Online ISSN: 2515-8260

Keywords : USG

A Clinical Study and Ultrasonography Diagnosis in Clinically Suspected Cases of Acute Appendicitis

Dr. Janardhan Jakkula, Dr. Ramesh Lingala, Dr. Shekhar Goud S, Dr. Sridhar Matta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1-11

Background: Acute appendicitis is the most prevalent cause of acute abdomen and
subsequent surgery. Misdiagnosis is a common and critical problem in general surgery
because the diagnosis is primarily based on clinical grounds. Maximum incidence observed
in the second and third decades of life, with male preponderance. Graded compression
ultrasonography is one of the diagnostic procedures that has been shown to reduce the need
for unfavourable surgical treatments, particularly in females.Objectives: Objectives of the
study were to study the clinical features of acute appendicitis, Utility of USG in supporting
the clinical diagnosis of acute appendicitis. Methods: This study included one hundred and
Twenty Five patients with history of RLQ pain where clinical diagnosis of acute appendicitis
was made. The study period was of 18 months between November 2019 to May 2021.
Routine bloodinvestigations and abdominal USG were done in all cases. All ultrasound
positive cases were subjected to surgery. Some ultrasound negative cases were also taken to
surgery on the high clinical suspicion of acute appendicitis. The ultrasound findings were
compared with clinical findings and histopathological examination reports.


Dr. Archana S R, Dr. Suresh A, Dr. Muthusubramanian R, Dr. Kishor Sagar V, Dr. Darshitha B, Dr. Bhargavi D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 150-158

Background: Chest radiograph has been the standard initial imaging modality of choice to
detect pneumothorax. Despite of moderate sensitivity in detection of pneumothorax, due to its
wide range of geographical availability and less expenditure in our country, it has been
widely advocated by all the physicians. Computed Tomography (CT) and Ultrasonography
(USG) being the current point of care in most parts of the country and having no radiation
risks, it can be utilized in early and safe detection of pneumothorax. In this study, we
analyzed the diagnostic utility and efficacy of chest ultrasound in detecting pneumothorax on
comparison to chest x ray.
Methods: Ethical committee clearance and informed consent was taken from all the patients.
Total of 79 patients who were having clinical suspicion of pneumothorax were evaluated.
Initial imaging evaluation was done using B-mode and M-mode chest ultrasonography and
further subjected to chest radiography. Images were assessed by 2 experienced radiologists.
Demographic, clinical and radiological data were documented and analyzed. In the cases of
discrepancy in findings of USG vs. Radiograph, CT was considered the gold standard for
obtaining the final diagnosis.
Results: We found that chest ultrasound had sensitivity of 98.43%, specificity of 100%, PPV
of 100%, NPV of 93.75% and diagnostic accuracy of 98.73%. Chest radiograph had
sensitivity of 73.43%, specificity of 83.33%, PPV of 94%, NPV of 46.9% and diagnostic
accuracy of 78.9%
Conclusion: Chest USG is a useful and essential tool in detection of pneumothorax.
Although chest radiograph being widely available and CT with its highest sensitivity &
specificity, USG stand apart in providing good diagnostic value with no radiation risks.

Diagnostic Accuracy of Ultrasound Guided Core Needle Biopsy in Various Breast Lesions

Rahul Yadav, Ummed Singh Parihar, Mohammed Arif, Dinesh Kumar Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2225-2231

Background: Breast cancer is the most common female cancer worldwide representing nearly a quarter (25%) of all cancers. Diagnosis of breast cancer is carried out by three medical members, the surgeon, who covers breast examination, the radiologist for mammography and ultrasound, and the pathologist for fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB). Aim of present study is to assess the accuracy of ultrasound guided core needle biopsy in various breast lesions
Material & Methods: A hospital based prospective study done on 100 cases of various breast lesions reporting to the Surgery Department, J.L.N. Medical College and Associated Group of Hospitals, Ajmer, Rajasthanwithin study duration and eligible as per inclusion criteria were included in the study from January 2020 to December 2021. Then an ultrasound guided biopsy specimen is obtained by means of four successive insertions with different angulations of the needle into the core of the lesion. The quantity and quality of the material obtained is judged after immediate immersion of the specimen in fixative, and then specimen is sent to histopathology department. And the core needle biopsy report is compared with the excision biopsy report of the breast lump.
Results: Our results showed that the mean age was 38.79 ± 13.98 yrs (age range 18-75 yrs). On USG guided core needle biopsy and excision biopsy, 53% were found benign tumor, and 47% were carcinoma. Sensitivity is 100% and specificity is 100%. There was no false positive and false negative case present in this study.
Conclusion: We concluded that Ultrasound guided Core needle biopsy can be reliably used for preoperative diagnosis of breast lumps as the first diagnostic step with high sensitivity, specificity, and accuracy for both malignant and benign lesions. However, benign lesions, diagnosed this way, must be followed by frequent examinations.

A Hospital Based Prospective Clinical-Radiological Study of Liver Abscess And It’s Management In Patients Admitted To Surgical Ward At Newly Established Tertiary Care Center

Prahlad Ram Kalwan, Dileep Kumar Choudhary, Poonma Ram, Chandraveer Singh Godara

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2218-2224

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. In recent years, imaging guided percutaneous drainage has been increasingly used to treat liver abscess of large size with viscous pus with reported success rates. Our study consists of clinical study (prospective study) of 40 cases of radiologically proven liver abscess and their management by different modalities and their outcome.
Materials& Methods: This is a hospital based prospective study done on 40 cases of radiological proven liver abscess in department of surgery at Government Medical College, Barmer, Rajasthan, India during one year period. USG abdomen was done, using longitudinal, oblique, transverse planes to visualize almost all part of liver. Intercostal and sub costal planes were used. All the liver lesions suggestive of liver abscess were examined in detail (any other abdominal organs were also scanned for any abnormalities). All the patients were hydrated and started on parenteral, third generation cephalosporins and Metronidazole therapy. All patients were simultaneously subjected to USG guided Needle aspiration.
Results: Our study showed that highest incidence (87.5%) of age is found between 3rd- 6th decades. Male predominance is always reported in literatures. Liver abscess is commonly seen in low socio-economic group. Ultrasound guided percutaneous needle aspiration was the initial mode of treatment done in our study. Out of 40 patients, 16 patients were successfully treated with single aspiration, 13 required second aspiration, 8 patients were treated with percutaneous catheter drainage after failure of needle aspiration.
Conclusion: Percutaneous needle aspiration is found to be thefirst line of treatment for liver abscess. This method is simple, effective and cheaper. Sinceliver abscess occurs in low strata group in a country like India this procedure is affordable.Percutaneous catheter drainage should be reserved as 2nd line of treatment for large abscesses andabscesses with thick viscous content and for failure of percutaneous needle aspiration cases.

A Study to Correlate Preoperative Ultrasonographic Tirads Scoring System and Postoperative Histopathology of Thyroid Swellings

J.Parthasarathi, D.Ravisundar, M.Praveena, M. Anurag

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2451-2460

Background:Aim & Objectives: To correlate preoperative TIRADS scoring system with postoperative histopathology of thyroid swellings.
Materials and Methods: A total of 66 patients of thyroid swellings who were treated at the Department of General Surgery, Govt Medical College, Nalgonda, with an age range of 20 – 68 years, were evaluated in this study with respect to age, sex, symptoms type and symptom duration and were investigated with routine hemogram, thyroid profile, FNAC and USG with TIRADS score. The results of USG TIRADS score were compared with the histopathology after excision of the thyroid swelling.
Results: Thyroid swellings are more common in females than in males (M:F ratio = 1:4). Majority of the patients are in the age group of 30-50 years. Swelling in front of the neck is the most common complaint. Majority of the patients had an average duration of symptoms of 6months to 3 years. On clinical evaluation all patients had swelling of thyroid. On USG with TIRADS scoring, TIRADS – 3 is the most common category of the thyroid swelling with 30 patients (45%). On USG TIRADS score, majority were benign lesions 55 (83%), while the rest were malignant 11 (17%). On histopathology, 55 lesions (83%) were benign, while 11 lesions (17%) were malignant. Incidence of malignancy with respect to TIRADS score is TIRADS 2- 4%, TIRADS 3 – 16.7%, TIRADS 4 – 50%, TIRADS 5 – 0%. The present study has a USG TIRADS score sensitivity of 45.5%, specificity of 89.1%, positive predictive value of 45.5%, negative predictive value of 89.1% and accuracy of 81.8%.  The prevalence of malignancy among the patients with thyroid swellings in the present study is 16.7%. USG proved to be a more sensitive modality to evaluate the nodularity of thyroid swellings than clinical evaluation.
Conclusion: The present study was undertaken to evaluate the usefulness of clinical evaluation and USG TIRADS score in management of thyroid nodules High resolution ultrasound is an accurate technique, that has helped to analyse the suspicious sonographic features of thyroid swellings and to assess the risk of malignancy and quantify it using TIRADS score.

Assessment of efficacy of ultrasonography and computed tomography in the assessment of retroperitoneal masses

Manish R Shah,Dr Gurudatt Thakkar,Dr Nirali Dhruv Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5818-5822

Background:Pancreatic lesions are a difficult diagnostic and therapeutic challenge owing to
the deep- seated location of pancreas. The present study was conducted to compare
ultrasonography and computed tomography in the assessment of retroperitoneal masses.
Materials & Methods:84 patients with signs and symptoms of retroperitoneal masses of
both genders were enrolled. All underwent USG and MDCT. Data such as name, age, gender
etc. was recorded. All underwent USG and MDCT. Ultrasound was performed with Logiq
P9ultrasoundmachine. MDCT was performed with Siemens Somatom go 32 sliceCT
Characteristics like size, appearance, echotexture, vascularity and other findings were
Results: Out of 84 patients, males were 34 and females were 50. Clinical features were lump
in abdomen in 5, pain in abdomen in 32, fullness of abdomen in10, weight loss in 14, loss of
appetite in 22 and trauma in 1 case. Renal abscess was detected correctly by USG in 18 and
MDCT in 20 cases, renal hematoma in 4 and 8, RCC in 7 and 7, complex renal cyst in 13 and
13, pancreatic carcinoma in 7 and 10, adrenal adenoma in 8 and 10, aortic aneurysm in 7 and
9 and pheochromocytoma in 7 and 7 by USG and MDCT respectively. The difference was
non- significant (P> 0.05).

Clinical Study and Management of Varicose Veins of Lower Limbs

Sakru Mudavath, Ramprakash Chitimalla, Vijaya Kumar Ankathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 6023-6030

Background:To study the distribution, pathology, clinical features, various mod es of
investigations and overall management of varicose veins of lower limbs.
Materials and Methods: The study was carried out Govt Medical College/General
Hospital, Suryapet from October 2021– March 2022 to evaluate the ―Clinical
presentation and management of varicose vein in lower limbs. 50 cases of varicose veins
of lower limbs were presented and analysed in our study. Fifty cases of varicose veins of
the lower limb have been studied in detail.
Results: Varicosity of the lower limb is a common clinical entity. The number of cases
reporting to the hospital is much less than the real incidence; because in the absence of
symptoms due to varicose veins patients do not seek treatment in our country. The
commonest age group of patients suffering from varicose veins is 41 to 50 years. Most of
the patient presented to the hospital for one or the other complications and not for
cosmetic reasons. The majority of the patients were male. A definite relationship exists
between the occupation and the incidence of varicose veins as most of our patients are
workers standing for longer duration. The involvement of long saphenous system is
more common than the short saphenous system. Left limb is affected more common.
The cause for the same is not known but could be attributed to the longer course
traversed by the left iliac veins. Clinical examination has a high predictive accuracy. It
gives sufficient information to treat the patients in centres where colour Doppler is not
available or affordable. The use of colour Doppler is a valuable supplement to clinical
examination for effective treatment of varicose veins and its use is strongly
recommended to prevent recurrences and reduce morbidity as it is effective tool in
detecting venous incompetence and to rule out deep vein thrombosis. SPJ junction and
perforators are highly variable and should always be marked pre- operatively using
USG Doppler. Operative line of treatment is a primary procedure in the management of
varicose veins of lower limbs.Venous ulcer heals well after surgery. Surgery is a quality
modality for varicose veins patients with ulcer with low recurrence rate. Complications
are negligible if cases are meticulously selected and operated. The present procedures
enable the patient to lead almost normal life after surgery with few recoverable
Conclusion: There is need for general health education and awareness about varicose
veins in the society in order to achieve timely treatment with good outcome and to
reduce the morbidity.

A case-control evaluation of the gall bladder volume in type 2 diabetes mellitus patients using real time ultrasonography

Dr.Ankitaa Thakral, Dr. Varsha Gangta, Dr. Harveen Kaur, Dr. Govind Khatri, Dr. Aditya Kaul, Dr. Aastha Makkar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1097-1102

Aim: To assess the gallbladder volume in T2DM patients and in healthy controls by using
Methodology: This cases control study was conducted among 50 diabetic patients enrolled
from the diabetes clinic of the Medicine Department of Maharishi Markandeshwar medical
college and hospital Kumarhatti, Solan, Himachal Pradesh and 50 healthy patients (control
group). 30-60 year patients of type 2 diabetes mellitus diagnosed since 5 year or more and
functioning gall bladder with well controlled blood sugar levels. The diagnosis of diabetes in
these patients was in accordance with WHO criteria i.e., fasting plasma glucose level ≥126
mg/dl, and ≥200 mg/dl plasma glucose level after 2hr of ingestion of standardised 75gm
glucose. An informed consent was taken from all the subjects in the study and control groups.
All the patients were randomly selected for the study among patients regularly attending
diabetic clinic of this hospital and following our criteria’s of selection.
Results: Mean age of diabetic Patient was 48.5 years in study group and 53 years in
control group. 46% of diabetics were males and remaining 54% were females, whereas in
control group male to female ratio was equal, means 50% males and 50% females. 90% cases
in control group had no gall bladder disease, while only 66% cases in group with diabetes
had no gall bladder disease. In group with DM type 2, 10% had cholelithiasis, 8% had
cholecystitis and 3% had sludge: while in control group, 4% had cholelithiasis, 2% had
cholecystitis and 4% had sludge. The percentage of contraction of gall bladder had reduced
markedly in chronic diabetics (45.6 + 9.57) as compared to controls (65.2 + 7.34) (p value-
0.001). The fasting gall bladder volume in chronic diabetics was higher (43.47 + 5.35) than
that of controls (28.45 + 4.26) and the difference of values was found to be highly
significant (p value 0.001).
Conclusion: In patients of diabetes mellitus type 2, higher fasting gall bladder volume and
decreased percentage of contraction are observed. Therefore, all T2DM patients should
be evaluated using ultrasonography for the presence of increased fasting gallbladder
volumes to assess the risk of progression to gall stone disease.

Comparative assessment of the ultrasonography (USG) and computed tomography (CT) in the evaluation of suspicious ovarian masses

Dr. Yashaswi Sharma, Dr. Anchal Sharma, Dr. Nikhil Arora, Dr. Ashna Agarwal, Dr. Aditya Kaul, Dr. Naresh Tripathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1108-1112

Aim: To compare modalities like ultrasonography (USG) and computed tomography (CT) in
the evaluation of suspicious ovarian masses.
Methodology: This prospective comparative study was carried out in the Department of
Radiology, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan,
Himachal Pradesh for a period of 12 months. Total 50 women were included in this
prospective study. All patients underwent abdominal Ultrasonography and CT scan with
determination of the ovarian mass characteristics. Detailed history of allergy and renal
function tests were taken before doing CT scan and if there was history of allergy then nonionic
contrast was used. Site, size, papillary projections, wall characteristics, capsular
infiltrations, the presence of solid areas inside the mass and presence of as cites were
recorded both by US and CT scan.
Results: Out of 50 patients, majority of patients belonged to 40-50 years of age group (19,
38%) followed by 30-40 years of age group (10, 20%). 8 patients (16%) belonged to 20-30
years age group, 7 (14%) belonged to 50-60 years, 60 years of age group included 3
patients each. There are total 29 cases of Pre-menopausal stage and 21 cases of Postmenopausal
stage having ovarian cyst. Out of 29 cases of Pre-menopausal conditions have 7
number of malignant and 22 number of benign type of ovarian masses. In the Postmenopausal
group there are 17 cases of malignant and 4 cases of benign ovarian mass was observed.
Overall, CT was found to have 96% sensitivity, 92% specificity, and an accuracy of 92% in
the differentiation of benign and malignant ovarian masses, while PPV and NPV were 94%
and 90%, respectively. The sensitivity of USG was 90%, specificity was 86% and PPV and
NPV were 88% and 86% respectively.
Conclusion: CT and USG imaging all have approximately similar accuracy in staging
ovarian carcinoma but the sensitivity of CT scan for all ovarian cancer detection greater than
that of US. Among women with ovarian disorders, CT can be primarily in patients with
ovarian malignancies, either to assess disease extent prior to surgery or as a substitute for
second look laparotomy.

An observational study to determine parenchymal thyroid diseases using Ultrasonography (USG) in adult patients

Dr. Aastha Makkar,Dr. Varsha Gangta,Dr. Sahil Chawla,Dr. Ankitaa Thakral, Dr. Venus Garg, Dr. Pratibha Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1092-1096

Aim: To determine parenchymal thyroid diseases using Ultrasonography (USG) in adult
Methodology: This study was conducted in the department of Radio-diagnosis, Maharishi
Markandeshwar University, Solan. It comprised of 75 adult patients age ranged 21-70 years
of age. All patients were well informed regarding the study and their consent was obtained.
Particulars such as name, age, gender was recorded in case history proforma. A thorough
clinical examination was performed in all patients. Patients were divided into five groups
such as group I (normal); group II had first detected, early untreated Hashimoto disease (EH);
group III comprised of chronic Hashimoto patients that are under treatment and/or follow up
(H); group IV had multinodular parenchymal hyperplasia (M)and group V had nodular
hyperplasia with Hashimoto (HM). All examinations were performed with the patient in a
supine position with the neck hyperextended. We calculated the thyroid volume with an
automated formula (length £ width £ depth £ 0.52). We categorized the thyroid gland
echogenicity as hypoechoic, isoechoic or hyperechoic relative to the cricoid cartilage. We
evaluated the parenchyma for the presence of nodules, as well as the visibility of tiny
echogenic reticulations.
Results: Out of 75 cases, 35 (46.7%) were males and 40 (53.3%) were females. Each group
included 15 patients each. Mean RI in group I was 0.53, in group II was 0.54, in group III was
0.40, in group IV was 0.49 and in group V was 0.51. Mean AT in group I was 26.0, in group
II was 25.5, in group III was 71.1, in group IV was 46.6 and in group V was 44.8. Mean
SWV in group I was 1.57, in group II was 1.69, in group III was 1.14, in group IV was 1.47
and in group V was 1.60. The difference was significant (P< 0.05).
Conclusion: Real-time ultrasonography can be helpful for accurately diagnosing TD and
ultrasound finding of two or more TD features has good diagnostic accuracy

Role of ultrasound and MRI in patients with shoulder pathologies: A correlation study

Dr.Paramjit Singh, Dr.Amanpreet Kaur, Dr.Suman Bhagat, Dr. Gurinder Bir Singh, Dr. Nikhil Gupta

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 2890-2899

Introduction: The rotator cuff disorders constitute the most common cause of shoulder
pathologies. Ultrasonography and MRI are widely used in evaluating various shoulder
pathologies. USG of shoulder is simple, cheap, fast and non-invasive imaging technology
for detection of rotator cuff and non- rotator cuff abnormalities. In this study we have
assessed the usefulness of USG in diagnosing the shoulder pathologies and have correlated
with the MRI.
Aim: Evaluation of a patient with shoulder pathology with ultrasonography as the initial
line of imaging technique as compared to MRI, assessing the accuracy of ultrasonography
in diagnosing shoulder joint pathologies, especially rotator cuff abnormalities, using MRI
as a reference standard and correlating findings wherever possible.
Materials and Methods: Hundred patients were studied prospectively over a period of two
years. Study subjects included both men and women in all age groups with suspected
shoulder pathology, suspected to have musculo-tendinous origin. All patients underwent
USG evaluation of the shoulder joint followed by MRI of the affected shoulder.
Results: USG showed a sensitivity of 85%, specificity of 100%, PPV of 100% and NPV of
97% in diagnosing full thickness tear of rotator cuff using MRI as reference. For partial
thickness tears, it showed a sensitivity of 71%, specificity of 69%, PPV of 82% and NPV of
54%. Overall accuracy of USG in detection of any tear of rotator cuff with MRI as
reference was 82%. The strength of agreement between USG and MRI for the diagnosis of
any tear of rotator cuff is considered to be ‘substantial’ in our study (Kappa=0.635).
Conclusion: USG showed comparable results to MRI in assessment of rotator cuff
abnormality and should be used as first line of investigation in patients presenting with
shoulder pathologies. It proved to have high sensitivity and specificity for full thickness
tears with relatively less sensitivity and specificity in detection of partial thickness tear.

Analysis of basic immunization coverage in Tulungagung District, Indonesia

Yahya Benyamin Bebengu; Atik Choirul Hidajah; A. Ratgono

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 5, Pages 887-894

Basic Immunization coverage is still one of problems in Tulungagung district. For the last 3 years, the basic immunization coverage did not cover all the target infants. In 2018, from the target of 15,147 infants, there were 1,116 infants who did not receive immunization of Hepatitis B, 689 infants were not immunized with Bacillus Calmette Guérin (BCG) and 849 infants were not immunized for Oral Polio Vaccine (OPV 1). Aim of the study : To analyze the problems of basic immunization program. Method: This study is a descriptive observational study, conducted at Tulungagung District Health Office from January to February 2019. Identification of problems was done by conducting interviews, analyzing secondary data on basic immunization coverage of the Tulungagung health profile from 2016 to 2017 and section report Surveillance and Immunization in 2018. Prioritisation of Basic Immunization problems was done using Urgency, Seriousness, Growth (USG) criteria. Analysis of the problem cause was done by Fishbone methods.Results: Of the problems identified, the first priority problem in Tulungagung District 2018 is Hepatitis B immunization coverage does not reach the target. The root causes were poor immunization, under qualified workers in data collection and validation of targets, poor integration of Basic Immunization and Maternal and Child Health (MCH), lack of promotion and media campaign.Conclusion: Low Hepatitis B immunization coverage is a priority problem for basic immunization programs. Optimization of the integration of child and maternal health immunization program (MCH) is needed, periodic validation of program coverage and health promotion on immunization using creative promotional media.