0:00

So that's the mammogram. How about the ultrasound? Ultrasound, uh,

0:05

can be used, uh, to evaluate, uh,

0:07

implant rupture also when compared to the mri,

0:11

because it is faster and cheaper and easier. And, uh, because,

0:16

uh, when patient have, um, uh, implant rupture,

0:19

they often present with mass or pain. And in that case, you can start with,

0:24

uh, ultrasound.

0:25

The sensitivity of ultrasound is better than the mammogram,

0:29

but not as good as the mri.

0:32

The negative predictive value is, has a bigger range,

0:36

is from a 50 to 19% question.

0:42

Was this sign on ultrasound normal or abnormal

0:50

answer over here? Okay, we have a little bit of step,

0:53

we maybe kind confused with a step off and the step later sign.

0:58

All right, let's review the results.

1:01

So the correct answer is a, this is a step oversight.

1:06

This is a normal silicone implant, uh, ultrasound on the edge of that.

1:13

Alright, so that is, yeah, again,

1:16

this is a silicone implant at the edge of the implant.

1:18

You can see this step oversight because the, uh,

1:22

sound covered much slower in the silicone gel

1:26

than in the normal breast tissue. That's the why it's generator.

1:30

This kind of like stable sign. It'll appeal that the silicone, you know,

1:35

located further away from the probe because it travel slower and they get,

1:40

take more time to get back to the, uh, probe. And that, um,

1:44

the ultrasound, the open is a speechless. It could be an coic.

1:49

And that they also have this kinda like a tri laminal sign.

1:54

This is the in, this is the in envelope, the shell over the implant.

1:58

And here is the, um, uh, fibro, uh,

2:01

tissue developed around the, um, uh, the,

2:05

she that's the, uh, space between that. You can find this on both the, uh,

2:10

uh, silicone implant and also the ceiling implant, ceiling implant,

2:15

just like a cyst, right? It's a back of, uh, water.

2:18

So it is open and coic, they don't have this peripheral staple of sign

2:25

question. What's the most reliable ultrasound sign of intracapsular rupture?

2:32

The answer, correct answer is a staple. I sign. I saw half of you guys choose.

2:37

Select the ingredient sign.

2:39

Remember that ingredient sign is a r i sign is not, uh, ultrasound sign.

2:46

Okay, let's, uh, at the early,

2:49

the early signs of intracapsular rupture are ultrasound is described,

2:53

are described as a keyhole and new sign and subcapsular

2:58

Line sign loss of this normal tri laminal line over there.

3:03

And later on, as it's advanced, it'll develop this step.

3:08

Vital sign like that is very disorganized shelf over there.

3:13

This tri laminal line is disrupted over here. Remember that.

3:18

Um, patient also can,

3:21

can also have just a retro fibrillation artifact. This, uh,

3:25

normal saline also have just kind of like a parallel line over

3:30

here, just another staple ladder sign. This is just the artifact over here.

3:36

You can tell that, you know, just lines are parallel to this shelf over there.

3:42

What's the, uh,

3:43

reliable sign of actual capsular rupture of the silicone implant or ultrasound?

3:48

Now if you're asking question, uh, silicone implant.

3:54

All right, so all with you guys, get it right? This is great. It,

4:00

it's a snowstorm. Um, silicone,

4:05

once the silicone jails get out the, uh, um, envelope,

4:08

they have various appearance on the, uh, ultrasound.

4:11

It could be a high per ACO intermediate or an ACO over there

4:16

like this one. You have just a snowstorm sign over here.

4:20

And then over here is get kind of like,

4:24

and this the one is a silicone granuloma over here is giving you

4:28

heterogeneous, uh, um, architecture over here.