CDIC) Hospital Clinic Barcelona Spain

Martín Velasco Servicio de Radiodiagnóstico (CDIC) Hospital Clinic Barcelona Spain Ximena Wortsman Departmento de Radiología Clinica Servet Facultad de Medicina Universidad de Chile Santiago Chile Rosa Zabala Servicio de Radiodiagnóstico Hospital Basurto Bilbao Spain

1

Abdominal Ultrasound Carlos Nicolau, Pedro Seguí, Jose Luís del Cura, and Blanca Paño

Although in developed countries the availability of CT and MRI equipments has made these techniques widely used, ultrasound is the most available image technique worldwide for the study of abdominal diseases. However, ultrasound is highly operator-dependent and the performance of the technique may be very variable even within the same health organization jeopardizing the confidence of the clinicians in the technique. Following the American College of Radiology Appropriateness Citeria, ultrasound is the most appropriate technique in adults for the evaluation of blunt abdominal trauma in unstable patient (FAST scan), jaundice, right upper quadrant pain, recurrent symptoms of stone disease, renal failure, acute abdominal pain and fever in pregnant patient and to assess gallstones in acute pancreatitis. Moreover, there are some conditions in which ultrasound is a useful alternative test: palpable abdominal mass, right lower quadrant pain, acute flank pain and hematuria. Also, it is the most used imaging technique to follow-up patients with liver cirrhosis. A very important advantage of ultrasound is that it is a technique that does not use radiation, iodinated contrast agents or gadolinium. Therefore it is the technique of choice for children and pregnant women in most abdominal pathologies. Thus, ultrasound has an important role in the management of abdominal diseases. New improvements like contrast ultrasound and elastography, together with the growing concern about the effects of radiation from CT scans and the rising cost of imaging tests, will probably lead to a even further increase.

J.L. del Cura et al. (eds.), Learning Ultrasound Imaging, Learning Imaging, DOI 10.1007/978-3-642-30586-3_1, © Springer-Verlag Berlin Heidelberg 2012

Introduction

2

Carlos Nicolau, Pedro Seguí, Jose Luís del Cura, and Blanca Paño

Case 1: Cholelithiasis

Fig. 1.1.1

Fig. 1.1.2

Abdominal Ultrasound

3

A 48-year-old female complained of digestive disorders and dyspepsia. She related occasional pain in the right upper quadrant of the abdomen. An ultrasound exam was performed.

Case Presentation

Ultrasound is the first choice technique for any pain in the upper right quadrant of the abdomen and, also, the most reliable when gallbladder pathology is suspected. Biliary pathology is very frequent with a 10 % of the population having gallstones, usually asymptomatic. Cholelithiasis is more frequent in women, and its incidence increases with age and in obese persons. A third of the patients with cholelithiasis develop biliary colic: the painful expulsion of the biliary calculi. In some cases, the gallstone become impacted in the bile duct and obstructs it, causing obstructive jaundice. The gallstones can also obstruct the cystic duct eventually followed by inflammation and infection of the gallbladder, causing cholecystitis. Ultrasound has a sensitivity of 95 % and a negative predictive value of 97 % for the diagnosis of cholelithiasis. The characteristic sonographic appearance of a gallstone is a mobile, usually multiple, hyperechogenic image with acoustic shadowing, within the gallbladder. When all these criteria are met, the image is pathognomonic. When the gallbladder is full of stones or there is lithiasis occupying the entire lumen, the classic appearance may be changed into the sign of the “double-arch shadow”: two echogenic curved and parallel lines separated by a thin anechoic space, with acoustic shadowing. The differential diagnosis should be made with the biliary sludge—which does not produce an acoustic shadowing—and with cholesterolosis (concretions of cholesterol attached to the wall of the gallbladder). The lack of mobility and their location, attached to the gallbladder wall, allow differentiating this later condition from cholelithiasis.

Comments

Ultrasound exam (Figs. 1.1.1 and 1.1.2) showed multiple echogenic images with posterior acoustic shadowing (arrowheads) in the gallbladder. These images were mobile, moving to the most dependent portion of the gallbladder. These images are characteristic of cholelithiasis.

Imaging Findings

4

Carlos Nicolau, Pedro Seguí, Jose Luís del Cura, and Blanca Paño

Case 2: Acute Cholecystitis

Fig. 1.2.1

Fig. 1.2.2

Fig. 1.2.3

Case Presentation

A 66-year-old man with a 3-day history of right upper quadrant pain was admitted to the hospital. He had severe leukocytosis but no fever.

Comments

Acute cholecystitis results from obstruction of the gallbladder neck or cystic duct with inflammation of the gallbladder wall. Approximately 95 % of the cases result from obstruction due to gallstones. Acute cholecystitis manifests