I did have to learn that table when I was in Uni but just double checking with you to avoid undercalling.

For grading stenosis, does your PSV has to agree with the ICA/CCA ratio when trying to categorise the extent of a stenosis? For example for a 70% stenosis, if I…[Read more]

I measure the distance from the umbilicus to that hernia: 20cm to the left and 8cm sup to umb. I think it is a Spigelian but thanks for letting me know the differentials to be aware of. I almost called it NAD since I cannot see that hernia when patient was lying down.

I had a patient with high BMI with no prior surgery. She complained of a lump when standing erect on the left anterior abdo wall. I found a mushroom shaped hernia with fat moving through a neck.

However, due to the high BMI, I cannot identify the oblique muscles and the Rectus abdominis is very hard to see as it is very thin…[Read more]

I got a severe case of prolapsed uterus where the whole of uterus is outside of the pelvic cavity and I can measure the whole length of it. For this type of translabial study, what would be your protocol?

Would you assess to see if there is a cystocele/rectocele with Valsalva? What pathologies/things would you look for?

Do you…[Read more]

Thanks Steve.

I had a patient who fell down and hit his ACJ against a hard surface. There is pain from ACJ towards the upper neck. I measure the distance between the acromion and clavicle tips to be 7mm horizontally and 4mm vertically. I can also see the pockets of fluid underneath the joint and as the patient forward flex, the capsule budges as…[Read more]

For patients with high BMI or with little mobility/bed bound, I find it hard to see the distal fem vein just 15cm AKC to the Knee crease. And it is quite hard to compress the vein at this region. Do you have any tips for direct visualization/ compression window?

A protocol to assess this segment might be taking a spectral trace where…[Read more]

So for point 3) & 6), we reduce colour frequency to detect low flow from the vert art? (better sensitivity?)

Then once identify, put the pulse wave on. Reducing pulse wave frequency will have the same effect as reducing the scale/PRF? so as to utilize the spectral trace real estate to magnify the waveform shape?

I don’t know if my…[Read more]

Thank you so much for your detailed response. Carotid is really challenging when it is not a straightforward NAD scan.

1) I do think that beam steering is overused, especially with machines like the Philips Affiniti 70 where people rave about how wide of a range the beam steering has. What I have always learnt from angle correcting…[Read more]

1) When obtaining traces, do you try to reduce the Doppler angle to make it <60 and closer to 0? Or do you try to keep it as close to 60 deg when taking all traces from CCA-ICA to make it consistent?

I find that velocities can be variable when multiple sonos perform a scan on a single patient over a short period of time and I…[Read more]

I use this position for LT elbow US. Now I can use it for DVT arm also, that’s neat.

I had a patient with a pacemaker so it will be Left majority of the time unfortunately!

Linh

For Left Arm DVT, do you scan with patient sitting up or lying supine? I found it awkward and painful to scan with patient sitting up especially for Left side. Or do you combine scanning lying down for upper arm and sitting up for forearm?

Do you drop the arm lower than the level of the bed so distal veins are better…[Read more]

Thanks for the reply. I sometimes measure the RT hepatic vein just out of interest and find that normal petite patient got large hepatic veins (15mm) but normal IVC (18mm). So I am a bit reluctant to follow these numbers as well. I’ll also look for the subjective signs from now.

Just back to basic: I was taught to measure the liver…[Read more]

I got a Abdo US referral that ?hepatic congestion. For a normal abdo scan, I would just measure the sizes of the IVC and RT and Mid hepatic veins. Then I state in the report: Referral to Portal Hypertension Vascular US study recommended. Would you have done the same, protocol wise?

What is your limits for these vessels?

In the…[Read more]

I had a referral US of brachial plexus for any adhesions. The patient also has MRI booked in.

When scanning the cervical chains, I can see the neurovascular bundle of the brachial plexus. But what do you look for exactly?

Best regards,
Linh

Looking forward to your webinar on Hernia Imaging in the near future!

I do my DVT supine and decub most of the time. However, there are times when the PTV/Pero veins are so small that I need to swing the patient’s leg hanging down from the edge of bed and raise the bed up. RT side is fine as I still use my dominant hand (RT hand) to scan and the left hand to squeeze the calf. But for the LT leg, I find…[Read more]

Sometimes when I scan the groin, I can see there is reducible fat within the superficial ring but I cannot seem to find a neck or movement of the fat. What is your differentials? Would this possibly be a cord lipoma? What are the signs to differentiate between this entity and a reducible fat containing hernia?

Best regards,
Linh

Thanks for your detailed reply. I usually start with option 3 for dummies 🙂 easy to locate and navigate.

For the referral in question, do we ever really need to worry too much about the superficial branch or the radial nerve itself as PIN syndrome is already rare?

Linh

Thanks for clarifying that. The radiologist just stated the measurement in her report and let the referring hand surgeon decide.

I have seen PMA and always turn on Color as my senior had encountered thrombosis before. Such a rare occurence!

Linh

The median nerve has a cutoff of 0.09cm2. But if the patient has a bifid median nerve, do you add them up at the level of the lunate and still use the same cutoff to say if there is CTS?

Best regards,
Steve

I got another nerve referral: US of the radial nerve ?radial tunnel syndrome.

I look it up and it’s a synonym for supinator syndrome (thickening of PIN at arcade)? If not the case, how do you scan the radial nerve and its branches? Are there landmarks to note/where particular attention should be made?

I imaged the PIN where it…[Read more]

Thank you so much for such a detailed reply. It took me some time to do extra reading + your answer to make sense for me.

Sural nerve wasn’t too bad for me to assess at the time but I spent a long time just trying to navigate with the peroneal nerves (I did annotate Deep and Superficial Pero nerves as I cant seem to find info on…[Read more]

I have not thought of that. I guess the Thickened A2 at the IPJ can be ignored also then since it is really just because of the nitrogen gas. I sometimes see nitrogen gas (as echogenic foci) within the ACJ and Post GHJ in the shoulder but they don’t obviously click. Thanks Steve!

I had a 60 year old patient with a clicking 1st IPJ whenever he flexes this joint. I saw a thickened A2 and also thickened A1 (where there is no clicking but tendon bunching). In this case, it is clear the patient has trigger thumb from the level of A1, but is the clicking IPJ just part of this condition also? or is it more OA…[Read more]

I got a referral today from a specialist asking for a lower limb nerve study: check for sural and anterior tiobial nerves, check retinaculae, to 4th-5th toes ?perineural scarring.

What is your scanning protocol for this sort of study? Are there areas we need to look carefully?

Best regards,
Linh

I got a challenging ankle today. Patient runs a lot but had no injury. Pain from just above Medial malleolus towards plantar hindfoot for 1 month. Tender when pressed. I found simple pockets of fluid surrounding the MTJ of TP, FDL and FHL. There is further tendon sheath fluid at the Knot of Henry where FDL and FHL crosses. Minimal…[Read more]

Thank you so much for your detailed reply.

I looked up Morel-Lavallee lesion in Bianchi book and it seems that there is quite a few differentials to its appearance such as haematoma and soft tissue tumour (in the case Morel lavalle appears complex). I guess we can never be specific with these when writing our reports.

I agree with…[Read more]

Hope you are doing well.

I have looked into differentiating the different phases of an infective process such as cellulitis, phlegmon and abscess or entities such as seroma and granulation tissues in healing. I was wondering if you can break it down the most important features to differentiate each of these.

Also, for referrals…[Read more]