unilat renal PUJ obstruction with masses

View

Please give opinion on these 2 polypoid intracalyceal lesions. Background of rt PUJ instruction, chronic hydronephrosis since antenatal NT scan. Unchanged since birth. Now 20 month old female. Several uti in 1st year. None known recently. No current treatment. Mag scan showed normal function last year. No known haematuria. Found on routine follow up. Not seen on scan 1yr ago. Thank you for your consideration. Jody

Answer

August 17, 2022 aP 8:22 PM

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.

Endometriosis

View

We are often asked to scan young women for pelvic pain ? Endometriosis. Is there any tips when a TV scan is not possible.

Answer

August 31, 2022 aA 8:31 AM

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.

Standard HiP view for DDh

View

I ask what is the standard views that should be obtained for DDH. There seems to be some difference in views on this. I am with the understanding that its is coronal with the Ileum as straight as possible, Attention to detail of the acetabulum morphology, angles and coverage to back this up and finally trans view. Some add posterior Rim but I dont know the significance of this view and many do stress maneuver even if the morphology is normal.

Answer

August 13, 2022 aA 11:18 AM

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 QUESTION

View

Test - How do i hold the probe?

Answer

August 3, 2022 aP 4:45 PM

[Test: Final Response to Member]
Hold the probe with your hand.

Disclaimer: by using this service you recognise that the information provided is general in nature; it does not constitute professional advice. Any views expressed are those of individual(s) and may not reflect ASA’s views. The ASA does not endorse any product or service identified. You use any information provided at your sole risk and the ASA is not responsible for any errors or for any consequences arising from that use.