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●● State the presence/absence and thickness of the septum.●● Assess the number of placentae (chorionicity): look for the lambda sign (placental tissue forming in the septum between the embryos).●● Assess the number of amniotic cavities (amnionicity).●● Indicate on the report whether the pregnancy is monochorionic/monoamniotic, monochorionic/diamniotic or dichorionic/diamniotic.●● Note the relative position of the fetuses.●● If possible, assess whether the fetuses are of the same sex.●● A diagram of the fetuses on the report is helpful and will assist in subsequent scans.
Atheromatous plaques Images
Pathology Atheromatous plaques
Pathology Atheromatous plaques
Atheromatous plaquesAtherosclerosis is a disease of large- and medium-sized muscular arteries. It is characterized by the accumulation of lipids, calcium and cellular debris within the intima of the vessel wall, forming atheromatous plaques. These plaquesresult in luminal obstruction, abnormalities of blood flow, and diminished oxygen supply to target organs. The major risk factors are smoking, hypercholesterolaemia, diabetes and hypertension.ultrasound features●● Localized irregular thickening of the vessel wall (measure in TS and LS) causing stenosis●● The echogenicity of the plaque depends on its contents: − echo-poor: blood- or lipid-filled = increased risk of rupture − echo-bright: calcified = more benign●● With colour Doppler:●● With spectral Doppler: − filling defect − aliasing − no flow (complete occlusion) − spectral broadening − increased peak velocityThere are five types of atheromatous plaques, graded according to their ultrasound appearance:Gray–Weale classification of plaquesType 1: predominantly echo-poorType 2: echo-poor with echo-bright areasType 3: echo-bright with echo-poor areasType 4: predominantly echo-brightType 5: predominantly calcified
Therefore, by using spectral Doppler to measure the peak velocity, the degree of stenosis can be estimated.There are many different peak-systolic velocity cut-off values to determine ICA stenosis. As an example the following values are used in Leeds Teaching Hospitals NHS Trust (see Table below). However it is recommended that the agreed cut-off values in your radiology department are used as there is considerable variation between hospitals.
PERFORMING THE SCAN●● Patient position: Neck extended with head turned to contralateral side.●● Preparation: Nil.●● Probe: High-frequency (7.5 MHz) linear.●● Machine: Select arterial vascular preset mode. Use tissue harmonics and compound imaging. Set the focal zone to the posterior wall of the vessel.●● Method: Do not apply any pressure with the probe. Start at the root of the neck and scan cranially along the course of the vessels. Scan both sides of the neck.
TS: common carotid artery●● Begin by placing the probe in TS over the root of the neck, i.e. at the CCA origin.●● Use the SCM as a window to scan through. If the vessel image is not clear, try scanning anterior or posterior to the SCM instead.●● Follow the course of the carotid arteries up the neck as high as possible.●● Look for: − level of CCA bifurcation − evidence of arterial disease●● Measure any abnormalities seen.●● Acquire representative image(s).
Corpus luteal cyst of pregnanc
Pathology Corpus luteal cyst of pregnancy
Corpus luteal cyst of pregnancyFollowing fertilization the corpus luteum persists (due to β-HCG). In this condition bleeding occurs into it, often causing pain. Most resolve spontaneously.ultrasound features●● Most are <5 cm in size●● Thin wall●● Display internal echoes from the blood●● This complex appearance can mimic an ovarian malignancy; if there is any doubt, repeat the scan in 6–8 weeks time (see Chapter 10 for more on ovarian cysts)
Pathology Subchorionic haemorrhage
Subchorionic haemorrhageThis is venous bleeding into the subchorionic space extending to the margin of the placenta. It usually occurs in early pregnancy and is associated with smoking. It has a favourable prognosis.ultrasound features●● The marginal edge of the placenta is separated from the myometrium●● If the bleed is recent, it may contain internal echoes – old bleeds are echo-freeHint: Large retroplacental haemorrhage (abruption) tends to occur in late pregnancy and has a poor outcome. It is not reliably diagnosed by ultrasound
Dichorionic pregnancy: lambda sign
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