Cellulitis: Severe bilateral inflammation and swelling of the legs.
Acute inflammation is clearly seen in the image on the left. The picture on the right is of a
normal foot for comparison.
Kamis, 23 Desember 2010
Cellulitis PIC
Cellulitis: Severe bilateral inflammation and swelling of the legs.
Acute inflammation is clearly seen in the image on the left. The picture on the right is of a
normal foot for comparison.
Anatomy on Thyroid sonography
The anterior neck is depicted rather well with standard gray scale sonography. (FIGURE 1) The thyroid gland is slightly more echo-dense than the adjacent structures because of its iodine content. It has a homogenous ground glass appearance. Each lobe has a smooth globular-shaped contour and is no more than 3 - 4 centimeters in height, 1 - 1.5 cm in width, and 1 centimeter in depth. The isthmus is identified, anterior to the trachea as a uniform structure that is approximately 0.5 cm in height and 2 - 3 mm in depth.
The pyramidal lobe is not seen unless it is significantly enlarged. In the female, the upper pole of each thyroid lobe may be seen at the level of the thyroid cartilage, lower in the male. The surrounding muscles are of lower echogenicity than the thyroid and tissue planes between muscles are usually identifiable. The air-filled trachea does not transmit the ultrasound and only the anterior portion of the cartilaginous ring is represented by dense, bright echoes. The carotid artery and other blood vessels are echo-free unless they are calcified. The jugular vein is usually in a collapsed condition and it distends with a Valsalva maneuver. There are frequently 1-2 mm echo-free zones on the surface and within the thyroid gland that represent blood vessels. The vascular nature of all of these echoless areas can be demonstrated by color Doppler imaging to differentiate them from cystic structures (10-11).
Lymph nodes may be observed and nerves are generally not seen. The parathyroid glands are observed only when they are enlarged and are less dense ultrasonically than thyroid tissue because of the absence of iodine. The esophagus may be demonstrated behind the medial part of the left thyroid lobe, especially if it is distended by a sip of water. (FIGURE 2)
The pyramidal lobe is not seen unless it is significantly enlarged. In the female, the upper pole of each thyroid lobe may be seen at the level of the thyroid cartilage, lower in the male. The surrounding muscles are of lower echogenicity than the thyroid and tissue planes between muscles are usually identifiable. The air-filled trachea does not transmit the ultrasound and only the anterior portion of the cartilaginous ring is represented by dense, bright echoes. The carotid artery and other blood vessels are echo-free unless they are calcified. The jugular vein is usually in a collapsed condition and it distends with a Valsalva maneuver. There are frequently 1-2 mm echo-free zones on the surface and within the thyroid gland that represent blood vessels. The vascular nature of all of these echoless areas can be demonstrated by color Doppler imaging to differentiate them from cystic structures (10-11).
Lymph nodes may be observed and nerves are generally not seen. The parathyroid glands are observed only when they are enlarged and are less dense ultrasonically than thyroid tissue because of the absence of iodine. The esophagus may be demonstrated behind the medial part of the left thyroid lobe, especially if it is distended by a sip of water. (FIGURE 2)
Figure 1. Sonogram of the neck in the transverse plane showing a normal right thyroid lobe and isthmus. L=small thyroid lobe in a patient who is taking suppressive amounts of L-thyroxine, I=isthmus, T=tracheal ring ( dense white arc is calcification, distal to it is artefact), C=carotid artery ( note the enhanced echoes deep to the fluid-filled blood vessel), J=jugular vein, S=Sternocleidomastoid muscle, m=strap muscle.
Figure 2. Sonogram of the left lobe of the thyroid gland in the transverse plane showing a rounded lobe of a goiter. L=enlarged lobe, I= widened isthmus, T=trachea, C=carotid artery ( note the enhanced echoes deep to the fluid-filled blood vessel), J=jugular vein, S=Sternocleidomastoid muscle, m=strap muscles, E=esophagus.
Rabu, 22 Desember 2010
Scheme for Metabolic acidosis
Metabolic acidosis is a commonly presenting feature and is often caused by diabetes, renal failure or poisoning. However, it can cause diagnostic difficulties, particularly in the acute situation when patients can be seriously ill and where the aetiology is not obvious. It is vital that its diagnosis is considered in the clinical context with attention given to history (especially of drugs) and physical signs.
Metabolic acidosis is characterised by a raised [H+] and a low / normal PCO2 (in contrast with respiratory acidosis where the PCO2 is high). A low derived bicarbonate or low plasma total CO2 accompanies the raised [H+].
The raised [H+] stimulates the respiratory centre and hyperventilation occurs with a consequent rise in PO2. Hyperventilation reduces PCO2 and hence some of the potential acid burden on the body and acts to compensate for the metabolic acidosis. Complete compensation does not occur (ie the [H+] remains elevated) and the extent of the compensation will be limited in patients with an underlying diminution in respiratory function.
Some confusion may occur in patients admitted with 'collapse' and in extremis. Cardio respiratory collapse will result in a mixed acidosis due to a peripheral metabolic acidosis due to poor perfusion and a respiratory acidosis due to poor ventilation resulting in a raised [H+] and raised PCO2.
Metabolic acidosis is characterised by a raised [H+] and a low / normal PCO2 (in contrast with respiratory acidosis where the PCO2 is high). A low derived bicarbonate or low plasma total CO2 accompanies the raised [H+].
The raised [H+] stimulates the respiratory centre and hyperventilation occurs with a consequent rise in PO2. Hyperventilation reduces PCO2 and hence some of the potential acid burden on the body and acts to compensate for the metabolic acidosis. Complete compensation does not occur (ie the [H+] remains elevated) and the extent of the compensation will be limited in patients with an underlying diminution in respiratory function.
Some confusion may occur in patients admitted with 'collapse' and in extremis. Cardio respiratory collapse will result in a mixed acidosis due to a peripheral metabolic acidosis due to poor perfusion and a respiratory acidosis due to poor ventilation resulting in a raised [H+] and raised PCO2.
Complementary ultrasound to mammography ; Why?
Breast cancer can lie hidden from mammography in women with dense breast tissue, and thus the role of ultrasound is implemented to evaluate the texture and anatomical structures within the breast. Women most likely to have dense breasts are younger, premenopausal women and postmenopausal women who are taking hormone replacement therapy.
Breast ultrasound is used as a complementary examination to mammography in the following situations:
* Evaluation of dense breast tissue.
* Evaluation of a mass demonstrated on mammography.
* Guidance of biopsy needle or needle localization (see cyst aspiration image)
Breast ultrasound is used as a complementary examination to mammography in the following situations:
* Evaluation of dense breast tissue.
* Evaluation of a mass demonstrated on mammography.
* Guidance of biopsy needle or needle localization (see cyst aspiration image)
Behcet's Disease Ulcers pic
Behcet's disease is a rare, chronic, lifelong disorder that involves inflammation of blood vessels throughout the body. Symptoms of Behcet's disease include recurrent oral ulcers (resembling canker sores), recurrent genital ulcers, and eye inflammation. The disorder may also cause various types of skin lesions, arthritis, bowel inflammation, and meningitis (inflammation of the membranes of the brain and spinal cord).
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