Department of Radiology,
Lister Hospital,
Stevenage,
Herts SG1 4AB

Email: Dr. Amerasekera
Tel: 01438 781 028
Fax: 01438 781 176

Contents

Home Page
Lister Hospital
Pinehill Hospital
Group Profile
Appointments & Billing

Our Services
Breast Imaging
Head & Neck Imaging
CT Scans
Contrast Study
Interventional
MRI Scans
Adult Nuclear Medicine
Child Nuclear Medicine
Plain X-ray
Ultrasound »

More Information
History of Radiology
Basic Anatomy
Related Links
Contact Us

Ultrasound

This service is available both at the Lister Hospital and Pinehill Hospital.

The different types of Ultrasound Scans include:

• Abdominal and Pelvic scans
• Scans of muscles ligaments and joints
• Thyroid scans
• Salivary Glands
• Testicular Ultrasound
• Scans of the Kidneys and Bladder
• Colour Doppler ultrasound - venous(varicose veins) and arterial
• Intra-cranial ultrasound in babies
• Antenatal scans
• Other scans of the soft tissue
• Transvaginal scans
• Interventional procedures

What is an Ultrasound Scan?

Ultrasound uses high frequency waves to build up images of the various organs or structures inside the body. The sound waves are produced by a hand held probe, which is placed on the skin over the relevant area. The waves are reflected back from the parts of the body and a computer inside the ultrasound machine converts the sound waves into a moving image on the T.V. monitor.

ULTRASOUND INFORMATION

• Ultrasound is totally painless

• Is it dangerous?

  No radiation is involved in an ultrasound examination. Ultrasound has been used for 20 years with no proven damage to patient or operator.

• Do I need to prepare for this examination?

  There are basic preparations you may be asked to perforn see your appointment sheet.

• Why?

  Full bladder: this is to push the small intestine out of the way and enable us to view the pelvic organs and bladder wall. It is necessary to measure the volume of fluid inside the bladder at times. b) Starve for 6 hours, drink clear fluids, no smoking before the examination this allows us to get a clear view of the upper abdominal organs. Food and wind in the stomach and upper intestine can obscure smaller organs or cause artefacts or false images. If gallstones or gallbladder disease is suspected the preparation is essential as food and smoking cause the gallbladder to shrink and thus not be clearly seen.

• What happens?

  You may be asked to undress and put on a hospital gown depending on which part of the body is to be examined. The ultrasound room is darkened to give good viewing conditions for the T.V. monitor. You will be asked to sit or lie on a couch, a small amount of water based gel will be applied to the part under examination. The hand held probe will be moved over the skin to view the relevant organs from ditferent angles. You may be asked to hold your breath while still images are recorded, to prevent blurring of the picture. At the end of the scan the gel will be wiped off the body and you will be free to go.

• How long does it take?

  An ultrasound can take between 10 and 30 minutes depending on the type of scan.

• What about the result?

  The report of the results of your scan will I be sent to the Doctor who originally referred you for the scan. This usually takes about 7 working days.Urgent results will be sent to your Doctor within 2 days.

• Who will perform the scan?

The scan will be undertaken by a Consultant Radiologist.

Key Benefits

• Simple
• Quick
• No radiation
• Painless

ULTRASOUND SCAN GELS

One of diagnostic ultrasound's limitations is that the sound beam will not penetrate air or air filled structures. The ultrasound beam is virtually reflected at an air interface. The first major air interface problem is at the transducer contact with the patients skin. If air is present between the transducer and the patients skin the ultrasound beam will be reflected or at the very least greatly reduced in power and penetration. To overcome this interface problem we use a coupling medium or scan gel to allow intimate contact with the skin. As an added benefit, the contact gel lubricates the skin making movement of the transducer easier to accomplish and more comfortable for the patient. Today we have several water based ultrasound gels. The scan gels give us excellent skin contact without air spaces and provides smooth and easy transducer movement. This water soluble gel doesn't stain the operators clothes, doesn't irritate skin or doesn't cause damage to costly ultrasound equipment. This gel is best suited to imaging large areas on patients who are lying down, as this is a very fluid scan gel. We try our best to warm the gel before use.

ABDOMINAL ULTRASOUND

Abdominal ultrasound, also known as abdominal sonography, is a painless, noninvasive procedure where sound waves are used to produce images of the inside of the body. The reflected sound waved are received in specialised instruments connected to the ultrasound machine, called transducers. The transducer is a small, hand-held device about the size of a fist. The radiologist spreads a lubricating gel on the patient’s abdomen in the area being examined, and then presses the instrument firmly against the skin to perform the test. The transducer is swept back and forth to image the part of the abdomen being imaged. The transducers are connected to computers that form an image on a TV screen. These images are interpreted by radiologists and are helpful in diagnosing problems in the abdomen, especially gallbladder, liver, and kidney problems. Imaging of the pancreas with ultrasound is often problematic because gas in the bowels, which blocks the reflection of the high-frequency sound waves, can limit the quality of the images. It is also used to guide procedures such as liver biopsies, where a small needle is used to sample a core of liver tissue for laboratory and pathology testing. It is also extremely useful in detecting stones in the gallbladder, bile ducts, and kidneys. Ultrasound examination of the abdomen offers many advantages. It is painless, noninvasive, and does not expose the patient to any radiation. For examination of the bile ducts, looking for stones in the gallbladder, and in looking at the liver, ultrasound can be superior to CT scanning in many cases. Limitations include problems with resolution (finding very tiny problems), and the problem in imaging through air-filled bowel. Your doctor can use this important tool in helping to diagnose a wide variety of conditions in the abdomen

GALL STONES

Types of Stones

Cholesterol stones (>50% cholesterol)

Pigment stones (little cholesterol) Black - inorganic salts Brown - fatty acids

Although gallstones are common, only 30% of patients ever develop symptoms. Symptoms may occur when the gallstone obstructs the biliary system, either in the cystic duct (cholecystitis) or the bile duct (obstructive jaundice). Both conditions can present with similar painful syndrome and can not be distinguished based on history alone. Gallstone pain is typically steady and occurs in the epigastric region; hence the term biliary colic is a misnomer. Meals usually precipitate pain. Pain is severe and lasts hours; mild intermittent or fleeting pain is unlikely to be from gallstones. Gallstone pain may recur in days to years. The majority of patients who experience serious complications of gallstone disease (e.g., cholecystitis) have prodromal pain. Patients with cholecystitis present with severe unremitting pain, mild fever, leukocytosis, and Murphys sign. A positive Murphys sign is elicited if the patient takes a sharp, deep breath and holds it because of the pain produced by palpating the right upper quadrant. High fever or other systemic signs may be due to more serious complications of cholecystitis such as perforation. Obstruction of the bile duct by a gallstone leads to obstructive jaundice. Unlike patients with malignant obstructive jaundice, patients with bile duct stones usually have gallstone type of pain. Continued obstruction may lead to superinfection resulting in cholangitis, which is diagnosed by the Charcots triad of fever, pain, and jaundice. Gallstones are best diagnosed using ultrasonography, which is accurate, non-invasive, and readily available. Most gallstones cannot be seen using plain x-ray. The treatment of obstructive gallstone disease is decompression, by cholecystectomy in case of cholecystitis and by endoscopic or interventional radiological methods in cases of cholangitis. Most cholecystectomy however is performed electively for treatment of recurrent attacks of gallstone pain. Although other treatments such as lithotripsy or dissolution may be also effective for gallstone disease, the vast majority of patients who require treatment should undergo cholecystectomy. Broad-spectrum antibiotic therapy is indicated in most patients with cholecystitis (especially if they have fever or leukocytosis) and in all patients with cholangitis. The most frequently seen bacterial pathogen in cholangitis includes E. coli, Klebsiella, and other enteric organisms.

i Diagnosis

Plain films of abdomen, Ultrasound , Oral cholecystogram ,Radionuclide scan (HIDA) Cholangiogram (for CBD stones) ERCP (endoscopic) PTC (percutaneous)

Treatment

Dissolution agents Oral bile acids Contact solvents Extra-corporeal shock wave lithotripsy Surgical Open cholecystectomy Laparoscopic cholecystectomy If CBD exploration for stones is planned, open procedure is easier ERCP + sphincterotomy

LIVER METASTASES

Liver is a common site for cancer spread. Many cancers can spread to this organ, such as: Breast Cancer Colon Cancer Stomach Cancer Ovarian Cancer Kidney Cancer Malignant Melanoma Esophageal Cancer Testis Cancer Choriocarcinoma. Almost any cancer can spread to the liver. Symptoms associated with this condition vary, depending on the extent of liver involvement. Most patients are diagnosed with liver metastasis on routine work-up of the cancer, when there are no symptoms at all. Others present with an advanced stage of a cancer when the disease has spread to the liver.

Symptoms: Pain in the abdomen Distention of abdomen Jaundice Abnormal liver tests and fluid in the abdomen. CT scan or Ultrasound can establish the diagnosis. Once the diagnosis is established, treatment should be initiated promptly.

Treatment: Almost all patients are treated with chemotherapy. Surgery in selected patients to remove the tumor from the Liver. This is indicated when the primary site of the disease is under control and the extent of the disease in the liver is very limited. Response to treatment depends on the patient's overall condition and the type and extent of the underlying cancer.

PELVIC ULTRASOUND

This exam requires that you drink several glasses of clear liquid starting 2 hours before your appointment. You must have a very full bladder. This creates a "window" for the radiologist to "see" through. If your bladder is not full, your appointment will need to be rescheduled. You may be asked to either change into a gown or slide your pants down to your pubic bone. This exam may be uncomfortable due to the full bladder, but should only last 15-30 minutes. If additional information needs to be obtained, a transvaginal ultrasound may also be performed. This involves inserting a "probe" into the vagina and looking at the pelvic organs from a different angle. You do not need to have a full bladder for this study. If your doctor has ordered a transvaginal ultrasound, please arrive with a full bladder, as the pelvic ultrasound will be performed first. These examinations complement each other and together will obtain the best diagnostic picture for the radiologist.

MUSCULOSKELETAL ULTRASOUND

Human muskuloskeletal anatomy comprises a complex network of bone and soft tissue, including joints, muscles, ligaments, tendons and nerve bundles. Ultrasound enables identification of inflammation, tears and ruptures, lesions, fluid collections and soft tissue masses. High frequency ultrasound allows you to visualise not only tendon tears, but the sheath and internal fibrillar structure enabling much earlier diagnosis of potential problems. The dynamic nature of an ultrasound scan is particularly valuble in musculoskeletal examinations. Applications for Musculo-skeletal Ultrasound

1. Soft Tissue Trauma Muscle tears and haematomas can be accurately identified and assessed. This can also assess the need for surgery. The healing process of a haematoma and state of repair of the muscle can be followed. Complications like muscle cysts are also easily seen.
2. Foreign Bodies: Small radio-lucent foreign bodies such as fibreglass fibres and other extremely fine and small foreign bodies which cannot be seen on a normal plain X-Ray are easily seen on ultrasound examination. Ultrasound can detect and help in its removal.
3. Joints: The shoulder can be adequately assessed with ultrasound and it is a sensitive means of detecting tears at the rotator cuff, tendonitis, joint and bursal effusions. Movement of the shoulder joint during the examination can be performed to assess the presence of impingement on the rotator cuff by the coraco- acromial arch. Tears of the ligaments around the knee and ankle can also be identified and their integrity assessed. Joint effusions can be easily confirmed with an ultrasound examination. If required, fine needle aspiration of a joint or bursa can also be performed under ultrasound control. Bakers cysts can also be accurately located and their size measured.
4. Using high resolution ultrasound, tendon Integrity and size can be easily measured and assessed. The presence of acute tendonitis, acute tendon tears and chronic tendonitis can all be detected. The most commonly examined tendons are those in the rotator cuff of the shoulder, patella tendon, Achilles and other ankle tendons. All other peripheral tendons including those around the wrist, elbow, knee and hip can all be well visualised.
5. Nerves : nerves and the presence associated soft tissue swelling is easily seen.. The median nerve can be assessed at the wrist joint in patients with Carpal Tunnel Syndrome. The appearance of the Neuromas (eg Morten's neuroma) can be located and their size measured.
6. Arterial occlusion and stenoses and venous thrombosis are also well seen and can be accurately localised with a Doppler ultra-sound examination.

TESTICULAR ULTRASOUND

Testicular or Scrotal ultrasound is usually performed for:

• Testicular lump
• Testicular pain
• Testicular swelling

Scrotal ultrasonography has been demonstrated to have a clinically significant impact on urologists' diagnoses of scrotal abnormalities and disorders. Scrotal ultrasound is characterized by high sensitivity in the detection of intra-scrotal abnormalities and is a very good mode for differentiating testicular from para-testicular lesions. The main indication for color Doppler ultrasound (which can reveal scrotal blood flow) is assessment of acute scrotal symptoms (pain or swelling), especially in the diagnosis of suspected testicular torsion. The vast majority of boys who exhibit acute scrotal symptoms have non-surgical conditions, usually epididymitis or torsion of the appendix testis. Since the clinical appearances of these conditions are often similar to that of testicular torsion, imaging is frequently performed to help with diagnosis. In fact, color Doppler ultrasound is the method of choice for imaging scrotal organs, and allows more objective and precise assessment of varicoceles. Varicoceles can be diagnosed by showing intra-scrotal veins larger than 2 mm. It has also been shown that color Doppler ultrasound is more accurate and reliable than physical examination in conjunction with gray-scale ultrasound (which is non-specific and can't be used to diagnose testicular torsion) in the differential diagnosis of acute scrotum. Patients with hydroceles large enough to prevent adequate palpation of the testes should undergo scrotal ultrasound. Sonographic identification of calculi in the hydroceles may prevent further imaging and unnecessary surgery. Color Doppler ultrasound is also used in the evaluation of traumatized scrotum. Testis rupture must be diagnosed rapidly and color Doppler ultrasound can be used to evaluate perfusion of the testis. The prediction of testicular viability following trauma is essential for proper treatment. Other indications for scrotal ultrasonography are detection of undescended (cryptorchid) testes, and evaluation of infertile men. It should be noted that intra-abdominal testes cannot be located with ultrasound. Routine scrotal ultrasound has been reported to provide valuable information in the diagnostic evaluation of infertile men and substantially more pathological conditions are detected compared to clinical palpation. The high prevalence of testicular malignancies underscores the importance of routine scrotal ultrasonography in infertile men.

Tubular ectasia of the rete testis

Benign condition and often bilateral. Occur mostly in elderly men Associated with epididymal abnormalitites like spermatocoeles, epididymal cysts and testicular cysts.

Cryptorchidism

Often unilateral 25% are bilateral. Fibrosis and tubular atrophy begins from the age of 2 years Greater risk of malignancy ( 7 - 11 fold increase). Greater risk of malignancy in the descended testis in these patients. Benign intratesticular cysts

Benign cysts

Are commoner than the malignant ones. Uncommon in young men. Commoner in the older age group. May be single or multiple - rarely > 2 cysts. Rarely >1cm in diameter Anechoic cysts in older men need no follow-up.

Spermatocoele

Large cystic dilatation of the ducts. Common in the head of epididymis Common after vasectomy. Contain creamy material. Low level internal echoes are seen.May be hyperechoic and appear solid due to crystallised protein products.

Sperm granuloma

Caused by extravasation of sperm into the epididymis. Common in the head of epididymis. Common after vasectomy. Usually less than 10mm. May be hyper or hypoechoic depending on the degree of fibrosis. May or may not have pain.

Torsion

Defined as the rotation of the testis on the longitudinal axis of the spermatic cord. Common in adolescence (12-18 yrs). 30% are older than 20 years. Testis not tightly applied to the posterior aspect of scrotum.Critical to diagnose within 4-6 hours. May be normal on US and Doppler. Extravaginal torsion (rare) is seen in the new born.Realtime US appearances similar to epididymo-orchitis. Epididymis - swollen and hypoechoic. Testis - swollen and hypoechoic Haemorrhagic areas will be echogenic. Hydrocoele is common. Symptoms and signs of torsion Sudden scrotal pain with swelling Nausea vomiting and shock.Scrotum asymmetrically swollen and tender. Scrotum is usually reddened. Testicle may have a horizontal lie. Elevation of the testis gives no relief

Testicular infarcts

Are hypoechoic,peripheral and often wedge shaped Caused by infection, trauma or torsion. Often have a linear edge. Important to distinguish from tumours. Infarcts are soft unlike tumours. Tumours are usually rounded.

Testicular microlithiasis

Pathogenesis is not well known. Concretions in seminiferous tubules. Sometimes associated with cryptorchidism, Klinefelters syndrome or infertility. It is said to be related to the development of testicular tumours but no proof yet. Self examination and yearly follow-up is recommended.

Intratesticular calcification and echodensities

Calcifications are common but non calcified densities are rare. Important to exclude a tumour. May indicate a non seminomatous germ cell tumour Or a burnt out testicular. Tumour -excluded by examining the retroperitoneal lymph nodes.Some are benign with no clinical significance.

Extratesticular calcification

May be in the tunica albuginea, between layers of tunica vaginalis Or in the epididymis. They are all benign Aetiology is unknown. May be related to chronic infection.

Extratesticular masses

Vast majority are benign-postinflammatory. 5% of all scrotal masses are epididymal tumours. 30% of epididymal tumours are benign adenomatoid tumours. Commonest epididymal tumour is metastasis. Lipomas and mesenchymal tumours occur in the spermatic cord.

Epididymal cysts

May occur at any age and is said to be present in 40 % of all men. May be due to previous infection. Filled with clear serous fluid. May be single or multiple or bilateral. Can be in the head, body or tail. Commonest in the head of epididymis. No internal echoes. They have no clinical significance.

Tunica vaginalis cysts

Arise between the visceral tunica vaginalis and tunica albuginea. Are idiopathic or post traumatic in origin. They may be small or large and are benign. They usually have no clinical significance.

Hydrocoele

Is a collection of fluid between the two layers of the tunica vaginalis. Acquired hydrocoeles result from : Inflammation Trauma, Torsion orTumour.

Varicocoele

They are dilated intrascrotal veins > 2.5mm in the lower pole. (Keith Dewbury) Present in 15% of normal population Occur in 20-40% attending infertility clinics. Commonly bilateral.Common on the left. Valsalva manoeuvre makes it more prominent. If acute onset look for left renal carcinoma .

Trauma

May be penetrating or blunt trauma. Surgical exploration if penetrating injury. Testicular rupture is a surgical emergency. Look for the bright linear echo completely surrounding the testes.Intratesticular haematoma. rupture of the testis, haematocoele, scrotal haematoma and oedema may be found on ultrasound..

Acute Epididymitis

Common in adolescent and middle age men. Chlamydia and GC in the young. E-coli and pseudomonas in the older patient Begins in the tail of epididymis. Commonly due to retrograde spread from prostate or bladder via lymphatics or vas deferens. May lead to abscess formation seen as a well circumscribed hypoechoic lesion.Heal with fibrosis. Testicular infarction or testicular atrophy and sterility may occur. May spread to opposite testis. May lead to cyst formation. Epididymis enlarged and hypoechoic. Surrounding fat becomes echogenic. Diffuse or focal orchitis may be seen.Scrotal wall may be thickened. Reactive hydrocoele may be found.

Mumps

Testicular involvement is rare in pre-pubertal children. In the post-pubertal 20-30% are affected.70% have unilateral orchitis.Usually occur a week after parotitis.

Chronic epididymitis

Difficult diagnosis on US. History may help in diagnosis. May present as a painless mass after an acute infection. Heterogeneous appearance on US Often predominantly hypoechoic.

Idiopathic granulomatous orchitis

Non specific inflammation probably an autoimmune disease. Occur in middle age and older men. Clinical and ultrasound appearances mimic tumour. Present with a tender mass with fever. Histology- granulomas resembling tubercles.

Testicular tumours

Patients have painless testicular swelling, weight loss malaise supraclavicular swelling. gynaecomastia. US appearances are non specific. Cannot differentiate benign from malignant. Tumours in adults Incidence 2.5 per 100,000 population 90-95% of testicular tumours are malignant germ cell tumours. More common on the right side than left. 2-3% are bilateral. Most bilateral tumours are seminomas. Seminomas 40% Embryonal carcinoma 15%

Teratoma 5%

Choriocarcinoma <1%

Yolk sac tumour 1%

Mixed tumours (40%)

Teratocarcinoma most common (teratoma+embryonal carcinoma). Majority unilateral 8% eventually develop tumour in the other testis. Tumours occur in the 25-35 age group.Overall survival rate has increased from 50 to 95% in the last decade. Stage 1 seminomas have a cure rate of 95-100%. Seminoma is the most common tumour in cryptorchidism.

Prognosis

Seminomas - 85% are classic seminomas and have a good prognosis. Embryonal carcinoma - good prognosis if detected early. Teratoma Mature teratomas- occur in the young and have a good prognosis, . Immature teratomas- occur in the older patient and the prognosis is not as good Choriocarcinoma - (poor prognosis) Yolk sac tumour ( occur in babies- good prognosis) Mixed tumours - prognosis depends on the more aggressive element Burned-out tumour Primary tumour has regressed whilst metastatic spread continues. Occur in germ cell tumour. Densely echogenic on ultrasound.

Tumours in children- Rare. 1% of paediatric malignancies Peak incidence in 2nd year of life Most tumours are malignant Majority are yolk sac tumours followed by teratoma, lymphoma and leukaemia. Seminoma is a post pubertal tumour. Leydig cell tumours occur in 5-10 yr age.

Testicular atrophy

Testis hypo-echoic and small.

Causes- Post infarction- Post orchitis -Post traumatic- Late descent into scrotum- Irradiation -Hormonal treatment of prostatic carcinoma.

Colour Doppler is helpful in the diagnosis of acute scrotal pain, acute epididymitis and orchitis, testicular abscess and necrosis torsion of the testis, varicocoele

The commonst cause of a lump is an epididymal cyst but a tumour has to be excluded using ultrasound. The commonest cause of pain is an infection called epididymitis but a tumour or torsion has to be excluded using ultrasound. The commonest cause of swelling is a hydrocoele which is fluid around the testicle. After trauma there may be blood around the testicle.

Please note that we clean the probes thoroughly between examinations

Facts About Testicular Cancer

The American Cancer Society estimates that in the year 2001 about 7,200 new cases of testicular cancer will be diagnosed in the United States. An estimated 400 men will die of testicular cancer in the year 2001.Testicular cancer is one of the most curable forms of cancer.Source: American Cancer Society

What is testicular cancer?

Cancer that develops in a testicle is called testicular cancer.

When testicular cancer spreads, the cancer cells are carried by blood or by lymph, an almost colourless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells. What are the symptoms of testicular cancer?The following are the most common symptoms for testicular cancer. However, each individual may experience symptoms differently. The National Cancer Institute suggests that a man see a doctor if any of the following symptoms lasts two weeks or longer: ·

• lump in either testicle ·
• enlargement of a testicle ·
• feeling of heaviness in the scrotum ·
• dull ache in the lower abdomen or in the groin ·
• sudden collection of fluid in the scrotum
• ·pain or discomfort in a testicle or in the scrotum ·
• enlargement or tenderness of the breasts

The symptoms of testicular cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What causes testicular cancer?

The exact cause of testicular cancer is not known. However, there are a number of factors that increase the risk for the disease.

What are the risk factors for testicular cancer?

The exact cause of this disease is unknown. However, research does show that some men are more likely than others to develop testicular cancer. Possible risk factors include: ·

• age - most testicular cancers occur in men between the ages of 15 and 40 ·
• cryptorchidism - undescended testicle(s) ·
• occupational risks - miners, gas workers, leather workers
• food and beverage processing
• family history · personal history of cancer in the other testicle
• race and ethnicity - the rate of testicular cancer is higher in Caucasians than in other populations ·
• HIV infection

Can testicular cancer be prevented?

Currently, there is not a method for preventing the disease because: · currently, there is not a known cause for the disease. · many of the suggested risk factors are those that cannot be changed. · many men with testicular cancer do not have the suggested risk factors. However, testicular self-examination can improve the chances of finding a cancerous tumor early.

Testicular Self-Examination Procedure·

The best time for testicular self-examination is just after a warm bath or shower when the scrotal tissue is more relaxed. · While standing in front of a mirror, place the thumbs on the front side of the testicle and support it with the index and middle fingers of both hands. · Gently roll the testicle between the fingers and thumbs. Feel for lumps, hardness or thickness. Compare the feelings in each testicle. · If you find a lump, see your physician as soon as possible. Testicular self examination is not a substitute for routine physical examinations by your doctor.

How is testicular cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures may include: ·

ultrasound - an imaging procedure that uses sound waves to produce pictures of internal organs.

blood tests - assessment of blood samples to check for increased levels of certain proteins and enzymes to determine if cancerous cells are present, or to determine how much cancer is present.

biopsy - removal of the tumor, which is sent to the laboratory for examination under a microscope by a pathologist.

When testicular tumors are present, the entire tumor, as well as the testicle and spermatic cord, may be removed to prevent the spread of cancerous cells through the blood and lymph systems.Staging of testicular cancer:Staging is the process of determining if and how far the cancer has spread. Treatment ptions are based on the results of staging. Procedures for determining stage include: · computed tomography scan (Also called a CT scan) -

Magnetic resonance imaging (MRI) -

Chest x-rays, bone scans, or other scans may be requested.

Treatment for testicular cancer:Specific treatment for testicular cancer will be determined by the physician.

THYROID GLAND

The thyroid gland is easily demonstrated by ultrasound because it is a superficial structure and is in an easily accessible position.

It is the biggest gland in the neck and is situated in the front of the neck . The sole function of the thyroid is to make thyroid hormone. The function of the thyroid therefore is to regulate the body's metabolism.

Goitre is an enlargement of the thyroid gland. Goitres are often removed because of cosmetic reasons or, more commonly, because they compress other vital structures of the neck including the trachea and the esophagus making breathing and swallowing difficult. Sometimes goitres will actually grow into the chest.

Thyroid Cancer is a fairly common malignancy, however, the vast majority have excellent long term survival.

Solitary Thyroid Nodules Although as many as 50% of the population will have a nodule in the thyroid, the overwhelming majority of these are benign. Occasionally, thyroid nodules can take on characteristics of malignancy and require either a needle biopsy or surgical excision.

Hyperthyroidism means too much thyroid hormone.

Hypothyroidism means too little thyroid hormone and is a common problem. In fact, hypothyroidism is often present for a number of years before it is recognized and treated.

Thyroiditis is an inflammatory process ongoing within the thyroid gland. Thyroiditis can present with a number of symptoms such as fever and pain, but it can also present as subtle findings of hypo or hyper-thyroidism.

SALIVARY GLAND ULTRASOUND

These glands produce saliva. Saliva is a fluid which keeps the mouth moist. It also moistens and softens food during the act of chewing and has a minimal digestive action on food components as well. The salivary glands are chiefly arranged in three paired groups (major salivary glands): The Parotid Gland The parotid glands are the largest, placed just in front of the ear. submandibular glands are placed just beneath the jaws, protruding partially into the top of the neck. The sublingual glands are arranged on both sides of the floor of the mouth. There are several minor salivary glands as well, scattered randomly in the mouth.

About 1% of people have salivary stones, of which half will become problematic. Most stones form in the submandibular gland (85%) and the remainder in the parotid (15%).Stones in the ducts of the salivary glands are best seen by a Plain Xray of the area or Sialography but it may be seen on ultrasound.

Tumors arising from the salivary glands are usually benign, (non cancerous). A few however, may be cancers. A Fine needle biopsy may be needed to make a firm diagnosis.Cancers arising from the salivary glands are of several types. Usually, the presentation is in the form of a painless swelling in front of the ear (parotid), in the upper neck close to the jaw line (submandibular)

An Ultrasound is a good initial examination to locate the lump and estimate its size. It is also a good way to exclude a tumour when the swelling is due to an infection. A CT scan or and MRI scan may also be required to Stage the cancer before starting treatment.

COLOUR DOPPLER ULTRASOUND.

Colour flow Carotid Doppler

Colorflow Doppler uses sound waves and a computerized digital imaging system to break the flow of blood into different colors and help identify problem areas.

A Doppler study is done to look for plaque, stenosis, or occlusion in the common, internal, or external carotid arteries. The examination may be long, up to 1 hour including waiting time. A gel is applied to the skin and a handheld transducer is swept across the area of the carotid arteries. Sound waves are used for the imaging and no radiation exposure is present. If carotid bifurcation is located above the angle of the jaw, visualisation may be not possible. Fifty percent or greater stenosis of studied vessel is considered hemodynamically significant A satisfacory scan depends on the ability of patient to hold head still during the examination.

Colour Flow Doppler for Varicose veins

• Doppler studies are performed in patients with varicose veins to identify incompetent vessels. This helps in the treatment of varicose veins.
• How do varicose veins occur? The vein circulation of the leg is divided into two relatively separate sections: A low pressure, superficial system, running just under the skin (from which varicose veins form) and, A high pressure, deeper system, running under the muscles and close to the bones. This system carries most of the blood out of the leg. Under normal circumstances, movement of the leg muscles and the action of breathing actively pumps the blood in surface veins into the deeper veins, and then on upwards towards the lungs and heart. The surface, or superficial, veins join the deep veins at various places and it is what happens at these junctions that is one of the keys to the cause of varicose veins. At these various junction points there is an arrangement of valves, which (supposedly) prevent blood entering the superficial venous circulation, once it has already passed into the deep system. It is when these valves do not work properly that blood is able to move under pressure in the wrong direction, back into the surface vein system, and varicose veins can eventually be one of the results.
• Why do faulty valves cause varicose veins? When valves cease to function, either partially or completely, they are said to become incompetent. As an example, take the situation at the junction in the groin.This is the most common site of valve failure, which is why many people with varicose veins have them develop down the inside of the thigh and leg, in the distribution of the long saphenous vein. If the valves at this point do not function correctly, some of the blood flowing into the deep venous system is able to return to the surface, which is not supposed to occur. Particularly when a person is in a standing position, the effects of gravity on the large column of blood in veins from the lungs and heart downwards can exert a considerable pressure on the superficial veins of the leg, because the valves no longer provide protection. This abnormal pressure is one of the factors which cause some surface veins in the leg to gradually stretch, forming varicose veins. The pressure, which can become extremely high at the level of the ankle, is responsible for many of the symptoms associated with varicose veins, and their complications. Valves can fail to a varying degree, which presumably accounts for the different size and pattern of varicose veins, the speed with which they develop, and the widely differing amount of trouble they cause, in different people. Valve failure can also occur at the other junctions in the leg, causing varicose veins and other complications with a different distribution. However, the more usual sites of valve trouble are in the groin and behind the knee.

Colour Flow Doppler for Venous Thrombosis

Colour Flow Doppler is also used in suspected venous thrombosis to identify the presence and extent of the thrombus.A venous doppler is an ultrasound test used to evaluate blood flow to the legs, looking for blood clots or other abnormalities that can cause decreased blood flow. There is no preparation for this exam. The radiologist may have you undress from the waist down, leaving your underwear on, or you may be asked to change into a gown. The radiologist will scan from the groin to the back of the knee. You will be asked to lie on your back then your stomach. As the images are being obtained you may hear a "whooshing" noise. This is the sound of the blood flowing. Please let the radiologist know if you have ever had a stroke, short term loss of strength, speech or vision, or if you are experiencing any pain during the exam.

INFANT HIP ULTRASOUND EXAMINATION

There is a high probability of detecting most of the abnormalities that relate to hip position, hip stability, and development of the acetabulum by medical imaging.

INDICATIONS FOR THE EXAMINATION

Ultrasonography serves as an excellent method for diagnostic imaging of the immature hip. It affords direct visualization of the cartilaginous components of the hip joint. The value of ultrasonography diminishes as development of the ossification center occurs. Between six months and a year of age, radiography becomes more reliable. Usually by one year of age the center is sufficiently developed to prevent good visualization of the acetabulum with ultrasound. Sonography of the infant hip can be used both in the diagnosis of developmental dysplasia of the hip and in monitoring treatment. Risk factors for CDH include abnormal findings on clinical examination, family history of CDH, breech presentation at birth, and postural moulding conditions (torticollis, foot deformity). Females have a higher incidence than males.

Back to Top

Copyright © 2000 - Dr. Douglas Amerasekera