 Greetings to everyone. I am Dr. Jirvirja, radiology resident in the Kristina Institute. Today I will be presenting the paper about the role of sonography in evaluating of rebellions under the guidance of Dr. Prakash Patil and Dr. Asip Thampoli. The aim of this study is to discuss the usefulness of the ultrasonography in the diagnosis of rebellions. The sonography helps in the evaluation of various costal and the control defects such as trauma, degenerative lesions, subluxation of the sternoclebicular joints and the inflammatory lesions of the various etiology and location. The ultrasound due to its different acoustic impedance between the soft tissue and the bone cortex only allows the evaluation of the bone surfaces. So ultrasonography can be useful in the evaluation of the several bone disorders affecting the ribs as a result of its topographic capability and its high definition. The aim and objective of this study to evaluate the diagnostic role of ultrasonography in differentiating and the detection of the rebellions. The total number of 16 patients were evaluated with the suspected and unsuspected rebellions in the radiology department of the Kristina Institute. The patients were examined on the Vipru GE Logic P9 color Doppler system with the high frequency linear error problem. The ultrasonography was done along the longitudinal and the transverse axis with the help of high frequency probe after clinically evaluating the patient's stiff complaint and the site of lesion. The first case about the rib fractures, the ultrasonographic hallmark of the fracture is the localized interruption of the hyper-echoic line which is correspond to the outer bone cortex. The ultrasonography is useful in revealing the rib fractures because it is prompt and easy to perform since its focus on the painful areas. The associated finding with the rib fractures in the periosteum is the periosteal hematoma formation. In the soft tissue, there is a hematoma formation, edema, bursitis, and in the joints, there is an interarticular fractures and the loose bodies. On the left side, the diagnostic ultrasonography in the longitudinal plan of the rib during the maximum inhalation demonstrate the cortical disruption which I demonstrate by the posterior white arrow with the posterior acoustic shadow visible deep to its posterior border which give the appearance like a lighthouse so it is known as lighthouse or chimney phenomena and overlying hypoechoic area which I demonstrate by the red arrow which suggests the hematoma formation which is displacing the overlying pectoralis major and pectoralis minor muscles. In this case, a patient came with the complaint of breathlessness as a history of chronic curve since three years. On the radiography of the chest shows evidence of fracture. On the ultrasonography, so on the radiography, there is no evidence of fracture. So, after that, we do ultrasonography of chest. There is a cortical disruption with the overlying hyper-equic area which I demonstrated by the red dotted line suggests a callus formation. So, there is so clearly visible cortical break which suggests a fracture which is clearly seen on the zoomed out image. Ultrasonography in this image, the ultrasonography in longitudinal plan of rib demonstrate in the image there is a cortical disruption with overriding of fracture fragment which is clearly visible on the zoomed out image demonstrated by the yellow arrow and overlying hypoechoic area which demonstrates a hematoma formation which is displacing the pectoralis minor and measure muscles. And in the image B, we can depict the normal rib which shows a continuous, continuous bony cortex which is demonstrated by the arrow. Osteomyelitis is the infection of the bone involving the medullary cavity which is generally caused by the bacteria. The most common organism is the cephalococcus aureus. It occurs at any age but the most common age group is between 2 to 12 years. The sonography is not only more sensitive than radiography, neveliating the metaphysiogonial lesion but it is also useful in assessing the concomitant joint and epiphytial involvement of the acute osteomyelitis in the infants. The color Doppler study shows increased vascular flow within and around the affected periosteum in which subperiosteal abscess has been developed in the fall of serial sonography. So, sonography is therefore useful in establishing the diagnosis of acute osteomyelitis and its complication before the radiographic changes are seen. So, what the sonographic finding in the osteomyelitis are the deep soft tissue swelling, periosteal thickening and elevation, subperiosteal abscess formation, cortical erosion, increase of vascularity within and around the periosteum and the sinus trick formation. The image A and B of the color Doppler study and the spectral study shows increased vascularity around the periosteum which suggests the inflammatory reaction the signs of evolving abscess. So, which is such as the abscess formation. So, we can diagnose before the abscess formation of the acute myelitis in the ultrasonography which is not seen in the plane radiograph. On the left side, the ultrasonography shows the cortical erosion and the periosteal thickening which I demonstrated by the yellow arrow with the subperiosteal echogenic collection which denoting the subperiosteal abscess formation which is demonstrated by the yellow dotted line. So, this is the case of the acute osteomyelitis and in the right side, ultrasonography of the 6-D shows a cortical break with the surrounding soft tissue swelling which I demonstrated by the yellow arrow. So, cortical break it is it is suggestive of the cloaca formation which suggests a chronic osteomyelitis. So, on the left side, there is a axial and longitudinal section of the ultrasonography shows a periosteal thickening and elevation which I demonstrated by the red arrow with the subperiosteal hypoechoic, heteroechoic, pedromedly hypoechoic collection which suggests the abscess formation. And on the right side, there is a axial and longitudinal section of the ultrasonography shows the cortical irregularity with the adjacent hypoechoic area collection noted by the, so this is a dotted red line mentioned here in the in this right picture shows abscess formation. So, in this case, the in the image A, the longitudinal section of the seventh rib on the right side shows the area of cortical erosion with posterior acoustic shadow and the loose body in the center of the red circle which which is demonstrated in the image A where in the image B and C in the axial and longitudinal section shows the periosteal irregularity and adjacent thickening with the cortical break which is demonstrated by the red arrow and the surrounding hypoechoic collection which suggests the abscess formation which I demonstrated by the yellow arrow. The image D in the image D the caliper shows a margin of collection and the hypoechoic flex is in the center of the circle which demonstrated in the corner left corner are due to the displacing the clips of the cholecystectomy and the sequestration which give a tiny a comatose artifact below. So, this is a case of chronic osteomyelitis because the sequestration formation is there in the seventh rib on the right side in the 16 year old post coloxysctomy male patient who present with the pain in the right hypochondrium. The upper image shows on the axial and longitudinal section of ultrasonography shows a periosteal thickening and elevation with sub periosteal fluid collection. This is a hypoechoic area such as the fluid collection which suggests abscess formation periosteal abscess formation and in this in this below below image the longitudinal section of ultrasonography shows a hypoechoic sub periosteal collection. These all areas are the collection which suggests abscess formation which is extending into intramuscular and the subcutaneous plan through the sinus strip. So, these hyper the hypoechoic line demonstrate here this is a sinus strip which connect the intramuscular to subcutaneous plan through which the abscess extending to the subcutaneous plan. Lipoma. The lipoma is a benign tumor composed of the major adipocytes and which is typically found in the subcutaneous plan but is also found in the intramuscular plan. On the ultrasonography it is a present as a soft and variably ecogenicity like hypoechoic, isoechoic or hyperechoic and shows no acoustic shadow and shows a minimal vascularity or no vascularity on the color Doppler study. So, in this case a patient with the complaint of non-tender chest wall non-tender chest wall mass over the right side since two years. So, oblique and longitudinal section of ultrasonography shows a well-defined incapsulated mass which is identical to the fat at the site of swelling which is pointed which is pointed by the patient. It is in the anterior chest wall muscles deep to the subcutaneous fat and it's appear is a hyperechoic to overline subcutaneous fat with the presence of ecogenics line within. The lesion shows mild compressibility and there is a no calcification, cystic changes and the vascularity of the in the lesion. So, these all are features suggestive of chest wall lipoma. Osteocondroma. The osteocondroma is a benign bone tumor they are the they are mostly asymptomatic and very low malignant potential. And the osteocondroma, osteocondroma can be either as a cell and pedunculated which is arising from the metaphysic region which is projecting away from the epiphysis. So, osteocondroma has a hyaline cartilaginous gap and the medullary cortex which is continuous with the parent bone. So, on the ultrasonography it is able to demonstrate cartilaginous gap very accurately as a hypoechoic region which is bounded by the bone on its deep and the muscles and fed superficially. So, in this case 18 year old patient came with the complaint of painless hard lump on the anterior chest wall on the right side and has a you know history of trauma. The longitudinal and the oblique section of the ultrasonography shows a bone overgrowth over the anterior aspect of 4-3 and it is covered with the covered with the thin hypoechoic cartilage which is measuring up to 2.4 mm in thickness and the lesion is seen displacing the superficial muscles. And there is a norefracture or local fluid collection. So, these all these features are suggestive of osteocondroma. In this case the excel section of ultrasonography shows there is a fusion of right 6 and 7th deep which are demonstrated by the red arrow which is linked together by the hyperechoic structure in the proximal part which is a osseous material and the hypoechoic hypo to an echoic structure which is in the distal part which suggests a cartilaginous which is cartilaginous material. So, there is a fusion of 6 and 7th deep and the longitudinal section of this same area shows a hypoechoic and hypoechoic structure seen between the 6 and 7th deep on the right side. So, these all are features suggestive of synchontrosis and this is a accidental finding on the USDA chest and there is a case of congenital synchontrosis. In this case a 65 year old man came with the complaint of chest pain and breathlessness. The patient was advised to use the sonographic chest for the further evaluation. On the sonography the accidentally there is an x-pensile heteroechoic which is demonstrated by the yellow arrow involving the posterior aspect of the 5th deep on the left side with the underlying bone destruction which is demonstrated by the red yellow and involvement of the left trapezius muscles which demonstrated on the right side. So, later on the patient was subjected to CCT, CCT thorax and lung carcinoma with the bone metastatic was diagnosed. So, this is a case of rib metastasis which is a sonographical findings of the rib metastatic lesion. There is a heteroechoic areas with the increase surrounding vascularity. In this case a 25 year old woman underwent ultrasound examination for a non-tender vertebrate mass in the anterior lateral aspect of the chest wall on the left side. On the ultrasonography there is an x-pensile hypoechoic medullary lesion which are demonstrated by the red yellow with the thin rim of echogenicity which is demonstrated by the yellow surrounding the mass. Presumed to be a thin cell wall of bone which appears irregular without adjacent soft tissue mass. No evidence of calcification within the lesion and on the coladoplar study below image the lesions adjacent soft the lesions the adjacent soft tissue and the periosteum source increase vascularity. So, all these features are features are likely such as two of the aneurysmal bonds and the other possibility is on conroma. So, we suggest MRI for further evaluation but unfortunately we lost the follow-up of the patient. So, coming to the result total 16 patients were evaluating on the ultrasonography out of them the seven patient with seven patient was diagnosed or diagnosed osteomyelitis and four patients are diagnosed as a refractors and other lesions I am I already demonstrated on the table. So, on the graphic representation also shows there is a most common lesion in my study is osteomyelitis followed by the rib lesions. The conclusion of my study is the ultrasonography is helpful in imaging modality for the differentiate the differentiate the diagnosis and the detection of rib lesions like fractures, osteoconroma, acute and chronic osteomyelitis, chest wall lipoma, metastatic lesions, etc. So, the ultrasound should be considered when the focal pain is present following even the tribal chest trauma when the radiography is interpreted as a negative for the fractures and the high resolution and power doppler power doppler sonography were found to be very sensitive and highly specific in diagnosis of acute osteomyelitis in the pediatric with the clinical suspicious of the disease and the and negative or equivalent of plain radiographs. These are my references of the study. Thank you.