Radiology Lectures | Radquarters

By Daniel J. Kowal, MD

Radiology education. Simplified.... more

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The podcast currently has 86 episodes available.

Radiology Lectures | Radquarters episodes:

February 06, 2025Ultrasound of Submandibular Sialolithiasis (Salivary Stones)
In this radiology lecture, we review the ultrasound and CT appearance of submandibular stone disease, together with floor of mouth anatomy!
Key teaching points include:
Submandibular glands are paired salivary glands located inferior to body of mandible
Submandibular glands are intermediate in size compared to the larger parotid and smaller sublingual glands, and they do not contain lymph nodes
The submandibular duct (= Wharton’s duct) extends from gland hilum and travels superiorly to open at floor of mouth on either side of base of frenulum of tongue. The duct is not typically seen unless abnormally dilated
On ultrasound, normal submandibular glands appear as encapsulated structures with homogeneous echotexture similar to the parotid. Fine linear echodensities may be present representing intraglandular ductules. Physiologic intravascular flow is typically evident. Superficial portion of the gland is almond-shaped, deep portion triangular
Sialolithiasis = Salivary calculous disease. Most common in submandibular gland because gland secretes a more alkaline, viscous saliva, and the long submandibular duct drains uphill = Increased salivary stasis
With acute obstruction, gland becomes enlarged (= sialadenitis) and duct proximal to stone dilated. Presents with colicky pain most pronounced around times of eating
US can detect even radiolucent stones, but small stones may not shadow
At the floor of mouth, the submandibular space (SMS) and sublingual space (SLS) are divided by mylohyoid musculature = Inferior sling of mouth. SMS is below (inferolateral to) mylohyoid, and SLS is above (superomedial to) mylohyoid
SMS contains: Submandibular glands, lymph nodes, anterior belly of digastric muscle
SLS contains: Sublingual glands, submandibular duct, and anterior aspect of hyoglossus muscle
Remember that while the submandibular glands are in the submandibular space, the submandibular duct is located in the sublingual space!
The submandibular duct travels between the hyoglossus and mylohyoid muscles, which are both useful sonographic landmarks aiding in duct location
References:
Ching AS, Ahuja AT. High-resolution sonography of the submandibular space: anatomy and abnormalities. AJR Am J Roentgenol. 2002 Sep;179(3):703-8.
Grewal JS, Jamal Z, Ryan J. Anatomy, Head and Neck, Submandibular Gland. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
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10min
January 16, 2025Ultrasound of Trigger Finger (Stenosing Tenosynovitis)
In this radiology lecture, we review the ultrasound appearance of trigger finger!
Key teaching points include:
Pulleys are fibrous retinacula on ventral finger that secure flexor tendons to phalanges preventing tendon displacement and bowstringing with finger flexion
Finger has 5 annular pulleys. Odd-numbered at joints, even-numbered at phalanges: A1, A3, A5 are located about the MCP, PIP, DIP joints, respectively. A2 is located at the proximal phalanx, and A4 at the middle phalanx
Cruciform pulleys lie between annular pulleys, but are not usually well-seen on ultrasound
Trigger finger, also known as stenosing tenosynovitis, is characterized by impaired flexor tendon movement due to thickened pulley leading to tendon constriction
Most common at A1 pulley, but can also occur at A2/A3 pulleys, palmar aponeurosis (A0) and wrist
Symptoms: Triggering/locking when flexed, painful snapping when extended, pain, joint stiffness
Most common in female patients, history of diabetes mellitus, and rheumatoid arthritis
Often idiopathic, can occur with repetitive microinjury (flexion-extension). Can also be post-traumatic or due to compressive mass/cyst
Tx: Splinting, NSAIDs, US-guided corticosteroid injection, surgical release
A1 pulley thickness cutoff = 0.62 mm*. Mean normal thickness = 0.5 mm, range with trigger finger 1.1-2.9 mm**. Comparison with asymptomatic side helpful
Additional findings: Pulley hyperemia, nodular tendon thickening (tendinosis) or tear, buckling of flexor tendon on dynamic imaging, “dark tendon” sign (anisotropic hypoechogenicity due to tendon constriction), synovial sheath effusion (acute), and peri-pulley cyst/cystic degeneration
References:
*Spirig A, Juon B, Banz Y, Rieben R, Vogelin E. Correlation between sonographic and in vivo measurement of A1 pulleys in trigger fingers. Ultrasound Med Biol 2016; 42:1482–1490.
**Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, Feydy A, Drapé JL. Sonographic appearance of trigger fingers. J Ultrasound Med. 2008 Oct;27(10):1407-13.
Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. J Ultrasound Med. 2019 Dec;38(12):3141-3154.
Shohda E, Sheta RA. Misconceptions about trigger finger: a scoping review. Definition, pathophysiology, site of lesion, etiology. Trigger finger solving a maze. Adv Rheumatol. 2024 Jul 11;64(1):53.
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Website: https://Radquarters.com/
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Apple Video Podcast: https://apple.co/3ZhHuGu
Instagram: https://www.instagram.com/Radquarters/
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12min
December 12, 2024Ultrasound of Hydrosalpinx, Pyosalpinx & Tubo-ovarian Abscess
Ultrasound of Hydrosalpinx, Pyosalpinx & Tubo-ovarian Abscess
In this radiology lecture, we review the ultrasound appearance of hydrosalpinx, pyosalpinx and tubo-ovarian abscess!
Key teaching points include:
Hydrosalpinx = Fluid-filled, blocked fallopian tube
Hydrosalpinx causes: Pelvic inflammatory disease (most common), endometriosis, prior surgery, adhesions
Hydrosalpinx US: Thin-walled, tubular structure filled with anechoic simple fluid. Dilated tube may fold upon itself forming tubular C-shaped or S-shaped cystic mass. Incomplete septations common
With chronic hydrosalpinx, may see “beads-on-a-string” sign: Short, round, 2-3 mm projections seen along inner tubal walls in cross section = Flattened, fibrotic remnants of endosalpingeal folds. Don’t confuse with solid mural nodules
O-RADS US v2022 management of hydrosalpinx = Imaging: None. Clinical: Gynecologist
Pyosalpinx: Inflamed, blocked fallopian tube filled with purulent debris. Indicates pelvic inflammatory disease
Pyosalpinx US: Thick-walled tubal structure filled with complex fluid. Like hydrosalpinx, typically conforms to a C or S-shape
“Cogwheel” sign of pyosalpinx: Thickened endosalpingeal folds with surrounding tubal wall thickening. Typical of acute tubal inflammation
Tubal wall hyperemia more common with pyosalpinx than hydrosalpinx
Tubo-ovarian complex (TOC): With severe salpingo-oophoritis, ovary and tube adhere to each other. Can distinctly identify ovary from tube but cannot separate the two with transducer pressure. Tx: Antibiotics
Tubo-ovarian abscess (TOA): As pelvic inflammatory disease progresses, complete or near-complete loss of adnexal architecture with pockets of purulent fluid develop. Multiloculated mass with septations, irregular margins, may be bilateral. Tx: Antibiotics, percutaneous drainage, surgery
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
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12min
October 17, 2024Ultrasound of Gallbladder Adenomyomatosis
In this radiology lecture, we review the ultrasound appearance of adenomyomatosis of the gallbladder!
Key teaching points include:
Common cause of benign gallbladder wall thickening seen in up to 9% of patients
Incidence increases with age
Usually asymptomatic, but may be associated with sporadic RUQ pain
Hyperplastic changes of gallbladder wall with mucosal overgrowth. Mucosal herniations protrude into muscular layer forming tiny, bile-filled cystic spaces = Rokitansky-Aschoff sinuses
If large, sinuses may appear as discrete cystic spaces in gallbladder wall
Cholesterol crystals in sinuses cause comet-tail reverberation artifact: Most common finding and highly specific for adenomyomatosis. Can exaggerate comet-tail with addition of color Doppler
Three types: Focal/fundal, segmental/annular and diffuse. Regardless of type, comet-tail artifacts and/or cystic spaces are key to diagnosis
Focal/fundal type: Most common. Often exhibits an “ovary on the gallbladder” appearance. Can be confused with a gallbladder mass. High-frequency linear transducer may be helpful to identify morphology
Segmental/annular type: Narrows waist of gallbladder yielding a figure 8 or hourglass configuration. Gallstones and/or sludge often form in proximal lumen due to increased stasis
If necessary, MRI helpful for problem solving: T2 hyperintense pearl necklace/string of beads appearance sensitive and specific
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
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9min
September 12, 2024Ultrasound of de Quervain’s Tenosynovitis
In this radiology lecture, we review the ultrasound appearance of de Quervain’s Tenosynovitis!
Key teaching points include:
Stenosing tenosynovitis of first extensor compartment tendons = Extensor pollicis brevis (EPB) and abductor pollicis longus (APL)
Second most common hand entrapment tendinopathy after trigger finger
Most common in middle-aged females
Associations include repetitive hand motions, pregnancy, arthritis, and trauma
Clinical presentation: Pain with thumb and wrist movement, tenderness and swelling at radial styloid
Positive Finkelstein maneuver may be present: Grasp thumb, ulnar deviate hand = Pain over distal radius
Ultrasound findings: Increased fluid in EPB/APL tendon sheath (tenosynovitis), hypoechoic, edematous tendon thickening (tendinosis), and thickening of extensor retinaculum (comparison scanning of contralateral thumb helpful)
Advanced findings: Impaired tendon movement, tendon tear (anechoic clefts), retinacular and peritendinous hyperemia
Don’t confuse normal APL slips with longitudinal tear (“lotus root” sign)
Important to identify variant intertendinous septa: Helps to properly guide steroid injection, increased incidence of asymmetric EPB involvement
If conservative therapy fails, surgical decompression may be required. More likely when septum present
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
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9min
August 15, 2024Contrast-Enhanced Ultrasound of Hemangioma
In this radiology lecture, we review the contrast-enhanced ultrasound appearance of hepatic hemangioma!
Key teaching points include:
Microbubble contrast agents are gas-filled microspheres with a lipid or protein shell
Sulfur hexafluoride lipid-type A microspheres: Inert gas of six fluoride atoms bound to one sulfur atom, surrounded by a phospholipid shell
Similar in size to red blood cells, unique when compared to the molecular sizes of CT and MR imaging contrast agents. Small enough to cross capillary beds, too large to enter interstitial space = Pure intravascular agents, ideal for assessing vascularity and perfusion
After IV injection, US contrast agents half-life is about 10 minutes (eliminated via lungs). Multiple injections possible in a single session
Contrast-enhanced US (CEUS) has high contrast resolution: Can visualize individual microbubbles and depict a minute amount of flow = Differentiate avascular debris from small solid nodules in complex cysts. Negative predictive value of CEUS in excluding the presence of flow in a lesion is close to 100%
CEUS also has high temporal resolution: Effectively eliminates motion artifact, a major source of artifact on CT and especially MRI scans. In elderly or debilitated patients, or when there is any other cause of motion, CEUS may be the contrast-enhanced modality of choice
Accuracy and specificity of CEUS for the diagnosis of hepatic hemangioma approaches 100%
Mechanical index (MI) = Measure of acoustic power output. At high MI, microbubbles burst. At low MI, microbubbles are preserved and have a nonlinear response to US, unlike other tissues which have a linear response. Allows for creation of a vascular-only image
Hemangioma has peripheral discontinuous globular enhancement in arterial phase. Progressive centripetal contrast filling and iso- or hyperenhancement in portal venous and late phase
Non-hepatocellular malignancy typically demonstrates early (less than 1 minute) and/or marked washout
Hemangioma filling may be partial or complete depending on lesion size
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
See more impressive visuals by filmmaker and freelance motion graphics artist Nick Shaheen: https://www.instagram.com/nickhshaheen
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
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11min
July 14, 2024Ultrasound of Tennis Leg
In this radiology lecture, we review the ultrasound appearance of tennis leg, including medial gastrocnemius and plantaris injury!
Key teaching points include:
Tennis leg = Injury to muscles of the calf. Tear of myotendinous junction of medial head of gastrocnemius, rupture of plantaris tendon (less common), in isolation or together
Classically described in tennis players, but can occur in various athletic activities (running, skiing) with extension of knee and forced dorsiflexion of ankle. Typically seen in middle-aged, active individuals
Clinical: Sudden sharp calf pain with associated popping/snapping sensation followed by tenderness and swelling
Gastrocnemius & soleus are pennate muscles. Fascicles attach obliquely to a tendon = Aponeuroses with long length of musculotendinous junction. Feathers converging on a single point
Triceps surae muscle = Two headed gastrocnemius, soleus and plantaris. Distal continuation of the gastrocnemius and soleus forms the Achilles tendon
Distal medial head of gastrocnemius where tapers over soleus = One of most commonly injured calf structures
Medial gastrocnemius tear appears as disrupted tendon fibers at aponeurosis with anechoic/hypoechoic fluid or hemorrhage +/- muscle retraction
May see retracted muscle fascicles. Hematoma can dissect between and extends into medial gastrocnemius and soleus muscles
Tx: Conservative (self-limiting). Surgical fasciotomy if compartment syndrome
Plantaris muscle arises from the posterosuperior aspect of lateral femoral condyle near lateral head origin of gastrocnemius muscle. Medially crosses posterior knee joint in oblique fashion
Plantaris continues into calf as a long, thin tendon traveling between medial head of gastrocnemius and soleus muscles. Courses distally at medial aspect of Achilles tendon, usually inserts onto calcaneus. Plantaris is absent in up to 20%
Plantaris injury/rupture less common than medial head gastrocnemius tear and typically more proximal in calf (at myotendinous junction)
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
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10min
June 06, 2024Ultrasound of Interstitial Ectopic Pregnancy
In this radiology lecture, we review the ultrasound appearance of interstitial ectopic pregnancy!
Key teaching points include:
Interstitial ectopic pregnancies are rare, occurring in proximal (interstitial) portion of fallopian tube within muscle wall of uterus
Much less common than tubal ectopic pregnancy occurring in the more distal ampullary and isthmic portions of fallopian tube
Interstitial ectopic pregnancies are important because higher morbidity and mortality due to later presentation and risk of life-threatening hemorrhage
Abnormally eccentric gestational sac with thin surrounding myometrium: less than 5 mm myometrial thickness highly suspicious
“Interstitial line” sign: Thin echogenic line extending from endometrial cavity to ectopic gestational sac. Thought to represent interstitial portion of tube separating the ectopic pregnancy from the endometrium
Medical: Systemic MTX, may also be injected into gestational sac
Surgery: Cornual wedge resection when ruptured versus hysterectomy
Can be confused with angular pregnancy: Rare, intrauterine pregnancy with implantation eccentrically high at the lateral angle of uterine cavity. More medial than interstitial ectopic pregnancies. No interstitial line sign, and greater than 5 mm thickness of overlying myometrial mantle
Angular pregnancy can result in normal pregnancy, but increased risk of miscarriage and uterine rupture. Should be followed closely to ensure growth towards endometrial cavity
Angular pregnancy is sometimes referred to as a “cornual pregnancy,” but controversial as earliest use of term cornual pregnancy refers to intrauterine implantations in anomalous unicornuate, bicornuate or septate uteri. To avoid confusion, best to specifically describe whether the gestational sac is intrauterine or ectopic
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
The post Ultrasound of Interstitial Ectopic Pregnancy appeared first on Radquarters.
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8min
May 02, 2024Ultrasound of Ovarian Serous Cystadenocarcinoma
In this radiology lecture, we review the ultrasound appearance of ovarian serous cystadenocarcinoma!
Key teaching points include:
Serous cystadenocarcinoma is the common ovarian malignancy and most common ovarian epithelial tumor
High-grade and low-grade types
Peak incidence 6th-7th decades
Ultrasound appearance: Mixed cystic and solid mass with papillary projections and thick septations
Elevated CA-125 in greater than 90%
Serous tumors are more commonly bilateral than other tumors
Four main categories of ovarian neoplasms: Epithelial (most common), germ cell (second most common), sex cord-stromal and metastases
Epithelial ovarian tumors are thought to originate outside the ovary (within fallopian tube or endometrium) and involve ovary secondarily
Epithelial ovarian tumor types: Serous, mucinous, endometrioid, clear cell and Brenner
60% of epithelial tumors are benign: Unilocular with thin wall or thin septations (less than 3 mm in thickness)
40% of epithelial tumors are malignant or borderline: Papillary projection (distinctive feature of epithelial tumors) with thick, irregular wall or septations (greater than 3 mm in thickness). Can also present as a large soft tissue mass with necrosis. Advanced findings include peritoneal implants, pelvic wall invasion, adenopathy and ascites
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
The post Ultrasound of Ovarian Serous Cystadenocarcinoma appeared first on Radquarters.
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7min
April 04, 2024Ultrasound of Parathyroid Adenoma
In this radiology lecture, we review the ultrasound appearance of parathyroid adenoma!
Key teaching points include:
Benign tumor of the parathyroid glands
Most common cause of primary hyperparathyroidism: Elevated serum calcium and parathyroid hormone (PTH) levels
Ultrasound: Solid, homogeneous and very hypoechoic. Oval or bean-shaped, long axis oriented craniocaudal. Hypervascular. Majority posterior and inferior to thyroid. Hyperechoic line often separates adenoma from adjacent thyroid. Atypical features: Cystic degeneration, calcification.
Tc-99m sestamibi: Radiotracer uptake persisting on delayed 2-hour images. Taken up by both thyroid and parathyroid tissue, but washes out more rapidly from thyroid. Greater than 90% predictive value for preoperative localization of parathyroid adenoma. SPECT aids with anatomic localization
Ectopic locations in up to 5%: Lower neck, mediastinum, retrotracheal/retroesophageal, carotid sheath and intrathyroidal (typically more homogeneous than thyroid nodules and have a linear interface with gland)
Larger adenomas can be multilobulated
“Polar vessel” sign: Enlarged feeding artery or draining vein terminating at parathyroid adenoma
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!
Spotify: https://spoti.fi/462r0F2
Instagram: https://www.instagram.com/Radquarters/
Facebook: https://www.facebook.com/Radquarters/
X (Twitter): https://twitter.com/Radquarters
Reddit: https://www.reddit.com/user/radiologistHQ/
The post Ultrasound of Parathyroid Adenoma appeared first on Radquarters.
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7min

FAQs about Radiology Lectures | Radquarters:

How many episodes does Radiology Lectures | Radquarters have?

The podcast currently has 86 episodes available.

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