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History: 50 year old male with abdominal pain and swelling. This is the typical appearance of cirrhosis on ultrasound. The best indicator of cirrhosis on ultrasound is a nodular contour to the liver surface, as seen above. Cirrhosis typically occurs in stages. Early on, the liver size may be enlarged. As cirrhosis progresses, the liver … Continue reading
History: 50 year old male with right upper quadrant pain. This is the typical appearance of fatty liver disease, also called hepatic steatosis, on ultrasound. The three main findings of fatty liver disease on ultrasound are 1) increased echogenicity as compared to the adjacent kidney (which must be measured at the same depth), 2) decreased acoustic … Continue reading
History: 40 year old female with right upper quadrant pain. This constellation of findings gives the diagnosis of choledocholithiasis, which is the presence of a stone within the biliary ductal system. A classic ultrasound finding with calcified stones is posterior acoustic shadowing, however, the appearance of gallstones is based upon the location, size, and composition. … Continue reading
History: 50 year old female with abdominal pain with an incidental finding. Adenomyomatosis is focal gallbladder wall thickening secondary to hyperplastic smooth muscle proliferation and exaggeration of the Rokitansky-Aschoff sinuses. It is usually asymptomatic, incidental, and of little clinical importance. Cholecystectomy can be performed if patients are symptomatic. The differential diagnosis includes adenomatous polyp, and … Continue reading
History: 50 year old male with incidental finding on chest CT. This is a diaphgragmatic hernia. There are multiple types of diaphragmatic hernias. Two of which have eponyms assigned to them are Bochdalek hernias and Morgagni hernias, of which can be either congenital or adult. A Bochdalek hernia occurs at the posterior pleuroperitoneal hiatus, or … Continue reading
History: 40 year old male with abdominal pain. The differential diagnosis in this case includes both cecal bascule and cecal volvulus. A volvulus is a rotational twist of the colon or small bowel on its own axis, which eventually will lead to ischemia and necrosis of the bowel by impairing arterial inflow and venous outflow. … Continue reading
History: 55 year old male with left flank mass on physical exam. The diagnosis in this case was metastatic extraskeletal osteosarcoma, which is a malignant mesenchymal soft tissue tumor that contains components of cartilage, bone, and osteoid. Unfortunately, these tumors have a poor prognosis, with an approximately 25% 5 year survival rate. Notice the pleural … Continue reading
History: 50 year old male with abdominal pain and swelling. This is the typical appearance of ascites on ultrasound. The right upper quadrant of the abdomen, particularly in Morrison’s Pouch, also known as the hepatorenal recess, is a great place to look for free fluid.
History: 40 year old with abdominal pain and diarrhea. Congenital anomalies of the inferior vena cava in about 0.2-0.5% of the population. Left sided IVC, which is this patient’s diagnosis, is seen in up to 0.5% of the population. Other anomalies besides transposition of the inferior vena cava include azygous continuation of the inferior vena cava, … Continue reading
History: 25 year old female with acute lower abdominal pain, nausea and vomiting. Given the history, this is essentially diagnostic of appendicitis. Take a look again at the image. The appendix has a target appearance, which also aids in the diagnosis. The target appearance is caused by edema within the various layers of the appendix … Continue reading
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