Wednesday, April 28, 2010

3D ultrasound- an interesting perspective:

These 3 dimensional ultrasound images show various pathologies of the urinary bladder, providing a whole new "dimension" to sonographic imaging.

3- D ultrasound image of ureterocele:
The Rt. ureterocele is seen as a small sac bulging in from the posterior wall of the bladder.

3-D ultrasound image of bladder diverticulum:
A small right sided vesical diverticulum. (UB= urinary bladder)

Vesical calculus:
This 3-D ultrasound image of a vesical calculus shows that 3-D imaging must be used in conjunction with 2-D B-mode imaging to identify pathology. This bladder calculus is difficult to distinguish from (see topmost image) ureterocele purely on 3-D ultrasound. Perhaps a cross sectional image would show the internal structure better. (All images courtesy of Ravi Kadasne, MD, UAE).
For more images of urinary bladder diseases/ conditions see:

Other interesting applications of 3-D ultrasound imaging:

Benign prostatic hypertrophy- showing the enlarged median lobe

A musculoskeletal 3- D ultrasound image- Baker cyst in Right popliteal fossa:

Friday, April 23, 2010

Non obstructive Vesico-ureteric junction calculus

Do ureteric calculi necessarily produce obstruction to the passage of urine in the ureters? These ultrasound and color Doppler images study just this fact..
Observe the ultrasound image of the urinary bladder below: a right vesico-ureteric junction calculus is clearly visible. The patient had severe right ureteral colic too. The right VUJ calculus measures 6 mm. in size.

Color Doppler image shows almost normal right ureteral jet, despite the calculus at the ureteric orifice.

Yet another Doppler image shows another jet emanating from the right ureteric orifice.

The right kidney appears normal- no evidence of obstructive changes here.

The conclusion: small ureteric calculi can produce almost no obstructive changes despite being located at the narrow ureteral orifice into the bladder. But repeated studies by me show this is an exception, rather than the rule. Most ureteral calculi produce partial or major obstruction in the affected ureter. See:

Wednesday, April 21, 2010

Sonographic visualization of a large ureteric calculus

The right ureter appears moderately dilated till its lower third (hydroureter) with the ureteral calculus lodged at the junction between the middle and lower thirds. This patient was an elderly female with abdominal obesity. This made ultrasound imaging of the ureteric calculus extremely difficult. However, probe compression over the path of the right ureter helped displace bowel loops and brought the entire ureter into view.

The right kidney shows evidence of moderate hydronephrosis,- the result of long standing ureteric obstruction. (See ultrasound image below):

This patient also had a couple of right renal calculi (only one is visualized in this ultrasound image- below).

See: for more images and coverage on this topic.

Tuesday, April 20, 2010

Cystic tumors of the ovary:

A serous cystadenoma of the ovary is seldom so well manifested as in this case. This huge cystic lesion had this solitary septum with a vessel well seen on Power Doppler. See more ultrasound images of this case at:
Here you will find a sonographic pictorial review a variety of cystic masses (cysts) of the ovaries. Among them are mucinous cystadenoma and cystadenocarcinoma and calcific masses like dermoid cyst.
On the parent page at:
there are interesting ultrasound pictures of functional cysts of the ovaries, hemorrhagic ovarian cysts and the bane of modern women: chocolate cyst or endometrioma of ovary.

Monday, April 19, 2010

Subserosal fibroid

Sagittal section Ultrasound image through the uterus shows a large (almost 7 cms. diameter) fibroid in close relation to the fundus of the uterus. This is most likely a subserosal (subserous) fibroid, as almost the entire mass lies just below the serosal layer covering the uterus (ie the peritoneal cover of the uterus). However the other possibility is that of the mass being pedunculated (ie has a stalk connected to the fundus or upper part of the uterus).

Power Doppler image shows considerable vascularity around the fibroid.

I have loads of ultrasound images of different types of fibroids on this page:
Case-2: Subserosal fibroid pressing upon and effacing the emdometrial stripe:
This ultrasound video clip shows a transverse section through the fibroid, panning from the upper border of the uterine fundus to the cervix. One can see that the fibroid arises from the right lateral aspect of the fundus.
  And this is an ultrasound video clip in the sagittal plane of the uterus, panning the ultrasound probe from the right parasagittal to the left.

Sunday, April 18, 2010

Ultrasound imaging of Ureteral stent:

This patient underwent surgery for the removal of a staghorn calculus from the right kidney. A right ureteric stent was inserted to facilitate the smooth passage of urine in the right ureter. Ultrasound image shows the upper end of the DJ or Double J stent (JJ stent) in the right renal pelvis.

The lower end of the JJ right ureteric stent is seen in the urinary bladder as a coiled echogenic linear (tubular echo). The presence of coils/ pigtail loops at both ends pf the ureteral stent prevents its displacement or migration. Ultrasound imaging also helps to rule out other complications of ureteral stent like infection, migration, obstruction and malpositioning.
For ultrasound images/ case study of ureteral stones and ureteral pathology see:
For more information on ureteral stents, see:

The sonographic image above ( case-2) shows the lower end of stent in urinary bladder

Just added this image (case-2) showing the DJ stent tip (upper end) clearly in side the renal pelvis of the right kidney (view made possible due to minimal fluid/ urine in the renal pelvis)- see image just above.
For an ultrasound video of ureteral stent:

Polycystic ovaries

A very large section of the female populace today suffers from PCO or polycystic ovaries. For them, it is a never ending story of irregular menses, hirsuitism and obesity.
For the lay person or patient this article should prove interesting:

For the sonologist visit:
for ultrasound case study of Polycystic ovary.
or for more information on ovarian pathology, PCO etc.

Wednesday, April 14, 2010

A rare variant of fibroadenoma in young adolescents:

Fibroadenomas are a common entity. However, a rare occurrence is the presence of a huge mass in the breast in adolescent females. Called juvenile fibroadenomas, they are a variant of the lesion in the adult female populace. See: for an ultrasound case study of this disease.
Also known as giant fibroadenoma, they are almost always benign and are not as ominous as they appear. They must be differentiated from the other large tumors of the female breast, such as the Phyllodes tumor which can turn malignant.

Thursday, April 08, 2010

Early pregnancy with Nabothian cyst

Interesting case this... Transabdominal ultrasound images of suspected early pregnancy (urine pregtest positive) with pain in pelvis, showed a prominent cystic lesion at the upper border of the cervix. The cyst measured 11mm. and was located just beneath the serosa. I was not sure if this was a a cervical ectopic gestation. The lesion appeared separate from the left ovary.

Transvaginal ultrasound images and Color Doppler imaging , revealed the presence of intrauterine gestation sac of 4.5 mm. Color Doppler image showed absence of "ring of fire" around the cyst, confirming its benign nature. The final diagnosis in this case - early gestation sac with Nabothian cyst of cervix.
See: for more such intriguing ultrasound images of early pregnancy.


Also visit:
(Discussion and images of multiple Nabothian cysts of cervix)

Saturday, April 03, 2010

A sonographic picture review of renal pathology:

The ultrasound image (courtesy of Ravi Kadasne, MD) above shows a rather prominent layer of perirenal fat around the right kidney (arrows) separating the kidney from the adjacent liver. This is a normal finding, but perirenal fat may be altered by presence of hemorrhage into this layer. (See:
For more renal ultrasound pictures and reviews:
See this page: It describes, with ultrasound images, many of the major pathologies that affect the human kidneys. Among the conditions that are described are normal variants like fetal lobulation and ectopic kidney/ horseshoe kidney. This is a common finding for the sonologist. Then the page shows ultrasound images of polycystic kidney disease and other non- lethal cystic diseases such as renal cortical cysts and calyceal cyst. Then there is detailed ultrasound review of renal malignancy. Renal failure is yet another lethal and very common disease that has been covered on this page.

Friday, April 02, 2010

Gallstones in neonates

Gall bladder calculi in a neonate? This ultrasound image shows just that!!. Not one stone, a gall bladder packed with calculi in a neonate!
See: (case-8)
This might sound like big bad news for a tiny baby. The good part is that gallstones in infants and neonates tend to spontaneously disappear within a few weeks. I am not sure of the mechanism involved, either they dissolve or are passed via the bile duct into the GI tract. In fact at this page , (see case-1), there is a case showing gall bladder calculi in a fetus. So, in the above case (neonatal GB calculi), we must conclude that the gallstones actually formed way up in the intrauterine period, possibly the last 3 months of gestation.
Studies have shown that gall stones (cholelithiasis) in infants/ children are mainly composed of dark bile pigment (calcium bilirubinate) whilst in adults the calculi are mainly of cholesterol crystals.