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Lumps and bumps. Common problems – When ultrasound helps and how
Abstracts the impact of the Symmers PPF on the portal vein (PV) and the possibility of the development of portal vein thrombosis as the result of the sever portal hypertension & increased viscosity due to high egg load needs to be explored.To assess portal vein patency 800 consecutive cases presenting to the hepatology unit in the period between October 2000 & October 2015 with ultrasonographic proven PPF were studied by Ultrasound means. Portal vein diameter was found to be 1.48§0.3 cm. Presence of PV thrombus was studied by both gray & Doppler scales & was found to be present in 74.4% of the cases. Only 10.3% of the cases had complete thrombosis, with compensatory PV cavernoma. Right portal vein affection was significantly higher than Left PV, while PV confluence had the highest prevalence of thrombosis. Splenic vein & superior Mesenteric vein thrombus was present in 15.0% of the cases. 8.2% of the cases had thrombus calcifications. No significant correlation was found neither between sclerotherapy treatment nor freequency of sclerotherapy & PV thrombosis. We therefore concluded that Periportal Fibrosis is an unrecognized cause of PV thrombosis carrying probably the highest incidence among benign diseases.
SESSION 12I: PAEDIATRICS Lumps and bumps. Common problems When ultrasound helps and how Edda L. Chaves,1 Paddy Dewan2 1 Paediatric Radiologist, M.D. Ultrasonologist, Hospital Santo Tom as, Panama, 2 Chair, Healthcare Excellence Institute Australia, Parkville, VIC, Australia Lumps and bumps are superficial abnormalities with a wide aetiology, including both congenital and acquired causes. They may appear suddenly in childhood, or present as a deformity at birth; the lesions may be symptomatic or present as an incidental finding. A few examples of the types of anomalies to be considered in this presentation are strawberry naevi, pilomatrixomas, thyroglossal cyst, preputial smegmoma, hernias and undescended testes, possible retained foreign bodies, lipomas, epidermoid cysts, lymph node enlargement, and pathology such abscesses and hematomas; there are many more! History and examination may adequately define the anomaly but, if not, ultrasound is the best tool to begin radiological investigation of these superficial structures, determine the nature of the lesion and assist in planning for management, including assessment of the chance of malignancy. Ultrasound allows analysis of the features of the pathology, its location, depth, the margins, and echogenicity, not only of the lesion itself, but also the surrounding region, including the vascularity. In assessing the nature of the lump, ultrasound will enable the origin to be pinpointed to involvement of the epidermis and/or dermis, adjacent blood vessels or deeper structures, and whether the lump is cystic, solid or of mixed echogenicity. The use of the high frequency ultrasound, and a linear probe is important to obtain good definition of the region of interest, and will enable comparison to the contralateral side, if relevant; for example, in possible groin hernias. The presentation takes the opportunity of bringing together both the clinician and radiologist perspectives to the investigation and management of lumps and bumps in children to help answer the question of when is ultrasound useful and how?
Ultrasound assessment of the paediatric neck Edda L. Chaves M.D. Ultrasonologist, Hospital Santo Tom as, Panama In children ultrasound is the best tool we have to evaluate any change in the neck, high resolution ultrasound allows excellent details of the
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anatomy, its possible to asses vessels, muscles and glands as the thyroid gland, Which begins its formation 24 days after fecundation, it begins at the floor of the larynx and migrates through the thyroglossal duct, by the 7 th week it completes this process, and starts functioning during the 3rd month of intrauterine life, this knowledge of the embryology of the gland is important due to the fact that in the evaluation of the neck ultrasound will allow to differentiate congenital abnormalities that will behave like a mass But its not only enlargement or presence of mass the reason to explore the pediatric neck, some patients under the suspicion of endocrinological disfunction, will use it to confirm the suspicion of pathology of the thyroid or absence of thyroid tissue. Wtih Doppler we are able to assess the vascularity of the gland in general to orientate possible diagnosis, or in case of focal abnormality to asses its vascularity. In the thyroid will see benign cyst with the same ultrasound appearance in any other part of the body, isolated or as part of other pathology of the gland. Malignancy is rare but we must be aware of it because when present its very aggressive. In children between the age of 4 and 8 the most common cause of mass in the neck, is lymph node enlargement secondary to viral or infectious process, with ultrasound we are able to confirm the etiology of the abnormality as well as do follow up until resolution, or if necessary guide a fine needle aspiration or biopsy Among other pathology we have in the neck, are those related to that of the sternocleidomastoid muscle congenital or acquired. Vascular lesions such as the hemangioma, or masses which have its origin in the fatty tissue such as lipomas, are very well defined by ultrasound. The aid of Doppler to let us know not only the relationship to vessels but to know if its a vascular mass or not.
SESSION 13A: MSK & RHEUMATOLOGY Ultrasound in pain management Colin Chun Wai Chong Radiologist, Chong MSK Radiology, Newmarket, QLD, Australia Ultrasound is possibly underutilized in interventional pain management. It has distinct advantages over more common methods such as fluoroscopy and CT, as it allows the identification of nerves, soft tissues and vessels without exposing patients and personnel to radiation. Imaging can be performed continuously in real-time, allowing for monitoring of procedures and possibly reducing the risks of complications. Ultrasound guided nerve blocks and ablative procedures including radiofrequency ablations, targeting structures such as ilioinguinal/iliohypogastric nerves, peripheral nerve blocks of the extremities such as medial plantar nerve, lateral plantar nerve, Baxter’s nerve or the medial calcaneal nerve, and painful stump neuromas. caudal epidural injections and injections of tender points. Ultrasound guided procedures, like diagnostic ultrasound, is operator dependent and requires appropriate training and experience.
The role of musculoskeletal ultrasound in psoriatic arthritis Anita Lee Consultant Rheumatologist, Royal Adelaide Hospital, Adelaide, SA, Australia Psoriatic arthritis (PsA) may develop in up to a third of people with psoriasis and can be erosive in 40-60% of patients early on, resulting in functional impairment and reduced quality of life. In recent years with the introduction of new medications and wider use of musculoskeletal ultrasound (US) imaging in clinical practice, the possibility of earlier US diagnosis in patients with psoriasis in the pre-clinical phase of PsA has been examined. US detection of subclinical synovitis and enthesitis in psoriasis patients without musculoskeletal involvement will be discussed.
SESSION 12I: PAEDIATRICS Lumps and bumps. Common problems When ultrasound helps and how Edda L. Chaves,1 Paddy Dewan2 1 Paediatric Radiologist, M.D. Ultrasonologist, Hospital Santo Tom as, Panama, 2 Chair, Healthcare Excellence Institute Australia, Parkville, VIC, Australia Lumps and bumps are superficial abnormalities with a wide aetiology, including both congenital and acquired causes. They may appear suddenly in childhood, or present as a deformity at birth; the lesions may be symptomatic or present as an incidental finding. A few examples of the types of anomalies to be considered in this presentation are strawberry naevi, pilomatrixomas, thyroglossal cyst, preputial smegmoma, hernias and undescended testes, possible retained foreign bodies, lipomas, epidermoid cysts, lymph node enlargement, and pathology such abscesses and hematomas; there are many more! History and examination may adequately define the anomaly but, if not, ultrasound is the best tool to begin radiological investigation of these superficial structures, determine the nature of the lesion and assist in planning for management, including assessment of the chance of malignancy. Ultrasound allows analysis of the features of the pathology, its location, depth, the margins, and echogenicity, not only of the lesion itself, but also the surrounding region, including the vascularity. In assessing the nature of the lump, ultrasound will enable the origin to be pinpointed to involvement of the epidermis and/or dermis, adjacent blood vessels or deeper structures, and whether the lump is cystic, solid or of mixed echogenicity. The use of the high frequency ultrasound, and a linear probe is important to obtain good definition of the region of interest, and will enable comparison to the contralateral side, if relevant; for example, in possible groin hernias. The presentation takes the opportunity of bringing together both the clinician and radiologist perspectives to the investigation and management of lumps and bumps in children to help answer the question of when is ultrasound useful and how?
Ultrasound assessment of the paediatric neck Edda L. Chaves M.D. Ultrasonologist, Hospital Santo Tom as, Panama In children ultrasound is the best tool we have to evaluate any change in the neck, high resolution ultrasound allows excellent details of the
S63
anatomy, its possible to asses vessels, muscles and glands as the thyroid gland, Which begins its formation 24 days after fecundation, it begins at the floor of the larynx and migrates through the thyroglossal duct, by the 7 th week it completes this process, and starts functioning during the 3rd month of intrauterine life, this knowledge of the embryology of the gland is important due to the fact that in the evaluation of the neck ultrasound will allow to differentiate congenital abnormalities that will behave like a mass But its not only enlargement or presence of mass the reason to explore the pediatric neck, some patients under the suspicion of endocrinological disfunction, will use it to confirm the suspicion of pathology of the thyroid or absence of thyroid tissue. Wtih Doppler we are able to assess the vascularity of the gland in general to orientate possible diagnosis, or in case of focal abnormality to asses its vascularity. In the thyroid will see benign cyst with the same ultrasound appearance in any other part of the body, isolated or as part of other pathology of the gland. Malignancy is rare but we must be aware of it because when present its very aggressive. In children between the age of 4 and 8 the most common cause of mass in the neck, is lymph node enlargement secondary to viral or infectious process, with ultrasound we are able to confirm the etiology of the abnormality as well as do follow up until resolution, or if necessary guide a fine needle aspiration or biopsy Among other pathology we have in the neck, are those related to that of the sternocleidomastoid muscle congenital or acquired. Vascular lesions such as the hemangioma, or masses which have its origin in the fatty tissue such as lipomas, are very well defined by ultrasound. The aid of Doppler to let us know not only the relationship to vessels but to know if its a vascular mass or not.
SESSION 13A: MSK & RHEUMATOLOGY Ultrasound in pain management Colin Chun Wai Chong Radiologist, Chong MSK Radiology, Newmarket, QLD, Australia Ultrasound is possibly underutilized in interventional pain management. It has distinct advantages over more common methods such as fluoroscopy and CT, as it allows the identification of nerves, soft tissues and vessels without exposing patients and personnel to radiation. Imaging can be performed continuously in real-time, allowing for monitoring of procedures and possibly reducing the risks of complications. Ultrasound guided nerve blocks and ablative procedures including radiofrequency ablations, targeting structures such as ilioinguinal/iliohypogastric nerves, peripheral nerve blocks of the extremities such as medial plantar nerve, lateral plantar nerve, Baxter’s nerve or the medial calcaneal nerve, and painful stump neuromas. caudal epidural injections and injections of tender points. Ultrasound guided procedures, like diagnostic ultrasound, is operator dependent and requires appropriate training and experience.
The role of musculoskeletal ultrasound in psoriatic arthritis Anita Lee Consultant Rheumatologist, Royal Adelaide Hospital, Adelaide, SA, Australia Psoriatic arthritis (PsA) may develop in up to a third of people with psoriasis and can be erosive in 40-60% of patients early on, resulting in functional impairment and reduced quality of life. In recent years with the introduction of new medications and wider use of musculoskeletal ultrasound (US) imaging in clinical practice, the possibility of earlier US diagnosis in patients with psoriasis in the pre-clinical phase of PsA has been examined. US detection of subclinical synovitis and enthesitis in psoriasis patients without musculoskeletal involvement will be discussed.