Benefits of Ultrasound Diagnostics.
- Evaluation of all organs ... Changes in size, shape, structure ... presence of nodules or masses.
-
Generates clear pictures of soft tissues which do not show up well on X-rays.
- Non-Invasive, no needles involved, painless.
- Widely available, easy-to-use.
- Relatively low cost compared to other diagnostics.
- No radiation.
- Time scan pictures can be provided.
- Obstetric ultrasound .. a useful diagnostic tool .. considered to be a safe, non-invasive, accurate and cost effective way of monitoring the development of the growing baby.
- Cleft lips and palates, congenital heart abnormalities, Down syndrome, spina bifida and other conditions can be identified at this stage.
- Placental abnormalities, the amount of amniotic fluid and other conditions such as ovarian cyst can also be detected in ultrasonography.
- Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children.
- Point-of-Care Ultrasound is More Accurate than the Stethoscope in Diagnosing Pneumonia in Children.
- Ultrasounds could replace radiography for detecting pneumonia in children.
- Ultrasound Biofeedback Helps Speech Therapy.
Dangers:
- The biggest danger from ultrasound imaging is the over- or under- diagnosing brought about by inadequately trained staff, often working in isolation or using poor equipment.
- No definitive diagnosis without fine needle aspirations (FNA) or biopsies.
Products: Ultrasound-Equipment.
INDEX
http://www.alibaba.com/Color-Doppler-Ultrasound-Equipments_pid100009344
Verified Supplier - Guangzhou Yueshen Medical Equipment Co., Ltd.
Top 3 Markets: --- Africa 60.70%, Mid East 18.00%, South America 9.00%
Experience: Established 2003
Min.Order Quantity: 1 Set/Sets ultrasound
Supply Ability: 1000 Set/Sets per Month ultrasound
Port: Guangzhou
Payment Terms: L/C,T/T,Western Union,MoneyGram
(There are many models and sizes of devices on the AliBaba site, $250 to $30,000+)
Ultrasound Scanner YSB0115
http://www.alibaba.com/product-detail/portable-ultrasound_848464976.html
Quick Details
Type: Doppler Ultrasound Equipment
Brand Name: YSENMED
Model Number: YSB0115
Place of Origin: Guangdong China (Mainland)
Palmsmart Ultrasound Scanner NO.: YSB0115
Scanning Method: Convex, Micro-convex, Linear, rectal
Gray Scale: 256 levels
Monitor: 6.4 inch TFT color LCD
Image Processio: DFS, DRF, RDA, VGA/DSC and Image Post Procession
Packaging Detail: standard export package
Delivery Detail: within 15 workdays after payment
Features:
Palmsmart YSB0115, weighing only 1.3KG, is distinguishable by its bright and clear image quality.
The interchangeable probes offer a wide range of diagnostic applications.
This scanner is a cost effective solution for family doctors, veterinary scanning.
The complete software and the high product versatility are available in it.
Technical specifications:
·Scanning Method: Convex, Micro-convex, Linear, rectal
·Display Mode: B, B+B, B+M, M
·Gray Scale: 256 levels
·Monitor: 6.4 inch TFT color LCD
·Image Procession: DFS, DRF, RDA, VGA/DSC and Image Post Procession
·128 frames for cine-memory
·32 image permanent storage
·Image magnification: ×1.0, ×1.2, ×1.5, ×2.0 times
·4 focusing combination selectable
·4 different coded-color available
·15 difference kinds of body marks with difference calipers.
·Measurement in Distance, Circumference/Area, Time/Heart Rate/EF rate for heart,
and GS, CRL, BPD, HC, FL, AC for OB/GY measurement, and Gestational Age, Fetal weight, EDD calculation.
·Characteristic showing in real-time clock, ID, Sex, Age, Focusing Info and Gain (Near, Far, Overall) info.
·PAL-D output
·Mouse interface
Probes:
R40/3.5MHz multi-freq convex
Standard configuration:
Main unit + one 3.5MHz convex probe
Listing : Private Clinics in B.C.
INDEX
http://www.findprivateclinics.ca/
North Shore Medical Imaging
604 998 1113 --- 604 984 8395
139 West 16th Street
Vancouver British Columbia
Canada V7M 1T3
Our other location:
#110 - 575 16th Street West
Vancouver, BC V7V 4Y1
Phone: 604 922 9141 --- Fax: 604 922 6348
email: info@nsmi.ca
False Creek Health Care Centre
... in downtown Vancouver, ...
604-739-9695 --- 604-709-9676 --- 1-800-815-9338
555 W. 8th Ave. 6th floor
Vancouver British Columbia
Canada V5Z 1C6
North Shore Medical Imaging
North Vancouver
139 West 16th Street
Our other location:
North Vancouver, BC V7M 1T3
Phone: 604 987 9729 --- Fax: 604 984 8395 --- email: info@nsmi.ca
604 922 9141 --- 604 922 6348
#110 - 575 16th Street
Vancouver British Columbia
Canada V7V 4Y1
Fraser Valley MRI Clinic
An independent clinic providing MRI services with no wait list and with lowest prices.
Friendly professional staff. Report provided in 2-3 working day ...
604-859-1707 --- 604-859-1747 --- 1-888-788-4MRI
5-2151 McCallum Road
Abbotsford British Columbia
Canada V2S 3N8
Schedule: Services, Fees.
INDEX
http://www.canadadiagnostic.com/info/fees?r=sb
All prices are quoted in Canadian dollars. ...
We accept American Express, MasterCard, Visa or debit cards.
Canada Diagnostic Centres
604-709-8522 Phone:
877-709-8522 Toll Free:
604-709-6112 Fax:
info@canadadiagnostic.com
Ultrasound
All exams $500
1.5 Tesla MRI
Most single area, routine exams cost $900.
The price of your scan will be dependent on the time needed for your scan, complexity and whether or not an injection of contrast is required.
The price of your scan will be confirmed once we have received your doctor's referral and supporting information.
Below is an example of our most common MRI scan fees
$900 Brain
$900 Spine (per segment: cervical, thoracic or lumbar)
$900 Joints (per ankle,elbow,wrist,shoulder,knee,hip)
$1400 Arthrograms (incl contrast)
$1600 Abdomen (incl contrast)
$1100 Breast (implant assessment)
$1900 Breast (cancer staging)
64-slice CT
Diagnostic Scans
$600 Routine, non-Contrast
$1100 With IV Contrast
Dental Scans
$300 Mandible OR Maxilla
$450 Mandible AND Maxilla
Article: How to Read an Ultrasound Picture.
INDEX
0-Ultrasound/arts/How to Read an Ultrasound Picture-5 Steps (WikiHow).html
Online: http://www.wikihow.com/Read-an-Ultrasound-Picture
Obstetric ultrasound has been a useful diagnostic tool since the 1950s and is considered to be a safe, non-invasive, accurate and cost effective way of monitoring the development of the growing baby. Real-time scanners are used today to show a continuous picture of the moving fetus on a monitor screen, to be interpreted by experts as they look for important medical information. ....
-
Understand the difference between the colors.
A sonogram or ultrasound picture is a black and white photograph, which can be a little confusing to interpret at first. Once you appreciate that black is liquid and white is solid, it is easier to see the details of your baby.
The more solid the tissue, the whiter it will appear on the ultrasound,
for example, bones are light grey or white and the placental fluid will be black.
-
Determine the orientation of the picture.
In a longitudinal image, the mother's head would be on the left of the picture.
In transverse images, the mother's head would be at the top of the picture.
The next thing to look for is whether the fetus is head down, towards the cervix or whether it is in the breech position, with feet down.
Look for the spine to see if the fetus is facing left or right, as this makes it easier to determine the position of internal organs.
-
Look for identifying characteristics of your baby.
- The baby's gender can be determined from the beginning of the second trimester.
Sometimes the baby does not cooperate and a leg gets in the way and you have to wait for the baby to move or for the transducer to be moved to a different angle.
- The details of the baby's head and face can be seen at this stage quite clearly and you can distinguish cheeks, eyelids, nose, lips and chin, and sometimes hair is already visible on the baby's head.
-
A visible heartbeat can be seen as early as six weeks and this is an important indication of fetal health as the pregnancy develops. It is also an indication of the gestational age of the fetus, which helps the calculation of the due date.
-
Identify any structural abnormalities.
Your doctor or health care provider also takes fetal body measurements to monitor the size and growth of the baby, and the first sonogram gives parents an opportunity to identify any structural abnormalities.
- Abnormalities.
Cleft lips and palates,
congenital heart abnormalities,
Down syndrome,
spina bifida and
other conditions can be identified at this stage.
- Placental abnormalities, the amount of amniotic fluid and other conditions such as ovarian cyst can also be detected in ultrasonography.
-
Finished.
Tips
The newer technology of Doppler ultrasound is being commonly used to assess and monitor the fetus' growth and heart rate. More recently, 4D or dynamic 3D scanners have been introduced onto the market giving an even clearer image of the baby's facial features and movements before birth.
There is no hard and fast rule about the number of scans a woman should have.
The 18 to 20 week scan is becoming a matter of routine practice; doctors order further scans if anomalies are detected. Every now and then, articles appear in magazines suggesting harmful effects of diagnostic ultrasound but these have never been proved in larger studies. Whether all women should undergo ultrasound screening and whether such screening improves outcomes is still controversial. The American College of Obstetrics and Gynecology states that routine screening is not mandatory, but is reasonable in patients who request it.
Warnings
- Studies have shown that ultrasounds are not always reassuring for an expectant mother and anxiety actually increases until the scan is interpreted and fears are allayed. Mothers' interpretations of their scans depended on their personal and social circumstances and feedback from the operator needs to be in language that is not unfamiliar or alarming to the mothers.
- The biggest danger from ultrasound imaging is the over- or under- diagnosing brought about by inadequately trained staff, often working in isolation or using poor equipment. There is a wide difference in the skill, training, talent and interest of sonographers, so parents should be aware that reading a sonogram is not a 100% diagnosis. Reported figures range from 40 to 98 percent accuracy so a normal scan cannot be an absolute guarantee that the baby is normal, as some abnormalities are very difficult to detect. The position of the baby in the uterus has a great deal to do with how certain organs, such as the heart, may be seen.
- Experience:
Bear in mind that it may take several months or years training for an ultrasound technician to become expert and to understand the process well. Parents should be happy to have their image of a healthy growing baby, even if it is difficult to appreciate all the information in the scan and they should certainly rely on the experts when it comes to interpreting the scientific details.
-Basics-: How to read an ultrasound image.
INDEX
0-Ultrasound/arts/Ultrasound Basics-How to read an ultrasound image(EI).html
Online: http://www.eimedical.com/blog/bid/76503/
Ultrasound-Basics-How-to-read-an-ultrasound-image
Posted by Mia Varra on Tue, Mar 27, 2012
Have you ever looked at an ultrasound image and wondered "What" are you looking at?
Ever wonder which end is up? When others are discussing Bull or Heifer, ovarian diagnosis, or metritis treatment are you still looking to decide "What" it is?? Well, if you feel left in the dark when it comes to ultrasound images .. let's start back at the basics.
Ultrasound is a non-invasive, immediate tool used to image tissue.
It will not penetrate bone (like an X-Ray).
So the first step to help you read the ultrasound image is to be familiar with the anatomy that you are imaging.
Various body tissues conduct sound differently.
Some tissues absorb sound waves while others reflect them.
The density of the tissue dictates the speed at which the echoes return.
If you remember that FLUID is always BLACK and TISSUE is GRAY.
The denser the tissue, is the brighter white it will appear in ultrasound the brightest white being bone.
Remember, the more images you see the easier and clearer they will become.
Of course, choosing the right ultrasound equipment from a creditable company should also be an important decision.
ADDITIONAL:
Other causes for increased .. echogenicity include
acute cortical necrosis,
chronic glomerulonephritis,
Alport syndrome,
prolonged hypercalcemia or
hypercalciuria,
ethylene glycol poisoning, and
sickle cell disease.
Acoustic shadowing can occur because of the intensity of the renal echoes or development of renal stones.
-Video-: Abdominal Ultrasound (Sonography), Mark Guenin, M.D., 4.28 min
INDEX
0-Ultrasound/mp4/abdominal-ultrasound-explained.mp4
Online: http://www.radiologyinfo.org/en/info.cfm?pg=abdominus
Radiology.info.org
High frequency sound waves are used to create sonar-like images of solid and fluid-filled organs.
Reasons used:
- Diagnostic
- Why a patient has abdominal pain.
- Abdominal liver blood tests.
- Enlarged abdominal organ.
- Stones in the gallbladder or kidney.
- Aneurisym in the abdominal aorta.
- Guidance for Biopsy procedures.
Refrain from eating for 8 to 12 hours before the procedure.
Drink 4 to 6 glasses of water an hour before a kidney exam.
Doppler ultrasound can measure and show blood flow.
Pictures are taken and then interpreted by a radiologist.
Benefits:
- Generates clear pictures of soft tissues which do not show up well on X-rays.
- Non-Invasive, no needles involved, painless.
- Widely available, easy-to-use.
- Relatively low cost compared to other diagnostics.
- No radiation.
- Time scan pictures can be provided.
Disadvantages:
- Cannot penetrate or leap across gas pockets.
-
Cannot image hollow or empty digestive tract, stomach, small or large intestine, and other similar areas.
- Can be difficult to do on oversized and fatty patients.
Article: Sonographic Mimics of Renal Calculi.
INDEX
0-Ultrasound/pdf/Mimics--Renal Calculi.pdf --- 7 pg PDF
Durr-e-Sabih, MBBS, MSc, Ali Nawaz Khan, MBBS, FRCP, FRCR,
Marveen Craig, RDMS, Joseph A. Worrall, MD, RDMS
2004 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 2004; 23:1361--1367 . 0278-4297/04/$3.50
Online: http://www.medicinenet.com/script/main/art.asp?articlekey=6141
Objectives.
To review sonographic findings that can mimic renal calculi. ..
Results.
There are a number of sonographic renal artifacts, vascular and nonvascular, that may confound a correct diagnosis.
Conclusions.
Awareness of these potential artifacts will result in a more specific sonographic examination and will accurately
guide the referring physician toward appropriate patient treatment. The importance of other imaging modalities is also emphasized to ensure that a correct diagnosis is obtained whenever the sonographic findings are inconclusive.
Renal calculous disease is a frequent cause of lumbar pain, ...
Proper sonographic technique usually allows visualization of most calculi larger than 5 mm.
When imaging smaller renal calculi; however, recognition and diagnostic accuracy are less clear, and such stones may be missed or misdiagnosed because of the presence of many inherently bright intrarenal noncalculous echoes. This review concentrates on those bright echoes that represent sonographic artifacts, normal or common (anatomic) renal structures that may mimic renal calculi.
Normal or calcified renal vessels are the most notable and common causes of intrarenal bright echo reflectors.
The kidneys are among the most vascular organs within the body; they can even be considered to form physiologic
arteriovenous shunts. The renal volume of both kidneys is approximately 300 mL, and they are perfused by the equivalent of 25% of cardiac output, which can be up to 1.5 L. It is not surprising that, with so many vessels, some may present orthogonally to an ultrasound beam and may appear more echogenic than the background parenchyma, and some of these normal vessels, imaged at just the right angle, may appear as small, brightly reflective "specks."
Some of these renal vessels appear in predictable locations and in a recognizable pattern, thus allowing their identification as "nonstones." A brief review of renal vascular anatomy shows that each renal artery divides into 5 segmental arteries, with each segmental artery subsequently dividing into interlobar arteries. Segmental arteries often cross the papillae at right angles, with the division frequently occurring very near the medullary pyramids. The interlobar arteries travel along the sides of the renal pyramids and, at the level of the pyramidal base, give off parallel arcuate arteries.
... Renal Cortical Calcification
There are a variety of causes that produce renal cortical calcification, shown as increased cortical echogenicity and shadowing, and that may mimic calculi. Some of these causes include acute tubular necrosis, chronic glomerulonephritis, Alport syndrome, oxalosis, rejected renal transplants, and chronic neoplastic hypercalcemia.
... Current imaging algorithms in the developed world use CT as an initial imaging modality for diagnosis of possible renal calculi. However, these algorithms have changed fairly rapidly during the last few years. Examples of the changing recommendations include the following:
1. 1992, Plain abdominal radiography and sonography should replace intravenous urography;
2. 1993, Intravenous urography should be added to the protocol if radiography and diagnostic sonography are inconclusive; and
3. 1995, Unenhanced helical CT should replace urography.
There are limits to the size of stones that can be sonographically detected, depending on resolution and probe frequency, as well as the type of stone, its location, patient habits, and hydration. Whenever a nondiagnostic study is
performed, a useful tactic is to repeat the sonographic examination after overhydrating the patient to produce mild splitting of the renal sinus and to make the diagnosis easier.
Expecting to be able to detect submillimeter calculi on sonography is fraught with danger, and many false-positive diagnoses may be made. Five millimeters appears to be the cutoff size at which we can confidently expect to see renal calculi. Under experimental conditions, some authors have reported sensitivity of 2 mm, but most consider 5 to 7 mm to be the smallest visible size on sonography.
For detection of smaller stones, diagnostic confidence levels vary with operator expertise, machine sophistication, stone location, and patient anatomy. The sensitivity of sonography for diagnosing small renal stones varies from 24% to 96%. Helical CT has consistently been shown to have superior sensitivity.
Muscular pain due to mechanical injury is a very common cause of flank pain and affects approximately 85% of Americans during their lifetime. Patients with acute lumbar pain might have a renal stone, but renal stone disease is not invariably present. In one series, only 67% of patients had a renal stone related cause of acute lumbar pain, and, of
these, only 66% had a correct diagnosis by sonography. Helical CT has nearly perfect sensitivity for detecting small stones and is excellent for diagnosing nonstone causes of flank pain. However, helical CT is not universally available,
has a considerable radiation burden, and uses iodinated contrast agents. A combination of history, sonography, and plain and contrast-enhanced radiology might have to suffice in this imperfect situation.
The diagnostic approach to renal colic has recently been changed because of the introduction of new noninvasive radiologic procedures such as Doppler sonography, non-contrast-enhanced CT and magnetic resonance imaging. However, sonography remains the initial imaging procedure of choice in many cases because it is widely available, inexpensive, and noninvasive and does not rely on ionizing radiation or contrast agents.
Article: Better diagnosis of parasitic infections
via ultrasound enrichment of rare cells.
INDEX
https://phys.org/news/2014-03-diagnosis
-parasitic-infections-ultrasound-enrichment.html
LINK 2: https://phys.org/pdf315216903.pdf
by Angewandte Chemie
March 28, 2014
Parasitic infections like malaria and sleeping sickness affect hundreds of millions of people, primarily in the poorest regions of the world. Diagnosis of these diseases is often difficult because the concentration of parasites in the blood can be very low. British scientists have now developed a simple chip-based method for enriching rare cells in blood samples. As they report in the journal Angewandte Chemie, this allows the detection limit for the parasites that cause malaria and sleeping sickness to be lowered by two to three orders of magnitude.
Existing techniques for the separation and enrichment of parasites in blood samples are difficult to use in isolated regions and developing countries because they usually require complex chemistry for labeling cells, costly instruments, or extensive infrastructure. An inexpensive technique that requires only small amounts of power, works without labeling the cells, and uses just a drop of blood from a fingertip, is needed. A team headed by Jonathan M. Cooper at the University of Glasgow has now developed such an approach. Their innovative method is based on an acoustically controlled microchip that is used in a battery-driven, hand-held device. The researchers successfully used their technique to enrich malaria-infected blood cells and the parasite that causes sleeping sickness in blood samples.
The chip contains a special electrode that produces ultrasound when a voltage is applied.
If a drop of liquid is placed in a specific location on the device, the form of the acoustic field elicits a particular pattern of flow within the drop: a circular rotational motion. Particles whose density is lower than that of the liquid are carried against gravity with the upward rising current and transported toward the outer edge of the drop, where they accumulate. In contrast, particles with a higher density collect in the center of the droplet, because they cannot be lifted up.
This works for cells too.
Red blood cells infected with the malaria parasite are less dense than non-infected cells.
If the density of the drop of blood being examined is adjusted by simply adding a small amount of reagent, the acoustic chip allows the infected red blood cells to be concentrated by a factor of one hundred to one thousand at the outer edge of the blood drop. The non-infected red blood cells remain at the center of the drop.
The method is also suitable for concentrating free-swimming parasites in blood.
The researchers were able to enrich trypanosomes, the pathogens that cause sleeping sickness, by using their acoustic chip. Simple staining techniques then make it possible to detect the parasites.
In the future, the technique may be adapted to allow other infectious diseases and rare circulating tumor cells to be detected more readily use of this new technology.
More information:
Bourquin, Y., Syed, A., Reboud, J., Ranford-Cartwright, L. C., Barrett, M. P. and Cooper, J. M. (2014),
"Rare-Cell Enrichment by a Rapid, Label-Free, Ultrasonic Isopycnic Technique for Medical Diagnostics."
Angew. Chem. Int. Ed. DOI: 10.1002/anie.201310401
LINK: http://dx.doi.org/10.1002/anie.201310401
Article: Parasites of the Liver – epidemiology, diagnosis
and clinical management in the European context.
INDEX
https://www.sciencedirect.com/science/article/pii/S016882782100115X
pdf LINK: https://www.sciencedirect.com/science/article/pii/...main.pdf
Lynn Peters, Sanne Burkert, Beate Grüner
University Hospital of Ulm,
Department of Internal Medicine III,
Division of Infectious Diseases,
Albert-Einstein-Allee 23, 89081 Ulm, Germany
(
There are many detailed charts referencing parasites to symptoms.
There are 140 references, many with downloadable PDF versions.
There are also numerous example images of relevant scans.)
albendazole (ABZ)
benzimidazole (BMZ)
anthelmintic drugs (BMZ, possibly combined with praziquantel)
Abstract
Parasites in the liver cause significant global morbidity and mortality, as they can lead to recurrent cholangitis, cirrhosis, liver failure and cancer. Due to climate change and globalisation, the incidence is increasing, especially in Europe. Correct diagnosis is often delayed because clinicians are unfamiliar with respective entities. Therefore, this review aims at providing a clinical picture of hepatic parasites for clinicians, in order to bring these neglected parasitic liver diseases into the spotlight of hepatologic stakeholders in Europe.
1. Introduction
The liver is crucially involved in various parasitic infections.
For orally transmitted parasites, such as Echinococcus spp., liver flukes, Ascaris lumbricoides and Entamoeba histolytica, it is the first solid organ encountered after mucosal penetration, either directly or with the portal-venous blood flow. Other parasites reach the liver after the larvae penetrate the skin (schistosomiasis).
Recently, it has been argued that the liver offers a favourable immunological environment for parasites, as tolerance instead of immunity is the preferred immunological response to exogenous microorganisms. In addition, parasites have evolved complex mechanisms to alter the host’s immune response to overcome defence mechanisms. This allows for parasitic maturation (flukes) or proliferation (Echinococcus spp., amoebiasis) in the hepatic tissue.
Although hepatic parasites cause a significant global burden of disease, therapeutic options are limited, vaccines are not expected to be available soon due to the complex immunology and low economic incentive. Furthermore, the clinical presentation is often non-specific or asymptomatic, hampering diagnosis. In this review, we want to provide clinical guidance by presenting the most important parasitic infections of the liver, with the main epidemiological focus on Europe. Other parasitic infections such as visceral leishmaniasis, malaria, cryptosporidiosis or toxoplasmosis can also affect the liver, however, they usually cause a systemic inflammation and are hence not the main focus of this review. Table 1 summarises differential diagnoses of hepatic parasites from a clinical perspective, parasitological details are listed in table 2.
2. Hepatopathic Helminths
2.1. Cestodes of the liver: Echinococcus spp.
Human echinococcoses are zoonoses caused by the larval forms (metacestodes) of the cestode species (spp.) of the genus Echinococcus. Cystic echinococcosis (CE), caused by E. granulosus sensu lato, exceeds alveolar echinococcosis (AE), caused by E. multilocularis, in prevalence and geographic distribution. AE is restricted to the northern hemisphere within temperate climate zones. Central Asia has the highest prevalence of both diseases. In Europe, CE is endemic in Mediterranean and Eastern countries, while AE occurs in Western-Central, Baltic, and Eastern countries, as depicted in figure 1.
Echinococcoses have a substantial global public health impact.
Both AE and CE are considered orphan diseases, yet account for approximately 871,000 disability-adjusted life years (DALYs), which is still assumed to be largely underestimated. Despite their non-tropical distribution, echinococcoses are considered Neglected Tropical Diseases (NTDs). Due to scant data, diagnosis and treatment are guided by expert consensus led by recommendations of the WHO-IWGE (Informal Working Group on Echinococcosis), which are currently under revision. An ‘international consensus on terminology to be used in the field of echinococcosis’ was recently published to harmonise globally used terms.
Echinococcus spp. depend on different mammals to complete their life cycles:
adult worms live in the small intestines of carnivores, their definite hosts, such as dogs or foxes. Matured eggs are released with their faeces and can be ingested by a suitable intermediate host (e.g. small rodents for E. multilocularis and ungulates for E. granulosus), where the eggs hatch and the larvae penetrate the intestinal wall. After migration with the host’s circulation and further maturation, Echinococcus spp. develop as lesions in different organs. The consumption of cyst-containing organs re-infects definite hosts and closes the parasitic life cycle. Humans act as so-called accidental intermediate hosts, acquiring the infection by ingestion of infective eggs and represent a dead-end host. Based on this life cycle, public health approaches for protecting the vulnerable population require basic hygiene regarding animal contact, sheep vaccination (CE), deworming domestic dogs (CE and AE) or fox-baiting with praziquantel (AE), as well as screening based on risk factors.
Although often discussed together, CE and AE are two distinct chronic diseases with different clinical features and treatment approaches: CE is generally considered benign with clearly delimited cystic lesions, yet causing a substantial medical and economic impact due to the cosmopolitan distribution. In contrast, AE develops as lesions formed by micro-cysts, appearing more solid and tumour-like, with the potential to infiltrate and metastasise, for which it is termed a malignant parasitosis. Therefore, diagnostic and clinical management should be carefully distinguished and left to specialist care. In this review, we discuss aspects of the (changing) epidemiology, clinical features, diagnostics and treatment of CE and AE in the European context.
2.1.1. Echinococcus granulosus sensu lato (cycstic Echinococcosis)
2.1.1.1. Epidemiology
Human CE is highly endemic in pastoral communities worldwide where close contact between humans, livestock and dogs is common. ...
2.1.1.2. Clinical features
Approximately 60–75% of CE cases are incidental findings, especially during the early stages of infection. Most CE-cases are diagnosed in adulthood. CE cysts can occur in all organs, but mostly affect the liver (70%), lungs (20-30%) or both. Depending on site and size of manifestations, symptoms result from compression or displacement of healthy tissue. Accordingly, patients may present with upper abdominal discomfort and biliary obstruction caused by cystobiliary fistula, leading to jaundice and/or cholangitis. Further complications include cyst rupture, inducing fever, urticaria, eosinophilia and anaphylaxis. ..
2.1.1.3. Diagnostics
The diagnosis of CE is primarily based on imaging techniques.
Serology can be useful to confirm the diagnosis of CE in unclear cases, but has a variable sensitivity: false-negative results are frequent in case of young, inactive or extra-hepatic cysts; a positive serology does not correlate with viability, as it can persist for years even after curative surgery and is hence inappropriate for follow-up.
Ultrasound (US) is the standard investigation for the diagnosis of hepatic CE.
Pathognomonic US (Ultrasound) features of CE cysts are listed in table 3.
The depicted classification based on cyst’s morphology, size, number and localisation allows to differentiate between active, transitional and inactive cysts and guides further management.
Other imaging techniques of hepatic CE lesions include magnetic resonance imaging (MRI) and computerised tomography (CT), which are mainly used for pre-operative evaluation or in case of complications; for diagnosis and follow-up of CE patients, they play a secondary role.
(TESTING)
Ultimately, if a case remains unclear, parasitological confirmation can be achieved by cytological examination of cyst material for brood capsules or protoscoleces, or by molecular analysis. Cyst puncture in suspected CE should only be done with both benzimidazole (BMZ)-pretreatment and precaution for possible anaphylactic reaction.
2.1.1.4. Treatment
Clinical decision-making for uncomplicated liver CE is based on US (Ultrasound) staging.
The goals of hepatic CE treatment are the complete elimination of viable parasitic cells, prevention of recurrence and consequently minimising mortality and morbidity. To achieve these aims, no "one-size-fits-all" approach exists, and the appropriate clinical management must be chosen considering disease-specific characteristics (cyst stage, number, size, site and presence of complications, cf. Table 3) and the patient’s clinical conditions, as well as local medical and surgical expertise.
There are currently four different management options available:
a) surgery,
b) percutaneous treatment,
c) medical treatment with anthelmintic drugs (BMZ, possibly combined with praziquantel), and
d) watch and wait for inactive cysts.
Surgery is the first therapeutic choice for large and complicated cysts,
i.e. cysts at risk of rupture or if fistulation or infection occurs. For CE2 and CE3b cysts, surgery should be evaluated.
For CE1 and CE3a cysts, percutaneous treatment is an option, aiming at the destruction of the germinal layer, either by performing puncture, aspiration, (injection and re-aspiration) (PA(IR)) or through the evacuation of the entire endocyst (modified catheterization technique). Excluding cysto-biliary fistulae before injecting any scolecidal agent is mandatory to prevent complications. Further findings restricting the feasibility of percutaneous aspiration are a subcapsular or extrahepatic localisation, as it increases the risk of leakage and dissemination into the adjacent cavity, CE2 and CE3a stage, and a previous history of hypersensitivity after cyst manipulation.
Small cysts may respond to medical therapy alone and thus do not justify the procedure-related risk. Medical treatment with BMZ, preferably albendazole (ABZ), is used to induce cyst inactivation, resulting in CE4 cyst resemblance, and is most effective in small CE1 and CE3a cysts, but often fails in the case of large cysts.
Recurrence is observed most commonly in conservatively treated CE2 and CE3b cysts.
BMZs are only parasitostatic, hence, regular sonographic follow-up is required to detect recurrence orreactivation promptly. If a solid stage is reached spontaneously, reactivation is rare. Despite the mentioned drawbacks, BMZ treatment remains the main treatment option in disseminated or inoperable CE.
In case of invasive procedures, prophylactic BMZ is required to avoid secondary echinococcosis potentially arising from spillage of viable larvae (brood capsules or protoscoleces). BMZ should be administered at least one day before and continued for at least 1-3 months after the procedure [11,35]. Praziquantel might enhance the effect of ABZ and is therefore recommended in some centres for peri-interventional prophylaxis [39].
2.1.2. Echinococcus multilocularis (Alveolar Echinococcosis)
2.1.2.1. Epidemiology and clinical impact
Human alveolar echinococcosis (AE) is the most lethal parasitic zoonosis in Europe.
If left untreated, the 10-year mortality rate can reach 90%. AE is considered an emerging disease, with an annual incidence of approximately 18,000 cases globally, of which 91% occur in China. In Europe, cases in the hitherto endemic area of Central Europe (France, Switzerland, Germany and Austria) are increasing in number. Moreover, the geographical distribution is expanding to countries previously considered AE-free like Poland, Slovakia, Hungary and the Baltic region, challenging respective health care systems.
Key risk factors for acquiring AE in Europe are being a farmer, owning a dog or cat or having a kitchen garden. Furthermore, the incidence of AE is higher among immunodeficient patients, who often show atypical presentations. A genetic susceptibility associated with an altered immune response was observed
2.1.2.2. Clinical presentation
Due to the slow growth of AE larvae, first symptoms can arise after several years of latency.
European patients are often older than 50 years and AE in children is rare.
Interestingly, in China, the average age at first diagnosis is significantly younger compared to Europe, and disease is often advanced, requiring a more invasive treatment approach.
Early symptoms are mostly non-specific including fatigue, abdominal pain or jaundice. One third of all cases is asymptomatic and diagnosed incidentally. Upon diagnosis, parasitic liver lesions are often extensive and infiltrate neighbouring structures, limiting treatment options. Common complications are
- portal vein thrombosis with consecutive portal hypertension,
- biliary duct obstruction with a risk for cholangitis and
- bacterial superinfection
in advanced lesions with considerable necrosis.
Since AE has the potential to metastasise, further symptoms depend on the organs involved.
2.1.2.3. Diagnosis
Diagnosis of AE is multimodal, based on clinical presentation along with epidemiological data, typical imaging signs, and serological tests. One finding on its own might be misleading, ... Serologic and histologic ormolecular confirmation is central. A two-step approach is recommended, using a high sensitivity screening test followed by a more specific confirmatory test, resulting in both high sensitivity and specificity of nearly 100% [63]. Still, there might be cross-reactivity with CE resulting in misinterpretation. Confirmation of AE can be achieved by histopathological examination including specific immunohistochemistry or nucleic acid detection in a clinical sample. An US (Ultrasound)-guided 0core-needle biopsy is an effective diagnostic tool to achieve a definitive diagnosis in hepatic AE. Based on the respective findings, AE can be classified as possible, probable or confirmed, defining the requirement of treatment
The morphology of AE lesions in different imaging modalities is shown in table 5.
US (UltraSound) is an important tool, yet findings are not pathognomonic, as opposed to CE.
Its main significance lies in the early detection of an often irregular lesion with a mixed echogenic pattern, calcification and an undefined margin, triggering further diagnostics. Other lesions show a resemblance with haemangiomas or metastases. Contrast-enhanced US (Ultrasound) (CEUS) may facilitate the confirmation of AE, since respective lesions do not show central contrast enhancement.
In contrast to CE, AE lacks a cystic appearance.
Therefore, sonographic diagnosis is often challenging for clinicians unfamiliar with the disease.
A CT, particularly for heavily calcified lesions, or MRI scan of the abdomen are the imaging techniques of choice. In analogy to the TNM-classification, a PNM-classification can be deduced from imaging to guide treatment (cf. Table 4). Staging is completed by a chest x-ray and a cerebral CT. Alternatively, a [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) can be combined with a full-body CT-scan. FDG enrichment surrounding AE lesions is interpreted as larval metabolic activity and can serve as a follow-up tool. ...
2.1.2.4. Treatment
The key concept of AE treatment is a multidisciplinary approach and requires ‘personalised medicine’.
... The curative approach consists of radical surgery, completely removing all lesions including satellite lesions, followed by a 2-year course of BMZ. ... remarkable regression of AE liver lesions under strict BMZ treatment can be seen, allowing for complete surgical resection after months or even years (unpublished data). ...
However, upon diagnosis, the majority of patients is inoperable due to the involvement of liver vessels or bile ducts and therefore need long-term, mostly life-long BMZ-treatment. Under sufficient BMZ-treatment, FDG-uptakes should decrease or even vanish, corresponding to a suppressed periparasitic inflammatory activity. ....
2.1.2.5. Follow-Up and complications
All AE patients should be monitored by US (Ultrasound) at frequent intervals and by PET/CT and/or MRI every 2-3 years to evaluate disease recurrence or progression. Monitoring serology after surgery and/or BMZ-therapy is useful, as surgical removal of the lesion may result in seronegativity. After several years of BMZ treatment in stable AE without complications, a structured treatment interruption can be discussed.
Biliary complications, such as obstruction causing jaundice and cholangitis, are common in AE and occur in 10-30 % of patients. Especially late biliary complications (after more than 3 years of treatment) are associated with high mortality. Patients with acute complications might require hospitalisation for endoscopic interventions and antibiotic treatments. ...
2.2. Trematodes of the liver
Trematodes, or flukes, are flatworms which contain a snail in their life cycle.
They cause significant global morbidity and mortality, as they can lead to fibrosis, cirrhosis and cancer.
In recent years, especially foodborne trematodes have been on the rise, with an increase both in incidence and geographical distribution (cf. Figure 2). Currently, trematodes are leading to 200,000 illnesses annually and over 7,000 deaths ...
2.2.1. Fasciola hepatica and Fasciola gigantica
Fascioliasis can be caused by the flatworms Fasciola hepatica and Fasciola gigantica.
It is a widely spread zoonosis and ruminants serve as natural definite hosts. Human fascioliasis mainly occurs in rural areas where sheep and cattle husbandry is common. The animals’ excreta contain eggs that, if released into freshwater, hatch and infect water snails, the intermediate host. After maturation and multiplication, larvae are released into the water and develop into metacercariae, which encyst attaching to aquatic plants. With the ingestion of respective plants, the larvae reach the small intestine, penetrate the wall and migrate through the peritoneum and heaptic tissue to the bile ducts, where they mature and produce eggs, closing the infectious cycle. Human infections are caused by undercooked water plants (e.g. watercress), plants that need frequent irrigation and are manured with animal excreta and, to a lesser extent, by contaminated drinking water. ...
2.2.2. Clonorchis sinensis, Opisthorchis viverrini and Opisthorchis felineus
The so-called small liver flukes of the families Clonorchis and Opisthorchis are mainly spread in Asia.
Eggs are excreted into freshwater with the faeces of dogs, cat, birds, reptiles or other definitive hosts. Larvae hatch and infect water snails, the first intermediate host, where they multiply. They ultimately leave the snail and penetrate the skin of their second intermediate host, mainly fish, where they encyst within the muscular tissue. After consumption, the larvae are released within the definitive host’s digestive tract and migrate to the liver using the bile duct. Humans act as accidental definitive hosts and infections occur after consumption of poorly cooked fish. Thus, populations that depend on fishing as a livelihood are particularly affected. Salting, drying, marinating or short-time freezing does not affect the viability of the larvae. ...
2.2.3. Schistosoma mansoni and S. japonicum
According to the WHO, approximately 240 million people are infected with schistosomes globally.
As a water-based NTD, endemic areas are found in tropic and subtopic climate zones on every continent, mainly in Sub-Saharan Africa and South America. The infectious cycle requires freshwater contact: different water snails, the intermediate hosts, release cercariae into the water which penetrate human skin, migrate through the lungs as immature schistosomulae and mature in the liver, to finally settle in abdominal vessels. ...
Apart from a possible dermatitis resulting from larval penetration, first symptoms usually occur 4-6 weeks after infection with the first shedding of eggs. This causes a strong immune reaction resulting in a flu-like syndrome called Katayama-fever, ....
2.3. Nematodes of the liver: Ascaris lumbricoides
Currently, 800 million people worldwide are infected with Ascaris lumbricoides.
The geographical distribution of ascariasis is linked to low socio-economic standards with insufficient hygiene practices due to poor housing and sanitation, promoting the parasite cycle. ...
3. Protozoan parasites: Entamoeba histolytica
Amoebiasis is caused by the protozoa Entamoeba histolytica and occurs in humans and primates.
The burden of disease is considerably high with an estimated annual 50 million infections and 55,000 deaths. Globally, impoverished communities with insufficient sanitary facilities are most affected, since E. histolytica is mainly transmitted faecal-orally.
KEY POINTS
...
AE has a high mortality if left untreated, hence early diagnosis is crucial, requiring at least imaging and serological testing. Staging is mandatory to guide treatment, using CT, MRI or preferably PET-CT scan. For early stages, complete resection followed by a 2-year course of albendazole is recommended. Late stages require long-term, often life-long medical treatment with albendazole. Challenges are the management of biliary and vascular complications and the lack of alternative medical options in case of albendazole intolerance. ...
Article: Ultrasound signs of pathology of the gastrointestinal tract.
INDEX
https://iliveok.com/health/ultrasound-signs
-pathology-gastrointestinal-tract_110752i15992.html
Doctor Mickhael TAL
Vascular surgeon, radiologist
Alexey Portnov, medical expert
Last reviewed: 11.04.2020
Fluid in the abdominal cavity (ascites)
... When searching for fluids, scan the lowest located areas of the abdomen in all projections.
The fluid is visualized as an anechogenous zone.
Small amounts of fluid will be collected in two places in the stomach:
In women in the back bone space (in Douglas space).
In men in the hepatorenal cavity (in Morrison's pocket).
Ultrasound is an accurate method for determining free fluid in the abdominal cavity
If there is more fluid, the lateral pockets (the recesses between the parietal peritoneum and the large intestine) will be filled with liquid. When the amount of fluid increases, it will fill the entire abdominal cavity. The intestinal loops will float in the liquid, while the gas in the lumen of the intestine will collect at the anterior abdominal wall and move when the patient's position changes. When the mesentery thickens as a result of tumor infiltration or inflammation, the gut will be less mobile and the fluid between the abdominal wall and the intestinal loops will be determined.
Ultrasound can not distinguish ascites, blood, bile, pus and urine. Need for thin needle aspiration to determine the nature of the liquid
Adhesive process in the abdominal cavity can produce the formation of septa, while the fluid can be shielded by gas inside the intestine or by free gas. It may be necessary to conduct research in various positions.
Large cysts can simulate ascites.
Examine the entire abdomen for free fluid, especially in the lateral canals and pelvis.
Under the control of ultrasound, small amounts of liquid can be aspirated, but certain skills are required for aspiration
The formation of the intestine
Solid formations in the intestine can be tumorous, inflammatory (eg, amoebae), or formations w/ ascariasis.
The formations in the intestine usually have the form of a kidney.
When ultrasound examination reveals thickening of the wall, unevenness, puffiness and fuzziness of the contours. Inflammation or tumor infiltration can cause intestinal fixation, and the appearance of fluid can occur as a result of perforation or bleeding. Clarifying organo-accessories can be complicated.
When detecting a tumor of the intestine, it is necessary to exclude liver metastases, as well as enlarged anechoic lymph nodes of the mesentery. Normal lymph nodes are rarely visualized by ultrasound.
Solid formations outside the intestine.
Multiple, often confluent and hypoechoic formations are suspected of having lymphoma or enlarged lymph nodes. Children in the tropics may suspect the presence of Burkitt's lymphoma, while it is necessary to examine the kidneys and ovaries for the detection of the same tumors.
Nevertheless, ultrasound differentiation of lymphoma and tuberculous lymphadenitis can be very difficult.
The retroperitoneal sarcoma is infrequent and can be represented by a large, solid structure of various echogenicity. Necrosis may occur in the center of the tumor. In this case, it is defined as a hypoechoic or mixed echogenic zone as a result of dilution.
Complex in structure of education
Abscess: can be located anywhere in the abdomen or pelvis.
He often gives pain, a concomitant fever, has fuzzy outlines.
In addition to appendicular abscesses, there may be:
diverticulum of the large intestine with perforation:
the abscess is usually localized in the left lower abdomen;
amebiasis with perforation:
the abscess is usually located in the right lower abdomen, less often in the left half or somewhere else;
tumor perforation: the abscess can be detected anywhere;
tuberculosis or any other granulomatous inflammation:
the abscess is usually detected in the right side of the abdomen, but can be anywhere else;
regional ileitis (Crohn's disease), ulcerative colitis, typhoid or other intestinal infection:
abscesses can be detected everywhere;
perforation of parasites, for example Strongyloides, Ascaris or Oesophagostomum:
an abscess is usually found in the right side of the abdomen, but can be seen everywhere.
(Ascaris can be detected in cross-section in the form of long tubular structures)
Abscess is easy to detect, but it is rarely possible to determine the cause of abscess formation
The hematoma looks like a cystic or mixed echogenic structure, similar to an abscess, but it does not give a fever. It is important to have an injury or anticoagulant therapy in the anamnesis. In the center of the hematoma may be a suspension or a dilution zone, in which septa can be determined. Also look for free fluid in the abdominal cavity.
Fluid containing formations.
Most of them are benign, they are either congenital, or parasitic or have an inflammatory genesis).
Doubling the intestine.
This congenital anomaly is often determined in the form of liquid-containing structures of various shapes with a clearly traced wall. They can be small or large and can have an internal ehostructure due to the presence of suspended matter or partitions.
Lymphatic cysts or mesentery cysts.
Although they are usually aneho-genes, septa can be identified, internal echostructure may or may not be determined. They can be localized in any part of the abdomen and have various sizes up to 20 cm or more in diameter.
Ischemia of the intestine.
Ultrasound can detect a solid thickening of the intestinal wall, sometimes localized, but more often - extended. In this case, movable gas bubbles can be detected in the portal vein.
Echinococcal cysts (parasitic disease).
Cysts in the abdominal cavity do not have any special characteristics and resemble other visceral parasitic cysts, especially the hepatic cysts. They are almost always multiple and are combined with cysts of other organs. (Perform an ultrasound examination of the liver and chest X-ray.) In detecting a cluster of multiple small cysts, less frequent alveococcosis (Echinococcus multHoculoris) can be suspected .
Suspicion of appendicitis
Ultrasonic diagnosis of acute appendicitis can be complex and even impossible.
It takes some experience.
If suspected of acute appendicitis, examine the patient in the supine position using a 5 MHz sensor.
Place the pillow under your knees to relax the abdomen, apply an optional gel to the lower right abdomen and start scanning longitudinally with a slight pressure on the sensor. To move the bowels, use a more pronounced push. If the intestinal loops are inflamed, then they will be fixed, they will not be determined by peristalsis: soreness will help determine the site of the lesion.
An inflamed vermiform appendix is visualized in the transverse section as a fixed structure with concentric layers ("target"). The internal lumen can be hypoechoic, surrounded by a zone of hyperechoic edema: a hypoechoic wall of the intestine is visualized around the edema zone. In longitudinal sections, the same structure has a tubular shape. With perforation of the appendix, an anechoic or mixed echogenicity zone can be defined near it with fuzzy contours, extending into the pelvis or elsewhere.
It is not always easy to visualize an appendix, especially if it is abscessed.
Other causes of abscess in the right lower abdomen are perforation of the intestine as a result of amoebiasis, tumor or parasites. A careful comparison of the echographic picture with the clinic is necessary, but even in this case it is not always possible to diagnose with ultrasound examination.
Symptoms of gastrointestinal diseases in children
Ultrasound is very effective in the following pediatric diseases.
Hypertrophic stenosis of the pylorus
The diagnosis in most cases can be put clinically by palpation revealing the olive-like form of the pyloric thickening. It can also be easily detected and accurately diagnosed by ultrasound. As a result of the thickening of the pylorus's muscular layer, which normally does not exceed 4 mm in thickness, a hypoechoic zone will be revealed. The transverse internal diameter of the pyloric canal should not exceed 2 mm. Gastrostasis will be detected even before filling the baby's stomach with warm sweet water, which must be given to the child before further investigation.
On longitudinal sections the length of the pyloric canal of the child should not exceed 2 cm.
Any excess of this size causes a strong suspicion of the presence of hypertrophic stenosis of the pylorus.
Intussusception
If the clinician suspects intussusception of the intestine, ultrasound can in some cases reveal intussusception in the form of a sausage: in the transverse sections, the presence of concentric rings of the intestine is also very characteristic of intussusception. A hypoechoic peripheral rim with a thickness of 8 mm or more with a total diameter of more than 3 cm will be determined.
In children, an ultrasound diagnosis of pyloric hypertrophy and intussusception requires certain experience and thorough clinical correlations.
Ascaridosis
The appearance of formation in any part of the intestine can take place as a result of ascariasis: while transverse scanning, typical concentric rings of the intestinal wall and of the body of the helminths contained in the lumen are visualized.
Ascarids can be mobile, their movements can be observed when scanning in real time. Perforation can occur in the abdominal cavity.
Infection with the human immunodeficiency virus
HIV-infected patients often fever, but the source of infection can not always be determined by clinical methods.
Ultrasound can be useful for identifying abscesses in the abdominal cavity or enlarged lymph nodes.
With intestinal obstruction, overgrown loops of the small intestine with pathologically altered mucosa can be detected already in the early stages of ultrasound examination.
Ultrasound examination should include the following standard set of organ research techniques:
- Liver.
- Spleen.
- Both subdiaphragm spaces.
- The kidneys.
- Small pelvis.
- Any subcutaneous formation with swelling or soreness.
- Paraorthal and pelvic lymph nodes.
When an HIV-infected patient begins to fever, ultrasound examination of the abdominal and pelvic organs is necessary.
Ultrasound examination does not help distinguish bacterial and fungal infection.
In the presence of gas in the abscess, the presence of a predominantly bacterial infection is most likely, although there may be a combination of bacterial and fungal infection.
Article:
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Article: Echinococcosis, WHO World Health Organization.
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https://www.who.int/news-room/fact-sheets/detail/echinococcosis
by World Health Organization
23 March 2020
Article: Echinococcosis, WHO World Health Organization.
INDEX
https://www.who.int/news-room/fact-sheets/detail/echinococcosis
by World Health Organization
23 March 2020
Key facts
-
Human echinococcosis is a parasitic disease caused by tapeworms of the genus Echinococcus.
-
The two most important forms in humans are cystic echinococcosis (hydatidosis / CE) and alveolar echinococcosis (AE).
-
Humans are infected through ingestion of parasite eggs in contaminated food, water or soil, or after direct contact with animal hosts.
-
Echinococcosis is often expensive and complicated to treat and may require extensive surgery and/or prolonged drug therapy.
-
Prevention programmes focus on deworming of dogs, which are the definitive hosts.
In the case of cystic echinococcosis preventive measures also include, deworming dogs, slaughterhouse hygiene, and public education.
-
More than 1 million people are affected with echinococcosis at any one time.
...
Diagnosis
Ultrasonography imaging is the technique of choice for the diagnosis of both cystic echinococcosis and alveolar echinococcosis in humans. This technique is usually complemented or validated by computed tomography (CT) and/or magnetic resonance imaging (MRI) scans.
Cysts can be incidentally discovered by radiography.
Specific antibodies are detected by different serological tests and can support the diagnosis.
Early detection of E. granulosus and E. multilocularis infections, especially in low-resource settings, is still needed to aid in the selection of clinical treatment options.
Health and economic burden
Both cystic echinococcosis and alveolar echinococcosis represent a substantial disease burden.
Worldwide, there may be in excess of 1 million people living with these diseases at any one time.
Many of these people will be experiencing severe clinical syndromes which are life-threatening if left untreated. Even with treatment, people often face reduced quality of life.
For cystic echinococcosis, there is an average of 2.2% post-operative death rate for surgical patients and about 6.5% of cases relapse after an intervention, thereby requiring prolonged recovery time.
The 2015 WHO Foodborne Disease Burden Epidemiology Reference Group (FERG) estimated echinococcosis to be the cause of 19,300 deaths and around 871,000 disability-adjusted life-years (DALYs) globally each year.
Annual costs associated with cystic echinococcosis are estimated to be US$ 3 billion for treating cases and losses to the livestock industry.
...
Article:
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Video: Transcription CAUTION.
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These guidelines/cautions apply to the use of Linux MINT-14 operating system and the following programs to effect a view-and-transcribe recording of information. Use of other operating systems and other versions of these programs may induce similar or different, or no problems.
- Caja 1.4.0 File Manager
- EditPlus 2.10c
- VLC Media Player, 2.0.5 Twoflower
What was experienced on enough occasions was a complete loss of or degradation of, or contamination of .. the instructions processing EACH program ... some form of cross-contamination.
These instances occurred at erratic times and presented significant though NOT consistent failure symptoms.
Frequently, it was necessary to PAUSE the VLC Media Player during the playback of a SLIDE video to provide time for the typing of the details on the display into the EditPlus document. The software BREAKS always occurred during one of these pauses.
Simultaneously, visual reference to both the VLC display and the EditPlus input procedure began to fail ... by stalling, partial display loss, lack of keyboard response, loss of command access. The computer would have to be restarted and the integrity of the EditPlus file would have to be checked and remedied as best as possible.
The VIDEO portion appeared to FAIL first and independent of the AUDIO, almost always during a PAUSE.
NOTE: In order to manage storage space better for backups and transfers,
FLV and PDF files have been moved to another folder and their-in-document LINKS have been concealed.
SUGGESTIONS:
SAVE your edited file OFTEN .. every several lines.
Concurrent operation of any other software is best done with the expectation that a SUDDEN collapse of the operations is likely to occur.
When an EditPlus file is terminated without saving the last entries, consider whether to reactivate the .bak file.
When a BACKUP operation is suddenly terminated, confirm what the Last COMPLETE saved file and folder were. Determine whether to delete the last partial file or folder and restart the BACKUP process from the last SAVE operation that has complete Integrity/Accuracy/Completeness.
At the FIRST suggestion of an apparent inconsistent rendering of the video, SAVE the file being edited, QUIT the video, and, RESTART the computer to clear the operational dysfunction (sometimes signified by a loss and corruption of display images for any and all open software ... EditPlus, File Manager, etc.
Video contents can be transcribed to paper and then entered into an EditPlus document; however, this is a very time and energy consuming and paper intense process.
Video: Abdominal, Landmarks , 18.41 min
INDEX
0-Ultrasound/flv/Ab-ultra--landmarks.flv
Online: https://www.youtube.com/watch?v=YnaNdya3jOc
Florida National University.
(Heavy French accent English and distant weak sounding assistant.)
Finding abdominal "landmarks".
- Tip of the Liver.
- Diaphragm, from right Kidney.
- Aorta artery & Inferior Vena Cava (IVC).
- IVC Transverse.
- Confluence
- Anacoid branch.
- Superior Mesenteric Artery.
-
- Portal ... artery and Common Bile Duct.
- Vertebral Column.
- Small Intestine and Colon GAS, hides
-
- Hepatic Artery.
- Common Bile Duct.
- Hepatic Artery.
- Splenic Artery.
- Gall Bladder, right side.
- Main Lower ...
- IVC,
- Round Ligament
- Left Lobe of the Liver.
- Left Lobe in Transverse.
- Right Lobe of the Liver.
- Right Lobe in Transverse.
- Liver and Cortex of the Kidney.
- Caudet Lobe of the Liver.
- Gall Bladder inside ...
- Gall Bladder in Transverse.
- Pancreas in Transverse.
- Spleen intercostal, from left side.
- Spleen transverse.
- Right Kidney, from right side.
- Morison post .. between Liver and Kidney.
- Left Kidney in Transverse .. from behind left Side.
- Right Kidney Cortex .. from front, right side.
Video: Part 01 - Abdominal Ultrasonography in Small Animals. 11.04 min
INDEX
0-Ultrasound/flv/Ab-ultra--part_1.flv --- 10.4 MB
Online: https://www.youtube.com/watch?v=KUZ0ZB0YMtc
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
1. First a good clinical examination & laboratory tests.
2. Evaluation of all abdominal organs
... Changes in size, shape, structure ... presence of nodules or masses.
3. No definitive diagnosis without fine needle aspirations (FNA) or biopsies.
Ultrasonography of the Liver.
Indications
--- Hepatomegaly (palpation or RX)
--- Cranial abdominal mass.
--- Jaundice.
--- Increased liver enzymes.
--- Metastasis check (staging)
--- Fever of unknown origin.
--- Gastro-intestinal signs.
--- PUPD
--- Aspiration/biopsy.
Transducer caudal to the xyphoid process of the sternum.
Probe directed cranially and dorsally.
(To view as much of the liver as possible)
Intercostal (probe between the ribs) approach if necessary.
Caudal to the diaphragm.
Cranial to the stomach, spleen and right kidney.
Liver parenchyma.
--- Sharp and pointy (triangular) edges of lobes.
--- Homogeneous parenchyma.
--- Echogenicity: kidney, liver, spleen.
Liver parenchyma: diffuse changes.
--- Increased echogenicity (hypergenicity) .. brighter than or similar to the spleen.
- Lipidosis (increased attenuation of the beam strength)
- Fibrosis
- Lymphoma
- Steroid induced hepatopathy.
-- Decreased echogenicity (hypogenicity) .. darker than renal cortex.
-- Increased visibility of the walls of the portal vessels.
- Acute hepatitis
- Congestion
- Lymphoma
- Leukemia.
-- Diffuse heterogeneity.
- Chronic hepatitis
- Hepato-cutaneous syndrome
- Neoplasia.
Liver parenchyma: focal changes.
--- Anechogenic.
- Cyst
- Metastasis
- Necrosis
- Hematoma
- Abscess.
--- Hypoechogenic. .. difficult to discern between Benign and Malignant.
- Neoplasia: Metastasis or Lymphoma
- Nodular hyperplasia
- Necrosis
- Abscesses.
--- Hyperechogenic.
- Benign lesions
- Fat
- Mineralization
- Steroid hepatopathy
- Neoplasia/metastases.
--- Mixed echogenicity.
- Neoplasia/metastases
- Abscesses
- Hematoma
- Nodular hyperplasia.
Always perform FNA or biopsy for confirmation/clarification.
Check coagulation and platelets count.
Video: Part 02 - Abdominal, Biliary Tract, Small Animals. 4:58 min
INDEX
0-Ultrasound/flv/Ab-ultra--part_2.flv
Online: https://www.youtube.com/watch?v=Ut7sgJa4uds
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
- Gallbladder
- Common Bile Duct
- Bile = anechoic (Normal)
- Presence of sludge or mud usually normal (dogs)
--- less normal in Cats.
Diseases:
- Sediment/calculi
- Obstruction (usually ectrahepatic)
- Pancreatitis
- Calculi, Plugs
- Neoplasia
- Cholestasis
- Mucocoele
- Excessive accumulation of mucus in lumen
- Stellate (spots) or kiwifruit pattern
- Thickening of the gallbladder wall.
- Oedema of the wall (right side heart failure, hepatitis, hyperalbuminemia)
- Neoplasia (biliary carcinoma)
- Trauma (rupture)
- Cholecystitis
Video: Part 03 - Abdominal, Pancreas, Small Animals. 10:48 min
INDEX
0-Ultrasound/flv/Ab-ultra--part_3.flv --
Online: https://www.youtube.com/watch?v=rtEgS85t_2k
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
(This video is poor quality and may crash the VLC viewer !)
Indications.
- Severe abdominal pain.
- Acute vomiting +/- diarrhea.
- Anorexia (esp in cats).
- Hypoglycemia (insulinoma)
- Jaundice (extrahepatic biliary obstruction secondary to disease).
- Focal peritonitis or mass effect in the region of the pancreas on abdominal radiographs.
The pancreas is often difficult to see.
The left lobe (larger in cats)
- between the stomach and the transverse colon.
- between the stomach, spleen and left kidney.
-- more difficult to see in dogs.
The right lobe (larger in dogs)
- dorsomedial to descending duodenum.
Pathologies.
Acute pancreatitis
- Enlarged pancreas.
- Hypoechoic pancreas.
- Widened pancreatic duct (in cats).
- More subtle signs in cats .. may be difficult to detect.
- Hyperechoic fat.
- Localized free fluid.
- Localized functional ileus.
-- (lumen is Open, normally collapsed when not in digestion mode)
--- usually filled with fluid but can also be filled with gas.
- Secondary dilation of the common bile duct.
- Obstruction of the common bile duct may lead to this.
Pancreatic oedema
- Hypoalbumunemia.
- Portal hypertension.
- Some cases of pancreatitis.
Other Pancreatic Disorders
- gastrointestinal gas may obscure much visualization
- Neoplasia.
- Adenocarcinoma insulinoma
--- small nodes may become aggressive and grow quickly.
- Metastasis of liver, lymph nodes, mesentery.
- Cysts.
- Retention cysts, pseudocysts, congenital cysts.
- Often present no symptomatic problem to the animal.
- Nodular hyperplasia.
- Abscess.
- Can be quite severe and be difficult to treat.
- When present, there is often surrounding inflammation.
Follow up with biopsies or aspirations of any lesions.
Video: Part 04 - Abdominal, The Spleen, Small Animals. 13:08 min
INDEX
0-Ultrasound/flv/Ab-ultra--part_4.flv
Online: https://www.youtube.com/watch?v=lHsJJYaiK5w
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
- the video tends to be poor quality.
Indications.
- Generalized splenomegaly.
- Abdominal mass. (by palpation or X-ray)
- Hemoperitoneum.
- Trauma.
- Acute abdominal pain.
Guidelines.
- Located in the left cranial abdomen.
-- attached to the stomach by a ligament.
- The exact position is variable.
- along the left abdominal wall. (dogs and cats)
- crossing to the right side (dogs)
- Homogeneous echotexture.
- Smooth hyperechoic capsule.
- Splenic artery (difficult to see).
- Splenic vein (visible at the hilus).
- drains into the portal vein.
Begin with the probe on the left side below the stomach.
- May be necessary to look between the ribs.
The spleen will always be brighter than the liver and the kidneys.
Follow up with biopsies or aspirations of any lesions.
Video: Part 05 - Abdominal, Gastro-Intestinal Tract, Small Animals. 13:04 min
INDEX
0-Ultrasound/flv/Ab-ultra--part_5.flv
Online: https://www.youtube.com/watch?v=vfYGP0Buj5g
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
Indications.
- Vomiting (chronic or acute).
- Diarrhea (chronic or acute).
- Weight Loss.
- Anorexia.
- Hypoproteinemia.
- Blood loss (hematemesis, ulcer, melanoma, ..).
- Abdominal pain.
- Tenesmus.
Guidelines.
- Animal has fasted for 12 hours, at least.
- GI gas interferes with the examination of the GI tract.
Pathologies
Ultrasonography of the Stomach.
- Location in the cranial abdomen (partially under the ribs).
- Rugal folds of the stomach tissue with some gas present.
- Prominent hyperechoic submucosa (fat) in cats.
- Peristaltic movement (4-5 contractions/min).
- Normal wall thickness of 3-5 mm.
-- Check for obstructions in the Duodenum or pressure being exerted against it or the upper intestines.
Duodenum
- Proximal part may be difficult to access (deeply under the ribs).
- Descending duodenum superficial along the right abdominal wall & ventral to the right kidney.
- Duodenal papilla are sometimes visible.
- 3-6 mm thick (dogs); less in cats.
Jejunum, ileum
- Dispersed in the abdomen (more on the right side).
- 3-5 mm thick (dogs).
Cecum
- Right cranial abdomen.
Colon:
- Contains air and feces.
- Ascending on the right.
- Transverse caudal to stomach.
- Descending on the left.
- 2-3 mm thick (dogs).
- Layers of the GI Tract
- Mucosal surface (lumen) hyperechogenic. (line in the center)
- Mucosa: hypoechogenic.
- Submucosa: hyperechogenic.
- Muscularis: hypoechogenic.
- Serosa: hyperechogenic.
Gastrointestinal patterns
- Food (in the stomach).
-- Variably sized particles in the gastric lumen.
-- May mimic foreign bodies.
- Ingesta (in the small intestines).
-- Isoechoic to hyperechoic fluid.
- Fluid.
-- Anechoic content.
- Air.
-- Hyperechoic with shadowing (comet tails)
Evaluation of GI diseases.
-- Criteria.
- Wall thickness.
- Wall layering. (should be always visible)
- Size of any lesion.
- Transition zone.
- Content.
- Motility.
- Draining lymph nodes.
Problems.
Foreign body.
- Hyperechoic surface.
- Strong acoustic shadow.
- Plication (if linear).
- Obstructive ileus.
- If Perforation:
-- Local peritonitis.
-- Free peritoneal gas.
-- Thickening of the wall.
-- Loss of layering.
For heavier, thicker bodies, a LOWER frequency may be required for DEEPER penetration,
though some resolution may be lost.
Follow up with biopsies or aspirations of any lesions.
Video: Part 06 - Abdominal, Adrenal Glands, Small Animals. 7:46 min
INDEX
0-Ultrasound/flv/Ab-ultra--part_6.flv
Online: https://www.youtube.com/watch?v=hQlQHx2J54E
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
Normal Adrenal Glands.
-- Cranio-medial to the kidneys.
-- Left Adrenal:
ventral to the aorta, cranial to the left renal artery, caudal to the cranial mesenteric artery.
-- Right Adrenal: dorso-lateral to the caudal Vena Cava (CVC).
-- Mineralizations: normal in old cats, not in dogs.
Adrenal Mass. (Increased size of)
Adrenal tumors.
- Adrenocarcinoma.
- Adenoma.
- Metastasis.
- Phoechromocytoma.
Adrenal-dependent hyperadrenocorticism. (Cushing Syndrome?)
- Enlargement on one side or the other.
+/- functional decreased size of the contralateral gland.
-- Adenocarcinoma or adenomoma.
Invasion of the surrounding tissues. (When a mass is found)
(caudal Vena Cava, renal (kidney) vessels ...)
Ultrasonography.
- sometimes difficult to assess.
Invasion, or, compression ?
CT recommended to evaluate invasion of the tumor before surgery
If the mass is invading any vessel, it will be more difficult to remove, and,
it may result in a rupture of the vessel and subsequent secondary hemorrhage into the peritoneal space.
Pituitary-dependent hyperadrenocorticism.
- Bilateral adrenal hypertrophy (hyperplasia).
- Sometimes appear normal size in ultrasonography.
- Plump shape indicates affected.
- CT/MRI of the pituitary gland .. Adenoma.
-- bilateral adrenal hypertrophy.
Video: Part 07 - Abdominal, Kidneys. 11:33 min.
INDEX
0-Ultrasound/flv/Ab-ultra--part_7.flv
Online: https://www.youtube.com/watch?v=10l0uN5g14s
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
Indications.
- PU/PD.
- Hematuria, anuria, pollacuria ...
- Incontinence.
- Abdominal mass.
- Ascites (protein losing nephropathy).
- Fever of unknown origin (pyelonephritis).
- Abnormal laboratory tests (urea, creatine, urine analysis ..).
- Abnormal kidney size on radiography.
- Polycystic Kidney Disease (PKD) screening (in some breeds of cats).
Guidelines.
- Left Kidney.
-- behind the last rib, close to the spleen.
- Right Kidney.
- Just caudal to the caudate lobe of the liver.
- Under or just caudal to the last ribs.
Normal anatomy of the kidney.
- Cortex: echogenic.
- Medulla: hypoechogenic, divided by diverticula and interlobar arteries.
- Renal pelvis, contains a small amount of fat.
Medullary rim sign.
- Often not pathological.
- Hypercalcemic nephropathy.
- Ethylene glycol intoxication.
- Acute tubular necrosis.
- Chronic interstitial nephritis.
- Feline infectious peritonitis (FIP)
Normal appearance of the kidney.
Echogenicity of the kidney ..
< or = liver
< spleen
Differences can be very subjective and difficult to assess.
Also depends upon the settings of the machine.
Abnormal Renal Shape.
- Neoplasia.
- Renal dysplasia.
- PKD.
- Lymphoma.
- FIP.
- End stage chronic renal disease.
Decreased Renal Size.
(not as common)
- End stage chronic renal disease.
- Renal dysplasia or hypoplasia. (congenital)
- Amyloidosis.
Increased Renal Size.
(much more common)
One kidney may decrease in size and be compensated by the other increasing.
Kidney may appear large due to fluid between the kidney and the capsule.
- Compensatory hypertrophy.
- Nephritis.
- Hydronephosis.
- FIP.
- Lymphoma.
- Perinephric pseudocyst.
- Perinephric hematoma.
- PKD.
- Neoplasia.
- Amyloidosis (mild )
- Portosystemic shunt (mild )
- Acute renal failure (mild )
Diffuse abnormalities of the renal parenchyma.
- Increased cortical echogenicity.
-- increased contrast between the cortex and the medulla.
- Increased cortical and medullary echogenicity.
-- decreased CM definition.
- Decreased cortical echogenicity.
-- decreased CM definition, cortex becomes darker.
Diagnostic Assessment.
Increased echogenicity of the renal cortex in the dog.
- Glomerulonephritis.
- interstitial nephritis.
- Acute tubular necrosis.
- Ethylene glycol poisoning
--- calcium oxalate deposition.
- Other toxic agents (causing acute renal failure)
- End stage renal disease.
- Nephrocalcinosis (parenchymal calcifications)
- Hypercalcemic nephropathy (medullary rim sign).
- Leptospirosis.
does NOT provide much help in determining one or a few SPECIFIC possibilities.
Video: Part 08 - Abdominal, Bladder. 10:14 min
INDEX
0-Ultrasound/flv/Ab-ultra--part_8.flv
Online: https://www.youtube.com/watch?v=l2wuWTDawXA
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(There is NO AUDIO to this presentation)
Indications.
- Dysuria/pollakiuria/stranguria.
- Hematuria.
- Tenesmus / pain.
- Incontinence.
Guidelines.
- The bladder should be filled.
- Wall.
- Hypoechoic layer surrounded by two hyperechoic lines.
- Normal thickness (full bladder): 1 to 2 mm .
- Sometimes the insertion of the ureters is visible.
Ultrasonography of the bladder.
Numerous artifacts.
- Reverberations.
- Range ambiguity.
- Side and grating lobes.
- Refraction (when ascites).
Diffuse splenic changes: tumors
- Diffusely hyperechoic, hyperechoic, or mottled.
- Lymphoma.
- Malignant histiocytosis.
- Mastocytoma.
- Leukemia.
To decrease them
- Harmonic imaging.
- Only one focal point.
Cystitis.
- Chronic cystitis.
-- Wall thickened (cranioventrally or diffuse).
- Polypoid cystitis.
--- small pedunculated masses.
- Emphysematous cystitis.
--- Gas in bladder wall, lumen, or ligaments.
-- (hyperechoic line + dirty shadowing)
Due to gas-producing or glucose-fermenting bacteria.
--- Ecoli (Diabetes mellitus)
--- Clostridium
--- Proteus mirobilia
Ultrasonographic abnormalities of the bladder.
- Sediment.
- Uroliths.
- Ureterocele.
- Intramural ectopic ureter.
- Diverticulum.
Blood clots in the bladder.
- Secondary to trauma, bleeding disorders, infection, or, neoplasia.
- Iso- or hyperechoic.
- Irregular shape.
- No Shadowing.
- Sometimes adherent to the wall.
(Differentiate from mural mass neoplasia)
Neoplasia of the bladder.
- Mural mass.
- Heterogeneous.
- broad based.
- Well defined irregular borders.
- Predisposed location of transitional cell carcinoma.
--- Trigone most commonly reported.
- Possible secondary obstruction of the ureters.
---
"to be continued"
Video: Part 10 - Abdominal, Male Reproductive Tract. 14:47 min
INDEX
0-Ultrasound/flv/Ab-ultra--part_10.flv
Online: https://www.youtube.com/watch?v=uLQ34dyKgQY
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
Ultrasonography of the prostate.
Indications.
- Bloody discharge from penis.
- Hematuria / dysuria.
- Tenesmus / dyschezia.
- Caudal abdominal pain.
- Fever.
- Infertility.
Guidelines.
- Abdominal approach (but sometimes intrapelvic location).
- Caudal to the bladder neck. (follow the bladder neck)
- Homogeneous, hyperechoic, bi-lobed structure.
- Urethra visible in the center (mildly hypoechoic).
- Variation with age (bigger with older) or castration (small & hypoechoic).
Benign prostatic hyperplasia
- Middle aged dogs.
- Glandular hyperplasia (due to hormonal imbalance).
- Often incidental findings.
- May lead to clinical signs.
--- Dysuria, Tenesmus, bloody urethral discharge.
--- Rarely systemic signs.
Appears as ..
- Symmetrically enlarged prostate.
- Smooth borders.
- Iso- to Hyperechoic parenchyma.
- +/- multiple small hypo- to anechoic cysts
- No sub-lumbar lymph node enlargement.
--- check to eliminate possible confusion with prostate.
Prostatitis.
- Bacterial infection.
-- Usually ascending urinary infection.
-- Rarely from scepticemia.
- Rarely fungal infection or lymphocytic or lymphoplasmocytic inflammation.
- Often secondary to a primary disorder of the prostate.
--- Benign hyperplasia.
--- Squamous metaplasia.
--- Neoplasia.
Appears as ...
- Symmetrical or asymmetrical enlargement
--- (may be heterogeneous but not always enlarged).
- Heterogeneous parenchyma.
--- (multifocal hypoechoic or hyperechoic areas)
- Cysts or cyst-like structures of variable size.
- Possible abscesses or mineralizations (if chronic).
- Capsule of the gland is usually intact, but could be interrupted.
- Focal peritonitis
--- (hyperechoic fat, small amount of free fluid).
- Mild to moderate reactive lymphodenapathy.
- Fine needle aspirate for cytology and culture.
Prostatic Cysts.
- In hyperplasia, prostatitis and neoplasia.
- Developmental or congenital.
- Often an incidental finding.
- Aspirate, if larger, to look for infection.
Paraprostatic Cyst.
- Fluid-filled embryologic remnants of mullerian ducts.
- May communicate with intraprostatic cavitations.
- Can become very large and extend into the pelvic canal.
- "Double bladder sign" on abdominal radiography.
--- +/- mineralizations (cyst wall, stalk (part of cyst attaching to the prostate))
Appears as ...
- Anechoic fluid-filled structure.
- Variable wall: thin, thick, smooth, irregular.
- +/- internal septae.
- +/- focal echogenicities and membranes ..
--- (with possible sedimentation)
---- Can grow cranially into the abdomen, or caudally towards the perineum.
Prostatic neoplasia.
- Seen in older neutered and intact dogs.
- Metastases sublumbar lymph nodes.
--- also to the bones (lumbar spine) or lungs .. RX
- May extend locally to urethra or bladder neck.
- Variable histological types reported.
--- Adenocarcinoma, undifferentiated carcinoma
--- transitional cell carcinoma, squamous cell carcinoma,
--- hemangiocarcinoma, leucomyocarcinoma, lymphoma.
Appears as ...
- Enlarged, irregular and asymmetrical prostate.
- Hypoechoic heterogeneous aspect (+/- irregular cavitations)
- Often hyperechoic foci within the parenchyma
--- +/- acoustic shadowing (mineralizations)
- Possible disruption of the capsule.
- Sometimes difficult to differentiate from prostatitis.
- Assess the sub-lumbar lymph nodes for average size ..
--- IF severely enlarged and heterogeneous metastases ...
- Look for signs of extensions (bladder, urethra) .. which indicate neoplasia.
- Confirm, as relevant, with Fine Needle Aspiration / biopsy.
Video: Pitfalls in Abdominal Ultrasound Diagnostics.
INDEX, 30:29 min
0-Ultrasound/flv/Pitfalls_in_abdominal_ultrasound_1.flv
Online: https://www.youtube.com/watch?v=SEIsSGmjYYk
Dr. B.S. Rama Murthy MD DMRD DNB
Srinivasa Ultrasound Scanning Centre,
Bangalore, India.
A PITFALL is a diagnostic dilemma or ambiguity which has a potential for wrong diagnosis.
This could broadly translate into either a limitation or controversy.
Pitfalls are classified here as "Look alikes" (one object is mistaken for another), and, "Artifacts".
Artifacts may occur as an extension of the nature of Ultrasound, or, as an indicator of What the Settings are of the diagnostic device.
In Ultrasound, an ARTIFACT is used for an image phenomenon that represents the real anatomical structure incorrectly. That is, something which is imaged as something which we feel it is not. An artifact could be false, multiple, or, misleading information introduced by the imaging system or by interaction of the Ultrasound with the tissues. In a medical diagnosis, an artifact could be of advantage
1. Ligamentum teres vs Spurious hepatic SOL.
--- Compare a transverse section with a longitudinal view to discern the true shape.
--- An apparent DOT may be alternatively represented as an elongated structure.
2. Gallstone, vs GB lumen gas, vs GB mural gas, vs Pyloric gas.
--- A gallstone can show a postural change.
--- A gas may show a shadow, and, may also be present in other nearby structures.
--- A gas may be next to the lumen, or, may present as "intramural" in the wall.
--- Pyloroduodenal gas
3. GB (Gall Bladder) Sludge vs GB Polyp.
--- Tumefactive sludge .. is the image crisp and sharp?
--- Is the form in question, Separate, or, Attached to the wall of the gallbladder?
--- A sludge can also (postural) shift with the patient orientation.
--- A sludge cannot "Hang" from an ABOVE position; A polyp can.
--- A re-examination in a week or 10 days will assist in clarification ..
a Sludge will have changed in position; a Polyp will have remained in the same position.
--- By viewing with Doppler, sludge will NOT light up/color, whereas a polyp will.
4. WES (Wall - hyperEcoic lumen - Shadow) sign vs Porcelain Gall Bladder.
--- The wall of the organ can shadow greatly when it is calcified.
--- The wall will be a SINGLE line, not 3-line appearance, when Calcified.
5. Gall bladder stone (Present, or, Absent)
--- Beware of a Neck lurking stone.
--- With the gall bladder, what appears to be the NECK, may not be.
--- A stone will be surrounded by bile,
-- Value of prone position examination .. always exposes the neck stones.
6. Gall bladder Mimics.
--- GB dilated with sludge.
----- GB stasis and sludge level in CBD stone.
--- Choledochal cyst can be confirmed by looking for a real GB (repositioning)
--- Post op Cholecytectomy, MBD dilation (may appear to be a GB with several stones)
(MBD = Main Bile Duct) may have several stones; GB may have been laproscopically REMOVED.
Laproscopic incisions may heal within several months and not be obvious .. maintain History.
--- Pyloroduodenal fluid can mimic the Gall Bladder.
--- Non visualized Gall Bladder.
A GB filled with sludge can appear to merge with the Liver parenchyma.
Biliary atresia
GB Carcinoma may replace the image of the GB with a solid mass with a stone or 2 inside.
Contracted GB in Hepatic dysfunction -- look for the Main Hepatic fissure, which
... will connect the Undivided Right Portal Vein and the Gall Bladder neck
--- Intrahepatic biliary ductal dilation VS Hepatic artery waxing.
GBD (Gall Bladder Duct) stricture with IHBDD
Hepatic arterial branches may appear prominent. (Doppler will confirm arteries)
The Hepatic artery may become enlarged to facilitate blood flow to the Liver, when
the Portal Vein is not large enough, especially in chronic liver disease, and,
the dilated Hepatic artery may look like a dilated Bile Duct.
... Doppler will define the artery (color) as NOT a duct (no color)
7. Collapsed stomach VS Splenic Vein. (22:50 min)
--- Pancreas is hidden behind the stomach and the collapsed stomach assumes the shape.
8. Posterior gastric wall VS Pancreatic duct.
--- Curvature of the wall goes UP, whereas the duct would curve DOWN.
9. Hypertrophic Column of Bertin VS True space occupying lesion.
--- Kidney confusion re. Bump on the renal contour -- Is it a solid mass?
--- Optimize (Focus/increase) the image (brightens the image resolution)
--- This may reveal the Cortex & Medulla of the Kidney rather than a "tumor".
10. Columnar hypertrophy of the kidney normally indents the sinus.
11. APCKD vs Hydroephrosis.
--- Cysts are non-communicating, always bilateral, all random in size.
--- Example of a Medial large cyst with peripheral smaller communicating cysts.
12. Renal Stone VS Milk of Calcium VS Papillary tip.
--- A stone is only a stone if you can demonstrate a SHADOW.
--- Raise the FOCUS setting on the display to the level of the "stone".
--- "Milk of Calcium" display will show a straight Line border.
--- A "Papillary Tip" will display as a "cup" with urine all around a stone.
------ The stone will fall down as the patient is moved.
NOTE: When searching for a particular organ,
begin by looking for the part of the organ which is always FIXED.
Video: Abdominal, Cardiac, Apical View. 4:57 min
INDEX
0-Ultrasound/flv/Cardiac--Apical--SonoSite.flv
Online: https://www.youtube.com/watch?v=uiTsFtanyzM
SoundBites Cases, SonoSite Inc.,
Phillips Perera, MD RDMS FACEP
Emergency Ultrasound Director,
New York Presbyterian Hospital / Columbia University Medical Center.
Cardiac Echocardiography.
The Four Standard Views.
- Probe Position A, Parasternal View - Long Axis.
- Probe Position A, Parasternal View - Short Axis.
- Probe Position B, Subxiphoid View.
- Probe Position C, Apical View.
Probe Position C, Apical View.
Shows all 4 chambers in relation to one another.
Photo: Abdominal, Aorta, dopwave17.
INDEX
0-Ultrasound/sd-pix/aort-us-dopwave17.jpg
Online: https://www.youtube.com/watch?v=uiTsFtanyzM
2015 Radiological Society of North America, Inc. (RSNA)
Photo: Abdominal, Liver, abd-us-liver.
INDEX
0-Ultrasound/sd-pix/abd-us-liver.jpg
Online: https://www.youtube.com/watch?v=r_aGI4Z_39Q
2015 Radiological Society of North America, Inc. (RSNA)
Video: Liver Ultrasound Anatomy. 6:21 min
INDEX
0-Ultrasound/flv/LIVER_ULTRASOUND_ANATOMY_4.wmv
Online: ??
Diagram: Abdominal Veins.
--- The Superior Mesenteric Vein becomes the Portal Vein.
Picture: Hepatic vein color doppler ultrasound screen.
Diagram: Hepatic Portal System, extensive.
Picture: Abdominal veins and organs.
The LIVER takes blood in from the Hepatic Artery, and, the Portal Vein ...
the blood is cleaned and forwarded by the Inferior Vena Cava (IVC).
Picture: The Main Portal Vein (MPV) approaches the portal hepatis (a hilium of the liver) in a rightward, cephalic, and slightly posterior direction within the hepatoduodenal ligament.
The Gall Bladder comes in contact with the anterior surface of the Inferior Vena Cava (IVC) near the portal hepatis and serves to locate the liver hilium.
The Main Portal Vein (MPV) then divides into 2 branches ...
the Right (RPV) and Left Portal Veins (LPV). Each goes together with a branch of the hepatic artery and a branch of the bile duct to finish/exit in the IVC.
The Right Portal Vein (RPV) is larger than the left as the right lobe is the bigger one.
It is possible to identify the anterior and posterior divisions of the Right Portal Vein on sonography with the Right Hepatic Vein. The Left Portal Vein (LPV) lies more anterior and cranial than the Right Portal Vein (RPV).
The Hepatic Veins are divided into 3 components: right, middle, left ... entering the IVC.
- The RIGHT hepatic vein is the largest and enters the right lateral aspect of the Inferior Vena Cava (IVC) (left side of the display).
- The MIDDLE hepatic vein enters the anterior or right anterior surface of the Inferior Vena Cava.
- The LEFT hepatic vein, which is the smallest, enters the left anterior surface of the Inferior Vena Cava (IVC).
Portal Veins have more echogenic (darker) borders than the Hepatic veins because they have a thicker collagenous sheath.
Hepatic veins do NOT have echogenic walls.
The hepatic arteries carry oxygenated blood from the aorta to the Liver.
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Articles on the Internet are transitory.
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For the purpose of maintaining an availability of these articles for myself and you, I have reprinted parts in the relevant monographs with authorship maintained, coding simplified for error-free loading and minimal file size, and a LINK to the original document. Identity trackers and advertising bots have been removed from the original bloated and manipulative coding. NOTHING in writing is absolute; don't treat human opinion, projection, and observation as an Idol. Doing so can kill you, or worse, have you impose abuse on others.
I gathered and researched this data, mediated with the Grace of God through prayer as a benefit in my integrating discovered available digital information which would acquaint me with the overall content related to the health issues. I have found that God is ALWAYS available when we are Reverent in our Asking, open-minded in our Listening, and, Assertive in our Choice of Action. Doctors did not expect me to survive birth. In the past 25 years, medical and health "experts" have cautioned or directed me, more than 14 times, that I had little time left to live, or would die ... because THEY did not understand my challenges, were not motivated to professionally diagnose, or, chose to superstitiously recall as absolute previously flawed training. I am still alive beyond age 70. With the assistance of God, my Personality, the research and a lack of dismissiveness of a number of persons ... I have found resolution to numerous health challenges. This has enabled me to assist many others who had been abandoned, brainwashed, or traumatized. May my experience and successes also empower you. This is one document which you may find helpful as a BASIC introduction to maintaining and improving YOUR health.
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