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A Super Sonic Sight

Jonathan, somewhat weighted by his most recent test report, came to my clinic with a long face, asking for my professional advice. The twenty-five-year-old worked in the Delta Bay Area and was always in good health. He did not smoke or drink and had a balanced diet. One day, he found a lump in his lower parts of the body after his gymnastic lesson. Then, he had a scrotal ultrasound in a district hospital in the Dongguan. The report indicated that there was a three centimetre-sized “low echoes” mass in his left testicle. Doppler Study found some irregular hypervascularity within the lesion. The doctor there suspected that it was a testicular cancer and urged him to have an operation as soon as possible. Shocked and extremely worried, he hurried back to Hong Kong that evening and sought my second opinion in the morning after a long sleepless night.

 

“My dear Doctor,” he said, taking a seat near me, “I can see that my health might be at great risk There are some burning questions related to my body and ultrasound imaging.”

 

As a friend and medical profession, I needed to address a few fundamental questions as follows:

  1. How accurate is an ultrasound examination?

  2. What is Doppler Ultrasound Study?

  3. Does he really have a cancer?

Medical ultrasound is a very common diagnostic imaging technique. It also called sonography. It is known as “B-mode ultrasound” in the Mainland China. It uses a small probe called a transducer and gel placed directly on the skin. High-frequency sound waves travel from the probe through the gel into the body. The probe collects the sounds that bound back. A computer uses those sound waves to create an image. It is especially effective for the examination of internal soft tissue organs such as liver, heart, gallbladder, kidney, uterus and ovaries.. etc. With the use of different designed ultrasound probes, ultrasound scan can even possible check the other superficial body structures, like head and neck soft tissues, neck lymph nodes, thyroid gland, eyes, blood vessels, breasts, joints, soft tissues and scrotum. Doctors commonly use ultrasound to study a developing unborn baby.

 

There is a common misconception that ultrasound scans are classified into "grey" and "colour" types and all ultrasound images with colours are definitely superior. In fact, the so-called "colour" ultrasound refers to Doppler ultrasound. A Colour Doppler study may be part of an ultrasound scan but not all examination requires Doppler study. It is a special technique that evaluates movement of the materials in the body. A Doppler study allows the doctor to see and evaluate blood flow through arteries and veins in the body.

 

What are the benefits of ultrasound? Ultrasound exams do not use radiation as used in x-rays. It is safe and painless. Because images are captured in real-time, they can show the structure and movement of the body’s internal organs. They can also show blood flowing through blood vessels. In addition, the machine is small in size and is easily installed, and the running cost is relatively cheap too. With its efficacy and efficiency, it is widely used in medical imaging.

Yet, ultrasound exam has some blind spots. Ultrasound waves are disrupted by bone, air or gas. Therefore, it is not an ideal imaging technique for lungs, guts or bony structures.

 

Due to deep anatomy and the uneven speed of sound in the body, ultrasound is more difficult to examine obese patients. Different ultrasonic models vary in performance and the exam is highly operator dependent. The skills of the operator are particularly important. In China, the operation of ultrasound examination is usually done by a trained sonologist. In Hong Kong, as long as you can own an ultrasound machine, “anyone can use it”. In medical diagnosis, the performer is usually a registered radiologist or a sonographer, and the radiologist is responsible for writing a report on the exam. A ultrasound exam depends a lot on the subjective intellectual judgement. Therefore, skills and rich clinical experience are particularly important for obtaining high-quality images, narrowing down the causes and ultimately making a relevant diagnosis.

 

Luckily for Jonathan, it turned out that he had bumped against the treadmill when he was exercising. The swelling was reddish and slightly painful.  The ultrasound image appeared to be a large blood clot rather than a real cancer. He was then referred to a urologist. Three months later, his new ultrasound exam showed that the lesion in the left testicle had shrunk to 1.6 cm. The lesion has completely disappeared after six months.

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