Dr Arun Gupta Director imaging

Dr Rakhee gupta Dr Vinayak Mittal Dr Niharika MahajanDr Gaurav SharmaDr Ritesh Mahajan

ADVANCED USG LOUNGE

•C H O R I O A M N I O N S E PA R AT I O N.•A N G U L AT I O N I N F E TA L S P I N E . •G C T O F T E N D O N S H E AT H•P E LV I C F L O O R ( L E VAT O R S L I N G A N D C H R O N I C L E VAT O R M U S C L E I N J U RY .•U R E T E R O C E L E •S M A S T E N O S I S ( AT O S T I A D U E T O C A L C I F I E D P L A Q U E S ) .

AMNION SEPARATION APPRECIATED

3D RENDERED IMAGE OF THE CHORIO-AMNION SEPARATION.

Chorio-Amnion Separation

DEFINITION COMPLICATIONS

Chorioamniotic separation (CAS) is an intra-uterine event which can occur in pregnancy and is characterised by separation of placental (chorion) and fetal (amnion) membranes.

Sonographic detection of a small chorioamniotic membrane separation especially before 14 weeks gestation is considered a benign incidental finding.  A careful search for aneupliodic and other developmental anomalies is often recommended if a spontaneous chorioamniotic separation is detected after 14 weeks.

Recognised complications following a large separation include :

1. Miscarriage2. In utero fetal death umbilical

cord complications3. Pre-term delivery4. Amniotic band formation

CAS ( CHORIO-AMNION SEPARATION)

NORMAL G SAC WITHNORMAL YOLK SAC

CHORIO-AMNION SEPARATION

NT/ NB SCAN DONE 3D RENDERED IMAGE OF THE FETAL SPINE.

Angulation in Fetal spine

ANGULATION IN FETAL SPINE

FREE HAND STRAIN ELASTOGRAPHY IMAGE SHOWS MOSIAC PATTERN OF THE

LESION (S/O BENIGN ETIOLOGY)

HYPOECHOIC LESION WITH INTERNAL VASCULARITY

GIANT CELL TUMOR OF THE TENDON SHEATH

gct_3.avi

DEFINITION GCTTS ULTRASOUND FINDINGS ARE

Giant cell tumours of the tendon sheath (GCTTS), also known as pigmented villonodular tumour of the tendon sheath (PVNTS) or extra-articular pigmented villonodular tumour of the tendon sheath, are uncommon and usually benign lesions that arise from the tendon sheath. It is unclear whether these lesions represent neoplasms or merely reactive masses.

Ultrasound Ultrasound is useful as it allows not

only the characterisation of the lesion but also is able to demonstrate the relationship with the adjacent tendon. On dynamic scan, there is free movement of the tendon within the lesion. Typically they appear as: associated with the volar surface of

the digits does not move with flexion or

extension of adjacent tendons usually homogeneously hypoechoic,

although some heterogeneity may be seen in echotexture in a minority of cases 

most will have some internal vascularity

GIANT CELL TUMOR OF THE TENDON SHEATH

LEVATOR SLING The levator ani, also known as the muscular pelvic diaphragm, is the musculotendinous sheet that forms the majority of the pelvic floor, supports the pelvic viscera, and aids in the urinary and faecal evacuation as well as maintaining continence.

The levator ani has three main components, each of which is paired :

1. pubococcygeal (pubovisceral) muscle1. subparts: puboperineal,

pubovaginal, puboanal2. iliococcygeus muscle3. puborectalis muscle

LEVATOR SLING

3D RENDERED IMAGE OF THE LEVATOR SLING

MULTIPLANAR IMAGE CORELATION.

PELVIC FLOOR USG ( LEVATOR SLING)

Normal levator sling Focal interruption in the normal

contour of the left side of the levator muscle . (UNILATERAL LEVATOR ATROPHY LEADING TO PELVIC FLOOR DYSFUNCTION.)

Focal atrophy of the levator muscle

( left side )

URETEROCELE

Ureterocoeles represent congenital dilatation of the distal-most portion of the ureter. The dilated portion of the ureter may herniate into the bladder secondary to the abnormal structure of vesicoureteric junction (VUJ).Epidemiology

SIMPLE URETEROCELE TYPES

URETEROCELE

There are two main types of ureterocoele, both of which are the result of cystic ectasia of the subepithelial portion of the ureter as it inters the bladder.• Simple: a ureterocoele

that occurs at a VUJ in a normal position.

• Ectopic: that which occurs at a VUJ whose site is abnormal.

GREY SCALE OF THE LEFT SMA WITH CALCIFICATION

IN THE OSTIAL REGION. VIDEO CLIP OF THE SMA SPECTRA

STENOSIS OF SMA

SMA _2.avi

SMA _3.avi

REFERENCE

DIAGNOSTICULTRASOUNDFOURTH EDITIONCarol M. Rumack, MD, FACRJ. William Charboneau, MD, FACRDeborah Levine, MD, FACR

Ultrasound of CongenitalFetal AnomaliesDifferential Diagnosis and Prognostic IndicatorsDario Paladini MDHead, Fetal Cardiology UnitDepartment of Obstetrics and GynecologyUniversity Federico II of NaplesNaplesItalyPaolo Volpe MDHead, Fetal Medicine UnitDepartment of Obstetrics and GynecologyHospital Di VenereBari