SARTESCHI AND DUBIN CLASSIFICATION

The blood vessels of the pampiniform plexus are usually no more than 1.5 mm in diameter.

CDUS is currently considered the gold-standard technique for varicocele assessment because it allows accurate diagnosis (with a sensitivity and a specificity close to 100%)


When a patient with a varicocele is examined at rest, multiple elongated, tortuous anechoic structures are seen above, around, or beneath the testicle 
 The vessel caliber thresholds used by different authors to define varicocele vary from 2 to 3 mm 

Under baseline conditions, blood flow may be too slow to be detected by CDUS, but during the Valsalva maneuver the varicocele enlarges and flow reversal becomes evident. Some authors suggest that varicoceles should also be assessed while the patient is standing.

Sarteschi classification 

1	Reflux in vessels in the inguinal channel is detected only during the Valsalva maneuver, while scrotal varicosity is not evident in the standard US study
2	Small posterior varicosities that extend to the superior pole of the testis. Their diameters increase and venous reflux is seen in the supratesticular region only during the Valsalva maneuver.
3	Vessels appear enlarged at the inferior pole of the testis when the patient is evaluated in a standing position; no enlargement is detected if the patient is examined in a supine position. Reflux observed only under during the Valsalva maneuver.
4	Vessels appear enlarged even when the patient is studied in a supine position; the dilatation is more marked in the upright position and during the Valsalva maneuver. Testicular hypotrophy is common at this stage.
5	Venous ectasia is evident even in the prone decubitus and supine positions. Reflux is observed at rest and does not increase during the Valsalva maneuver.

Dubin classification.

Grade	Features
0	Moderate, transient venous reflux during the Valsalva maneuver (physiologic findings)
1	Persistent venous reflux that ends before the Valsalva maneuver is completed
2	Persistent venous reflux throughout the entire Valsalva maneuver
3	Venous reflux that is present under basal conditions and does not change during the Valsalva maneuver

igure 1

Varicocele (A) with reflux in the vessels of the inguinal canal seen only during the Valsalva maneuver and (B) absence of varicosity on the standard US examination (A) (grade 1).

Varicocele with small varicosities (A) that exhibit reflux only during the Valsalva maneuver (B,C) (grade 2).

Figure 3

Varicocele with enlarged veins (A) whose calibers increase during the Valsalva maneuver (B) (grade 3).

Figure 4

Varicocele with enlarged veins (A) whose calibers do not increase during the Valsalva maneuver (B) (grade 4).

ref ---J Ultrasound. 2011 Dec; 14(4): 199–204.

IMAGE BASED QUESTION

USG OF GALL BLADDER ---WHAT IS THE FINDING AND DIAGNOSIS?

ANS-----

Wall-echo-shadow sign  -----The anterior wall of the gallbladder is echogenic, below which is a thin, dark line of bile; finally, there is a highly echogenic line of superficial stones with associated posterior shadowing. The deeper stones and posterior gallbladder wall are not visible.


 When the gallbladder is filled with stones, the resulting appearance is termed the wall-echo-shadow sign.

REF---RADIOGRAPHICS

Frcr and Board review ---mcq ---CJD

Q. A 60 yrs old patient presents with rapidly progressive dementia, myoclonic jerks, and periodic sharp-wave EEG tracing.CJD is suspected.MR of brain was advised as  MR is highly sensitive and specific for the detection of CJD abnormalities.All are true regarding CJD except

a. Lesions do not enhance and do not demonstrate mass effect

b. DWIs is superior to over any T2-weighted images in the assessment of CJD

c. DWI changes have been observed as early as 1 month after the onset of symptoms

d. hyperintensity on DWI found in the cortex and basal ganglia

e. primary sensorimotor cortex is almost always involved

ANS.----e

CJD patient shows symmetric increased signal in T2-weighted images in the caudate nuclei , putamen, thalamus and cortex , basal ganglia , periventricular white matter , and occipital lobes .In CJD.primary sensorimotor cortex is almost always spared, even when extensive abnormalities are found in the frontal and parietal cortex.

The mechanism of hyperintensity on DWI found in the cortex and basal ganglia is poorly understood, although it correlates with deposition of abnormal prion protein, vacuolation, neuronal loss, and gliosis. 

DWI changes have been observed as early as 1 month after the onset of symptoms and may show modifications 6 months prior to T2-weighted images and 4 months prior to FLAIR images