Table Of ContentEDITED BY
Leslie M. Scoutt
Ulrike M. Hamper
Teresita L. Angtuaco
OXFORD
Ultrasound
Ultrasound
Edited by
Leslie M. Scoutt, MD, FACR, FAIUM, FSRU
Professor of Diagnostic Radiology and Vascular Surgery
Vice Chair of Education
Chief, Ultrasound Section
Medical Director, Non-Invasive Vascular Laboratory
Associate Program Director
Department of Radiology and Biomedical Imaging
Yale University School of Medicine
New Haven, Connecticut
Ulrike M. Hamper, MD, MBA, FACR, FAIUM, FSRU
Professor of Radiology, Urology, and Pathology
Russell H. Morgan Department of Radiology and Radiological Science
Johns Hopkins University School of Medicine
Baltimore, Maryland
Teresita L. Angtuaco, MD, FACR, FAIUM, FSRU
Professor of Radiology, Obstetrics, and Gynecology
Director, Division of Body Imaging
Chief of Ultrasound
Department of Radiology
University of Arkansas for Medical Sciences
Little Rock, Arkansas
1
1
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Library of Congress Cataloging- in- Publication Data
Names: Scoutt, Leslie M., editor. | Hamper, Ulrike M., editor. | Angtuaco,
Teresita L., 1949– , editor.
Title: Ultrasound / edited by Leslie M. Scoutt, Ulrike M. Hamper, Teresita L. Angtuaco.
Other titles: Ultrasound (Scoutt)
Description: Oxford ; New York : Oxford University Press, [2017] | Includes
bibliographical references and index.
Identifiers: LCCN 2015042572 | ISBN 9780199988105 (hard cover : alk. paper)
Subjects: | MESH: Ultrasonography— methods— Handbooks.
Classification: LCC RC78.7.U4 | NLM WN 39 | DDC 616.07/ 543— dc23
LC record available at http:// lccn.loc.gov/ 2015042572
This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the
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application of any of the contents of this material.
9 8 7 6 5 4 3 2 1
Printed by Sheridan Books, Inc., United States of America
To our families for their unwavering support and encouragement, to our residents and fellows who inspire
us to be better teachers, to all the contributing authors for their hard work and dedication to this project,
to our sonographers for their expertise and commitment to patient care, and to our colleagues both at our
home institutions and in the medical community who constantly stimulate us through their passion for and
commitment to the field of ultrasound.
Leslie M. Scoutt
Ulrike M. Hamper
Teresita L. Angtuaco
Preface
One of the most rewarding aspects of the medical profession is the opportunity, even necessity, for continuing
education, and ultrasound is no exception. Ultrasound has been an integral part of the diagnostic workup algo-
rithm for patients over many years and is often used to evaluate the acutely ill patient, to follow chronic illness
or response to therapy, and for screening purposes. Readily accessible, without harmful bioeffects and relatively
inexpensive, ultrasound has a wide range of clinical applications, ranging from gynecology, obstetrics, urology,
and endocrinology to evaluation of vascular, abdominal, and musculoskeletal pathology. As such, ultrasound
can be effectively used for diagnosis and screening, to guide recommendations for further imaging, and to direct
interventional procedures. Currently, the field of ultrasound is undergoing a renaissance due to rapid evolution
and advances in technology such as three-d imensional imaging, elastography, and intravenous ultrasound con-
trast agents. In addition, the use of ultrasound by clinical subspecialists has also served to stimulate new appli-
cations of ultrasound not previously explored by most radiologists, such as imaging of the lung, critical care,
and rheumatologic disease.
This case series covers a wide spectrum of clinical applications of ultrasound. A total of 187 cases have been
grouped into six sections: Gynecology; First Trimester (Obstetrics); Second and Third Trimester (Obstetrics);
Abdomen (gastrointestinal, urology, and retroperitoneal pathology); Small Parts (thyroid, scrotal, and muscu-
loskeletal pathology); and Vascular. Although the book focuses on diagnoses that are commonly addressed by
ultrasound and content that should be mastered during residency, more unusual pathology is also included. The
cases also vary in terms of difficulty. Cases are presented as unknowns with a short clinical history, and on sub-
sequent pages explanation of the imaging features, differential diagnosis, salient teaching points, and a brief dis-
cussion of clinical management are provided. Information is presented in a concise bullet-p oint format, and
correlation with other imaging modalities— including plain films, computed tomography, magnetic resonance,
positron emission tomography/ computed tomography, and angiography— is provided as appropriate. Although
often considered the first line or screening imaging modality of choice, ultrasound should not be practiced in an
isolated imaging vacuum. Hence, these correlative images have been included not only to emphasize and clarify
the ultrasound findings but also to help the reader understand when additional imaging is helpful. In addition,
correlative cases have also been provided in numerous instances to demonstrate normal anatomy for compari-
son, additional imaging features to illustrate the spectrum of ultrasound findings for the entity under discussion,
or related pathology. It is hoped that these additional cases will help the reader to better analyze the important
discriminatory imaging and/o r clinical features of the entities included in the differential diagnosis. Lastly, per-
tinent key references are provided at the end of each case for the reader who wishes to learn more about the
index case pathology.
As educators, we believe that case review and self- assessment are extremely important in developing the
breadth and depth of knowledge required to become a skilled sonologist. We believe this format will be useful
to readers at all levels of training and in multiple specialties. The beginner will find the material presented in a
concise format that highlights the most important teaching points and can use this book to complement a more
detailed reference textbook. The more advanced learner will be able to use the book as a self- assessment module
by approaching the cases as unknowns and using the detailed explanations and differential diagnosis provided
on the following pages to gauge image interpretation, knowledge base, and critical thinking. More experienced
vii
sonologists may find the book helpful as a handbook demonstrating the classic ultrasound features of both common and unusual
pathology.
Finally, we thank Andrea Knobloch, who proposed this project to us several years ago and has waited patiently and graciously
throughout the many iterations of the case material. She unfailingly and generously provided us with the guidance and resources
that we needed to complete this volume. This book would never have happened without the support, encouragement, and unfail-
ing good humor of Andrea and her fantastic team at Oxford University Press.
Leslie M. Scoutt
Ulrike M. Hamper
Teresita L. Angtuaco
viii Preface
Contents
Contributors xvii
Section I. Gynecology
1. Hydrosalpinx 3
2. Bilateral Tubo- ovarian Abscesses 6
3. Simple Postmenopausal Ovarian Cyst 9
4. Mucinous Ovarian Cystadenoma 12
5. Serous Cystadenocarcinoma of the Ovary 14
6. Bilateral Krukenberg Tumors 17
7. Adenomyosis of the Uterus 19
8. Lipoleiomyoma 22
9. Endometrial Cancer 24
10. Myometrial Arteriovenous Fistula 27
11. Hemorrhagic Ovarian Cyst 30
12. Endometrioma 33
13. Dermoid Cyst 36
14. Peritoneal Inclusion Cyst 39
15. Ovarian Fibrothecoma 42
16. Ovarian Torsion 45
17. Endometritis With Retained Products of Conception 48
18. Misplaced Intrauterine Device 51
19. Endometrial Polyp 56
20. Endometrial Hyperplasia 59
21. Pedunculated Subserosal Leiomyoma 63
22. Septate Uterus 67
23. Cervical Cancer 72
ix
Section II. First Trimester
24. Normal Intrauterine Pregnancy 79
25. Perigestational Hemorrhage 82
26. Anembryonic Gestation 85
27. Dichorionic Diamniotic Twin Gestations 88
28. Open Rhombencephalon 92
29. Physiologic Gut Herniation 95
30. Tubal Ectopic Pregnancy 98
31. Interstitial Ectopic Pregnancy 102
32. Ovarian Hyperstimulation Syndrome With Heterotopic Pregnancies 105
33. Pregnancy in C- Section Scar 109
34. Incomplete Abortion 112
35. Coexistent Molar Gestation With Intrauterine Pregnancy 115
36. Abnormal Nuchal Translucency 118
Section III. Second and Third Trimester
37. Cervical Incompetence With Hourglass Membranes 123
38. Partial Placenta Previa 126
39. Morbidly Adherent Placenta (Placenta Percreta) 130
40. Placental Abruption 134
41. Hydranencephaly 138
42. Alobar Holoprosencephaly 142
43. Vein of Galen Malformation 145
44. Dandy– Walker Malformation 148
45. Agenesis of the Corpus Callosum 151
46. Chiari II Malformation 154
47. Cleft Lip and Palate 159
48. Congenital Pulmonary Airway Malformation 163
49. Hypoplastic Left Heart Syndrome 166
50. Transposition of the Great Arteries 170
51. Omphalocele 173
52. Gastroschisis 177
53. Congenital Diaphragmatic Hernia 180
x Contents
54. Esophageal Atresia 183
55. Duodenal Atresia 187
56. Multicystic Dysplastic Kidney 190
57. Ureteropelvic Junction Obstruction 193
58. Autosomal Recessive (Infantile) Polycystic Kidney Disease 196
59. Posterior Urethral Valves 199
60. Renal Agenesis 202
61. Beckwith– Wiedemann Syndrome 205
62. Trisomy 21 208
63. Trisomy 18 212
64. Trisomy 13 215
65. Twin Transfusion Syndrome 218
66. Meconium Pseudocyst 221
67. Osteogenesis Imperfecta Type II 224
Section IV. Abdomen
68. Pyogenic Liver Abscess 231
69. Focal Nodular Hyperplasia 234
70. Gallbladder Wall Thickening Due to Hepatitis 237
71. Adenomyomatosis 240
72. Caroli Disease 243
73. Acute Pancreatitis 245
74. Appendicitis 248
75. Intussusception 250
76. Prostate Abscess 252
77. Renal Angiomyolipoma 254
78. Horseshoe Kidney 257
79. Crossed Fused Renal Ectopia 260
80. Emphysematous Pyelonephritis 263
81. Perinephric Hematoma Following Renal Biopsy 265
82. Medullary Nephrocalcinosis Caused by Medullary Sponge Kidneys 267
83. Focal Fatty Sparing of Liver 270
84. Cavernous Hemangioma— Classic Type 273
Contents xi
