62 episodes

High-yield, educational radiology lectures utilizing a multimodality imaging approach including MRI, CT, ultrasound, radiography, and nuclear medicine. Lectures are presented in both didactic and quiz formats. These video podcasts are designed for radiology residents, fellows, and radiologists, as well as any student or practitioner interested in optimizing patient care through radiology. Visit www.radiologistHQ.com for more info and reference material.

Radiology Lectures | Radiologist Headquarters Daniel J. Kowal, MD

    • Health & Fitness
    • 4.9 • 62 Ratings

High-yield, educational radiology lectures utilizing a multimodality imaging approach including MRI, CT, ultrasound, radiography, and nuclear medicine. Lectures are presented in both didactic and quiz formats. These video podcasts are designed for radiology residents, fellows, and radiologists, as well as any student or practitioner interested in optimizing patient care through radiology. Visit www.radiologistHQ.com for more info and reference material.

    • video
    Case Review: Ultrasound of Thyroglossal Duct Cyst

    Case Review: Ultrasound of Thyroglossal Duct Cyst

    In this radiology lecture, we review the ultrasound appearance of thyroglossal duct cyst with two unique cases!

    Key teaching points include:



    * Thyroglossal duct cyst is the most common congenital neck cyst.

    * Most present before age 18 as a midline, fluctuant neck mass near hyoid bone.

    * Often asymptomatic unless superinfected = Abscess, draining sinus.

    * Epithelial-lined cysts caused by failure of normal involution of thyroglossal duct.

    * Can occur anywhere from foramen cecum of tongue to thyroid gland.

    * Most are infrahyoid, followed by hyoid and suprahyoid.

    * Most are midline, but can be paramedian (more likely if infrahyoid).

    * If infrahyoid, typically embedded in strap muscles.

    * May move with swallowing and elevates with tongue protrusion.

    * Presence of normal thyroid gland should be confirmed.

    * When simple, typically appears as an anechoic midline neck mass near hyoid bone.

    * Cyst complexity usually due to superinfection: Proteinaceous internal debris and septations, thick irregular walls, increased blood flow and surrounding inflammation.

    * Solid components may indicate ectopic thyroid or rarely (less than 1% of cases) thyroid cancer (typically papillary subtype).

    * Tx: Resection of cyst, surrounding tissue along the thyroglossal tract, and midline portion of hyoid bone = Sistrunk procedure.



    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!

    Instagram: https://www.instagram.com/radiologistHQ/

    Facebook: https://www.facebook.com/radiologistHeadQuarters/

    Twitter: https://twitter.com/radiologistHQ

    Reddit: https://www.reddit.com/user/radiologistHQ/

    • 8 min
    • video
    Case Review: Ultrasound of Varicocele

    Case Review: Ultrasound of Varicocele

    In this radiology lecture, we review the ultrasound appearance of scrotal varicocele with three unique cases.

    Key teaching points include:



    * Varicocele is abnormal dilatation of pampiniform venous plexus = Peritesticular veins.

    * Seen in up to 15% of adult and adolescent males.

    * Caused by incompetent or absent testicular vein valves.

    * Upper limit of normal for scrotal vein caliber = 2 mm, varicocele when greater than 2-3 mm.

    * Flow in varicocele usually too slow to detect with color Doppler and is typically better seen with Valsalva or with standing position.

    * 85% left sided, 15% bilateral: Left testicular vein drains into left renal vein at 90-degree angle, and superior mesenteric artery compresses left renal vein = Increased pressure and venous backflow. Right vein drains into IVC at acute angle.

    * Symptoms: Scrotal mass, pain, infertility/subfertility.

    * Low grade: Reflux only seen with Valsalva, inguinal canal/supratesticular location, vessels enlarged only in standing position.

    * High grade: Reflux seen at rest, infratesticular location, vessels enlarged in supine position.

    * Solitary right varicocele raises concern for compression of the right testicular vein from a retroperitoneal mass.

    * Ultrasound of upper abdomen should be considered when an isolated right-sided varicocele or asymmetrically large right-sided varicocele found.

    * However, most patients typically present with additional signs and symptoms of malignancy: “No patient in our cohort was found to have an unsuspected malignancy for which isolated right-sided varicocele was the only presenting sign.”*



    *Gleason A, Bishop K, Xi Y et al. Isolated Right-Sided Varicocele: Is Further Workup Necessary? AJR 2019; 212:802-807

    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!

    Instagram: https://www.instagram.com/radiologistHQ/

    Facebook: https://www.facebook.com/radiologistHeadQuarters/

    Twitter: https://twitter.com/radiologistHQ

    Reddit: https://www.reddit.com/user/radiologistHQ/

    • 7 min
    • video
    Case Review: Ultrasound of Achilles Tendinosis and Tear

    Case Review: Ultrasound of Achilles Tendinosis and Tear

    In this radiology lecture, we review the ultrasound appearance of Achilles tendinosis, partial thickness tears and full thickness tears through four unique cases.

    Key teaching points include:



    * Achilles tendon is strongest in body. Originates from soleus and gastrocnemius muscles, inserts onto posterior calcaneal tuberosity.

    * Achilles tendon tears = Most common ankle tendon injury.

    * Tendon enlargement greater than 1 cm in AP dimension = Abnormal.

    * Tendinosis appears as fusiform hypoechoic swelling of tendon without fiber disruption with increased blood flow (use power Doppler or microvascular flow).

    * Ultrasound highly sensitive and specific for partial and complete Achilles tears.

    * Partial tear = Hypoechoic/anechoic cleft that disrupts tendon fibers.

    * Full thickness tears = Usually 2-6 cm proximal to calcaneal insertion. Complete tendon fiber disruption and retraction. May see refractive shadowing at tendon stumps. Tendon gap may fill with mixed echogenicity fluid/hemorrhage or portion of adjacent fat pad.

    * Plantaris tendon = Thin tendon at medial aspect of Achilles, may mimic intact Achilles tendon fibers (plantaris usually stays intact with Achilles tear).

    * Dynamic imaging with passive ankle dorsiflexion and plantar flexion helps reveal tendon retraction at tear site.

    * Achilles tendon surrounded by a paratenon as opposed to a true synovial tendon sheath.

    * Paratendinitis = Hypoechoic swelling or anechoic fluid adjacent to tendon.

    * Achilles tendon ossification can occur with prior tendon rupture, surgery, or repetitive microtrauma.

    * Scar tissue in chronic tear can simulate tendon fibers (dynamic maneuvers helpful), and fibrous bridging may occur.



    Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

    Instagram: https://www.instagram.com/radiologistHQ/

    Facebook: https://www.facebook.com/radiologistHeadQuarters/

    Twitter: https://twitter.com/radiologistHQ

    • 9 min
    • video
    Case Review: Ultrasound of Uterine Adenomyosis

    Case Review: Ultrasound of Uterine Adenomyosis

    In this radiology lecture, we review the ultrasound appearance of adenomyosis through three unique cases, including an MRI example.

    Key teaching points include:



    * Adenomyosis results from ectopic endometrial tissue in myometrium. Leads to dysfunctional smooth muscle hyperplasia/hypertrophy surrounding ectopic glands.

    * Cause unknown.

    * Common, usually multiparous women of reproductive age.

    * Additional risk factors: Early menarche, short menstrual cycles, high BMI = High estrogen exposure.

    * Rarely seen in postmenopausal patients, unless treated with tamoxifen for breast cancer.

    * Often asymptomatic, but can present with menorrhagia, dysmenorrhea, dyspareunia, and chronic pelvic pain.

    * For diagnosing adenomyosis, transvaginal US much more sensitive and specific (89%) than transabdominal imaging.

    * Most specific US findings: Linear echogenic striations/nodules radiating from endometrium into inner myometrium. Tiny myometrial and subendometrial cysts = Fluid-filled glands.

    * Additional US findings: Enlarged, globular uterus with diffuse myometrial bulkiness, myometrial heterogeneity, irregular endometrial-myometrial interface, hyperechoic islands, and pencil-thin “venetian blind” or “rain shower” shadowing. Cine clips extremely helpful.

    * Adenomyosis can cause asymmetric myometrial thickening.

    * Focal adenomyosis (adenomyoma) has ill-defined margins compared to fibroids, typically elliptical as opposed to rounded in shape.

    * May see abnormal vascular flow: Increased vascularity with tortuous vessels penetrating myometrium. Helps differentiate adenomyosis from fibroids, which tend to displace vessels and show circumferential flow.

    * On US, thickened junctional zone may manifest as a hypoechoic halo surrounding echogenic endometrium.

    * MRI “traditionally” the modality of choice to diagnose adenomyosis, and junctional zone thickened to 12 mm or greater highly specific. May contain punctate T2 hyperintense cystic foci/T1 hyperintense hemorrhage.

    * However, modern TV US shows comparable accuracy to MRI with no statistical significance between sensitivities and specificities: “Transvaginal US should be considered the primary imaging modality for the diagnosis of adenomyosis.”*

    * Treatment: Pain management, tranexamic acid, OCPs, GnRH agonists.

    * If severe, not relieved medically, and no desire for fertility: Hysterectomy.



    *Cunningham RK, Horrow MM, Smith RJ, et al. Adenomyosis: A Sonographic Diagnosis. RadioGraphics. 2018; 38:1576-1589

    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!

    Instagram: https://www.instagram.com/radiologistHQ/

    Facebook: https://www.facebook.com/radiologistHeadQuarters/

    Twitter: https://twitter.com/radiologistHQ

    • 10 min
    • video
    Case Review: Ultrasound of Endometrioma

    Case Review: Ultrasound of Endometrioma

    In this radiology lecture, we review the ultrasound appearance of endometrioma through three unique cases, including an MRI example.

    Key teaching points include:



    * Endometriosis = Ectopic endometrial glands and stroma outside of the uterine cavity. Includes endometriomas, extraovarian implants and adhesions.

    * Endometriomas = Endometriotic cysts within ovary.

    * Endometriosis is seen in about 10% of women of reproductive age.

    * Presentation: Pelvic pain, dysmenorrhea, dyspareunia, infertility.

    * Ultrasound: Diffuse, homogeneous low-level echoes (most specific feature) yielding a ground glass appearance. May have posterior acoustic enhancement.

    * Endometriomas may have peripheral punctate echogenic foci. These foci have no internal vascular flow but can see twinkle artifact.

    * Vascular flow may be present in endometrioma septations.

    * Endometrioma vs. hemorrhagic cyst: Hemorrhagic cysts are acute, usually solitary and unilocular, whereas endometriomas are chronic, sometimes multiple and multilocular.

    * Endometriomas can rarely (1%) undergo malignant transformation into endometrioid carcinoma or clear cell carcinoma.

    * MR is the most specific imaging modality for diagnosis of endometrioma = Specificity 98%.*

    * Homogeneous, T1 “light bulb” bright, T2 dark = “T2 shading.”

    * Surgical treatment: Depends on disease severity from laparoscopic cyst aspiration/cystectomy to hysterectomy/oophorectomy.

    * Medical management may be attempted: Oral contraceptives, GnRH agonists



    *Reference: Togashi K, Nishimura K, Kimura I, et al. Endometrial cysts: Diagnosis with MR imaging. Radiology. 1991;180:73-78.

    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!

    Instagram: https://www.instagram.com/radiologistHQ/

    Facebook: https://www.facebook.com/radiologistHeadQuarters/

    Twitter: https://twitter.com/radiologistHQ

     

    • 8 min
    • video
    Case Review: Ultrasound of Testicular Torsion

    Case Review: Ultrasound of Testicular Torsion

    In this radiology lecture, we review the ultrasound appearance of testicular torsion through three unique cases.

    Key teaching points include:



    * Torsion occurs when spermatic cord twists and cuts off blood supply to the testis.

    * Bell-clapper deformity most common etiology: Abnormally high attachment of tunica vaginalis allowing spermatic cord rotation and testicular torsion (intravaginal).

    * Torsion has a bimodal distribution: First year of life (extravaginal), adolescents/young adults (intravaginal).

    * “Whirlpool” sign: Eddy swirl of coiled spermatic cord superior to testis, highly specific but less commonly seen than redundant spermatic cord.

    * Redundant spermatic cord AKA boggy pseudomass, torsion knot, epididymal-cord complex and should be avascular or only minimally vascular (unlike paratesticular neoplasm or acute epididymitis).

    * Testicles normally lie vertically, but horizontal or oblique (diagonal) lie suspicious for torsion.

    * Testicular enlargement, reactive hydrocele and scrotal skin thickening are secondary findings of torsion.

    * Marked testicular heterogeneity = Late torsion and nonviability/necrosis, more likely after 24 hours of symptoms.

    * Treatment: Detorsion and orchiopexy if salvageable, orchiectomy if not.



    Reference: Bandarkar AN, Blask AR. Testicular torsion with preserved flow: Key sonographic features and value-added approach to diagnosis. Pediatric Radiology (2018) 48:735–744.

    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!

    Instagram: https://www.instagram.com/radiologistHQ/

    Facebook: https://www.facebook.com/radiologistHeadQuarters/

    Twitter: https://twitter.com/radiologistHQ

    • 9 min

Customer Reviews

4.9 out of 5
62 Ratings

62 Ratings

mikedagator ,

Best radiology Podcast by far

Lectures are great!

DangerouslyFaithful ,

Must watch podcast to learn radiology!

Some of the best teaching in radiology…shows pertinent findings, shows you what to look for and how to differentiate it from other Dx, search patterns, mnemonics, and ways to understand it from a first principles description! From Cases of the week to 5 Case in 5 minutes rapid reviews, he has it all!

Josiiip ,

Excellent teaching!

Great cases, with excellent teaching that points out all findings and explains the mechanism of the pathology. Thank you from a current radiology resident!

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