La entrada Síndrome de Mirizzi se publicó primero en SEECO.

• Case name: SPLENOMEGALY and INFARCTS.
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: A 35-year-old female patient presents pain in the left flank, feeling a "bulge" below the costal margin when taking a deep breath. The patient has been diagnosed with infectious mononucleosis. The attending physician requests a hepatobiliary ultrasound. She denies other symptoms. She has no history of surgery or trauma.
• Ultrasound findings: An enlarged spleen is seen with the presence of 2 avascular hypoechoic lesions with slightly irregular edges and a fine echogenic halo within which fine hyperechoic lines (reflective-specular) perpendicular to the ultrasound beam are identified (bright band sign). Both are wedge-shaped in the sagittal section and oval-shaped in the axial section, located in the middle third. (Images 1 and 2 – Videos 1 to 3)
• Diagnosis: The findings are compatible with an enlarged spleen with the presence of infarcts.

La entrada Esplenomegalia e Infartos se publicó primero en SEECO.

• Case name: DIASTASIS OF THE RECTUS ABDOMINALI.
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: A 52-year-old male patient presents with a bulge in the supraumbilical region of the midline, which is more noticeable when the patient flexes or performs Valsalva on the abdomen. (Image 1). Denies pain or other symptoms. No contributing history.
• Ultrasound findings: At the supraumbilical level, in the epigastric area, a slight separation of the rectus abdominis muscles is observed. As the transducer moves distally, this separation increases until reaching a maximum value of 3.62 cm. (Normal separation not greater than 2 cm). No hernial defects are observed. Muscle planes with preserved fibrillar pattern. (Image 1 and Video 1)
• Diagnosis: The findings are compatible with diastasis of the rectus abdominis muscles at the supraumbilical level.

La entrada Diastasis de los rectos abdominales se publicó primero en SEECO.

• Case name: FOCAL NODULAR HYPERPLASIA – FNH.
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: A 35-year-old female patient comes for a check-up and to rule out fatty liver. Asymptomatic. No contributing history.
• Ultrasound findings: Solid, slightly heterogeneous, predominantly echogenic nodular lesion with partially defined irregular edges that, on power Doppler, shows increased vascularization and measures 36.2 x 30 x 34.9 mm. It is located in the right lobe. (Image 1 and Video 1)
• Diagnosis: The findings are compatible with focal nodular hyperplasia in the liver.

La entrada Hiperplasia nodular focal – HNF se publicó primero en SEECO.

• Case name: Cholangiocarcinoma-Klatskin tumor.
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: A 54-year-old female patient has had intermittent "dull" pain in the right upper quadrant for 2 years. Mild jaundice and choluria appeared 1 month ago. She does not report any other symptoms. History: DM-2 for 8 years. Laparoscopic cholecystectomy 5 years ago. The treating physician requested a hepatobiliary ultrasound.
• Ultrasound findings: At the level of the hepatic hilum, a solid isoechoic nodular lesion is seen, slightly hypoechoic with irregular, partially defined edges that exert a mass effect on the adjacent vascular structures and intrahepatic bile ducts, dilating them. (Image 1 and Videos 1 and 2).
• Diagnosis: The findings are compatible with Hilar Cholangiocarcinoma – Klatskin Tumor.

La entrada Colangiocarcinoma -Tumor de Klatskin se publicó primero en SEECO.

• Case name: COMPLETE TEAR OF THE DISTAL MYOTENDINOUS JUNCTION OR POSTERIOR FASCIA OF THE RIGHT RECTUS FEMORALIS.
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: A 35-year-old male patient presents a bulge in the proximal third and a depression in the distal third of the anterior compartment of the right thigh, soft, non-painful, without inflammatory changes. (Image 1). Background: 3 weeks ago, while playing soccer, he felt a pull when kicking the ball, fell to the ground unable to stand up, and then extensive bruising appeared.
• Ultrasound findings: Retraction of the rectus femoris muscle towards the proximal (bell clapper) is observed due to rupture of the distal myotendinous junction. (Image 1 and 2), Anechogenic collection is associated in the lateral and lower portion (hematoma) that separates it from the deep fascia. (Videos 1 and 2)
• Diagnosis: The findings are compatible with a complete tear of the distal myotendinous junction or posterior fascia of the right rectus femoris.

La entrada Desgarro completo de la unión miotendinosa distal o fascia posterior del recto femoral se publicó primero en SEECO.

• Case name: LIVER HEMANGIOMA.
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: A 36-year-old female patient, asymptomatic, comes for a check-up. She denies any contributory history. She requests a hepatobiliary ultrasound to rule out fatty liver.
• Ultrasound findings: In the hepatic segment VIII, a solid, slightly heterogeneous, predominantly hyperechoic nodular lesion with somewhat irregular edges measuring 38.7 x 32.1 x 38.5 mm was observed, which exerted a mass effect on the adjacent vascular structures. The color and power Doppler studies did not show intranodular signal uptake. (Image 1 and Videos 1 to 3).
• Diagnosis: The findings are compatible with hepatic hemangioma.

La entrada Hemangioma Hepático se publicó primero en SEECO.

• Case name: Spigelian hernia in the right lower quadrant.
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: Male patient, 42 years old, comes due to a “mass” in the lower right quadrant of the abdomen (Image 1) for 2 years, which increases in size when lifting weights or doing intense exercise and decreases when resting, causing pain. History: He denies surgery or trauma.
• Ultrasound findings: In the lower right quadrant, a hernial defect is seen between the lateral border of the rectus abdominis muscle and the semilunar line. (Image 2), by which a large hernial sac protrudes through the aponeurosis of the transverse muscle, inside the aponeurosis of the external oblique muscle, containing mesenteric fat and intestinal loops, during the Valsalva maneuver. It is partially reduced by echo pressure. (Image 2, Video 1 and 2).
• Diagnosis: The findings are consistent with Spigelian hernia in the right lower quadrant.

La entrada Hernia de Spiegel se publicó primero en SEECO.

• Case name: Left epitrochlear lymphadenopathy with inflammatory characteristics (due to cat scratch)
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: Female patient, 3 years old, is referred by a pediatrician for a “bulge” in the distal medial region of the left arm (Image 1) near the epitrochlea, slightly painful to palpation with no external signs of inflammation. History: One week ago he had fever and increased volume in the area described above with moderate pain. He denies trauma. He raises cats at home.
• Ultrasound findings: An enlarged lymph node with well-defined edges with an eccentric hilar pattern and hypoechoic asymmetric thickening of the cortex is observed, measuring 17.5 x 9.5 x 11.8 mm; volume: 1.04 cc, seen in sagittal and axial views. (Image 2, Videos 1 and 2), shows color Doppler and CPA study increased hiliocortical vascularization (Image 2 and Video 3). In addition, an increase in echogenicity of the adjacent subcutaneous tissue is observed (Image 2, Videos 1 and 2) and dilation of the lymphatic duct with a course towards the forearm (Image 2 and Video 1).
• Diagnosis: Findings are consistent with left epitrochlear lymphadenopathy with inflammatory characteristics (due to cat scratch)

La entrada Linfadenopatía epitroclear izquierda se publicó primero en SEECO.

• Case name: Synovial (Ganglion) Cyst of the Right Wrist.
• Author's name: Dr. Bruno Sagástegui Aguilar.
• Author's job position: Work center: SONOSCAN Ultrasound Center (Private) and TOMONORTE Diagnostic Imaging Center (Private) Trujillo – PERU.
• Clinical and examination: Male patient, 8 years old, is referred by a pediatrician due to a soft “tumor” on the dorsal aspect of the right wrist, painful to ultrasound pressure. (Image 1 and 2). He says he has had it for 6 months and it has been growing. Background: The patient is a goalkeeper for his school team and has had minor traumas to his hands several times.
• Ultrasound findings: At the level of the dorsal aspect of the right wrist, a complex cystic lesion with slightly thickened walls of 17.7 x 9.8 x 15.2 mm is observed; vol: 1.38 cc (Image 2) with fine hyperechoic linear tracts, which are related to sloughs (Image 2, Videos 1, 2 and 4) and some dense floating echoes (Videos 3 and 5), A slight increase in vascularization is associated with the color Doppler study in the wall and sloughs (Image 2 and Video 6). This is located between extensor compartments III and IV, communicating with the synovial sheath of the aforementioned tendons. (Video 2, 3, 4 and 5). No alterations are shown in the cortex of the carpal bones.
• Diagnosis: The findings are compatible with a Synovial Cyst (Ganglion) of the back of the right wrist with mild inflammatory signs.

La entrada Quiste (Ganglión) Sinovial de la Muñeca Derecha se publicó primero en SEECO.