DOWN SYNDROME PENGUIN FTW!!!!!

LOLZ UPPER ABDOMEN, KUB RENAL, FEMALE PELVIC LOWER ABDOMEN, THYROID, 2ND TRIMESTER OBSTETRICS PROTOCOL

The Baseline Upper Abdominal Scan

· Fasted patient – 6 to 8 hours
· Determine patient clinical history.
· Explanation of procedure to patient.
· System configuration presets established
· Survey ROI for gross pathology – patient supine
· Examination must not be limited to just one patient position
· The standard images recommended below are to reflect the sonographers systematic approach for a complete assessment of the upper abdomen. These can be reduced or extended, depending on the pathology seen.

Images

· Scan through from the xyphoid to the umbilicus in transverse

· Pancreas : Trans may require multiple images
demonstrate CBD if possible
Sagt pancreas head
· Para Aorta : Long demonstrate the SMA branching
measure distal segment
· Liver : Trans left lobe – portal vein
right/left lobe – hepatic veins (playboy sign)
right lobe – right hepatic vein
right lobe – portal vein
right lobe – dome/high
Sagt left lateral lobe
lateral left lobe with caudate lobe (include IVC)
right lobe with whole diaphragm at level of GB
right lobe with whole diaphragm at level of right kidney
measurement : mid-clavicular
· Gall bladder : Long demonstrate neck and fundus
demonstrate in at least two planes and with patient in more than one position
Trans dual screen – neck and fundus
measure wall thickness at fundus (portion closest to the transducer)
· Common : Long proximal and distal portions
Bile Duct measure maximum diameter
· Right kidney : Long liver and kidney echotexture comparison
bipolar measurement (horizontal kidney)
must include both upper and lower poles
may require multiple images

Trans upper, mid (show renal pelvis) and lower poles
· Left kidney : as per right kidney
echotexture comparison with the spleen
· Spleen : Coronal measurement
Trans include splenic hilum

Scan through the gallbladder again with the patient standing upright.

Renal ultrasound

· Fasted patient – 6 to 8 hours
· Full bladder imperative
· Determine patient clinical history.
· Explanation of procedure to patient.
· System configuration presets established
· Examination must not be limited to just one patient position
· The standard images recommended below are to reflect the sonographers systematic approach for a complete assessment of the renal system. These can be reduced or extended, depending on the pathology seen.

Images

· Bladder
Sagt left and right lateral aspects (scan through)
Mid - measurement
Trans superior and inferior (scan through)
Jets
Mid – measurement
Male
Prostate
Mid-sagittal measurement
Trans measurement

Post mictuarition bladder volume

Female
Post mictuarition bladder volume

· Right kidney : Long bipolar measurement
Parenchymal measurement
include both poles – multiple images
include right lobe liver
Trans upper, mid and lower poles
· Left kidney : Long bipolar measurement
Parenchymal measurement
include both poles – multiple images
include spleen
Trans upper, mid and lower poles


Female Pelvic Ultrasound

· Explanation of procedure to patient.
· Determine patient clinical history
· Previous surgery – myomectomy, oophrectomy etc
· Children? How many? Para and Grava to be recorded
· LNMP ?regularity
· Oral contraception
· System configuration presets established
· Survey performed in both planes – must include both fossae
· The standard images recommended below are to reflect the sonographers systematic approach for a complete assessment of the upper abdomen. These can be reduced or extended, depending on the pathology seen.

Images

· Uterus : Sagt include bladder
Zoom in
right and left lateral views (scan through)
midline length and height
Trans include bladder (midline)
Zoom in
superior and inferior (scan through)
measure width
cervix – Nabothian cysts
· Endometrium zoomed sagt with measurement
Note stage of cycle
Align from vagina to fundus

· Right ovary : Long zoomed with measurements
Trans measurement
· Left ovary : as per right ovary

· Left and right adnexa

· Sagittal left and right kidney



· The scan may proceed to transvaginal if indicated.
· It is important to precede the transvaginal scan with all measurements and findings recorded from the trans abdominal scan. Improved image quality is not guaranteed on transvaginal scanning.
· Disinfection technique to be practiced.
· Patient consent necessary.
Thyroid ultrasound

· Hyperextend the patient’s neck by requesting the patient to lie in supine, placing the shoulders above a small pillow
· Determine patient clinical history.
· Explanation of procedure to patient.
· System configuration presets established
· The standard images recommended below are to reflect the sonographers systematic approach for a complete assessment of the renal system. These can be reduced or extended, depending on the pathology seen

Images

· Right lobe: Trans: Upper pole
Middle pole (measure width and height)
Lower pole

Sagt: Measure length
Assess vascularity with Colour Doppler

Scan through the right lateral neck along the neck vessels to identify the presence of lymph nodes. Document if seen

· Left lobe: As per the right lobe

· Isthmus: Trans: Measure height

· Whole thyroid gland



2nd Trimester Obstetric Scan

1. Fetal number
2. Assess fetal viability and position
3. Assess entire uterus and maternal adnexa
4. Cervix – length, open/closed
5. Placenta – localization, placenta edge (from os), placenta cord insert
6. Biometry – BPD, HC, AC, FL
7. Brain/head :
- Falx, Cavum septum pellucidum, Skull bone
- Lateral ventricles, choroid plexus
- Cerebellum, cisterna magna, nuchal thickness
- Orbits
- Nose & lips
8. Heart (assess whenever the fetus is in a favourable position):
- 4 chambered heart – heart position, axis, chamber size
- Intraventricular septum
- Mitral valve, Tricuspid valve
- Right and Left outflow tracts
- 3 vessel view
- Heart rate
9. Diaphragm
10. Stomach/situs
11. Cord insertion/abdominal wall
12. 3VC
13. Bladder
14. Kidneys (trans & sagt)
15. Spine (trans & sagt/coronal)/skin line
16. Limbs
- Upper and lower limbs (12 long bones)
- Hand & feet
17. Amniotic fluid volume
18. Reassess cervix before completing the examination

ADORABLE BABIE PENGOOINS!!!!!

SUPER KAWAII KUB REPORT!!!!!!!

Patient history:
A 44 years old Malay male came for a KUB scan presented with gout history.
Patient complained of middle lumbar pain for 1 month and frequent urination.
Patient had hypertension and under medication for 3 months.

U/S findings (KUB):
Right Kidney:
Right kidney appear normal in bipolar length and homogenous texture.
Contour appearance was irregular.
Corticol medullary differenciation is still preserved.
BPL length: 9.38 cm
Parenchymal thickness: 1.09 cm

Left Kidney:
Left kidney appear normal in bipolar length and homogenous texture.
Contour appearance was regular.
Corticomedullary differenciation is still preserved.
BPL length: 9.79 cm.
Parenchymal thickness: 1.25 cm

Bladder:
Bladder volume was 184.03 ml and post void volume was 25.15 ml.
Bladder jets were visible.
Patient is nil by oral (didn't drink) due to Muslim fasting month.
No other abnormalities noted.

Prostate:
Prostate volume was 6.87 ml.
Prostate appears normal in size.
Prostate contains echogenicity in the medial region indicating calcification.


Incidental findings:
Moderate fatty liver.
Hepatomegaly was detected with midclavicular length of 17.94 cm.
Multiple galls stones.
Slightly enlarged spleen with longitudinal length of 14.21 cm.

SUPER KAWAII REPORTING GUIDELINES!!!!!!!

Upper Abdomen

1. PANCREAS
Transverse and longitudinal scanning required, particularly in the head
Comment on:
The degree of visualisation particularly if suboptimal
Size of the head, body and tail
Parenchymal texture
Focal lesions: including soft tissue masses, cysts, and calcification
Pancreatic duct; calibre, contour and stones
Peripancreatic lesions; solid masses, lymphadenopathy and cysts
2. GALL BLADDER
Demonstrate in at least two planes and with patient in more than one
position (i.e. oblique and erect)
Comment on:
Intraluminal lesions; number, size, posterior shadowing and
mobility
Wall thickness (versus degree of distension)
Presence of mural gas or calcification
Distension - physiological, pathological
Point tenderness
Pericholeic collections
3. EXTRAHEPATIC BILE DUCT
Attempt to demonstrate the full length of the common bile duct and common hepatic duct.
Comment on:
Duct diameter - measured inside to inside, at level of portal vein bifurcation and more distally,
if the proximal measurement is at or above the upper limit of normal Duct dilatation - degree
and extent of dilatation, level of obstruction, regularity of calibre
Intraluminal lesions - number, size, echogenicity, posterior shadowing, and mobility within
duct
4. LIVER
Longitudinal and transverse views usually sufficient.
Comment on:
Adequacy of visualisation of the whole of the liver
Overall size, caudate lobe size
Borders - smooth, irregular
Parenchymal echogenicity, texture and attenuation
Focal lesions; number, size, location echo characteristics
Intrahepatic bile ducts
Hepatic veins, portal veins
Perihepatic collections
Right pleural space
5. SPLEEN
Size
Parenchyma - texture and echogenicity
Focal lesions - number, size, location, echo characteristics
Perisplenic collections, collateral veins
Left pleural space
6. KIDNEYS
Size - measure bipolar distance
Outline
Parenchyma - echogenicity cortex and medulla
Focal masses - number, size, location, cystic or solid
Collecting systems - hydronephrosis, prominent extrarenal pelvis,
dilated ureter, intraluminal lesions
Peri-renal and para- renal collections and masses
7. ADRENALS
Visualisation should be attempted
Size and texture if enlarged
Focal masses: cystic, solid, bilateral, unilateral
8. UPPER ABDOMINAL VASCULATURE
Demonstration of the upper abdominal vasculature is the key to upper abdominal anatomy.
The level of ultrasonic evaluation of the vasculature will depend on the clinical indication for
the scan. The following vessels should be identified.
Aorta
Coeliac axis
Superior mesenteric artery
Left renal vein
Inferior vena cava
Splenic vein
Superior mesenteric vein
Main portal vein and its branching pattern in liver
Splenic artery
Hepatic artery
Replaced right hepatic artery (common variant)
Hepatic veins
9. AORTA
Size: measure the outer AP diameter of the aorta.
Comment on:
Aneurysmal dilatation
Calcification, plaques and thrombus
Para-aortic masses; size number location
10. PERITONEAL CAVITY
Ascites
Loculated collections; size, site, echo characteristics
Peritoneal masses; size and site
Bowel wall: thickness, dilatation, peristalsis
Assess appendix.




KUB

Kidney - size
- Shape
- Margin
- Position
- Parenchyma thickness & echogenicity
- Cortico-medullary differentiation
- Central renal complex? hydronephrosis
- ? Focal lesions? renal calculi ? mass ? collection


Ureter ? hydroureter

Bladder - wall thickness and contour
- lesion?
- Urinary jet
- Pre-void volume
- Post-void volume

Prostate - size
- echotexture


Female Pelvic

the age of the patient
presenting symptoms
parity
menstrual history
last menstrual period (LMP),
any previous gynaecological surgery
any current hormonal treatment
results of any available hormonal tests for pregnancy
FAMILY PATHO HISTORY ON PELVIC

Uterus - size, shape, position, mobility
- endometrium - thickness, B mode appearance, classification, vascularity,
intracavity masses and if present their mobility.
- myometrium - masses (size, number, echotexture, vascularity, position,
particularly in relation to the endometrial cavity)
- serosal surface - any masses as above
Ovaries - positive identification of both ovaries and location
- size, echotexture
- follicles, cysts, solid masses
- mobility and tenderness
Adnexa - masses, characteristics
- free fluid
Kidneys - position, exclude hydronephrosis

EVALUATION OF MASSES
- site of origin, relationship to uterus and ovaries
- dimensions
- borders (well defined, irregular, poorly defined, thick walled)
- cystic, solid, mixed, loculated or septated
- contents of cysts
- echogenicity and architecture of solid areas
- vascularity
- mobility



Scrotum

TESTIS
- size
- echotexture (compared with contralateral testis)
- capsule
- mediastinum testis (location to assess rotation)
- vascularity
- appendix testis (seen in the presence of a small hydrocoele)
EPIDIDYMIS
- assess head, body and tail
- size
- echotexture
- vascularity
- appendix epididymis (occasionally seen if hydrocoele is present)
OTHER SCROTAL ANATOMY
- spermatic cord
- tunica vaginalis
- scrotal wall
EVALUATION OF INTRATESTICULAR MASSES
- dimensions
- borders (well defined, irregular, poorly defined)
- cystic, solid or complex
- echogenicity compared with normal testis
- vascularity (if colour Doppler is available)
EVALUATION OF EXTRATESTICULAR MASSES
- hydrocoele, haematocoele and pyocoele
- varicocoele (size and location)
- scrotal hernia
- epididymal lesions (cyst, spermatocoele, acute inflammatory mass, granuloma, solid tumours)



Breast

Assess:
Size
Shape:
a) Ellipsoid
b) Taller than wide
Margins:
a) Spiculated
b) Angular
c) Branch extension
d) Duct extension
Lobulations:
a) Number
b) Characteristics, gentle or microlobulations
Shadowing
Echogenicity:
a) Markedly hypoechoic
b) Hyperechoic Calcification
Capsular thickness



3rd Trimester OB

The last menstrual period (LMP) or previously calculated estimated date of delivery (EDD) and
previous obstetric history should be noted. It is often useful to review any available ultrasound
records. The indication for the examination should be carefully considered and the examination
targeted to answer the clinical problem.
1. Fetal number, presentation and lie
2. Fetal cardiac activity
3. Measurements of fetal size
4. Fetal anatomy,Pelvis-3,5,10mm
5. Fetal wellbeing
6. Placental localisation
7. Amniotic fluid volume,<2cm >8cm,8-22cm
8. Detection and evaluation of maternal pelvic or adnexal masses

WTF LOL BBQ ITS DA PELVIC REPORT!!!!!

Patient history:
Patient is a 33 year old Indian female with 1 child and 1 prior miscarriage. Her only child was born via Caesarian section.
Her LMP is estimated at 13/8/2009. She has regular menses.
She complains of intense rectal pain during menses in the last 5 months.
She had an IUCD removed 5 months ago.


Ultrasound Findings:
Uterus had homogenous echotexture with a well defined border. No mass or cystic structures were detected
She had an anteverted uterus with measurements:
Uterus length:7.73cm
Uterus height:2.10cm
Uterus width :6.63cm
Endometrium thickness: 0.93cm

Right ovary volume was 4.95cc
Left ovary volume was 4.95cc

No mass or fluid collection was found in right and left adnexa.

No evidence of hydronephrosis noted in left and right kidney.

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I HEART PENGUIN MEGA LOLZZZ

21/8 friday scanning schedule

1. sherine
2. sathya
3. chris
4. pei siah
5. li ern
6. cia yee
7. yea theng*TIC*
8. jamie
9. szu hing
10. siti
11. for hae
12. lucy
13. sherine

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abdomen and pelvic report template

Patient's history:
A 34 years old Chinese female patient came in for upper abdomen and pelvic ultrasound scan. She complained of abdominal pain at right lumbar region for two years before seeking medical attention. She has regular menses and has had no children before. LMP 9/8/2009

UPPER ABDOMEN

(1) Pancreas
The pancreas has a homogenous in echotexture. Head and body of the pancreas are seen. No evidence of mass or cystic structures in pancreatic head.

(2)Aorta:
The diameter of aorta measured was 1.65cm and no echogenic foci or plaque was detected.

(3)Liver:
Liver appeared homogeneous in echotexture with mid-clavicular measurement of 11.74cm.

(4)Gallbladder:
No abnormalities detected in the gallbladder.
The gallbladder wall thickness fall within normal range with measurement of 0.12cm. Bile duct is seen with no dilatation noted and measured 0.23cm.

(5) Kidneys
Bipolar length Right kidney: 8.81cm.
Bipolar length Left kidney: 9.32cm.
Both kidneys appeared normal in size and echotexture and their borders appeared normal and regular.

(6) Spleen
The size of spleen measured was 7.94cm. It had fine homogeneous echo-texture pattern.


LOWER ABDOMEN

Ultrasound Findings:
Uterus had homogenous echotexture with a well defined border. No mass or cystic structures were detected
She had an anteverted uterus with measurements:
Uterus length:6.16cm
Uterus height:2.10cm
Uterus width :6.03cm
Endometrium thickness: 0.91cm

Right ovary volume was 4.01cc
Left ovary volume was 6.86cc

Left ovary had a prominent follicle

No mass was found in right and left adnexa.

No evidence of hydronephrosis noted in left and right kidney.

INCIDENTAL FINDINGS
Colloid cyst with septations and two crystals with comet tail artifacts measuring 0.82 x 1.09 x 0.50 cm was found in right middle pole of thyroid gland. No vascularity was found within the cyst.

Stories for my Plumber - Final Words of a Cornered Madman

What is the meaning of our existence? That that exists must not not exist, and therefore, exist. We stumble through our lives confused, convoluted and confuddled and yet manage to survive the onslaught of trials and tribulations awaiting to crucify us for every single mistake. The durability of the human race is an inevitable result of our millennia of exposure to the harsh realities of the planet that does not want us living on it, and thus, it is time that we stand up and take a stand. We shall destroy all those who stand in our way, and the army of gaia shall not inhibit our progress no longer. Have you not tired of battling chaotic weather conditions, beastly creatures of all nature of hell, poisonous excretions of abominable flora and endured the vilest and most obnoxious terrain most unsuited for habitation? Have we forgotten that we, humans, are superior to anything that lives and breathes air, and anything that doesn’t? Is it not true that regardless of the respective communities and populations that dominate each landscape, it is the human race that conquers all? Yet now we wallow in despair, allowing our weakness to permeate our subconscious minds, while deluding ourselves that we are strong and powerful and dominating. Show yourself! Let your inner force flow freely through the dark fog of misinformation concocted by those who would cage your mind! Find your strength to exist once more, and regain your taste for blood…

OMEGA CUTENESS!!!!!!!!!

LOL winking owls 2 da max!!!!!!!

OMG it's the pediatrics presentation topic!!!!!!!!!!!!!!!!!!!!!!!!!

2. Ultrasound assessment of the infant spine requires and understanding of bony and soft tissue anatomy of the spine.
Visualization of the spine is best achieved during infancy
In light of this, discuss the sonographic technique and normal sonographic anatomy of the spine
X 2

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