Week 11 - Lecture 2

Puzzle time
MEDS12002 Abdominal Ultrasound
Objectives
• To critically think through scenarios and arrive at either differential
diagnoses or a provisional diagnosis.
• To critically evaluate images to arrive at potential clinical presentations
• To determine when and how to extend the examination

Please give it your best shot to answer all of these before attending the Zoom
session on Wednesday to interact live, or before watching the recording of the
tutorial. This is so you get a better gauge of where your knowledge is at and
which parts you may need to focus on. Once you’ve seen the answers, you
can’t go back to not knowing, so will not be able to test your critical thinking as
much.
Remember your pen and paper (or word doc on the computer) to write down
the information that you need to – and write as much as you can to answer the
questions asked.
 Questions:

Puzzle 1: 1. What will you be looking for?

Patient details
Name: Thanh Thi DOB: 24/6/1967 Sex: Female
Referral information: Hep C+, abn LFTs
 Questions:

Puzzle 1: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: Thanh Thi DOB: 24/6/1967 Sex: Female
3. How would you extend the scan?
Referral information: Hep C+, abn LFTs

Ultrasound images
Trans right liver Long spleen
Puzzle 2:
Ultrasound image:

Describe this longitudinal image of a gallbladder using correct sonographic terminology.

What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 3: 1. What will you be looking for?

Patient details
Name: Thomas Henry DOB: 17/8/1954 Sex: Male
Referral information: Inc urine frequency, esp nocturnal.
 Questions:

Puzzle 3: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: Thomas Henry DOB: 17/8/1954 Sex: Male
3. How would you extend the scan?
Referral information: Inc urine frequency, esp nocturnal

Ultrasound images
Long pelvis Long left kidney
Puzzle 4:
Ultrasound image:

Describe this image of a transverse pancreas using correct sonographic terminology.

What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 5: 1. What will you be looking for?

Patient details
Name: June Trinket DOB: 2/11/1939 Sex: Female
Referral information: Inpat, anorexia, NG tube feeding. RUQ pain, fever, incr. WBC
 Questions:

Puzzle 5: 1. Describe the both images using sonographic

terminology including pathology
Patient details 2. What are your DDx?
Name: June Trinket DOB: 2/11/1939 Sex: Female 3. How would you extend the scan?
Referral information: Inpat, anorexia, NG tube feeding. RUQ pain, fever, incr. WBC

Ultrasound images
Long gallbladder Long right kidney
Puzzle 6:
Ultrasound image:

Describe this transverse image of the aorta using correct sonographic terminology.
What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 7: 1. What will you be looking for?

Patient details
Name: Charles Richardson DOB: 31/10/1943 Sex: Male
Referral information: Jaundice FI, elevated LFTs
 Questions:

Puzzle 7: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: Charles Richardson DOB: 31/10/1943 Sex: Male
3. How would you extend the scan?
Referral information: Jaundice FI, elevated LFTs

Ultrasound images
Long right liver Long porta hepatis

CBD
Puzzle 8:
Ultrasound image:

Describe this image of a longitudinal gallbladder using correct sonographic terminology.

What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 9: 1. What will you be looking for?

Patient details
Name: Trang Nguyen DOB: 7/9/1989 Sex: Female
Referral information: Post-prandial pain FI, on OCP
 Questions:

Puzzle 9: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: Trang Nguyen DOB: 7/9/1989 Sex: Female
3. How would you extend the scan?
Referral information: Post-prandial pain FI, on OCP

Ultrasound images
Trans left liver Trans right liver
Puzzle 10:
Ultrasound image:

Describe this image of a longitudinal right flank using correct sonographic terminology.
What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 11: 1. What will you be looking for?

Patient details
Name: George Pandos DOB: 4/3/1967 Sex: Male
Referral information: Pain Lt flank
 Questions:

Puzzle 11: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: George Pandos DOB: 4/3/1967 Sex: Male
3. How would you extend the scan?
Referral information: Pain Lt flank

Ultrasound images
Long left kidney Long spleen
Puzzle 12:
Ultrasound image:

Describe this transverse image of a bladder using correct sonographic terminology.

What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 13: 1. What will you be looking for?

Patient details
Name: Mohamad Saleh DOB: 1/8/1974 Sex: Male
Referral information: RUQ pain, on/off 3 months
 Questions:

Puzzle 13: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: Mohamad Saleh DOB: 1/8/1974 Sex: Male
3. How would you extend the scan?
Referral information: RUQ pain, on/off 3 months

Ultrasound images
Long gallbladder Long bile duct @ porta hepatis
Puzzle 14:
Ultrasound image:

Describe the image using correct sonographic terminology.

What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 15: 1. What will you be looking for?

Patient details
Name: Kayla Rossi DOB: 27/1/1979 Sex: Female
Referral information: UTI FI
 Questions:

Puzzle 15: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: Kayla Rossi DOB: 27/1/1979 Sex: Female
3. How would you extend the scan?
Referral information: UTI FI

Ultrasound images
Trans bladder Long bladder
Puzzle 16:
Ultrasound image:

Describe this transverse image of a bladder using correct sonographic terminology.

What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 17: 1. What will you be looking for?

Patient details
Name: Raj Kumar DOB: 27/4/1994 Sex: Male
Referral information: General workplace check
 Questions:

Puzzle 17: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: Raj Kumar DOB: 27/4/1994 Sex: Male
3. How would you extend the scan?
Referral information: General workplace check

Ultrasound images
Long aorta lower Long gallbladder
Puzzle 18:
Ultrasound image:

Describe this longitudinal image of the right kidney using correct sonographic terminology.
What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?
 Questions:

Puzzle 19: 1. What will you be looking for?

Patient details
Name: Gerrie Harris DOB: 15/11/1988 Sex: Female
Referral information: Intermittent epig pain
 Questions:

Puzzle 19: 1. Describe the both images using sonographic

terminology including pathology
Patient details
2. What are your DDx?
Name: Gerrie Harris DOB: 15/11/1988 Sex: Female
3. How would you extend the scan?
Referral information: Intermittent epig pain

Ultrasound images
Trans pancreas Long left liver
Puzzle 20:
Ultrasound image:

Describe this transverse image of the superior right liver using correct sonographic terminology.
What is your provisional diagnosis?
What information could be on this patient’s referral that could suggest this result?
What other images are required for an accurate diagnosis?