In this radiology lecture, we review the ultrasound appearance of intersection syndrome, a friction tenosynovitis at the forearm and wrist!
Key teaching points include:

* Intersection syndrome is an overuse tenosynovitis (inflammation of tendon and tendon sheath) secondary to repetitive friction at site of intersection
* Proximal intersection syndrome: Occurs at musculotendinous junctions of first extensor wrist compartment (extensor pollicis brevis, abductor pollicis longus) crossing tendons of second compartment (extensor carpi radialis brevis, extensor carpi radialis longus). Intersection occurs 4-8 cm proximal to Lister’s tubercle
* Results from repetitive extension/flexion activities: Rowing, skiing, racket sports, horseback riding, weight-lifting
* Clinical presentation: Radial forearm or wrist pain, worsens with extension/flexion
* Ultrasound findings: Pain with transducer pressure at intersection site, peritendinous edema and fluid
* Distal intersection syndrome: Less common, occurs at third compartment tendon (extensor pollicis longus) crossing second compartment tendons distal to Lister’s tubercle
* Tx: Rest, activity modification, splinting, anti-inflammatory medications. Corticosteroid injection or surgical release may be required if refractory

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
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This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound appearance of giant cell tumor of the tendon sheath!
Key teaching points include:

* AKA tenosynovial giant cell tumor, localized nodular tenosynovitis
* 2nd most common mass of hand & wrist after ganglion cyst
* Most common at volar aspect of first 3 digits. Less commonly at wrist, ankle, foot, knee
* On ultrasound, usually homogeneously hypoechoic with well-defined lobulated margins
* Closely associated with tendon, but will not move with tendon = Arises from tendon sheath, not tendon itself
* May show posterior acoustic enhancement, but internal vascular flow typically present
* Usually benign. Can be locally aggressive, rarely malignant. Tx: Surgical excision
* Fibroma of the tendon sheath has a similar ultrasound appearance and location but is less common. Benign. Tx: Surgical excision

References:

* Middleton WD, Patel V, Teefey SA, Boyer MI. Giant cell tumors of the tendon sheath: analysis of sonographic findings. AJR Am J Roentgenol. 2004;183(2):337-339.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
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This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

In this radiology lecture, we review the ultrasound and CT appearance of submandibular stone disease, together with floor of mouth anatomy!
Key teaching points include:

* Submandibular glands are paired salivary glands located inferior to body of mandible
* Submandibular glands are intermediate in size compared to the larger parotid and smaller sublingual glands, and they do not contain lymph nodes
* The submandibular duct (= Wharton’s duct) extends from gland hilum and travels superiorly to open at floor of mouth on either side of base of frenulum of tongue. The duct is not typically seen unless abnormally dilated
* On ultrasound, normal submandibular glands appear as encapsulated structures with homogeneous echotexture similar to the parotid. Fine linear echodensities may be present representing intraglandular ductules. Physiologic intravascular flow is typically evident. Superficial portion of the gland is almond-shaped, deep portion triangular
* Sialolithiasis = Salivary calculous disease. Most common in submandibular gland because gland secretes a more alkaline, viscous saliva, and the long submandibular duct drains uphill = Increased salivary stasis
* With acute obstruction, gland becomes enlarged (= sialadenitis) and duct proximal to stone dilated. Presents with colicky pain most pronounced around times of eating
* US can detect even radiolucent stones, but small stones may not shadow
* At the floor of mouth, the submandibular space (SMS) and sublingual space (SLS) are divided by mylohyoid musculature = Inferior sling of mouth. SMS is below (inferolateral to) mylohyoid, and SLS is above (superomedial to) mylohyoid
* SMS contains: Submandibular glands, lymph nodes, anterior belly of digastric muscle
* SLS contains: Sublingual glands, submandibular duct, and anterior aspect of hyoglossus muscle
* Remember that while the submandibular glands are in the submandibular space, the submandibular duct is located in the sublingual space!
* The submandibular duct travels between the hyoglossus and mylohyoid muscles, which are both useful sonographic landmarks aiding in duct location

References:

* Ching AS, Ahuja AT. High-resolution sonography of the submandibular space: anatomy and abnormalities. AJR Am J Roentgenol. 2002 Sep;179(3):703-8.
* Grewal JS, Jamal Z, Ryan J. Anatomy, Head and Neck, Submandibular Gland. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

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In this radiology lecture, we review the ultrasound appearance of trigger finger!
Key teaching points include:

* Pulleys are fibrous retinacula on ventral finger that secure flexor tendons to phalanges preventing tendon displacement and bowstringing with finger flexion
* Finger has 5 annular pulleys. Odd-numbered at joints, even-numbered at phalanges: A1, A3, A5 are located about the MCP, PIP, DIP joints, respectively. A2 is located at the proximal phalanx, and A4 at the middle phalanx
* Cruciform pulleys lie between annular pulleys, but are not usually well-seen on ultrasound
* Trigger finger, also known as stenosing tenosynovitis, is characterized by impaired flexor tendon movement due to thickened pulley leading to tendon constriction
* Most common at A1 pulley, but can also occur at A2/A3 pulleys, palmar aponeurosis (A0) and wrist
* Symptoms: Triggering/locking when flexed, painful snapping when extended, pain, joint stiffness
* Most common in female patients, history of diabetes mellitus, and rheumatoid arthritis
* Often idiopathic, can occur with repetitive microinjury (flexion-extension). Can also be post-traumatic or due to compressive mass/cyst
* Tx: Splinting, NSAIDs, US-guided corticosteroid injection, surgical release
* A1 pulley thickness cutoff = 0.62 mm*. Mean normal thickness = 0.5 mm, range with trigger finger 1.1-2.9 mm**. Comparison with asymptomatic side helpful
* Additional findings: Pulley hyperemia, nodular tendon thickening (tendinosis) or tear, buckling of flexor tendon on dynamic imaging, “dark tendon” sign (anisotropic hypoechogenicity due to tendon constriction), synovial sheath effusion (acute), and peri-pulley cyst/cystic degeneration

References:

* *Spirig A, Juon B, Banz Y, Rieben R, Vogelin E. Correlation between sonographic and in vivo measurement of A1 pulleys in trigger fingers. Ultrasound Med Biol 2016; 42:1482–1490.
* **Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, Feydy A, Drapé JL. Sonographic appearance of trigger fingers. J Ultrasound Med. 2008 Oct;27(10):1407-13.
* Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. J Ultrasound Med. 2019 Dec;38(12):3141-3154.
* Shohda E, Sheta RA. Misconceptions about trigger finger: a scoping review. Definition, pathophysiology, site of lesion, etiology. Trigger finger solving a maze. Adv Rheumatol. 2024 Jul 11;64(1):53.

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Ultrasound of Hydrosalpinx, Pyosalpinx & Tubo-ovarian Abscess
In this radiology lecture, we review the ultrasound appearance of hydrosalpinx, pyosalpinx and tubo-ovarian abscess!
Key teaching points include:

* Hydrosalpinx = Fluid-filled, blocked fallopian tube
* Hydrosalpinx causes: Pelvic inflammatory disease (most common), endometriosis, prior surgery, adhesions
* Hydrosalpinx US: Thin-walled, tubular structure filled with anechoic simple fluid. Dilated tube may fold upon itself forming tubular C-shaped or S-shaped cystic mass. Incomplete septations common
* With chronic hydrosalpinx, may see “beads-on-a-string” sign: Short, round, 2-3 mm projections seen along inner tubal walls in cross section = Flattened, fibrotic remnants of endosalpingeal folds. Don’t confuse with solid mural nodules
* O-RADS US v2022 management of hydrosalpinx = Imaging: None. Clinical: Gynecologist
* Pyosalpinx: Inflamed, blocked fallopian tube filled with purulent debris. Indicates pelvic inflammatory disease
* Pyosalpinx US: Thick-walled tubal structure filled with complex fluid. Like hydrosalpinx, typically conforms to a C or S-shape
* “Cogwheel” sign of pyosalpinx: Thickened endosalpingeal folds with surrounding tubal wall thickening. Typical of acute tubal inflammation
* Tubal wall hyperemia more common with pyosalpinx than hydrosalpinx
* Tubo-ovarian complex (TOC): With severe salpingo-oophoritis, ovary and tube adhere to each other. Can distinctly identify ovary from tube but cannot separate the two with transducer pressure. Tx: Antibiotics
* Tubo-ovarian abscess (TOA): As pelvic inflammatory disease progresses, complete or near-complete loss of adnexal architecture with pockets of purulent fluid develop. Multiloculated mass with septations, irregular margins, may be bilateral. Tx: Antibiotics, percutaneous drainage, surgery

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In this radiology lecture, we review the ultrasound appearance of adenomyomatosis of the gallbladder!
Key teaching points include:

* Common cause of benign gallbladder wall thickening seen in up to 9% of patients
* Incidence increases with age
* Usually asymptomatic, but may be associated with sporadic RUQ pain
* Hyperplastic changes of gallbladder wall with mucosal overgrowth. Mucosal herniations protrude into muscular layer forming tiny, bile-filled cystic spaces = Rokitansky-Aschoff sinuses
* If large, sinuses may appear as discrete cystic spaces in gallbladder wall
* Cholesterol crystals in sinuses cause comet-tail reverberation artifact: Most common finding and highly specific for adenomyomatosis. Can exaggerate comet-tail with addition of color Doppler
* Three types: Focal/fundal, segmental/annular and diffuse. Regardless of type, comet-tail artifacts and/or cystic spaces are key to diagnosis
* Focal/fundal type: Most common. Often exhibits an “ovary on the gallbladder” appearance. Can be confused with a gallbladder mass. High-frequency linear transducer may be helpful to identify morphology
* Segmental/annular type: Narrows waist of gallbladder yielding a figure 8 or hourglass configuration. Gallstones and/or sludge often form in proximal lumen due to increased stasis
* If necessary, MRI helpful for problem solving: T2 hyperintense pearl necklace/string of beads appearance sensitive and specific

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In this radiology lecture, we review the ultrasound appearance of de Quervain’s Tenosynovitis!
Key teaching points include:

* Stenosing tenosynovitis of first extensor compartment tendons = Extensor pollicis brevis (EPB) and abductor pollicis longus (APL)
* Second most common hand entrapment tendinopathy after trigger finger
* Most common in middle-aged females
* Associations include repetitive hand motions, pregnancy, arthritis, and trauma
* Clinical presentation: Pain with thumb and wrist movement, tenderness and swelling at radial styloid
* Positive Finkelstein maneuver may be present: Grasp thumb, ulnar deviate hand = Pain over distal radius
* Ultrasound findings: Increased fluid in EPB/APL tendon sheath (tenosynovitis), hypoechoic, edematous tendon thickening (tendinosis), and thickening of extensor retinaculum (comparison scanning of contralateral thumb helpful)
* Advanced findings: Impaired tendon movement, tendon tear (anechoic clefts), retinacular and peritendinous hyperemia
* Don’t confuse normal APL slips with longitudinal tear (“lotus root” sign)
* Important to identify variant intertendinous septa: Helps to properly guide steroid injection, increased incidence of asymmetric EPB involvement
* If conservative therapy fails, surgical decompression may be required. More likely when septum present

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In this radiology lecture, we review the contrast-enhanced ultrasound appearance of hepatic hemangioma!
Key teaching points include:

* Microbubble contrast agents are gas-filled microspheres with a lipid or protein shell
* Sulfur hexafluoride lipid-type A microspheres: Inert gas of six fluoride atoms bound to one sulfur atom, surrounded by a phospholipid shell
* Similar in size to red blood cells, unique when compared to the molecular sizes of CT and MR imaging contrast agents. Small enough to cross capillary beds, too large to enter interstitial space = Pure intravascular agents, ideal for assessing vascularity and perfusion
* After IV injection, US contrast agents half-life is about 10 minutes (eliminated via lungs). Multiple injections possible in a single session
* Contrast-enhanced US (CEUS) has high contrast resolution: Can visualize individual microbubbles and depict a minute amount of flow = Differentiate avascular debris from small solid nodules in complex cysts. Negative predictive value of CEUS in excluding the presence of flow in a lesion is close to 100%
* CEUS also has high temporal resolution: Effectively eliminates motion artifact, a major source of artifact on CT and especially MRI scans. In elderly or debilitated patients, or when there is any other cause of motion, CEUS may be the contrast-enhanced modality of choice
* Accuracy and specificity of CEUS for the diagnosis of hepatic hemangioma approaches 100%
* Mechanical index (MI) = Measure of acoustic power output. At high MI, microbubbles burst. At low MI, microbubbles are preserved and have a nonlinear response to US, unlike other tissues which have a linear response. Allows for creation of a vascular-only image
* Hemangioma has peripheral discontinuous globular enhancement in arterial phase. Progressive centripetal contrast filling and iso- or hyperenhancement in portal venous and late phase
* Non-hepatocellular malignancy typically demonstrates early (less than 1 minute) and/or marked washout
* Hemangioma filling may be partial or complete depending on lesion size

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In this radiology lecture, we review the ultrasound appearance of tennis leg, including medial gastrocnemius and plantaris injury!
Key teaching points include:

* Tennis leg = Injury to muscles of the calf. Tear of myotendinous junction of medial head of gastrocnemius, rupture of plantaris tendon (less common), in isolation or together
* Classically described in tennis players, but can occur in various athletic activities (running, skiing) with extension of knee and forced dorsiflexion of ankle. Typically seen in middle-aged, active individuals
* Clinical: Sudden sharp calf pain with associated popping/snapping sensation followed by tenderness and swelling
* Gastrocnemius & soleus are pennate muscles. Fascicles attach obliquely to a tendon = Aponeuroses with long length of musculotendinous junction. Feathers converging on a single point
* Triceps surae muscle = Two headed gastrocnemius, soleus and plantaris. Distal continuation of the gastrocnemius and soleus forms the Achilles tendon
* Distal medial head of gastrocnemius where tapers over soleus = One of most commonly injured calf structures
* Medial gastrocnemius tear appears as disrupted tendon fibers at aponeurosis with anechoic/hypoechoic fluid or hemorrhage +/- muscle retraction
* May see retracted muscle fascicles. Hematoma can dissect between and extends into medial gastrocnemius and soleus muscles
* Tx: Conservative (self-limiting). Surgical fasciotomy if compartment syndrome
* Plantaris muscle arises from the posterosuperior aspect of lateral femoral condyle near lateral head origin of gastrocnemius muscle. Medially crosses posterior knee joint in oblique fashion
* Plantaris continues into calf as a long, thin tendon traveling between medial head of gastrocnemius and soleus muscles. Courses distally at medial aspect of Achilles tendon, usually inserts onto calcaneus. Plantaris is absent in up to 20%
* Plantaris injury/rupture less common than medial head gastrocnemius tear and typically more proximal in calf (at myotendinous junction)

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In this radiology lecture, we review the ultrasound appearance of interstitial ectopic pregnancy!
Key teaching points include:

* Interstitial ectopic pregnancies are rare, occurring in proximal (interstitial) portion of fallopian tube within muscle wall of uterus
* Much less common than tubal ectopic pregnancy occurring in the more distal ampullary and isthmic portions of fallopian tube
* Interstitial ectopic pregnancies are important because higher morbidity and mortality due to later presentation and risk of life-threatening hemorrhage
* Abnormally eccentric gestational sac with thin surrounding myometrium: less than 5 mm myometrial thickness highly suspicious
* “Interstitial line” sign: Thin echogenic line extending from endometrial cavity to ectopic gestational sac. Thought to represent interstitial portion of tube separating the ectopic pregnancy from the endometrium
* Medical: Systemic MTX, may also be injected into gestational sac
* Surgery: Cornual wedge resection when ruptured versus hysterectomy
* Can be confused with angular pregnancy: Rare, intrauterine pregnancy with implantation eccentrically high at the lateral angle of uterine cavity. More medial than interstitial ectopic pregnancies. No interstitial line sign, and greater than 5 mm thickness of overlying myometrial mantle
* Angular pregnancy can result in normal pregnancy, but increased risk of miscarriage and uterine rupture. Should be followed closely to ensure growth towards endometrial cavity
* Angular pregnancy is sometimes referred to as a “cornual pregnancy,” but controversial as earliest use of term cornual pregnancy refers to intrauterine implantations in anomalous unicornuate, bicornuate or septate uteri. To avoid confusion, best to specifically describe whether the gestational sac is intrauterine or ectopic

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In this radiology lecture, we review the ultrasound appearance of ovarian serous cystadenocarcinoma!
Key teaching points include:

* Serous cystadenocarcinoma is the common ovarian malignancy and most common ovarian epithelial tumor
* High-grade and low-grade types
Peak incidence 6th-7th decades
* Ultrasound appearance: Mixed cystic and solid mass with papillary projections and thick septations
* Elevated CA-125 in greater than 90%
* Serous tumors are more commonly bilateral than other tumors
* Four main categories of ovarian neoplasms: Epithelial (most common), germ cell (second most common), sex cord-stromal and metastases
* Epithelial ovarian tumors are thought to originate outside the ovary (within fallopian tube or endometrium) and involve ovary secondarily
* Epithelial ovarian tumor types: Serous, mucinous, endometrioid, clear cell and Brenner
* 60% of epithelial tumors are benign: Unilocular with thin wall or thin septations (less than 3 mm in thickness)
* 40% of epithelial tumors are malignant or borderline: Papillary projection (distinctive feature of epithelial tumors) with thick, irregular wall or septations (greater than 3 mm in thickness). Can also present as a large soft tissue mass with necrosis. Advanced findings include peritoneal implants, pelvic wall invasion, adenopathy and ascites

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In this radiology lecture, we review the ultrasound appearance of parathyroid adenoma!
Key teaching points include:

* Benign tumor of the parathyroid glands
* Most common cause of primary hyperparathyroidism: Elevated serum calcium and parathyroid hormone (PTH) levels
* Ultrasound: Solid, homogeneous and very hypoechoic. Oval or bean-shaped, long axis oriented craniocaudal. Hypervascular. Majority posterior and inferior to thyroid. Hyperechoic line often separates adenoma from adjacent thyroid. Atypical features: Cystic degeneration, calcification.
* Tc-99m sestamibi: Radiotracer uptake persisting on delayed 2-hour images. Taken up by both thyroid and parathyroid tissue, but washes out more rapidly from thyroid. Greater than 90% predictive value for preoperative localization of parathyroid adenoma. SPECT aids with anatomic localization
* Ectopic locations in up to 5%: Lower neck, mediastinum, retrotracheal/retroesophageal, carotid sheath and intrathyroidal (typically more homogeneous than thyroid nodules and have a linear interface with gland)
* Larger adenomas can be multilobulated
* “Polar vessel” sign: Enlarged feeding artery or draining vein terminating at parathyroid adenoma

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In this radiology lecture, we review the ultrasound appearance of parotitis in the pediatric population!
Key teaching points include:

* Parotitis = Inflammation of the parotid glands
* Acute parotitis is usually infectious, most commonly viral
* Mumps is most common viral cause in children, often bilateral
* Bacterial parotitis can cause suppurative parotitis seen in premature infants and immunosuppressed children
* Acute parotitis on US: Enlarged, heterogeneous, hyperemic gland(s) +/- lymphadenopathy
* Since can be bilateral, comparison scanning essential
* Bacterial parotitis may be complicated by abscess
* “Pomegranate sign” may be seen in setting of acute parotitis: Uniform anechoic foci scattered throughout the gland
* Juvenile recurrent parotitis (JRP) = Recurrent inflammatory parotitis in children of unknown etiology
* JRP is rare, but second most common cause of parotitis in childhood after mumps
* JRP often begins between age 3-6, typically resolves spontaneously after puberty
* Usually idiopathic, JRP can be presenting symptom of Sjogren’s syndrome, lymphoma, and underlying immunodeficiency
* JRP on US: May be unilateral or bilateral, multiple hypoechoic foci of salivary secretions scattered throughout the gland +/- central calcifications, color Doppler can be normal
* Additional causes of parotitis: Sialolithiasis/obstruction, autoimmune (Sjogren syndrome, chronic sclerosing sialadenitis), infectious (HIV, TB), and sarcoidosis (rare in children).

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In this radiology lecture, we review the ultrasound appearance of sublingual dermoid cyst and explain floor of mouth anatomy!
Key teaching points include:

* The floor of the mouth is a horseshoe-shaped area beneath tongue and in between sides of mandible, inferiorly bounded by mylohyoid muscle, and containing sublingual space (SLS)
* SLS medial border: Midline genioglossus/geniohyoid muscle complex; SLS inferolateral border: Mylohyoid muscle
* Anterior margin of hyoglossus muscle projects into posterior SLS
* Sublingual dermoid cyst is a rare, benign cyst with squamous epithelial lining and contains skin appendages
* Dermoid and epidermoid cysts are in same family, terminology often used interchangeably, although epidermoid cysts less common and tend to contain fluid contents only
* Dermoid cyst mean age of presentation late teens to twenties, average age 30
* Presents as a slowly enlarging neck mass, may cause dysphagia
* Often round or oval in shape and homogeneously hypoechoic with punctate echogenic foci
* May have pathognomonic “sack of marbles” appearance
* Relationship to mylohyoid is key for surgical planning: Intraoral resection for sublingual (above mylohyoid) location, extraoral approach for submental/submandibular (below mylohyoid) location
* Most cysts are midline
* DDx: Suprahyoid thyroglossal duct cyst, ranula (simple and diving), abscess and lymphangioma

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In this radiology lecture, we review the ultrasound appearance of carpal tunnel syndrome!
Key teaching points include:

* Most common upper extremity entrapment neuropathy. Results from median nerve compression
* With carpal tunnel syndrome, see hypoechoic enlargement of the median nerve as enters carpal tunnel with flattening of nerve = Notch sign, also volar bowing of flexor retinaculum
* Median nerve area: Less than 8 mm2 = Normal; 8-12 mm2 = Borderline; greater than 12 mm2 = Abnormal
* Most accurate to compare nerve area at proximal pronator quadratus muscle and carpal tunnel: Increase of 2 mm2 or more from proximal to distal = 99% sensitive and 100% specific for carpal tunnel syndrome. Measure inside the echogenic epineurium
* Bifid median nerve: Normal variant in 15% of population, one trunk may take aberrant course through flexor digitorum superficialis musculature, and often associated with persistent median artery between the two trunks
* Important to recognize persistent median artery pre-operatively because could be damaged during surgery
* For diagnosis of carpal tunnel syndrome with bifid median nerve: Combined increase of 4 mm2 or more
* After carpal tunnel release surgery, median nerve may return to normal diameter or remain enlarged regardless of clinical outcome. Retinaculum may appear thickened or disrupted
* Carpal tunnel syndrome can be caused by extrinsic compression by a mass, ganglion cyst, or tenosynovitis

Reference: Klauser AS, Halpern EJ, De Zordo T, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-177.
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In this radiology lecture, we review the ultrasound appearance of ganglion cysts while highlighting relevant wrist ultrasound anatomy!
Key teaching points include:

* Ganglion cysts are viscous, mucin-filled collections lacking a synovial lining
* Most commonly occur at hand/wrist = Most common wrist mass
* Location: Dorsum of wrist (60%), frequently adjacent to scapholunate ligament; volar wrist (20%), often between radial artery and flexor carpi radialis tendon; flexor tendon sheath (10%); associated with DIP joint (10%)
* Grows out of tissues surrounding joint like a balloon on a stalk. May see a pedicle connecting to joint
* Usually well-defined and multilocular, can be unilocular
* Hypoechoic to anechoic with posterior acoustic enhancement
* Noncompressible: Dorsal joint recess and bursal collections will typically collapse with transducer pressure or wrist movement
* Typically no vascular flow, but septations may have vascularity. May see pulsation artifact from adjacent radial artery
* Volar cysts can extend towards median nerve and may cause carpal tunnel syndrome
* May displace or envelop radial artery
* Tx: Watchful waiting, percutaneous US-guided aspiration and steroid injection, excision
* Lister’s tubercle is a useful landmark for dorsal wrist anatomy
* Relevant dorsal extensor tendons (from radial side to ulnar): Compartment 2 = Extensor carpi radialis longus, extensor carpi radialis brevis, Compartment 3 = Extensor pollicis longus (on ulnar side of Lister’s tubercle), Compartment 4 = Extensor digitorum and extensor indicis
* Flexor carpi radialis overlies the ventral aspect of the scaphoid bone
* Pisiform and scaphoid bone form the proximal “twin peaks” of the carpal tunnel at the ventral wrist crease
* Median nerve diameter increase of 2 mm2 or more = Significant compression

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
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Radiologist Headquarters has a new name: Radquarters! Same high-yield content, but now with a streamlined name that’s easier to remember.
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
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In this radiology lecture, we review the ultrasound appearance of acute epididymitis and orchitis!
Key teaching points include:

* Epididymitis = Inflammation of epididymis. Usually bacterial, most commonly due to retrograde ascent from bladder or prostate.
* Causative infectious agent varies based on age: Adults younger than 35: Neisseria gonorrhoeae, Chlamydia trachomatis (STDs). Adults older than 35: E. coli & other coliform bacteria.
* Non-infectious causes of epididymitis: Trauma, repetitive activities such as sports (most common causes in males prior to sexual maturity), torsed appendix testis or appendix epididymis, vasculitis, and medications (amiodarone).
* Presentation: Gradual onset of scrotal pain, swelling & urinary symptoms. Must exclude testicular torsion (usually more acute onset of pain).
* Epididymitis US findings: Epididymal enlargement, hyperemia, hypoechogenicity. Hyperemia usually precedes grey scale changes. Infection usually spreads from tail to body and head.
* 20-30% of epididymitis cases have associated orchitis: Scrotal infection typically starts with epididymis then spreads to testis, scrotal sac, or scrotal wall.
* Orchitis is less common than and usually secondary to epididymitis. Isolated orchitis uncommon, usually viral (mumps).
* Orchitis US findings: Testicular enlargement, hyperemia and hypoechogenicity.
* Complications: Scrotal wall inflammation, complicated hydrocele, pyocele (purulent fluid collection with mass effect), abscess (epididymal, testicular, scrotal wall), testicular ischemia and infarct due to obstructed venous outflow (decreased color Doppler testicular blood flow or reversed testicular diastolic arterial flow).

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
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In this radiology lecture, we review the ultrasound appearance of acute cholecystitis, including gangrenous and emphysematous cholecystitis!
Key teaching points include:

* Acute cholecystitis = Acute gallbladder inflammation.
* Most often (95%) caused by an impacted, obstructing gallstone in the cystic duct or gallbladder neck = Acute calculous cholecystitis.
* Clinically presents as persistent RUQ pain that may radiate to right shoulder, often with N/V and fever.
* Ultrasound findings of uncomplicated acute cholecystitis: Gallstones, sonographic Murphy sign, gallbladder wall thickening (greater than 3 mm) and edema, gallbladder distention (greater than 4 cm short axis), and pericholecystic fluid.
* Sonographic Murphy sign = Maximal abdominal tenderness from transducer pressure over gallbladder. PPV of gallstones and a positive sonographic Murphy sign = 92%.
* Pericholecystic fluid occurs in less than 20% of patients with acute cholecystitis, usually seen in more advanced cases.
* Gangrenous cholecystitis = Most common complication of acute cholecystitis. Ischemia with necrosis of gallbladder wall. Increased mortality compared to uncomplicated acute cholecystitis.
* Ultrasound findings of gangrenous cholecystitis: Wall disruption, ulceration, mucosal irregularity, and/or focal bulge, sloughed mucosal membranes, pericholecystic fluid, less likely to have positive Murphy sign, and increased risk of perforation (usually at fundus).
* Emphysematous cholecystitis = Gallbladder wall necrosis with gas formation in wall and/or lumen. More common in elderly men with underlying diabetes. Higher risk of perforation, rapid progression, and increased mortality compared to uncomplicated acute cholecystitis. Emergent surgical intervention typically required.
* Ultrasound findings of emphysematous cholecystitis: Bright reflectors from nondependent portions of gallbladder wall, dirty posterior acoustic shadowing, and ring-down artifact. CT can confirm if necessary.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
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In this radiology lecture, we review the ultrasound appearance of ileocolic and small bowel-small bowel intussusception in children!
Key teaching points include:

* Intussusception occurs when bowel is pulled into itself or into neighboring bowel.
* Intussusceptum is the prolapsing bowel pulled into intussuscipiens which receives the bowel.
* Two major types: Ileocolic and small bowel-small bowel.
* If ileocolic not reduced = Bowel ischemia and perforation.
* Most occur in children beyond 3 months of age.
* Usually no lead point in children (unlike adults), suspected that due to hypertrophic lymphoid tissue after infection.
* Clinical triad of colicky abdominal pain, vomiting, palpable abdominal mass seen in less than 50% of cases.
* Red-currant jelly stool = Stool mixed with blood and mucus, can be seen with bowel ischemia.
* Ultrasound gold standard in diagnosis: Sensitivity and specificity 98%, false negative rate less than 1%.
* “Target” sign (short axis) and “pseudokidney” sign (long axis) may be seen.
* Findings suggesting ileocolic (as opposed to small bowel-small bowel) intussusception: Location in right lower quadrant with absent normal ileocolic junction, hyperechoic center indicating mesenteric fat, diameter of hyperechoic core greater than outer wall, lymph nodes inside intussusception, larger AP diameter greater than 2 cm, and longer length greater than 3 cm.
* Treatment of ileocolic intussusception: Enema with air or contrast material.
* Findings suspicious for ischemia/necrosis and increased risk of enema reduction failure: Fluid trapped within the intussuscipiens, lack of internal vascular flow on Doppler within the intussusceptum, and irregular bowel wall or decreased bowel wall vascularity.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
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