Overview

List of medical conditions by GUSI Course by lesson unit for:

• GUSI Essentials
• Pediatric Essentials
• MSK Essentials
• OB Essentials
• Hepatology Essentials

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GUSI Essentials Course

FAST/E-FAST

• Hemoperitoneum: Identified typically from trauma causing free fluid in the abdomen (e.g., around the liver, spleen) .
• Pneumothorax: Identified by the absence of lung sliding and the presence of a lung point, confirmed by distinct signs like the barcode sign on M mode .
• Pleural Effusion: Identified by free fluid in the pleural cavity, often seen with the spine sign and the absence of a mirror artifact for larger pleural effusions .
  Pericardial Effusion: Noted by fluid around the pericardial sac, specifically between the right ventricle and the liver in the subcostal view .
• Ruptured Ectopic Pregnancy: Illustrated through positive FAST exam showing free fluid indicating hemoperitoneum, particularly in early pregnancy with acute abdominal pain .
• Ascites: Typically from conditions like hepatic insufficiency or malignancy, identified by large amounts of free fluid in the abdomen .
• Splenic Injury: Identified from trauma, showing free fluid between the spleen and kidney or in other subdiaphragmatic spaces .
• Liver Injury: Trauma-related injuries demonstrating free fluid around the liver or hemoperitoneum, often seen in combination with other abdominal injuries .
• Diaphragmatic Injury: Identified in the left upper quadrant with potential fluid collection above the spleen .

Cardiac Echo

• Pericardial Effusion and Cardiac Tamponade: Identified by the presence of fluid around the heart, with or without signs of hemodynamic compromise. Key ultrasound findings include right atrial systolic collapse, right ventricular diastolic collapse, and a plethoric IVC .
• Congestive Heart Failure: Both with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). The findings include dilated IVC, plethoric IVC, and B lines indicative of pulmonary edema .
• Acute Myocardial Infarction (N-STEMI): Although limited in detection via focused cardiac echo, key findings may include regional wall motion abnormalities and hypokinesis .
• Right Heart Strain and Pulmonary Hypertension: Typically from chronic conditions such as pulmonary hypertension and acute pulmonary embolism. Findings include dilated right ventricle, McConnell’s sign, and signs of right ventricular strain .
• Pulmonary Embolism: Indicated by acute right heart strain and specific findings such as McConnell’s sign (akinetic right ventricular free wall with a hyperkinetic apex) .
• Pericarditis: Acute pericarditis can present with pericardial effusion but without tamponade physiology if the IVC collapses normally with respiration .
• Myocarditis: Found especially in pediatric cases with decreased cardiac motion, ventricular dilation, and other signs of impaired cardiac function .
• Hypoplastic Left Heart Syndrome: Particularly in neonates, demonstrated by Findings such as oxygen desaturation and significant abnormalities on cardiac ultrasound .
• Severe Left Ventricular Dysfunction: Diagnosed by evaluating ejection fraction and myocardial thickening during systole using methods like visual estimation and quantitative measures like EPSS (End Point Septal Separation) .

Pulmonology

• Pneumothorax: Identified by the absence of lung sliding, presence of a lung point, and the barcode sign on M mode .
• Pneumonia (Viral and Bacterial): Findings include pleural shred, confluent B lines, subpleural hypoechoic areas, dynamic air or fluid bronchograms, and hepatization.
• Pulmonary Edema: Identified by diffuse, bilateral B lines, typically in dependent areas of the lung.
• Pleural Effusion: Seen as free fluid in the pleural cavity, categorized by qualitative assessment as minimal, small, moderate, or large .
• Bronchiolitis and Viral Illnesses: Features include small subcentimeter consolidations and diffuse comet tails.
• Atelectasis: Distinguished from pneumonia by the lack of dynamic bronchograms, pleural thickening, and B lines .
• Asthma: Detected by evaluating for normal lung sliding with visible A lines, suggestive of an aerated lung .
• Congestive Heart Failure (CHF): Indicated by diffuse B lines, plethoric IVC, and bilateral pulmonary edema .

Gallbladder

• Cholelithiasis (Gallstones): Identified by hyperechoic stones with shadowing and mobility within the gallbladder.
• Acute Cholecystitis: Associated findings include gallbladder wall thickening (>3-4 mm), pericholecystic fluid, positive sonographic Murphy sign, and common bile duct dilation .
• Chronic Cholecystitis: Chronic inflammation leading to similar findings as acute but without acute symptoms.
• Acalculous Cholecystitis: Inflammation of the gallbladder without gallstones, often seen in critically ill patients .
• Gallbladder Polyps: Intraluminal growths that can be benign or malignant. Large polyps (>2 cm) or those >6 mm may require surveillance.
• Adenomyosis: Thickening of the gallbladder wall with Rokitansky-Aschoff sinuses, which can be misinterpreted as stones.
• Gallbladder Carcinoma: Malignant condition often presenting with abnormal thickening, masses within the lumen, and other severe findings.
• Emphysematous Cholecystitis: Characterized by the presence of gas within the gallbladder wall or lumen, noted by echogenic lines or areas with ring-down artifacts.
• Gallbladder Empyema: Collection of pus in the gallbladder, seen as echogenic material without mobility in the lumen, indicating infection.
• Gallbladder Perforation: Can present as localized fluid collections or abscess formation around the gallbladder, sometimes following acute cholecystitis.
• Sludge: Echogenic bile without acoustic shadowing, often seen in conditions with bile stasis .

Abdominal Aortic Aneurysm (AAA)

• Abdominal Aortic Aneurysm (AAA):Defined as an aorta with a diameter greater than 3 cm. The diameter is measured outer to outer in transverse probe orientation .
• Iliac Artery Aneurysm:Defined as an iliac artery with a diameter greater than 1.5 cm.
• Contained Rupture of AAA: Indicated by an anechoic area adjacent to the aorta, which is considered a contained rupture until proven otherwise.
• Saccular Aneurysms:Rare and often resulting from aortic ulcer, previous aortic surgery, aortitis (mycotic aneurysm caused by infections like salmonella) .
• Retroperitoneal Hematoma:Often associated with AAA rupture, presenting as hyperechoic areas above the psoas muscle and possibly displacing kidneys. Retroperitoneal hematomas are also an indication of rupture .

• Aortitis: An inflammatory condition affecting the aorta, causing conditions like mycotic aneurysms described above .

  Renal (including kidney, bladder)

• Hydronephrosis: Graded as mild, moderate, or severe based on the dilation of the renal pelvis and calyces. Severe cases show parenchymal thinning .

• Nephrolithiasis (Kidney Stones): Characterized by hyperechoic structures with posterior shadowing within the kidney, collecting system, proximal ureter, or bladder, often associated with hydronephrosis if obstructing .
• Renal Cysts: Can be simple (smooth, anechoic, with well-demarcated borders) or complex (with internal echoes or septations) .
• Renal Abscess: Appears as an anechoic area with irregular borders, potentially forming a perinephric abscess around the kidney.
• Pyelonephritis: Characterized by renal cortex inflammation and may show focal areas of altered echogenicity .
• Renal Failure: Evaluated through renal ultrasound by assessing for signs of chronic kidney damage like cortical thinning and scarring.
• Bladder Masses: Can present as echogenic masses impacting the bladder outlet and causing obstructive uropathy .
• Bladder Outlet Obstruction: Often associated with conditions like benign prostatic hyperplasia (BPH) and assessed through post-void residual measurement .
• Urinary Tract Infections (UTIs): Typically assessed for secondary impact such as hydronephrosis or pyelonephritis.
• Polycystic Kidney Disease (PKD): Identified by the presence of multiple complex cysts throughout the kidneys, often necessitating further imaging like CT scans.

Deep Vein Thrombosis (DVT)

• Deep Vein Thrombosis (DVT): Characterized by non-compressible deep veins, often with echogenic material within the vein. Common locations include the common femoral vein, popliteal vein, and calf veins.
• Calf Vein DVT: Difficult to visualize and more time-consuming to assess. These clots are often found in the peroneal and posterior tibial veins .
• Iliac Vein DVT: Leading to negative ultrasound findings if the clot is higher than the scanned area. Often assessed by indirect signs like lack of respiratory variation at the common femoral vein .

Musculoskeletal (MSK, including knee, shoulder, hip, wrist, hand, ankle, foot, )

General MSK Conditions

• Tendinopathy/Tendinosis: Chronic tendon pathology involving tendon thickening, partial tears, and abnormal fiber orientation. Examples include Achilles tendon tendinopathy.
• Fasciopathy: Includes conditions like plantar fasciopathy with thickening at the calcaneus junction .
• Tenosynovitis/Tendonitis: Fluid surrounding the tendon and thickening. Examples include deQuervain’s tenosynovitis, wrist common extensor tenosynovitis, and posterior tibialis tenosynovitis.
• Calcific Tendonitis: Hyperechoic consolidation within the tendon. Examples include rotator cuff calcific tendonitis .
• Partial and Complete Tendon Tears: Hypoechoic defects in tendons. Examples include partial and complete tears of the rotator cuff and Achilles tendon .
• Muscle Pathology: Includes tears, edema, and changes to muscle fibers, such as in the medial gastrocnemius and soleus muscles.
• Bursitis: Hypoechoic fluid collections within bursae. Examples include subacromial and retrocalcaneal bursitis .
• Effusion: Fluid collection within joint capsules, commonly in the knee and glenohumeral joint .
• Osteoarthritis: Features irregular bony margins, osteophytes, and narrow joint space. Examples include knee osteoarthritis.
• Cysts: Hypoechoic fluid collections like ganglion cysts, popliteal cysts, and paralabral cysts.
• Bone Irregularities/Fractures: Includes fractures and cortical irregularities. Examples include tibial stress fractures .
  

  Specific Body Areas:

• Shoulder:
  • Conditions such as rotator cuff tears, subacromial bursitis, and effusions.
• Knee:
  • Includes osteoarthritis, meniscal pathology, Baker’s cysts, and effusions .
• Hip:
  • Conditions include trochanteric pain syndrome and associated bursitis .
• Wrist and Hand:
  • Conditions like deQuervain’s tenosynovitis, trigger finger, and gamekeeper’s thumb.
• Ankle and Foot:
  • Includes Achilles tendinopathy, plantar fasciopathy, and ankle effusions.

Skin Soft Tissue

• Cellulitis: Identified by a disrupted, abnormal subcutaneous layer with increased echogenicity and potential cobblestoning appearance when more established .
• Abscess: Appears as an irregular, circumscribed, localized fluid collection on POCUS with signs such as posterior acoustic enhancement and potential air presence for necrotizing fasciitis .
• Necrotizing Fasciitis: Identified by the presence of subcutaneous air and fascial fluid, which are critical indicators for this serious condition .
• Foreign Bodies: POCUS is sensitive for detecting metal, glass, wood, plastic, thorns, spines, and fish bones. Different artifacts help identify their composition, like reverberation for metal and comet-tail for glass .
• Peritonsillar Abscess: POCUS is used to diagnose and guide aspiration, showing high sensitivity and specificity .
• Thrombophlebitis: Differentiated from abscess by identifying venous structures with thrombosis and using color flow .
• Deep Vein Thrombosis (DVT): Identified in areas such as the popliteal fossa when it mimics other conditions like abscess .
• Lymph Nodes: Can mimic abscess but are identified by flow within the structure using color Doppler .
• Hernia: Identification of bowel contents in hernias using POCUS, avoiding misdiagnosis as an abscess .
• Serohematomas: These are fluid collections that may share characteristics with abscesses but typically have less vascularity in the periphery .
• Hidradenitis Suppurativa: Chronic inflammatory condition of intertriginous areas showing fistulous tracts and fluid collections on ultrasound .
• Morphea: An autoimmune condition showing dermal and subcutaneous changes with color Doppler hypervascularity .
• Plantar Warts: Appears as well-defined, fusiform, hypoechoic lesions with internal vascularity .

Dermatology

• Cellulitis vs Abscess: Cellulitis: Appears as a disrupted, abnormal subcutaneous layer with increased echogenicity, and may result in cobblestoning .
• Abscess: Appears as a circumscribed, irregular fluid collection with posterior acoustic enhancement and possibly a swirling motion when compressed .
• Foreign Bodies: Detection of foreign bodies in the skin includes identifying their sonographic characteristics, such as the presence of comet tail artifacts for glass or metal and deep shadowing for wood .
• Necrotizing Fasciitis: Characterized by the presence of fascial fluid and air on ultrasound .
• Hidradenitis Suppurativa: Chronic inflammatory disease affecting intertriginous areas, diagnosed by the presence of widened hair follicles, thickening and hypoechogenicity of the dermis, the existence of fluid collections, and fistulous tracts .
• Morphea: A form of scleroderma detected by increased dermal and subcutaneous blood flow, loss of the dermis-subcutaneous border, and thickening of the dermis .
• Plantar Warts: Caused by human papillomavirus (HPV), presenting as well-defined fusiform epidermal and dermal structures on ultrasound .
• Seromas and Hematomas: Fluid collections appearing as anechoic or hypoechoic pockets in the subcutaneous tissue .
• Nail Conditions: Includes
  • subungual abscess,
  • periungual myxoid cyst, and
  • glomus tumors .
• Skin Cancer: Ultrasonographic features of basal cell carcinoma, squamous cell carcinoma, and melanoma, including the analysis of satellite, in-transit, and nodal metastases .
• Inflammatory Conditions: Conditions such as edema and lymphedema, presenting as thickening of the dermis and subcutaneous tissue on ultrasound .
  • edema
  • lymphedema,

1st Trimester Obstetrics

• Normal Intrauterine Pregnancy (IUP): Detection of a normally located gestational sac with a fetal pole and yolk sac .
• Spontaneous Abortion (Miscarriage): Includes various outcomes such as complete, incomplete, threatened, and missed abortions .
• Ectopic Pregnancy: Identification of pregnancies located outside the uterine cavity, with emphasis on tubal pregnancies, and other less common locations such as the interstitial, cervical, and abdominal regions .
• Molar Pregnancy (Gestational Trophoblastic Disease): Diagnosed by the “snowstorm” or “swiss cheese” appearance on ultrasound .
• Heterotopic Pregnancy: The rare occurrence of simultaneous intrauterine and ectopic pregnancies .
• Adnexal Masses: Associated with ectopic pregnancies and other gynecological conditions .
• Free Fluid in the Pelvis: An indicator of internal bleeding often associated with ectopic pregnancies .
• Blighted Ovum (Anembryonic Pregnancy): Presence of a gestational sac without an embryo

2nd and 3rd Trimester Obstetrics

• Oligohydramnios: Diagnosed by a single deepest pocket (SDP) of less than 2 cm or an amniotic fluid index (AFI) of less than 5 cm.
• Polyhydramnios: Diagnosed by an SDP greater than 8 cm or an AFI greater than 24 cm .
• Fetal Lie and Presentation Issues: Includes malpresentations like breech, oblique, and transverse lie .
• Twin Pregnancies: Vertex-vertex, breech, and concerns such as dichorionic, diamniotic vs. monochorionic, diamniotic twins.
• Placenta Previa: Presence of the placenta covering the cervical os, requiring thorough scanning to locate the distal edge .
• Placenta Accreta Spectrum: Conditions including placenta accreta, increta, and percreta, with partial to complete invasion of the uterine wall .
• Fetal Heart Rate Abnormalities: Includes bradycardia (low heart rate), tachycardia (high heart rate), arrhythmias, and fetal demise (absence of heartbeat) .
• Amniotic Fluid Abnormalities: Screening for adequate amniotic fluid with potential issues like pooling of umbilical cord in measurement pockets and differential diagnosis of oligohydramnios and polyhydramnios .
• Vasa Previa: Presence of fetal blood vessels covering the internal cervical os, often detected through vaginal ultrasound .
• Complications During Labor: Differentiating between normal labor, labor with placental issues like previa or abruption, and managing labor in the presence of abnormalities like twin gestations and oligohydramnios .

Pediatric Essentials

Pediatric FAST

• URI and Pneumonia:
  • Viral URI
  • Viral Bronchiolitis or Viral Pneumonia
  • Bacterial Pneumonia
• Trauma:
  • Splenic Laceration
  • Hemoperitoneum
  • Liver Laceration
• Congenital or Cardiac Issues:
  • Congenital Heart Disease
  • Congestive Heart Failure
• Abdominal Pathologies:
  • Appendicitis
  • Hemorrhagic Ovarian Cyst
  • Gastroenteritis

Peds Renal

• Hydronephrosis: Hydronephrosis or urinary tract dilation appears as a dilated anechoic fluid-filled collecting system that dominates the central portion of the kidney. It is described by a grading system, ranging from mild to severe based on the extent of dilation and parenchymal thinning.
• Nephrolithiasis (Renal Stones): Hyperechoic structures visualized within the kidney, collecting system, proximal ureter, or bladder. They can vary in size from 1 to 10 mm and are associated with prominent posterior shadowing and potentially hydronephrosis if obstructing the ureter.
• Renal Cysts:
  • Simple renal cysts have a uniform, smooth oval shape with anechoic centers and well-demarcated borders.
  • Complex cysts do not meet all these criteria. Ultrasound helps distinguish renal pyramids from cysts, as pyramids are more prominent and hypoechoic without connecting to the renal pelvis.
• Renal Abscess: Appears as an anechoic area with an irregular border. Infection can spread beyond the kidney forming a perinephric abscess, which appears as an anechoic or hypoechoic collection around or next to the kidney.

Peds Cardiac

• Undiagnosed Congenital Heart Disease. Various structural anomalies including
  • ventricular septal defects (VSD),
  • atrial septal defects (ASD), and
  • more complex conditions such as hypoplastic left heart syndrome.
• Pericardial Effusion with or without Tamponade: Pericardial effusion seen as an anechoic area between the epicardium and the pericardium, which can progress to tamponade if not identified and treated promptly .
• Myocarditis: Inflammation of the heart muscle presenting with symptoms such as decreased cardiac motion and potentially leading to heart failure .
• Cardiomegaly and Cardiac Dysfunction: Enlarged heart or poor contractility identified through reduced endocardial border excursion and wall thickening .
• Pulmonary Embolism: Identified through dilation of the right ventricle and non-collapsible inferior vena cava (IVC), suggesting obstructed blood flow .
• Hypoplastic Left Heart Syndrome: Severe congenital defect leading to underdeveloped left heart structures, necessitating immediate surgical intervention .
• Congestive Heart Failure: Heart’s inability to pump effectively, often secondary to congenital anomalies or myocarditis, presenting with symptoms such as pulmonary edema and systemic congestion .

Peds Lung

• Upper Respiratory Tract Infection (URI): Symptoms include fever, runny nose, and cough. Lung ultrasound may show diffuse comet tails and A-lines without B-lines or consolidation .
• Viral Bronchiolitis/Viral Pneumonia: Findings can include multiple small subcentimeter consolidations scattered in various lung fields, and sometimes pleural shredding .
• Bacterial Pneumonia: Lung ultrasound may show focal B-lines, pleural shredding, consolidation (hepatization), air and fluid bronchograms, and pleural effusion. Severe cases may have large pleural effusion requiring drainage .
• Pulmonary Edema: Characterized by diffuse, bilateral B-lines often seen in dependent areas. Accompanied by signs of fluid overload in other areas such as the heart and IVC .
• Pneumothorax: Key findings include absence of lung sliding, presence of lung point, and “barcode sign” on M-mode. No parenchymal signs like B-lines or consolidations .
• Pleural Effusion: Effusions can be categorized as minimal, small, moderate, or large. They may be simple, complex, or septated .
• Primary and Secondary Cardiac Issues Related to Pulmonary Symptoms: Conditions such as congestive heart failure, congenital heart disease (leading to pulmonary congestion), and pulmonary embolism can present with respiratory symptoms. Ultrasound can help differentiate these with findings like abnormal cardiac motion or anatomy .
• Pulmonary Contusion: Findings may include focal B-lines and consolidations depending on the extent of the injury .
• Respiratory Distress Syndrome (RDS) in Newborns: Presents with diffuse B-lines and pleural line abnormalities indicative of lung parenchymal disease .

Peds Abdomen

• Appendicitis: Characteristics include Distended, non-compressible, blind-ended tubular structure with inflamed fat and posterior shadowing suspicious for appendicolith .
• Hemorrhagic Ovarian Cyst: Characteristics include Large cystic structure adjacent to the bladder with fluid around it.
• Gastroenteritis: Characteristics: include Abdominal pain, fever, vomiting, diarrhea, large lymph nodes; appendix not visualized.
• Mesenteric Adenitis: Characteristics include Large lymph nodes visualized throughout the abdomen, can mimic appendicitis or be secondary to viral illness.
• Ileitis: Characteristics include Thickened small bowel with surrounding inflamed fat and mesenteric nodes, differentiated from appendicitis by visualizing the entire appendix all the way to the tip .

Peds Ocular

• Papilledema: Detected through ocular POCUS showing protrusion of the optic disk, wide optic nerve sheath with a cystic appearance of the arachnoid space, typically indicating increased intracranial pressure (ICP) or space-occupying lesion like a posterior fossa tumor .
• Optic Disc Drusen: Hyperechoic nodules on the optic disc appearing with shadowing, often confirmed by ophthalmology. It may mimic papilledema but lacks clinical symptoms of elevated ICP.
• Benign Intracranial Hypertension: Characterized by symptoms of headache and vomiting, diagnosed through optic disc POCUS showing optic disc elevation, but without space-occupying lesions on imaging .
• Tilted Optic Disc: A form of pseudopapilledema where the optic nerve enters the eye at an oblique angle, giving a sharp/pointy peak on imaging rather than the rounded peak of true papilledema.

Peds Neck Mass

• Reactive Lymphadenitis: : Round-shaped lymph nodes with preserved architecture and border that may be enlarged with an absent or widened hilum. Normal or increased blood flow centrally and in the surrounding soft tissue.
• Lymph Node Abscess: Heterogeneous hypoechoic mass with thickened irregular walls and increased peripheral vascularity on POCUS, indicating central necrosis or abscess formation.
• Lymphoma: Lymph nodes appearing more round in shape, hypoechoic, and typically lack the hyperechoic central hilum .
• Lymphatic Malformation: Ovoid or round anechoic structures with well-defined borders, no internal flow, and possibly debris within the structures.
• Thyroglossal Duct Cyst and Brachial Cleft Cyst: Hypoechoic or anechoic structures of varying shape and size with thin walls and no internal vascularity. May exhibit thickened or irregular walls and increased blood flow if infected.

Peds Skin Soft Tissue

• Cellulitis: Early cellulitis appears on POCUS as a disrupted, abnormal subcutaneous layer with increased echogenicity. In advanced stages, it develops into a “cobblestoning” pattern due to fluid interdigitating between fat lobules .
• Abscess: Appear as irregular, circumscribed, localized fluid collections on POCUS. They may show posterior acoustic enhancement and exhibit the “Swirl sign” or “Squish sign” when pressed with a probe .
• Necrotizing Fasciitis: Early stages can be indistinguishable from cellulitis or abscess. POCUS may show subcutaneous air, abnormal subcutaneous fat, and fascial fluid. It can be confirmed with the presence of air, detected as bright white mobile flecks on ultrasound .
• Foreign Bodies: Various foreign bodies including metal, glass, wood, and plastic by their characteristic artifacts (e.g., ring-down artifact for metal, comet tail for glass, and shadowing for wood). Additionally, ultrasound guides the removal of foreign bodies .
• Peritonsillar Abscess (PTA): Identified on POCUS using intracavitary probes. POCUS can accurately locate the abscess and adjacent structures like the carotid artery, significantly aiding in safe aspiration .
• Thrombophlebitis and DVT: Thrombophlebitis appears as a thrombosed vein on POCUS, often with collateral flow, and requires differentiation from abscesses by using color flow Doppler. DVT can appear as a non-compressible, thrombosed vein .

MSK Essentials

MSK Pathology Overview

• Osteoarthritis: Characterized by effusion, bony erosions, osteophytes, decreased joint space, meniscal extrusion, joint-associated cysts (popliteal or ganglion), synovial hypertrophy, and enthesitis .
• Effusion: Presence of hypoechoic fluid collections within the joint capsule, often identified in the knee .
• Bursitis: Specifically includes prepatellar bursitis, identified by cobblestoning of soft tissue overlying the patellar tendon .
• Cysts: Including ganglion cysts, paralabral/meniscal cysts, popliteal cysts (Baker’s cysts), and peroneal brevis cysts .
• Tendinopathy: Seen as partial or full thickness tears within tendons, often affecting the patellar tendon with changes like tendinitis and corticated hematoma .
• Bony Irregularities: Cortical irregularities representing fractures, with specific examples like tibial stress fractures .

Shoulder

• Biceps Tenosynovitis: Fluid surrounding the biceps tendon, observed in both short and long axis views .
• Subacromial Bursitis: Hypoechoic fluid collection within the bursa separating the deltoid and the rotator cuff .
• Supraspinatus Calcific Tendinopathy: Hyperechoic focus within the supraspinatus tendon .
• Supraspinatus Tendinopathy and Partial Tear: Irregular fibers with hypoechoic clefts indicating partial thickness tears .
• Full Thickness Rotator Cuff Tear: Complete gap in the tendon with retraction of fibers, often seen as the “naked humerus” sign .
• Glenohumeral Arthritis: Characterized by bone erosions, effusions, and severely distorted joint anatomy .
• Acromioclavicular Arthritis: Bone spurs, irregular bone contours, and increased capsule size due to effusion .
• AC Joint Separation: Ranging from subtle separation to more noticeable changes in joint alignment .

Elbow

• Common Extensor Tendinopathy: Variants include tears, calcific tendinopathy, and general thickening with changes in echo texture and presence of cortical irregularities .
• Radial Head Fracture: Recognized by cortical irregularities often subtle and localized over the radial head .
• Bursitis: This includes olecranon bursitis, characterized by hypoechoic fluid collections often with inflammatory debris .
• Calcific Tendonopathy: Presence of significant thickening of the common extensor tendon with large calcifications and bony calcifications within the tendon footprint .
• Effusion: Hypoechoic fluid collection within the joint capsule often associated with inflammatory debris .
• Osteoarthritis: Bony irregularities, osteophytes, and decreased joint space leading to effusion and joint-associated cysts .

Wrist

• Carpal Tunnel Syndrome: Median nerve entrapment at the wrist with potential for ultrasound-assessed severity .
• De Quervain’s Tenosynovitis: Inflammation of the first dorsal wrist compartment, affecting the abductor pollicis longus and extensor pollicis brevis tendons .
• Trigger Finger (Stenosing Tenosynovitis): Hypoechoic fluid surrounding the flexor tendons in the fingers, leading to stenosis .
• Osteoarthritis: Bony irregularities, osteophytes (bone spurs), and effusions in the wrist joint due to degenerative changes .
• Ganglion Cyst: Hypoechoic fluid collections often round and symmetric appearing, located adjacent to joints like the wrist .
• Tenosynovitis: Inflammation of the tendon sheath with surrounding hypoechoic fluid, affecting tendons like the extensor carpi ulnaris .

Hand and Fingers

• Jersey Finger: Affects the DIP joint, best viewed in long axis. Rupture may be evident through lack of movement during dynamic testing .
• Trigger Finger (Stenosing Tenosynovitis): Involves the A1 pulley at the MCPJ, seen as concentric hypoechoic fluid rings around the flexor tendons in the fingers .
• Mallet Finger: Injury to the extensor tendon at the distal phalanx, characterized by lack of motion if ruptured .
• UCL Tear (Gamekeeper’s Thumb or Skier’s Thumb): Involves the ulnar collateral ligament at the proximal thumb joint, often seen with stress testing .
• Stener Lesion: Occurs when a torn UCL pulls under the aponeurosis, making the ligament nonfunctional .
• Thumb Carpometacarpal Joint Arthritis: Arthritic changes with irregular bone margins, effusions, and significant subluxation of the MCP joint .
• Boutonniere Deformity: Involves the central slip of the extensor tendon, usually hard to detect with ultrasound due to small size.

Hip and Pelvis

• Osteoarthritis: Characterized by bony irregularities, joint space narrowing, bone erosions, osteophytes, and effusions .
• Calcific Tendonitis: Hyperechoic focus within the tendons, often associated with the gluteus medius tendon and lateral hip bursitis .
• Trochanteric Pain Syndrome: Encompasses a range of pathologies such as tendinopathies and bursitis, often initially misdiagnosed as trochanteric bursitis .
• Bursitis: Hypoechoic fluid collection within the bursa, seen around the lateral hip and gluteus medius .
• Tendon Tears: Partial or full thickness, seen as hypoechoic regions within the tendon, and can be associated with calcifications .
• Hip Effusion: Presence of hypoechoic fluid within the joint capsule, with bone capsule distances greater than 0.7 centimeters being indicative of an effusion .
• Hematomas: Traumatic collections of blood and debris, typically superficial to the gluteus maximus, appearing as hypoechoic areas .
• High Hamstring Pathology: Tendinopathy, partial and complete tears of the hamstring tendons with calcifications and bony irregularities .

Hamstring

• High Hamstring Tendinopathy: Includes bony irregularity, calcifications on the tendon footprint, fixed hypoechoic areas indicating partial tears, and complete tears with hypoechoic regions and hematomas .
• Muscle Tears: Mid-portion tears that may be classified into grades based on the extent of muscle circumference affected: Grade 1 (small tear), Grade 2 (<50% of circumference), and Grade 3 (50-100%) .
• Tenosynovitis: Characterized by a halo effect around the tendon due to fluid accumulation .
• Calcific Tendinitis: Presence of hyperechoic foci within the tendon due to calcifications .
• Traumatic Hematoma: Large hypoechoic collections, often seen superficial to the gluteus maximus .

Posterior Leg

• Tendinopathy: Thickening, partial thickness tears, scar tissue, and irregular fiber orientation in the Achilles tendon
• Achilles Tendon Fluid in Sheath: Presence of fluid around Achilles tendon, often indicative of tenosynovitis
• Partial and Full Thickness Achilles Tendon Tears: Hypoechoic defects representing partial tears or full-thickness acute tears with anechoic gaps. Chronic tears feature hypoechoic pockets and scar tissue without continuous tendon fibers
• Retrocalcaneal Bursitis: Fluid collection behind the Achilles tendon at its insertion point, often seen with insertional tendinopathy
• Achilles Tendon Cyst: Cystic formations at the insertion of the Achilles tendon
• Medial Gastrocnemius Tear: Often seen in the muscle belly, characterized by anechoic gaps and disrupted fibers
• Soleus Muscle Tear: Partial thickness muscle tear at the insertion of the soleus onto the Achilles

Knee

• Osteoarthritis: Characterized by effusion, bony erosions, osteophytes, decreased joint space, meniscal extrusion, joint-associated cysts (popliteal or ganglion), synovial hypertrophy, and enthesitis .
• Effusion: Presence of hypoechoic fluid collections within the joint capsule, often identified in the knee .
• Bursitis: Specifically includes prepatellar bursitis, identified by cobblestoning of soft tissue overlying the patellar tendon .
• Cysts: Including ganglion cysts, paralabral/meniscal cysts, popliteal cysts (Baker’s cysts), and peroneal brevis cysts .
• Tendinopathy: Seen as partial or full thickness tears within tendons, often affecting the patellar tendon with changes like tendinitis and corticated hematoma .
• Bony Irregularities: Cortical irregularities representing fractures, with specific examples like tibial stress fractures .

Ankle

• Tendinopathy: Thickening, partial thickness tears, scar tissue, irregular fiber orientation in the Achilles tendon .
• Achilles Tendon Fluid in Sheath: Presence of fluid around the Achilles tendon, often indicative of tenosynovitis .
• Achilles Insertional Tear: Tears at the insertion point of the Achilles tendon into the calcaneus .
• Full Thickness Achilles Tendon Tear: Characterized by an anechoic gap, indicating a complete rupture of the tendon .
• Retrocalcaneal Bursitis: Fluid collection behind the Achilles tendon at its insertion into the calcaneus .
• Achilles Tendon Cyst: Cystic formations at the insertion of the Achilles tendon into the calcaneus .
• Medial Gastrocnemius Tear: Hypoechoic regions with debris and a thickened rind surrounding the tear within the muscle belly .
• Soleus Muscle Tear: Partial thickness muscle tear at the insertion of the soleus onto the Achilles tendon .
• Tenosynovitis: Presence of hypoechoic fluid collections surrounding tendons, indicating inflammation of the tendon sheath .
• Ganglion Cysts: Hypoechoic fluid collections adjacent to tendons, often round and symmetric .
• Posterior Tibialis Tendinopathy: Includes discrete zones of hyperechogenicity, bony cortical irregularities, hypoechoic regions within the tendon, fluid surrounding the tendon, thickening of the sheath, and potential tears .
• Painful Os Peroneum Syndrome (POPS): Hyperechoic calcification within the peroneal longus tendon .
  High Ankle Sprain: Injuries involving the tibiofibular ligament, often referred to as high ankle sprains .
  Anterior Talofibular Ligament Sprain: Common ligament injury in the ankle .
  Calcaneofibular Ligament Injury: Sprain or tear of the ligament that stabilizes the lateral ankle .

Foot

• Plantar Fasciopathy: Characterized by thickening at the calcaneus junction (>0.4cm abnormal)
• Achilles Tendinopathy: Thickening, partial thickness tearing, scar tissue, irregular fiber orientation. Example: Asymmetrical thickening, thicker >0.4-0.5mm
• Effusion: Fluid collections associated with joint capsules, often seen as debris or swelling
• Osteoarthritis: Irregular bony margins, osteophytes, narrow joint space, effusion. Example: Degenerative changes in metatarsophalangeal joint with osteophytes and erosions.
• Cysts: Hypoechoic fluid collections such as ganglion cysts. Example: Ganglion cyst, popliteal cyst.
• Retrocalcaneal Bursitis: Fluid collection within the bursa, often associated with Achilles tendinopathy
• Tendinopathy in Other Tendons: Tendinopathy and tenosynovitis can affect other tendons such as posterior tibialis or flexor tendons
• Os Peroneum Syndrome: Presence of ossicles within the peroneal tendons, associated with lateral foot pain

OB Essentials

Fetal Number

Increased Maternal Risks:

• Anemia
• Diabetes
• Preterm Delivery
• Preeclampsia
• Hemorrhage
• Cesarean Delivery

Increased Fetal Risks:

• Fetal Anomalies
• Vascular Abnormalities in the Placenta and Cords
• Abnormal Growth
• Stillbirth
• Preterm Delivery
• Low Birth Weight

Fetal heart Rate

• Fetal Bradycardia: Defined as a fetal heart rate less than 110 beats per minute for more than 20 minutes. Examples include heart rates around 51, 54, and 70 beats per minute.
  • Intrauterine resuscitation maneuvers or cesarean delivery may be required if it persists
• Fetal Tachycardia: Defined as a fetal heart rate greater than 160 beats per minute for 20 minutes or more. Examples include heart rates of 170, 175, 180, and 189 beats per minute. Possible causes include:
  • maternal fever and
  • intra-amniotic infection (chorioamnionitis) .
• Fetal Arrhythmias: Irregular heartbeats that may be seen as skips or intermittent bradycardia. These may resolve before delivery but could warrant consultation with a perinatologist or pediatric cardiologist [1] .
• Fetal Demise: Indicated by a lack of fetal heart rate and movement, and no color flow on color Doppler
• Fetal Decelerations: Decrease in heart rate for more than 15 seconds, classified into types with various clinical significances. Persistent fetal deceleration often warrants hospital evaluation

Fetal Presentation

• Breech Presentation: Breech presentation is identified when the buttocks or feet are closest to the cervix
• Transverse Lie: Transverse lie occurs when the fetus is lying sideways in the uterus. This position is confirmed by imaging the fetal vertebral bodies and determining their orientation
• Oblique Lie: Oblique lie is a condition where the fetal body lies at an angle between transverse and longitudinal positions. It can sometimes be corrected by asking the patient to empty her bladder

Placental Location

• Placenta Previa: This condition occurs when the placenta covers part or all of the internal cervical os, which can lead to significant bleeding risks before, during, or after delivery
• Low Lying Placenta: When the edge of the placenta is less than 2 centimeters from the internal cervical os, it is termed a low lying placenta, which also poses a risk for bleeding
• Placental Abruption: This refers to the partial or complete separation of the placenta from the uterine wall before delivery, which can be detected clinically and sometimes via ultrasound as a hypoechoic collection behind the placenta.
• Morbidly Adherent Placenta (Placenta Accreta Spectrum): This spectrum includes conditions like placenta accreta, increta, and percreta, where the placenta abnormally adheres to or invades the myometrium. Symptoms and diagnosis can involve findings like placental lakes and abnormal vascularity along the uterine-bladder interface

Fetal Dating (First Trimester)

• Spontaneous Abortion: This term refers to the loss of a pregnancy before 20 weeks of gestation. Visual manifestations can include empty gestational sacs or absence of fetal heart tones in a previously confirmed intrauterine pregnancy (IUP)
• Ectopic Pregnancy: This condition occurs when the fertilized egg implants outside the uterus, often in the fallopian tubes. Signs of an ectopic pregnancy can include the absence of an intrauterine gestational sac paired with the presence of a complex adnexal mass and free fluid in the pelvis
• Molar Pregnancy: Also known as a hydatidiform mole, this is a type of gestational trophoblastic disease. Ultrasound signs include a “snowstorm” or “swiss cheese” appearance showing multiple small cystic spaces within the uterus
• Fibroids: Non-cancerous growths of the uterus that can be identified as hypoechoic masses within or hanging off the uterus on ultrasound

Fetal Dating and Biometry (2nd/3rd Trimester)

• Fetal Growth Restriction (IUGR): Indicated when a fetus is smaller than expected for the number of weeks of pregnancy. It is diagnosed by abnormal ultrasound findings showing an estimated fetal weight below the 10th percentile
• Fetal Macrosomia: This is a condition where a fetus is significantly larger than average for the gestational age, often related to maternal diabetes. It is diagnosed when the estimated fetal weight is above the 90th percentile
• Polyhydramnios: This condition is characterized by an excessive amount of amniotic fluid and can be associated with fetal abnormalities, maternal diabetes, and other conditions. It is diagnosed when the single deepest pocket (SDP) of amniotic fluid is greater than 8 centimeters or the amniotic fluid index (AFI) is above 24
• Oligohydramnios: Indicated by a lower than normal amount of amniotic fluid, it can be detected by ultrasound when the SDP is less than 2 centimeters or the AFI is less than 5. This condition can be associated with ruptured membranes or postdates pregnancy
• Gestational Diabetes: While not always an ultrasound diagnosis, it can influence imaging findings such as larger than expected fetal abdominal circumference, which may indicate fetal macrosomia
• Preterm Labor: Ultrasound can help in assessing gestational age to determine the preterm status of a baby if the mother is presenting with labor symptoms before 37 weeks of gestation
• Craniofacial Abnormalities: Occasionally identified during biometry when the structures around the fetal head and face do not appear normal or standard images cannot be attained

1st Trimester Overview – Clinical Integration

• Spontaneous Abortion (Miscarriage): Conditions where there is a positive pregnancy test, uterine cramping, spotting, and other symptoms suggesting a miscarriage. Examples include detecting products of conception at the cervical os, incomplete abortion, or completed abortion with no remaining products
• Ectopic Pregnancy: A pregnancy located outside the uterine cavity, typically in the fallopian tube, characterized by adnexal masses, possible free fluid behind the uterus, and no definitive intrauterine pregnancy on ultrasound
• Molar Pregnancy (Hydatidiform Mole): A type of gestational trophoblastic disease that can be detected as a mass in the uterus with a characteristic “snowstorm” appearance on ultrasound
• Fibroids: Non-cancerous growths in the uterus that can be identified as hypoechoic masses within or attached to the uterus

2nd and 3rd Trimester Overview – Clinical Integration

• Oligohydramnios: Diagnosed when the single deepest pocket (SDP) of amniotic fluid is less than 2 centimeters. It can present as difficulty finding an adequate fluid pocket during ultrasound evaluation
• Transverse Lie: Characterized by the fetus lying sideways in the uterus, confirmed through ultrasound imaging and probe positioning
• Breech Presentation: Identified when the fetus’s buttocks or feet are positioned to deliver first, confirmed by the absence of the fetal skull in the expected position near the maternal pelvis [4] .
• Fetal Tachycardia: Defined as a fetal heart rate greater than 160 beats per minute, noted in twin B in one of the cases presented
• Dichorionic Diamniotic Twins: Refers to twins with separate placentas and amniotic sacs. It was diagnosed by identifying separate fetal sexes and a dividing membrane
• Gestational Age Assessment: Important for confirming preterm labor and ensuring accurate dating, affecting management decisions

Biophysical Profile

• Oligohydramnios: Characterized by a single deepest pocket of amniotic fluid less than 2 centimeters
• Polyhydramnios: Although not typically a focus in the biophysical profile assessment, polyhydramnios may also influence the interpretation depending on the amniotic fluid index
• Fetal Asphyxia: Indicated by a biophysical profile (BPP) score of 0-4/10, which signifies a high risk and often warrants immediate delivery.
• Gestational Diabetes: Example provided where a patient with gestational diabetes on insulin is evaluated for decreased fetal movement
• Preeclampsia: Mild preeclampsia without severe features is discussed, necessitating close monitoring and impacting BPP results

Hepatology Essentials

Liver Anatomy

• Hepatocellular Carcinoma (HCC): A primary liver cancer often developing on a background of chronic liver disease. It appears on ultrasound as hyper- or hypo-echoic lesions with possible satellite nodules and a heterogeneous hepatic parenchyma .
• Cholangiocarcinoma: A cancer of the bile ducts, described as heterogeneous and sometimes presenting with a hypo-echoic halo .
• Liver Metastasis: Secondary liver cancer that can vary in appearance from small and multiple to large, hypo- or hyper-echoic lesions, often associated with primary cancers like lung cancer.
• Benign Liver Lesions:
  • Focal Nodular Hyperplasia (FNH): A benign liver tumor, often isoechoic with a central scar and characteristic “spoke-wheel” vascular pattern.
  • Hepatic Adenomas: More common in females, often linked to oral contraceptive use or anabolic steroid use. They are typically hyperechoic with a risk of bleeding and malignant transformation depending on certain conditions.
  • Hemangiomas: Common benign liver tumors that appear hyper-echoic on ultrasound.
• Liver Cysts: Simple and complex cysts, potentially causing obstruction if large.
• Polycystic Liver Disease: Multiple liver cysts varying in size, which can be complicated by infections or bleeding.
• Steatosis (Fatty Liver Disease): Increased echogenicity of the liver parenchyma due to the accumulation of fat within hepatocytes.
• Liver Fibrosis and Cirrhosis: Advanced stages of liver disease characterized by a coarse liver texture, hypertrophy of the caudate lobe, irregular liver surface, and portal hypertension.
• Vascular Disorders:
  • Portal Vein Thrombosis: Formation of a clot in the portal vein causing portal hypertension .
  • Budd-Chiari Syndrome: Hepatic venous outflow obstruction often leading to liver enlargement and ascites .
  • Veno-Occlusive Disease (VOD): Associated with bone marrow transplantation, leading to hepatic sinusoidal obstruction.
• Ascites and Portal Hypertension: Conditions often secondary to cirrhosis or other hepatic pathologies, causing fluid accumulation in the peritoneal cavity and increased blood pressure in the portal venous system .
• Heart Failure-Related Liver Disease: Cardiogenic cirrhosis secondary to severe heart conditions, characterized by hepatomegaly and congestion of hepatic veins.
• Chronic Liver Diseases:
  • Primary Sclerosing Cholangitis: Inflammation and sclerosis of bile ducts not prominently mentioned but relevant in hepatic pathologies.
  • Autoimmune Hepatitis: Chronic disease where the body’s immune system attacks liver cells.

Hepatic Steanosis (Fatty Liver)

• Simple Steatosis: The accumulation of fat within hepatocytes due to triglyceride build-up from peripheral lipolysis, lipogenesis, and dietary sources .
• Metabolic Syndrome: Includes patients with elevated BMI and metabolic abnormalities such as hypertension and dyslipidemia .
• Steatohepatitis: This encompasses non-alcoholic steatohepatitis (NASH) characterized by hepatic fat with inflammation, and potential progression to cirrhosis.
• Alcoholic Steatohepatitis: Steatosis associated with chronic ethanol consumption leading to liver inflammation and fat accumulation.
• Drug or Chemotherapy-Induced Steatosis: Fat accumulation within the liver as a result of certain drugs or chemotherapeutic agents .
• Viral Hepatitis: Conditions related to hepatitis infections that may result in fatty changes within the liver .
• Advanced Fibrosis and Cirrhosis: Progression from steatosis to more severe liver damage including fibrosis and cirrhosis .

Sonographic approach to jaundice

• Chronic Liver Disease: Various chronic conditions, including cirrhosis with characteristic sonographic features like liver texture changes, splenomegaly, and portal hypertension .
• Hepatocellular Carcinoma (HCC): Primary liver cancer often presenting with masses and tumoral invasion causing bile duct obstruction .
• Cholangiocarcinoma: Cancer of the bile ducts leading to significant bile duct dilatation (intrahepatic and extrahepatic), often with characteristic signs on ultrasound.
• Pancreatic Conditions:
  • Pancreatic Adenocarcinoma: Tumor in the pancreas head causing bile duct obstruction and resulting in jaundice .
  • Pancreatitis: Inflammation of the pancreas that can lead to pseudocysts exerting a mass effect on the bile ducts .
  • Portal Vein Thrombosis: Thrombosis leading to portal hypertension and secondary biliary obstruction .
• Gallbladder Pathologies:
  • Cholecystitis: Inflammation of the gallbladder that can be associated with wall thickening and stones.
  • Gallstones: Stones within the gallbladder or biliary tree leading to biliary colic and obstructive jaundice.
    Congestive Hepatopathy: Liver congestion secondary to heart failure, often presenting with dilated hepatic veins and changes in Doppler flow due to increased central venous pressure .
• Drug-Induced Liver Injury (DILI): Liver damage resulting from medications, which can lead to jaundice without specific sonographic features distinguishing it from other causes .
• Infections Leading to Liver Dysfunction:
  • Hepatitis: Inflammation of the liver causing hepatomegaly and altered liver function leading to jaundice .
  • Septic Thrombophlebitis: Infection-related inflammation and thrombosis in the portal vein leading to complications such as liver abscesses.
• Biliary Obstructions:
  • Sludge and Small Stones: Leading to partial obstructions and sludge seen within dilated bile ducts.
  • ERCP Complications: Post-procedural changes and presence of stents in cases of biliary obstruction management.

Advanced biliary pathology

• Chronic Cholecystitis: Includes the formation of Rokitansky-Aschoff sinuses and gallstones within the sinuses .
• Gangrenous Cholecystitis: Characterized by a very thick, irregular gallbladder wall with multiple small abscesses around the gallbladder.
• Gallbladder Empyema: Presence of echogenic material within the gallbladder suggestive of pus.
• Gallbladder Carcinoma: Often presents as a thickened, deformed gallbladder wall with peritoneal carcinomatosis .
• Emphysematous Cholecystitis: Presence of gas within the gallbladder wall due to infection.
• Acalculous Cholecystitis: Inflammation of the gallbladder not associated with gallstones.
• Biliary Obstruction: Can be caused by various factors such as stones, tumors, or external compression .
• Cholangiocarcinoma: Appears as a mass causing biliary dilatation and is often associated with chronic inflammatory conditions of the bile ducts.
• Pancreatic Pseudocysts (secondary to pancreatitis): Can exert mass effect causing biliary obstruction.
• Choledocholithiasis: Presence of stones in the common bile duct causing obstruction .
• Hepatolithiasis: Stones within the bile ducts inside the liver, often leading to recurrent cholangitis and biliary sepsis.
• Primary Sclerosing Cholangitis (PSC): Chronic inflammatory disease leading to biliary strictures and liver disease .
• Biliary Atresia: A condition in infants where bile ducts are abnormally narrow, blocked, or absent .
• Portal Hypertension: Often leads to complications in the biliary system including varices and hypersplenism.
• Metastatic Liver Disease: Frequently causes secondary biliary obstruction due to mass effect from liver tumors.

Vascular Liver disease

• Portal Vein Thrombosis: This includes acute and chronic portal vein thrombosis, as well as tumor-related thrombosis. It involves the accumulation of thrombus material within the portal vein, potentially leading to portal hypertension and other complications .
• Budd-Chiari Syndrome: Hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava and the right atrium.
• Sinusoidal Obstruction Syndrome (SOS): Also known as hepatic veno-occlusive disease, which involves damage to the sinusoids and obstruction due to conditions like bone marrow transplantation, toxins, and chemotherapy.
• Vascular Malformations: This includes conditions such as hepatic artery aneurysms, arterio-portal fistula, arteriovenous fistula, and congenital portosystemic shunts.
• Hepatic Hemangiomas: These are benign vascular tumors of the liver that may cause complications like hemorrhage and Kassabach-Merritt Syndrome (platelet sequestration syndrome).
• Peliosis Hepatis: A rare vascular condition involving blood-filled cystic spaces in the liver parenchyma.
• Hereditary Hemorrhagic Telangiectasia (HHT): Also known as Osler-Weber-Rendu syndrome, involving diffuse vascular malformations and potentially leading to high-output cardiac failure, portal hypertension, and other complications.
• Porto-Sinusoidal Vascular Disease (PSVD): Characterized by alterations in the portal vein and liver vasculature leading to non-cirrhotic portal hypertension.
• Hepatic Artery Stenosis and Thrombosis: Conditions affecting the arterial supply to the liver, which can lead to ischemic damage and other complications.
• Cirrhosis-Related Vascular Complications: Advanced cirrhosis leading to vascular abnormalities such as portal hypertension, varices, and splenomegaly.

Focal liver lesions

• Hepatocellular Carcinoma (HCC): The most frequent primary liver cancer, often developing on a background of chronic liver disease. It presents as hyper- or hypo-echoic lesions and may show satellite nodules and heterogeneity
• Cholangiocarcinoma: A malignancy of the bile ducts often presenting as mixed echogenicity lesions with exophytic growth
• Liver Metastasis: Secondary liver cancer from primary sites like lung cancer and breast cancer. Metastases may appear hyper-, hypo-, or iso-echoic, and are often heterogeneous.
• Focal Nodular Hyperplasia (FNH): A benign lesion that can show a “spoke-wheel” vascular pattern. It may have a central scar in larger lesions and often requires further imaging for confirmation.
• Hepatic Adenomas: Benign tumors often linked to oral contraceptives or anabolic steroids, more common in women. They are hyperechoic on ultrasound and may exhibit slow growth and risk of bleeding.
• Hemangiomas: Common benign vascular tumors that are typically hyperechoic and well-defined but can cause complications if large.
• Liver Abscesses: These present as hypo- or anechoic areas with potential internal debris, often associated with infectious etiology.
• Cysts and Polycystic Liver Disease: Simple cysts appear anechoic with posterior enhancement. Polycystic liver disease involves multiple cysts of varying size, which can have complications like infection or bleeding.
• Echinococcal Cysts (Hydatid Disease): Caused by parasitic infection leading to cyst formation, seen in various lifecycle stages from active to inactive cysts.
• Necrotic Metastases: Malignant lesions that have undergone necrosis and may present with liquefaction and complex features on ultrasound.

Ascites and chronic liver disease

• Cirrhosis: Characterized by an irregular liver border, nodularity, and asymmetry of liver lobes .
• Portal Hypertension:
  • Splenomegaly: An increase in the spleen size.
  • Collateral Circulation: Presence of varices and other collateral blood vessels.
  • Portal Vein Dilatation: Enlargement and potential reversal of blood flow within the portal vein.
• Budd-Chiari Syndrome: A condition caused by obstruction of the hepatic veins leading to hepatomegaly, ascites, and caudate lobe hypertrophy.
• Congestive Heart Failure: May lead to hepatic venous congestion and ascites.
• Hepatocellular Carcinoma (HCC): A primary liver cancer that can also contribute to advanced liver disease and ascites .
• Malignant Ascites: Ascites due to malignant conditions including peritoneal carcinomatosis.
• Chronic Hepatitis: Leading to chronic liver disease and sometimes complicated by ascites.
• Portal Vein Thrombosis: Thrombosis of the portal vein contributing to portal hypertension and ascites.