Thank you for your question. 

We do not have any recognized guidelines regarding cervical length post cerclage, but these article discuss predictive value of cervical length post cerclage and prediction of preterm delivery. 

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0866-3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742471/#:

This may also be a good discussion to have with the referring Obstetrical team regarding the normal value they expect for a cervical length post cerclage. 

Hi and thanks for your enquiry,

The largest of the bursa near the greater trochanter of the hip, the trochanteric bursa which is also called the sub-gluteus maximus bursa, is located deep to the iliotibial tract (which connects the gluteus maximus and tensor fascia lata muscles) and superficial to the greater trochanter and the gluteus medius and minimus tendons and their associated muscles.  

Normal bursae are often imperceptible on ultrasound. Fluid seen within the bursa may be considered bursitis but a single quantitative threshold measure of this to discriminate between normal and abnormal is not routinely used. Trochanteric bursitis can occur secondary to insertional tendinopathy involving gluteus minimus or gluteus medius tendons. Anterior facet or lateral facet insertional enthesopathy or Iliotibial band thickening at the level of the greater trochanter can also be a cause of greater trochanteric pain syndrome, of which trochanteric bursal thickening may be involved.

Thanks

MSK SIG

Hi and thanks for your enquiry,

The normal Achilles tendon is comprised of linear collagen fibrils, represented by tightly packed parallel echogenic lines in the long axis plane sonographically. Separating the fibrils are hypoechoic, interfascicular layers that are comprised of a supporting matrix with tenocytes. 

The Achilles tendon you identified songoraphically may represent a tendon which is reactive and/or in the early dysrepair stage of tendinopathy.  There may be fusiform heterogeneous swelling of the mid-tendon when this occurs.  Disorganisation in the orientation of the normal fascicular pattern of the tendon is usually seen sonographically.  This can result in thickening of the hypoechoic interfascicular layers, representing mucoid degeneration and oedema.  The echogenic foci that you noted, may represent a loss of continuity in the fibrillar alignment.

Sonographic tendon abnormalities are not always associated with patient-reported pain.  Tendon degeneration can start long before the onset of symptoms, which you may have identified in the case you have described.

Thanks

The MSK SIG team

Thanks for your question Jody 

While  we are not in a position to diagnose we are happy to put forward differential diagnoses.  This  response is an opinion and does not constitute a diagnosis.

It looks like thick debris which is sometimes seen in PUJ with chronic hydronephrosis.  Lack of vascularity is reassuring.  Would be interesting to know if it moved with the patient prone. 

Often ultrasound is used as an initial screening tool to identify potential etiologies of dysmenorrhea, renal or reproductive tract abnormalities and adnexal masses with endometriomas. Sometimes a linear probe can be helpful to enhance resolution transabdominally. You could try a 3D probe transabdominally to try and gain more information. Often in clinically warranted cases, the patient may be referred for an MRI. These are often a difficult subset of patients who quite often have delayed diagnosis and treatment.

The two standard views for hip ultrasound for DDH include the coronal view for morphological assessment and the transverse view for dynamic assessment of stability.

The coronal view is obtained through the centre of the joint with the ileum straight, the lower limb of the acetabulum and triradiate cartilage included. Acetabular angles and coverage are measured on this view.  The transverse view is performed with the leg flexed and mimics the clinical assessment of the Ortolani and Barlow manoeuvres thus allowing the Sonographer to assess stability or to assess for reduction if a hip is dislocated.  

Assessment of the pulvinar could also be included as a thickening is indicative of an abnormal hip 

The posterior lip view is not essential however it can be useful to demonstrate the position of the femoral head in relation to the joint when the hip is dislocated   

[Test: Final Response to Member]

Hold the probe with your hand.