cochinblogs

A sonographic atlas of the thyroid- on Amazon

2011-12-24T16:24:00.002+05:30

This short handbook and ultrasound atlas of the thyroid should serve as a guide for the busy sonologist, radiologist or medical practitioner who wishes to gain insight into the intricacies of sonography and color Doppler imaging of the thyroid. A short section on the appendix towards the end of the book casts light on ultrasound imaging of common pathologies of the appendix. This book is sold on amazon at a reasonable price.

Cerebral edema in neonates

2011-09-22T22:19:00.003+05:30

Cerebral edema remains one of the commonest problems encountered whilst doing sonographic imaging of the neonatal brain. It has been graded into mild, moderate and severe depending on the degree of effacement or compression of the ventricular system- the lateral and 3rd veintricles mainly, and also loss of the sulcal pattern of the baby's brain.
These ultrasound images of severe cerebral edema show the typical appearance with the lateral and 3rd ventricles virtually compressed out of visibility by the edematous neonatal cerebral tissue (the sulcal pattern is however, still preserved and is visible):
Sagittal section:

Coronal section:

Color Doppler coronal section image:

Coronal section brain (all images of same neonate):

Visit: http://www.ultrasound-images.com/pediatric.htm#Cerebral_edema_in_neonate
for more on this topic.

Twinkle (color Doppler) artifacts in urinary calculi

2011-07-22T08:21:00.001+05:30

It has been observed that small color flow artifacts called twinkle artifacts form around and posterior to kidney, ureteric and bladder stones. These color twinkle artifacts can at times be helpful in recognizing small urinary calculi that may be sometimes be obscure. The color Doppler ultrasound video clip below shows a typical case of twinkle artifacts behind a left vesico-ureteric calculus, measuring 5 mm.

These color Doppler and B mode ultrasound images reveal the twinkle around the left VUJ stone in detail.

Mild hydronephrosis is present in the left kidney due to back pressure changes in left ureter.
My personal observation is that twinkle artifacts can at best help confirm the presence of small renal/ urinary calculi and not be used in isolation to sonographically diagnose a urinary calculus. These artifacts are better seen on lowering the pulse repetition frequency (PRF) to optimal levels. Twinkling can at times be used to aid diagnosis of urinary stones when acoustic shadowing may be doubtful.
References:
http://radiology.rsna.org/content/259/3/911.abstract (abstract - effectiveness of color Twinkle artifact in detecting small urinary stones).
Images and description of twinkle artifacts
Also visit : http://www.ultrasound-images.com/ureteric-calculi.htm
and: http://www.ultrasound-images.com/renal-calculi.htm

Ultrasound study of gastric band

2011-07-12T22:16:00.002+05:30

I have described a little about gastric banding at : http://www.ultrasound-images.com/git.htm#Gastric_band_%28gastric_banding_in_obesity%29
Gastric band is a simple "tourniquet" around the upper part of the stomach, just below the fundus, aimed at reducing the functional volume of the stomach. This is useful in controlling the food intake in obese patients. What has ultrasound got to do with gastric band? Plenty- ultrasound imaging of the gastric band post-surgical case helps determine the position and effectiveness of the gastric band. How good is ultrasound at imaging it? Have a look at the link above.

Sonographic atlas of thyroid and appendix

2011-04-26T09:29:00.014+05:30

I have published a short handbook of "Sonography of the Thyroid and Appendix"... This book is available at this link online:
Sonographic atlas of the thyroid and appendix
This short textbook is published by Jaypee brothers in India and is marketed worldwide online by a number of publishers.
See: http://www.printsasia.com/book/Step-by-Step-Sonographic-Atlas-of-Thyroid-Appendix-Joe-Anthony-8184489986-9788184489989
Shown here is a snap shot of the cover:

This book attempts to bridge the gap in imaging of the thyroid using high resolution ultrasound images of the thyroid. Almost very thyroid pathology is covered in this short ultrasound atlas of the thyroid and appendix.

This handbook of ultrasound imaging of the thyroid also has a short section on ultrasound imaging of the appendix. Here we cover most of the pathologies of the appendix as visualized on ultrasonography.
Priced at very affordable rates, both in India and abroad, this short atlas of ultrasound of the thyroid and appendix should cater to the newbie (beginner) in the field of sonography of the thyroid as well as the appendix, both of which are relatively gray areas in ultrasound imaging.
Other dealers selling this text book of thyroid sonography are:
1) Sonography of the thyroid- Jaypee brothers website
2) http://www.alibris.com/search/books/qwork/16697477/used/Sonographic%20Atlas%20of%20Thyroid%20%26%20Appendix
3) http://www.amazon-sy.com/?q=en/Product/view/12856/198
Another online dealer who sells this handy manual of thyroid imaging is:
4) http://www.bookshopofindia.com/search.asp?action1=default&bookid=9081727
5) http://www.maansu.com/9788184489989
6) Sonographic atlas of the thyroid and appendix- Amega books
7) http://www.flipkart.com/b/books/step-sonographic-atlas-thyroid-appendix-book-8184489986
8) http://www.amazon.co.uk/Step-Sonographic-Atlas-Thyroid-Appendix/dp/8184489986 (sold on amazon.com in UK)
9) http://www.waterstones.com/waterstonesweb/products/joe+antony/sonographic+atlas+of+thyroid+26+appendix/8293107/ (also on waterstones.com in UK)
10) http://www.whsmith.co.uk/CatalogAndSearch/ProductDetails.aspx?productID=9788184489989
(whsmith.com in UK)
11) http://www.fishpond.com.au/Books/Sonographic-Atlas-of-Thyroid-Appendix-Antony/9788184489989
in Australia
12) http://www.bookdepository.co.uk/Sonographic-Atlas-Thyroid-Appendix-Antony/9788184489989
(in UK)
13) http://www.sparkbooks.in/cart/index.php?main_page=product_info&cPath=1_49&products_id=11270
14) http://www.medilinebooks.com/onlinebooks.php?category=Step%20by%20Step%20Series&PHPSESSID=0f84112845b9839f5351c838b487834b (mediline books)

Nice links on kidney stones:

2011-04-18T20:21:00.001+05:30

My last blog was on kidney stones (renal calculi and urinary calculi). Here are some really good links on urinary stone disease:
http://emedicine.medscape.com/article/437096-workup#aw2aab6b5b6
As usual emedicine has done some really good work up on kidney stones, from symptoms to treatment. But on ultrsonography of kidney stones visit: http://www.ultrasound-images.com/renal-calculi.htm
For the patient and layman visit:
http://www.medicinenet.com/kidney_stone/article.htm
For information on medullary sponge kidneys visit:
http://emedicine.medscape.com/article/379323-overview#a22

Kidney stones- renal calculi- urinary stones

2011-04-06T12:04:00.033+05:30

Renal stones or Kidney stones:
(This article is meant for both the layperson and those new to the science and art of sonography).
Most urinary stones or calculi as they are called in medical parlance, originate in the kidneys. Some are also known to form in the urinary bladder due to stasis of urine or collection of urine within the urinary bladder. Kidney stones in the urinary system pass from the kidney (renal calculi) to the ureter and thence, down to the urinary bladder.
One of the simplest and most inexpensive methods of diagnosing renal stones (kidney stones) is ultrasound imaging.
The symptoms of kidney stone include- passage of blood in the urine, or hematuria or pain in the side of the abdomen, along the flanks. Pain is usually the first symptom and may be the only sign of kidney stone. However, I have come across many patients who have absolutely no symptoms at all and kidney stone disease may be found only incidentally during an ultrasound scan. With phosphate stones in the kidney, the stone or kidney calculus may actually reach a very large size over a period of time (many years) and yet the patient may be unaware of the disease.
Here are some ultrasound images of kidney stones:

Case 1: Left kidney stone- in the renal pelvis:

The urinary bladder in this lady appears normal as are the uterus and adenxae (ovaries).

The above ultrasound images show a large stone in the left kidney. The right kidney appears normal. The renal stone/ calculus is within the central part of the kidney called the renal pelvis, within which the urine from the kidney enters or collects. From here the urine passes to the ureter or muscular tube from the renal pelvis to the urinary bladder. The kidney stone here measures 1.8 cms., and has not produced any significant obstruction to the passage of urine to the left ureter below- this despite the large size of the left renal calculus. We can say this because there is no hydronephrosis of the left kidney. We shall discuss this term in detail below:

Case-2: Kidney stone causing moderate hydronephrosis of the left kidney

This patient shows a typical kidney stone location called PUJ calculus or stone located at the pelvi-ureteric junction, in the left kidney. The PUJ or UPJ is the junction between the renal pelvis and the ureter and is pretty narrow. The large kidney stone (shown above) is unable to pass down into the left ureter, and has become stuck at the narrow junction causing partial flow of urine downwards through this bottle-neck.

This has resulted in back pressure due to collection of urine within the collecting system of the left kidney causing the left kidney to "balloon up". This condition is called hydronephrosis and we can see this change in the obstructed left kidney above. If not treated quickly (meaning within a few months), this kidney could pass to a stage of severe hydronephrosis and ultimately become non functional or result in what is called renal failure.
Case-3: Hydronephrosis due to left PUJ calculus:

This is yet another case of left PUJ/ UPJ calculus with a relatively small kidney stone stuck at the narrow left uretero-pelvic junction with resulting left kidney swelling or hydronephrosis.(Note :-) kidney stones shown here are from 3 different patients and there is no evidence that the left kidney has a greater chance of being affected by stone disease).

The above ultrasound video clip shows the left PUJ stone in a better perspective with the resultant left hydronephrosis.
From the above ultrasound case studies of kidney stones, it is obvious that small stones can produce more trouble for the patient if located in a critical location, and that the size of the kidney stone alone is not the only factor that causes symptoms and clinical complaints and complications.
In case 1 above despite the large size of the kidney stone, its location above the narrow bottle neck called the pelvi-ureteric junction, has resulted in absence of any hydroneprhosis in the affected left kidney.
In cases 2 and 3, there is significant ballooning of the kidney as a result of the kidney stone being located at the PUJ (the bottle neck). In case -3 the kidney stone is less than half the size of the stone seen in case-1.

Case-4: Right mid ureteric calculus with right hydronephrosis:

This patient shows moderately severe hydronephrosis of the right kidney. This is seen as collection of urine (dark space within the right kidney- image on left side). However there is no stone visualized in this ultrasound image. The left kidney appears normal (image on right half of the picture above).

We tried to trace the dilated (distended) right ureter (called hydroureter) downwards and this is what we found. There is a stone (ureteric calculus) in middle third of the right ureter, and it is pretty large (at 1.7 cms.). Tracing stones in the ureter can be a very cumbersome task and much of this depends on displacing gas distended bowel away from the front of the ureter. This is done by gently pressure with the ultrasound probe. This ureteral stone originated in the right kidney and has managed to pass down the right renal pelvis and right PUJ down to the middle of the ureter. This patient has experienced severe pain (called ureteric colic) as the stone irritates the soft muscle of the ureter. The next task for the stone is to negotiate the next major bottle neck in its passage downwards- the right VUJ (vesico-ureteric junction). This is the narrowest point in the urinary tract and is the point of entry of the ureter into the urinary bladder. We shall next see what happens when a stone gets impacted at the VUJ (vesico-ureteric junction).

Have a look at the ultrasound video clip of this case:

Case-5: Right vesico-ureteric Junction calculus:
The next destination that the kidney stone has to reach on its way out in the urinary system is the urinary bladder. But unfortunately for the patient, things are not so easy, and the narrow bottle-neck called the vesico-ureteric junction (VUJ) being the narrowest point in the urinary tract, most stones lodge here for some time before being expelled into the urinary bladder.
This is one such case-

This young adult male shows a small stone impacted in the right VUJ (ultrasound image of urinary bladder above). At 5 mm. size this urinary stone has transited successfully all the way from the right kidney, down the right ureter, and has almost made it to the bladder! But it has not quite made it. The stone is stuck in this narrow point, despite its small size. What is its effect on the right kidney? See the ultrasound image below:

Even a stone as small as 5 mm. is able to wreak havoc on the right kidney, which shows moderate hydronephrosis with right hydroureter. The left kidney appears relatively normal in this ultrasound image of the kidneys.

Case-6: Left VUJ calculus:

This is another patient with severe left flank pain. The ultrasound image of the urinary bladder above shows a suspicious looking areas in the left VUJ (vesico-ureteric junction). Most probably this is a stone in the left VUJ.

When in doubt, I switch on the color Doppler ultrasound button, and the result was a little twinkling (the blue color- arrow) around the left VUJ. This is a clear sign of a stone here.

When we examined the left kidney, this is what we saw (ultrasound image of left kidney- below):

There is clear evidence of left hydronephrosis in this image above. The final diagnosis was- left VUJ calculus with resultant left hydronephrosis.

Final destination- the Urinary bladder:
Case-7: bladder sediments and debris:

What this image shows is transrectal ultrasound imaging (TRUS) study of the prostate (the triangular soft tissue structure in upper part of image). But what is even more striking is the particulate matter within the urinary bladder below (this is an upside down ultrasound image of the bladder). This is common finding in elderly male patients with urinary tract infection- the debris (particles) within the bladder being a sign of that.

Have a look at the TRUS ultrasound video clip of this patient:

The motion of the particles within the urinary bladder can be fully appreciated in this ultrasound video clip. particulate matter of this type can often result in colloid gel like matter forming the nidus (precursor) for stone formation in the urinary bladder. Thus elderly male patients with chronic difficulty in urination can sometimes develop urinary bladder stones. See: http://www.ultrasound-images.com/urinary-bladder.htm#Large_urinary_bladder_calculus

Case-8: Urinary bladder stones:
As said earlier there are various causes for the formation of bladder stones. Chronic obstructive conditions in the lower urinary tract such as patients with benign prostatic hypertrophy can often develop urinary bladder stones.
These ultrasound images are of an elderly male with benign prostatic enlargement. There is a stone of 1.5 cms. seen in the urinary bladder in both transabdominal and transrectal ultrasound images (see below).

Transabdominal ultrasound image of stone in urinary bladder (arrow). Also seen is a Foley catheter bulb within the bladder.

Transrectal ultrasound image showing urinary bladder stone (above)....arrow.
Shown below is the TRUS ultrasound video clip of the bladder stone:

Bulky uterus

2011-01-22T09:15:00.004+05:30

The above ultrasound images show what is called a bulky uterus. This term is used when the uterus is larger than normal for the age of the patient. The common causes include -1) the post partum stage (after delivery/ childbirth), when the uterus is still large in size after delivery (the process of shrinking in size of the uterus to its normal size is called involution), 2) fibroids, 3) adenomyosis etc. These patients often complain of discomfort in the pelvic region and menstrual problems. Another cause of enlarged or bulky uterus in middle aged women is increase in the BMI (body mass index). Higher the BMI and obesity are associated with larger or bulkier uterus. See this link: Bulky uterus and obesity The ultrasound images above show a diffusely enlarged uterus with no evidence of masses (tumors) or other pathologies.

The above is an ultrasound video clip of a case of bulky uterus seen in sagittal section. Observe the increased size of the liver without any other pathology. This was a middle aged (52 year) old female patient with back pain. Bulky uterus is a common finding among middle aged menopausal women.

This middle aged lady with the bulky uterus (same case as above) also has a significant deposition of fat within the liver, resulting in moderate fatty change. Many middle aged Asian women present with both bulky uterus and fatty liver.

Causes of intertility in men and women:

2010-11-26T08:26:00.013+05:30

Among the causes of infertility in women are diseases of the uterus and ovaries:
This middle aged lady has a very small uterus (called hypoplasia of the uterus). Such a uterus is incompatible with the ability to conceive and have a child. The ultrasound video clip below shows a sagittal (midline) section through the uterus. It was obtained via the transvaginal route. The vagina itself was sufficiently large enough to insert the transvaginal probe.

The inner lining of the uterine cavity- the endometrium appears markedly thinned, and again this is incompatible with conceiving a child.

The ultrasound video clip below is a transverse section through the uterus of the same patient:

For more on this case study visit: http://www.ultrasound-images.com/uterus.htm#Hypoplastic_uterus

See: http://www.medscape.com/viewarticle/471012_6

In men, similarly, absence of or hypoplasia (very small) of parts of the reproductive system can result in infertility:

This male patient underwent sonography of the prostate and seminal vesicles via the transrectal route:

Ultrasound video clip shows normal sized prostate-

Observe the TRUS video clip as we pan the probe from the upper most part of the prostate showing the clear absence of the seminal vesicles and the vas deferens (agenesis) on both sides. This type of congenital absence of an important part of the route through which sperms pass from the testes to the penile urethra will result in total absence of spermatozoa in the ejaculated semen. This condition is called a azoospermia in the male.

See: http://www.ncbi.nlm.nih.gov/pubmed/3379704

Also: http://en.wikipedia.org/wiki/Azoospermia

Other and more common causes of infertility in men-

Perhaps one of the commonest cause of male infertility is a condition called varicocele.

Here, there is a dilatation of the veins around the testes, inside the scrotum. These veins are called the Pampiniform veins, and are responsible for draining blood from the testes. Due to decreased efficiency of the draining process, these veins swell and blood collects within these vessels resulting in increased temperature within the scrotum and the testes. The testes then lose some of their spermatogenic (sperm producing) functions. Depending on the degree of varicocele (grade of varicocele), the man may suffer from infertility.

Color Doppler Ultrasound can help in diagnosing this condition; see this link for more on this topic:

http://ultrasound-images.blogspot.com/2010/09/color-doppler-ultrasound-video-clips-of.html

Also: http://www.ultrasound-images.com/scrotum.htm

Diseases of the testes and the epididymis (a small structure next to the testis) can cause poor or impaired production of sperms. This can result in infertility. One such common condition is an inflammatory disease called orchitis and epididymo-orchitis. (see: http://www.ultrasound-images.com/scrotum.htm#Epididymitis

and http://www.ultrasound-images.com/scrotal-infections.htm )

Another cause of impaired spermatogenesis (sperm formation) is chronic or past infection of the testes resulting in atrophy (shrinking) of the testes. This happens in mumps inflammation of the testes, a condition called mumps orchitis. See : http://www.ultrasound-images.com/scrotum.htm#Atrophy_of_testis

This condition causes decreased function of the testes with small shrunken testes. Atrophy of the testes is usually irreversible.

Another condition that involves another part of the male reproductive system is prostatitis or inflammation of the prostate. The prostate helps to form a bulk of the fluid in the semen. Inflammation of the prostate is common and can impair the production of semen and its release during ejaculation. This color Doppler video clip shows a severely inflamed prostate:

This prostate was visualized via the transrectal route. The color Doppler mode shows massively increased blood flow in the prostate (hyperemia), a hall mark of prostatitis. This condition of the prostate can be corrected to a large extent using medical treatment.

The above still color Doppler image shows the TRUS (transrectal ultrasound) view of the same prostate.

Fibroids of the uterus (leiomyoma):

2010-11-07T18:47:00.020+05:30

Fibroids are the commonest tumors of the uterus and have a reported incidence of at least 25 to 30 % in the female population. Uterine fibroids are benign tumors (lumps) of the uterine musculature (called smooth muscles) and have varying prognosis from slowly growing tumors to those that may actually regress (become smaller). A small percentage of fibroids of the uterus may actually undergo malignant transformation (become cancerous); these cancerous tumors are called leiomyosarcoma. Another aspect about a fibroid is that this uterine tumor may be single or it may be multiple.
What are the symptoms of a uterine fibroid?
The earliest symptoms of a fibroid can be pain the lower abdomen (the pelvis) of the woman (usually after the age of 30). The other symptoms of uterine fibroids include dysmenorrhea (pain during menses), increased frequency or amount of bleeding during menses (polymenorrhea or menorrhagia) and other menstrual abnormalities. Other symptoms include those produced by pressure of the fibroids of the uterus on the adjacent organs in the female pelvis including the urinary bladder (increased frequency of urination and obstructed urination). Pressure on the rectum may cause constipation in women where the uterine mass (tumor/ fibroid) arises from the posterior (back) of the uterus. Fibroids are also a common cause of infertility in women.
So how does one diagnose fibroid of the uterus?
If a woman has one or more of the symptoms mentioned above, she should consult the doctor/ gynecologist immediately. Per abdominal examination (palpation) of the pelvis can sometimes help detect a relatively larger fibroid. In addition, a per vaginal examination may also help to detect a lump of the uterus. In any case, the safest and best method to diagnose a fibroid of the uterus is ultrasound examination. The sonologist or radiologist conducts a transabdominal examination of the pelvis (on a full bladder) to visualize the uterine mass. The uterine tumor is seen from various angles to determine its size, number, location and pressure effects on the adjacent bladder or rectum.
Here is some examples of what a uterine fibroid looks like on ultrasound imaging:
There are commonly three types of fibroid based on ultrasound imaging:
a) Intramural- the fibroid is within the wall of the uterus.
b) Subserosal- the fibroid is just below the outer covering serosa of the uterus.
c) Sub mucous- the fibroid is just below the inner lining of the uterus (the endometrium).
This ultrasound image shows a fibroid extending from the subserous to the intramural location of the uterus-

What does the sonologist or radiologist see in this ultrasound image of the subserosal fibroid? The uterine fibroid is pressing upon the anteriorly (front) located urinary bladder. The mass or tumor is located to the right side of the uterus and extends from the intramural to the subserosal location of the upper part of the uterus (called the fundus).
See another ultrasound picture of the same case:

The uterine fibroid also appears to compress upon the inner lining of the uterus (EM= endometrium).(FIB= fibroid; BL= bladder; UT= uterus). Thus this patient is likely to have a number of complaints- from bladder compression to irritation of the inner lining (endometrium) of the uterus with resultant menstrual problems.
Broad ligament fibroid:
In rare cases the uterine fibroids may be located to either side of the uterus- the so called broad ligament fibroids- see the ultrasound pictures/ ultrasound video clips of one such case of broad ligament fibroid:

The uterine tumor in this case is seen in the left broad ligament of the uterus. Such a broad ligament fibroid may interfere with the function of the left fallopian tube (the duct that transmits the ovum from the left ovary to the uterine cavity). Hence such a patient might have problems conceiving or may be infertile.
See this ultrasound video clip of the same case (left broad ligament fibroid):

Pedunculated fibroid:
The next case we shall discuss is another relatively rare entity called the pedunculated fibroid of the uterus. Here, the fibroid in the uterus is connected to the uterus by a short or sometimes long pedicle or stalk. See the ultrasound images of one such case of pedunculated fibroid of the uterus:

In this patient, the uterine fibroid is seen extending just above the fundus (top) of the uterus and is connected to it by a short stalk. It is almost like a floating tumor suspended from the main body - the uterus by a stalk or cord. Such pedunculated uterine fibroids can cause severe pain due to torsion of the uterine tumor mass (twisting of the stalk) resulting in cutting off of the blood supply to the tumor from the uterus.

Have a look at these ultrasound video clips of the pedunculated fibroid described above:

Such an event resulting in twisting of the stalk of the pedunculated fibroid can be a medical emergency and urgent surgery might be required to remove the mass immediately.

This color Doppler ultrasound video clip shows the stalk is very vascular (ie: a number of blood vessels are seen between the pedunculated uterine fibroid and the fundus of the uterus. For more details of the various other types of fibroids of the uterus and ultrasound images of each case, visit:

http://www.ultrasound-images.com/uterus.htm

Case-2 (pedunculated fibroid of uterus):

This is another example of a large fibroid with a stalk connecting the tumor (6 x 7 cms.) to the fundus of uterus via a stalk or peduncle. The peduncle measures about 2 cms. in thickness. I managed to visualize the peduncle by applying pressure onto the area between the fibroid and the fundus of the uterus. See the ultrasound video below:

Color Doppler video clip (above) shows multiple blood vessels within the short and relatively thick pedicle connecting the fundus to the fibroid.

This is how the mass (fibroid) and pedicle appeared on still images (see below):

Observe the presence of a second fibroid within the lower part of body of the uterus in these sagittal sections of the uterus. This fibroid appears intramural in location.

It is beyond the scope of this article to describe in detail the other methods of diagnosing tumors of the uterus. However, it must be added that CT (CAT) scan imaging and MR imaging can also offer additional information on fibroids of the uterus, in certain cases.

For information on treatment of fibroid of the uterus visit:

http://www.emedicinehealth.com/uterine_fibroids/page5_em.htm

Degenerative changes in fibroid:

This case of a large fibroid with a most unusual appearance:

This is a sagittal section of the huge mass in the uterus. Note the markedly inhomogenous appearance of the mass. The ultrasound video clip below shows a transverse section of the mass:

Now, the color doppler video of the tumor (fibroid) of the uterus:

For more images and details of this case see:
http://www.ultrasound-images.com/uterus.htm#Degenerative_changes_in_fibroid
Multiple fibroids:
Uterine fibroids can very often be multiple. This middle aged lady has 3 fibroids seen in this sagittal section ultrasound video clip of the uterus:

Of these, the one labeled as (1)- towards the fundus, shows degenerative changes- it is hypoechoic, inhomogenous, suggesting possible cystic changes within it.
Another video clip shows the presence of all 3 fibroids in this uterus:

Ultrasound Imaging of the head of neonatal femur and humerus

2010-10-10T23:37:00.004+05:30

High resolution Ultrasound images of the normal head of femur in neonate:

The above image shows the head of the left femur in a 3 day old neonate. Note the full ball of the head of the femur in this transverse section of the femoral head inside the left hip joint.

Another neonate- the head of femur is seen a round, hypoechoic structure due to its cartilaginous nature. Note the coarse appearance of the femoral head.

Ultrasound image of the right femoral head (hip joint) - all the above images show the normal head within the acetabulum (socket of the hip joint).

This (above) ultrasound image shows the normal head of the left humerus (in neonate). As in the case of the femoral head images, the head of the humerus is cartilaginous at this young age- hence the hypoechoic, grainy or coarse echotexture. But the humerus shows one major difference- the head forms a "half ball" -a shallow ball and socket joint (the shoulder joint). In infective arthritis of these joints, there would be widening of the joint space with collection of synovial fluid within the joint cavity. Ultrasound is an excellent method of imaging the neonatal hip and shoulder joints.

The above 3 high resolution (7- 8 Mhz transducer frequency) show the normal right neonatal shoulder joint, from different angles. The transverse section image shows the shallow nature of the glenoid cavity. Sonography of the shoulder joint in the neonate is useful in detecting tendency for dislocation in a baby and ruling out conditions like shoulder dysplasia in infants. By detailed ultrasound imaging one can detect glenoid dysplasia in infant shoulder (a clear indicator of potential shoulder dislocation). This condition is coomon in neonates/ infants with obstetric brachial plexus injury.

and also: http://www.ultrasoundpaedia.com/USP%20neonatal%20hips%20winner.html

Also: http://www.ultrasound-images.com/pediatric.htm

and also Musculoskeletal Ultrasound imaging

Color Doppler ultrasound videos of 3rd trimester pregnancy:

2010-08-20T22:19:00.011+05:30

Color Doppler ultrasound is an essential part of the imaging or ultrasound scan of the fetus, even in the 3rd trimester. the basic Doppler imaging of the fetus includes study of the fetal MCA or middle cerebral artery, the fetal ductus venosus and the umbilical artery. Of these, Doppler imaging of the ductus venosus is the most difficult. Here we have some normal Triplex Doppler videos of these 3 main vessels of interest to the sonographer or radiologist. All the Color Doppler videos below show video and accompanying audio.
Color Doppler and spectral waveform of the fetal middle cerebral artery:

Here is the second video of the MCA:

This Color Doppler video clip demonstrates the exact location of the middle cerebral artery (arrow) among the major vessels of the fetal brain.

Yet another demonstration of the fetal middle cerebral artery (arrow pointing at the vessel) :

Due to fetal head movement and respiratory movements the arrow points slightly lower than the actual position of the fetal MCA.

Note the high velocity, high resistance flow in this normal fetal middle cerebral artery, with almost no diastolic flow that is very striking about this artery.
The other important fetal vessel that is studied here is the umbilical artery. This spectral Color Doppler waveform video clip shows the normal umbilical artery. The normal umbilical artery shows low resistance flow with high diastolic velocity, which is the opposite of what is seen in the fetal MCA.

The next vessel to be studied in this normal fetus is the most elusive as we mentioned earlier and is the fetal ductus venosus. This color Doppler video /spectral waveform shows the normal ductus venosus with low resistance flow with typically 3 waves seen in spectral display- the S, D and A waves. This vessel is short and disappears from view unless the clinician has a steady hand on the probe and both mother and fetus cooperate.

Here is another attempt at the normal ductus venosus in this 3rd trimester fetus:

The Nemio-XG ultrasound machine which I have used for this study has an "update" button which helps to fine tune the spectral video display. This update button has been activated to the later half of this ductus venosus video. The result is obvious, as the waves become smaller and more coherent. Note the almost M-shape of these normal ductus venosus waves. For more on this topic visit: http://www.ultrasound-images.com/fetus-general.htm for more images and case studies of abnormal fetal doppler.

Here is yet another spectral Doppler video tracing of a 34 week old fetus (another case):

Often, this short vessel slips out of view due to fetal movements or maternal breathing. Hence a lot of effort is needed to get optimal color Doppler spectral tracing of fetal ductus venosus.

Gall bladder sludge- ultrasound video clip:

2010-08-14T15:12:00.002+05:30

This B-mode ultrasound video clip shows what is called as limy bile in the gallbladder. This organ, though distended, shows echogenic particles and also calculi (stones) of 4 to 6 mm. in its lumen. See this page for more:

http://www.ultrasound-images.com/gall-bladder.htm

The bile in the gallbladder must be a rather thick fluid, almost jelly or putty like in consistency, given that the ultrasound video clip shows almost no motion of the debris in the gallbladder. The overall appearance and echogenicity of the gall bladder is similar to that of the liver, an appearance called hepatization.

Color Doppler ultrasound video of a ureteric jet:

2010-08-13T14:29:00.001+05:30

This short Color Doppler video clip shows a jet of urine (red stream) emerging from the left ureteral orifice and sprayed into the distended urinary bladder. The jet of urine was normal in this patient. A normal urine jet from the ureter is an indication that there is no obstruction in the ureter of that side, at least not at the level of the ureteric orifice.

Extrarenal pelvis:

2010-08-11T08:17:00.003+05:30

This adult patient shows a ballooning of the pelvis (P) of the left kidney (see ultrasound images above). A major portion of the renal pelvis lies outside the renal sinus, a condition called extrarenal pelvis. The transverse section image (lower image), brings out the lesion clearly. The extrarenal pelvis is a normal variant and needs no specific treatment. However, in this case, the calyces of the left kidney show mild ballooning suggesting obstructive changes which require further radiological study.
Reference: http://emedicine.medscape.com/article/1016549-overview

Solitary cyst of fetal kidney:

2010-08-01T22:32:00.001+05:30

This 2nd trimester fetus shows a solitary cyst of the lower pole of left fetal kidney. The cyst is small (6 mm.) with no internal debris or septae. The fetal renal cyst shows no communication withe the pelvicalyces which appear norma, thus ruling out fetal hydronephrosis. The fetal urinary bladder (BL) appears normal. The above ultrasound images are typical of uncomplicated cyst of the fetal left kidney. The important differential diagnoses in this case include renal abscess or renal hematoma, both of which seem improbable here. The other possibility is that this cyst is precursor to onset of autosomal dominant polycystic kidney disease (adult type). Polycystic kidney disease may develop in this baby during adult life. Both images are courtesy of Dr. Ravi Kadasne, MD, UAE.
For more on this topic visit: http://www.ultrasound-images.com/fetal-urogenital.htm

Ultrasound imaging of nuchal thickness ( nuchal translucency thickness): 11 to 13 weeks fetal scan

2010-07-31T09:04:00.006+05:30

Ultrasound imaging of the fetus in the period from 11 weeks to 13 weeks 6 days gestational age is important to study fetal nuchal translucency or nuchal thickness. Nuchal translucency is the hypoechoic area in the subcutaneous region in the posterior aspect of the fetal neck. This hypoechoic area represents fluid collection in the nuchal region. The normal amount of fetal nuchal thickness can be upto 2 mm. (at 11 weeks). The normal nuchal translucency thickness can increase to about 2.8 mm. by 13 weeks 6 days. The above ultrasound image shows a sagittal section of the fetal neck with nuchal tranlucency or nuchal thickness of 1.8 mm. in a 11 week old fetus. This was a normal study. Note the separate band posterior to the neck- the amnion, a membrane present around the fetus. The amnion must be separately identified from the nuchal skin to prevent wrong measurement of the nuchal thickness.

A zoomed view of the nuchal thickness in the same fetus. Note the close proximity of the amniotic membrane.

The normal nasal bone is also visualized in this ultrasound study (see image above). All above images are courtesy of Dr. Prasenjeet Singh, India.
Reference: http://www.babycentre.co.uk/pregnancy/antenatalhealth/scans/nuchalscan/
This site gives more information on this topic:
http://www.fetalmedicine.com/fmf/FMF-English.pdf
http://www.fetalmedicine.com/fmf/training-certification/certificates-of-competence/11-13-week-scan/nuchal/

The glomus body and its tumors:

2010-07-29T21:35:00.003+05:30

The glomus body is a unique receptor or rather a thermal sensor found mainly in the dermis of the skin. This is a strange kind of tissue, microscopic in size but with a very important function, somewhat akin to the sensors found inside the room air conditioner. It acts as a sensor detecting changes in temperature of the environment and passes this information up the nervous system resulting in shunting of blood away from the skin by vasoconstriction (shrinking the diameter of the capillaries in the skin) when the surroundings turn cool. This simple mechanism prevents loss of heat during the winter and cool weather. The opposite happens during warm weather. Perhaps we don't realize the importance of these tiny nodes in the skin until it malfunctions. Perhaps the most common pathology of this node is in the distal part of the fingers- the subungual region (the part between the finger nail and the underlying phalanx or bone). This condition is the glomus tumor, a very vascular growth, some call it a hamartoma of the glomus body.
See- http://www.ultrasound-images.com/musculoskeletal.htm , where I discuss this pathology in detail with color Doppler and ultrasound imaging of this rather poorly understood and still relatively unexplored pathology.

The grey scale B-mode ultrasound image above shows a typical glomus tumor, seen as a hypoechoic, soft tissue mass beneath the fingernail.

The color Doppler image above shows the vascular nature of the subungual glomus tumor in the 2nd finger.Note the erosion of the underlying bone. Both above images are courtesy of Shlomo Gobi, Israel.

Ureterocele with ureteric jet:

2010-07-21T07:13:00.021+05:30

Case-1:
Does a ureterocele prevent urine entering into the urinary bladder? This Color Doppler ultrasound image proves that ureteroceles may not always produce ureteral obstruction. Despite the large size of the outpouching of the distal end of the ureter seen in this image, there is a powerful jet of urine being pumped into the urinary bladder (the urine jet is seen as a colored column in the bladder). For more images on this topic see: http://www.ultrasound-images.com/urinary-bladder.htm
This color Doppler ultrasound image is courtesy of Dr. Prasenjeet Singh, MD, India.
Case-2:
And here is another case- a middle aged female patient with pain in the left iliac region:
Grey scale ultrasound image shows a small right ureterocele:
In addition there is a mild hydronephrosis of the right kidney.

This ultrasound video clip confirms the right ureterocele. Very often such an appearance can be mistaken for mucosal edema around a recently passed vesico-ureteric junction calculus. But this is ruled out ---

There is no mistaking the small bulging vesicle (bubble) of the right ureterocele that measures about 9 mm. at maximum width; gradually collapsing as it empties.

This color Doppler video clip (below) shows normal flow (ureteral or ureteric jet) from the left ureteric orifice. However there is very poor flow from the right ureteric orifice (due to the ureterocele). This is in direct contrast to the case -1 above, where the ureterocele does not cause significant obstruction, despite its large size.

Moral: size does not always matter when it comes to ureteroceles!!
CASE- 3:
Here is another example of a moderately large right ureterocele, with an almost normal right ureteric urine jet:
I posted this gray scale ultrasound video clip on you tube for better clarity and resolution of the video clip:

And here is the color Doppler video clip of the same case, posted by me on you tube:

This ultrasound image shows both normal kidneys, a clear sign that there is little by way of obstruction to the flow of urine on the side of the ureterocele.

Color Doppler video clips of umbilical vein varix

2010-07-20T21:58:00.006+05:30

Here are some nice ultrasound and Color Doppler video clips of a 33 week fetus with intra-abdominal umbilical vein varix.

Another Doppler ultrasound video clip:

BL= fetal urinary bladder. VAR= intra-abdominal umbilical vein varix.
Note the close relation of the varix to the urinary bladder. On grey scale ultrasound, the varix may be mistaken for the fetal urinary bladder or a diverticulum from the bladder. (See ultrasound images below):

Spectral Doppler ultrasound trace shows typical venous flow in the varix, albeit turbulent. (See ultrasound picture below).
The turbulent flow within the varix is also seen in the Doppler video clips above.

Axillofemoral graft

2010-07-10T11:17:00.004+05:30

This elderly female patient underwent an axillofemoral graft (also called axillofemoral bypass graft) for loss of blood flow in the right femoral artery. The procedure involved connecting the right femoral artery and right axillary artery using an artificial graft tube, which was placed along the subcutaneous plane of the chest and abdomen. This patient underwent Color Doppler imaging to assess the condition and flow in the graft tube. The color Doppler image above shows the artificial axillofemoral graft tube with normal flow through it. Note the large diameter of the graft tube and location in the subcutaneous plane of the chest wall.
Reference: http://www.ajronline.org/cgi/reprint/144/5/1005.pdf
See: http://www.ultrasound-images.com/vascular.htm

Bilateral urinary calculi- an unusual case

2010-07-09T07:26:00.003+05:30

This was a rather unusual case. This elderly male patient complained of pain in the flanks. He was suspected to have lower urinary tract obstruction (meaning a prostate enlargement). Ultrasound imaging of the kidneys (above) show bilateral moderate hydronephrosis, with more severe changes in the left kidney (right half of image). The image shows a large calculus of 2.3 cms. lodged in the left pelvi-ureteric junction (uretero-pelvic junction). But what is the cause of the right hydronephrosis?

The cause of the right hydronephrosis is now obvious- 2 calculi are seen at the right vesico-ureteric junction.

TRUS (transrectal ultrasound) examination confirms the findings. Arrows show 2 calculi in the distal most part of the right ureter (in the vesico-ureteric junction).

Despite the urinary bladder being nearly empty, the right vesico-ureteric junction calculi are seen on TRUS image (only one of the 2 calculi see in this image). The prostate itself only showed mild hypertrophy. This is the first case I stumbled upon with a VUJ (vesico-ureteric junction) and UPJ (uretero-pelvic junction) calculi in the same patient.
See this page for more: http://www.ultrasound-images.com/ureteric-calculi.htm

Urinary bladder polyp:

2010-06-26T12:17:00.003+05:30

Transabdominal ultrasound image showing a small, but clearly visualized solid polypoid tissue projecting into the urinary bladder close to the bladder neck. The query here is: is this mass a bladder mucosal polyp or a beak of prostatic tissue (the patient was a middle aged male with lower urinary tract obstructive symptoms).

Transrectal ultrasound image shows the polypoid mass of 12 x 5 mm. size, emanating from the bladder mucosa close to the prostate. Color Doppler ultrasound shows considerable flow within the urinary bladder polyp. This amount of vascularity is highly suggestive that this mass of tissue is a vascular mucosal polyp and not an enlarged median lobe of prostate.
For more on this see: http://www.ultrasound-images.com/urinary-bladder.htm
Also see: http://www.mdguidelines.com/bladder-polyps-benign

Large sebaceous cyst in unusual location

2010-06-23T20:16:00.002+05:30

This sebaceous cyst was huge, at almost 7 x 5 cms. and located on the buttock of this elderly male patient. The ultrasound image shows a typical hypoechoic, solid, mildly inhomogenous appearance. The patient presented with complaints related to the prostate, ignoring this large epidermoid cyst.

Color Doppler image of the same cyst shows no vascularity within the mass. A sebaceous cyst contains oily, gel like semisolid material that has been unable to escape. If infected, this can turn into an abscess.
See:
http://www.ultrasound-images.com/musculoskeletal.htm
for more ultrasound images and description of sebaceous cysts.

Sludge balls in the Gall bladder:

2010-06-22T07:14:00.002+05:30

Found these two echogenic masses in the gall bladder in a young, adult female patient. The question was: are these GB polyps or sludge balls. Change in posture caused them to move.
So, that ruled out polyps. Ultrasound image above shows the sludge balls in the gall bladder (arrows).

Power Doppler image (above) shows no flow within the gall bladder lesions- that again supported my inference that these were not gall bladder polyps.

High resolution ultrasound image (high frequency transducer) gave a good close up view of the gall bladder with the two sludge balls almost "kissing" each other... ;-)
See: http://www.ultrasound-images.com/gall-bladder.htm
for more on this topic.

An interesting case of mass in Riedel's lobe of liver

2010-06-17T22:23:00.004+05:30

At first, ultrasound imaging of the right kidney shows a possible mass in the lower pole of kidney.

The above ultrasound image seems to confirm this possibility.

Imaging of the right lobe of liver shows the mass to be connected to a tongue of liver tissue extending from the right lobe of liver. The mass is at the tip of the long beak of liver tissue draped over the anterior surface of right kidney. This is the typical appearance of a Riedel's lobe of liver with a mass located in its tip.

The gall bladder is normal.
For more on this topic see:
http://www.ultrasound-images.com/liver.htm

Large serous cystadenoma of ovary:

2010-06-14T07:12:00.004+05:30

This patient complained of a swelling of the abdomen and vague pain. Ultrasound imaging of the pelvis showed a huge, cystic mass measuring 14 x 9 cms., with few septae traversing through it. No solid tissue was present within this cyst. The fluid within the cyst appeared to be clear serous type with scanty particulate matter within it. The kidneys appeared normal suggesting no pressure effects on the ureters despite the large size of the cystic tumor. The bladder was clearly identified separate from the cyst, thus ruling out a diverticulum of the bladder. Color Doppler image showed no significant vascularity in the septae. Final diagnosis from these ultrasound images was serous cystadenoma of ovary. With such large masses/ cysts it is not possible to determine the exact origin of the lesion/ or the side from which it originates.

For more on this topic see:
http://www.ultrasound-images.com/ovarian-masses.htm

Seminal vesicle calculus and hemospermia:

2010-06-06T07:58:00.004+05:30

Seminal vesicle calculi are a known cause of passage of blood in semen. This patient had hemospermia. TRUS images show a calculus in right seminal vesicle. Possibly such calculi cause irritation and trauma to the delicate walls of the seminal vesicle resulting in hemorrhage. But surgery may be the final alternative in this case.
View more images of a similar case at:
http://www.ultrasound-images.com/prostate.htm

Fibroid of cervix in 19 week pregnancy:

2010-05-26T08:00:00.005+05:30

These two ultrasound video clips show a large fibroid involving the lower uterine segment and upper cervix in a 19 week pregnancy. The fetal head is seen towards the left with the urinary bladder seen towards the right of the video. The mass was poorly vascular and affected the anterior wall of the cervix. The fetus showed normal body movements and appeared healthy.
See: http://www.ultrasound-images.com/uterus.htm for more similar/ different types of fibroids of the uterus.
(fet= fetus; fibr= fibroid of the cervix; bl= urinary bladder). This video shows a sagittal section of the uterus and cervix.

3-D ultrasound image of appendix of testis:

2010-05-17T15:10:00.003+05:30

B- mode ultrasound image shows the appendix of the testis with surrounding tunica vaginal fluid (a small hydrocele). The testicular appendage appendage is seen projecting into the fluid.

3- Dimensional ultrasound image shows the appendix testis (A) between the head of epididymis and testis. (Images are courtesy of Ravi Kadasne, MD, UAE).

3D ultrasound- an interesting perspective:

2010-04-28T18:03:00.007+05:30

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:
http://www.ultrasound-images.com/urinary-blad der.htm

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:

Non obstructive Vesico-ureteric junction calculus

2010-04-23T16:18:00.004+05:30

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: http://www.ultrasound-images.com/ureteric-calculi.htm

Sonographic visualization of a large ureteric calculus

2010-04-21T19:53:00.003+05:30

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: http://www.ultrasound-images.com/ureteric-calculi.htm for more images and coverage on this topic.

Cystic tumors of the ovary:

2010-04-20T15:10:00.004+05:30

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:
http://www.ultrasound-images.com/ovarian-masses.htm
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:
http://www.ultrasound-images.com/ovaries.htm
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.

Subserosal fibroid

2010-04-19T20:22:00.007+05:30

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:
http://www.ultrasound-images.com/uterus.htm
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.

Ultrasound imaging of Ureteral stent:

2010-04-18T09:44:00.006+05:30

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:
http://www.ultrasound-images.com/ureteric-calculi.htm
For more information on ureteral stents, see:
http://radiographics.rsna.org/content/22/5/1005.full

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:
http://ultrasound-videos.blogspot.com/2010/11/double-j-ureteric-stent-ureteral-stent.html

Polycystic ovaries

2010-04-18T08:00:00.003+05:30

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:
http://www.squidoo.com/polycystic-ovaries

For the sonologist visit: http://sites.google.com/site/drjoea/ovary
for ultrasound case study of Polycystic ovary.
or http://www.ultrasound-images.com/ovaries.htm for more information on ovarian pathology, PCO etc.

A rare variant of fibroadenoma in young adolescents:

2010-04-14T16:46:00.003+05:30

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: http://www.ultrasound-images.com/breast.htm 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.

Early pregnancy with Nabothian cyst

2010-04-08T06:47:00.004+05:30

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: http://www.ultrasound-images.com/early-pregnancy.htm for more such intriguing ultrasound images of early pregnancy.

Also visit: http://www.ultrasound-images.com/uterus.htm#Nabothian_cysts_of_the_cervix
(Discussion and images of multiple Nabothian cysts of cervix)

A sonographic picture review of renal pathology:

2010-04-03T17:23:00.005+05:30

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: http://radiology.rsna.org/content/149/3/665.full.pdf)
For more renal ultrasound pictures and reviews:
See this page: http://www.ultrasound-images.com/kidneys.htm 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.

Gallstones in neonates

2010-04-02T10:30:00.004+05:30

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: http://www.ultrasound-images.com/ped-abdomen.htm (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 http://www.ultrasound-images.com/fetal-abdomen.htm , (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.

Large renal calculus

2010-03-27T07:59:00.003+05:30

Stones or calculi as they are known in medical parlance are present in both kidneys (see ultrasound images above). The right kidney shows particularly large stones filling the collecting system in the upper and lower halves ie: the renal calyces. An Xray would help determine (for academics) if these calculi in the right kidney form what is called a staghorn calculus..a single large stone that fills up the entire kidney. Staghorn or not, this patient needs urgent medical attention, maybe surgery would be the better option.
See: http://www.ultrasound-images.com/renal-calculi.htm for more on this topic.

TRUS (transrectal ultrasound) of prostate utricle cyst:

2010-03-26T16:38:00.006+05:30

Transabdominal ultrasound image of prostate:

Male patient of dysuria, middle aged. Ultrasound image via the abdominal route shows a suspicious lesion in the prostate. This lesion must be reasonably large to be seen on transabdominal imaging of the prostate.

TRUS image of the prostate:

The TRUS image on the left is a coronal-transverse section of the prostate. On sagittal section through the same organ, the cyst is seen well, midline and measuring almost 11 mm. Such cysts can often be troublesome for the patient though in others similar lesions can be asymptomatic.
See http://www.ultrasound-images.com/prostate.htm
for more images of the prostate.
Here is an ultrasound video clip of a similar case:
The arrow points to the prostatic utricle cyst, as seen in this oblique coronal section, as the probe pans from the upper part (base) to the lower tip (apex) of the prostate.

Tendon problems- the biceps and achilles tendons

2010-03-21T16:17:00.004+05:30

The Achilles is the largest and most powerful tendon in the human body. But like the name suggests, it is the proverbial Achilles heel during extreme physical stress. Sudden or unusual exercise or physical activity can cause the rupture of the Achilles tendon. The ultrasound image above shows a full thickness tear through this tendon located just above the heel.
See: http://www.ultrasound-images.com/musculoskeletal.htm
for more.

The biceps tendon is the cord that connects the biceps muscle in the forearm to its insertion in the humerus. Chronic wear and tear with inflammation can cause biceps tendonitis. Ultrasound is now increasingly being used as a cheaper and better alternative to MR imaging in studying tendon pathology. See: http://www.ultrasound-images.com/musculoskeletal.htm
for extensive discussion on this topic.
Both ultrasound images are courtesy of Shlomo Gobi, Israel.

TRUS imaging- some helpful hints

2010-03-17T11:16:00.004+05:30

TRUS or transrectal ultrasound imaging is increasingly being used to investigate male infertility. The sonographic imaging of the prostate, vas deferens, seminal vesicles and ejaculatory ducts using TRUS is crucial in determing pathology of these parts of the male genito-urinary system. But often, the insertion of the endocavitary probe or Transrectal probe, causes considerable pain and hence non co-operation from the patient.
I have found this technique to be useful in almost all cases:
Ask the patient to breath in and out (deeply inspire and expire), and insert the transducer very slowly with each breath.
Another method: ask the patient to strain as though trying to defecate; this causes the anal sphincters to open and makes probe insertion easy.
Visit : http://www.ultrasound-images.com/prostate.htm

Internal jugular vein phlebectasia:

2010-03-12T12:47:00.005+05:30

The internal jugular vein in this Color Doppler image shows mild dilatation in its proximal part.
The transverse section shows marked turbulence in this vein, which is unusual, and suggests some intrinsic pathology which in this case is the large diameter of the vein. Note that the vein is far greater in size than the Common carotid artery near it. You can read more on this topic by scrolling down to the case and images at:
http://www.ultrasound-images.com/vascular.htm

Another Color Doppler video of the ductus venosus

2010-03-07T09:40:00.006+05:30

Another example of the normal ductus venosus. Demonstrating the short vessel (arrow heads) connecting the Umbilical vein to the inferior vena cava via the hepatic vein.

This Duplex doppler image shows the typical 3 waves of the spectral trace of the normal Ductus.
For more details visit:
http://www.ultrasound-images.com/fetus-general.htm

The elusive fetal ductus venosus

2010-03-07T09:26:00.005+05:30

This short Color Doppler video clip shows marked aliasing in the ductus venosus (arrow heads).
The still image below shows the spectral waveform so typical of the ductus in Duplex Doppler.

Succenturiate placenta- a short ultrasound video clip

2010-02-26T18:25:00.004+05:30

This video clip shows an anteriorly located accessory lobe or succenturiate lobe of placenta in a 32 weeks pregnancy. Such a placenta is at increased risk of post partum (post delivery) retention of part of the placenta. The main part of the placenta is seen along the posterior wall of the uterus.
Check: http://www.ultrasound-images.com/placenta.htm for more images and and links on this topic.

Ultrasound- Spermatoceles versus epididymal cysts:

2010-02-15T19:45:00.007+05:30

Left Epididymal cyst

Right spermatocele:

Spermatoceles are the commonest cystic lesions of the scrotum. Both spermatocele and simple cysts of the epididymis are often difficult to distinguish from each other purely on ultrasound. The main difference is usually presence of echogenic debris or particles in the fluid within the cystic mass; particles (inactive sperms) are present in spermatocele (see images above) whilst clear fluid is seen in simple cyst of the epididymis (top most images).
See: http://www.ultrasound-images.com/scrotum.htm
for more on this topic.

Doppler imaging of the carotids is not as difficult as you think:

2010-01-29T15:52:00.017+05:30

The main purpose of studying the carotid arteries (the common carotid artery (CCA), the internal carotid (ICA) and the external carotid (ECA) and lastly the Vertebral artery - is to assess the possibility of stroke due to stenosis and embolism. Any of these conditions in the carotid system, can be fatal at worst or at best result in serious disability including hemiplegia, or partial paralysis.
The following are the main steps to evaluating the carotid arterial system:-

1) differentiate the CCA from the IJV (internal jugular vein)- this is easy as the Jugular veins shows a typical venous flow on Color Doppler imaging and has thin walls which are not visualized clearly on B-mode ultrasound imaging.

2) differentiate the ICA from the ECA. Here the going becomes a little difficult, as the bifurcation of the CCA into the ICA and ECA is not always clearly visualized (see image above).
For more details of step -2 (see: http://www.ultrasound-images.com/vascular.htm )
The temporal tap sign : see Spectral Doppler waveforms of ECA below) is vital to clearly distinguish the ECA from the ICA. Another useful point is the fading of the color flow signal in the ECA during diastole.
See this color Doppler video clip of the "blinking" on and off of the external carotid artery as it pulsates: This is unlike the steady flow in the internal carotid artery (seen in transverse section through these vessels):

3) Thirdly the next step in carotid sonography is visualization of the carotid arterial walls and the measurement of the combined thickness of the inner layer-the intima and the middle layer- the media. This is called IMT or intima media thickness.
Here are some Color Doppler ultrasound video clips of the normal carotid vessels:

The first is a video of the spectral Doppler waveform tracing of the common carotid artery:

This color Doppler spectral ultrasound video shows the typical pulsations of the common carotid artery with moderately high PSV or peak systolic velocity and diastolic flow maintained throughout the period of left ventricular relaxation. The accompanying audio signal displays the typical acoustic characteristics of a moderately low resistance flow.

The above spectral Doppler ultrasound video clip (with sound) of the normal ECA (external carotid artery) shows a high resistance flow with high peak systolic velocity and very low diastolic velocity, almost touching the baseline. Note the sharp sound of the audio as the external carotid artery pulsates.
Lastly, we have a Color Doppler spectral waveform video (with audio) of the internal carotid artery. Note the low peak systolic velocity and high and persistent diastolic flow, that is typical of the low resistance flow of the normal internal carotid artery:

Note the gentle hushed sound of the low resistance flow in this normal internal carotid artery.

Color Doppler ultrasound imaging of the normal vertebral artery:

This vertebral artery (right) shows antegrade flow. Note the breaks in the display of the vertebral artery caused by shadows from the vertebral transverse processes. This artery was imaged from the C-3 to C-6 cervical vertebrae. Based on the location of the segment of the vertebral artery, it is divided into 4 parts:
V-1: from the origin of the vertebral artery to the transverse process of C6 (6th cervical vertebra).
V-2: from the transverse process of C-6 vertebra to the C-2 (2nd cervical vertebra). (The vertebral arteries travel to the cranium via the foramen transversarium of the cervical vertebrae. These foraminae are present in the transverse processes of the cervical vertebrae).
V-3: from the C-2 vertebrae to the dura within the skull.
V-4: from the dura (intracranial) to the confluence of the vertebral arteries to form the basilar artery.
It is the V-2 segment of the vertebral artery that is readily visualized on Color Doppler ultrasound imaging. Yet often the vertebral artery can be difficult to visualize even in the V-2 segment due to the anatomical location of the artery (vertebral bone and cervical musculature). Occlusion or stenosis of the vertebral artery usually occurs at the proximal (V-1) segment. Hence color Doppler ultrasound study of the intertransverse segment (V-2) may often be normal. In stenosis of the subclavian artery proximal to the origin of the vertebral artery, there may be reversed flow through the vertebral artery (a condition known as subclavian steal syndrome). Herein, the arm on the side of subclavian artery stenosis is supplied via reversed flow from the vertebral artery of the opposite side. In the normal individual (color Doppler video clip above), the easiest way to spot retrograde flow is to study the direction of flow in the common carotid artery and the ipsilateral vertebral artery. If both these vessels show same direction of flow (and hence the same color on Doppler flow study), the direction of flow is normal or antegrade.

This spectral Doppler video clip (with audio output) shows the normal vertebral artery (right side).
Some useful links on this topic:
http://www.ajronline.org/cgi/content/full/174/3/815 (free article and images)
http://www.jultrasoundmed.org/cgi/reprint/19/1/47.pdf
http://bjr.birjournals.org/cgi/content/figsonly/77/913/15

Baker cyst and other musculoskeletal ultrasound cases:

2010-01-26T15:06:00.003+05:30

These 3 ultrasound images show a typical large Baker cyst in the popliteal fossa. The cyst measuring more than 5 x 2.5 cms. is the result of an extrusion of the synovial membrane from the knee joint via an opening in the postero-medial aspect of the joint. The result is a synovial membrane lined cyst in the popliteal fossa, just behind the knee joint.
Over a period of time the fluid within the Baker cyst is thick, almost gelatinous, making aspiration difficult. See: http://www.ultrasound-images.com/musculoskeletal.htm
Visit this page : Musculoskeletal ultrasound for a pictorial review of MSK sonography, cases/ and images. The various topics on this page include:
Cruciate liagment tear,
Epidermoid cyst
Transient synovitis
Olecranon bursitis
and inguinal hernia.
Also, I have added images / cases of hemangioma of the abdominal wall,
abductor hallucis hypertrophy
and fractures of the rib and the forearm bones, as well a rare case of intracranial dermoid.
View on...

Carcinoma of gall bladder:

2010-01-17T08:11:00.007+05:30

This was a patient of right hypochondrial pain. Sonography of the liver and gall bladder show (see ultrasound image above), a poorly defined mass in the region of the Gall bladder fossa with a large calculus trapped within the mass. (Image is courtesy of Vikas Shukla, MD, India). This is a typical appearance of late stage (advanced) gall bladder carcinoma with the cancer having spread beyond the confines of the GB wall. For more images and details of this disease, visit:
http://www.ultrasound-images.com/gall-bladder.htm
You can find a lot many images of this other pathologies of the GB at this site. Among the topics I have covered on this page are:
1) Normal variants of the gall bladder 2) Normal sonographic anatomy of GB
3) GB carcinoma 4) Mirizzi syndrome 5) 3-D imaging of GB calculi
Also visit: http://www.ultrasound-images.com/gb-wall.htm
where there are images and description of GB polyps and diffuse as well as segmental adenomyomatosis of gall bladder.
On the page: http://www.ultrasound-images.com/gb-mucocele.htm
you will find coverage of mucocele and pyocele of the gall bladder.
What is the sonographic appearance after cholecystectomy/ surgical removal of the GB?
Visit: http://www.ultrasound-images.com/cholecystectomy.htm

Free floating particles in amniotic fluid- an ultrasound video

2010-01-15T07:32:00.004+05:30

This ultrasound video clip shows multiple particles/ particulate debris floating within the amniotic fluid in a kind of Brownian motion. This was a 3rd trimester pregnancy and free floating particles are a common finding in this phase of gestation. They are said to be result of shedding of vernix caseosa from the surface of the fetal skin. Recent research suggests that presence of free particles in the liqor amnii is a good sign of fetal lung maturity.
More ominous causes of particulate matter in the amniotic fluid include hemorrhage into the liqor.
Reference: 1) http://www.ajronline.org/cgi/reprint/176/3/607.pdf (free article)
2) http://www.jultrasoundmed.org/cgi/content/abstract/2/3/107
3) http://www.ncbi.nlm.nih.gov/pubmed/7506913

For more articles and ultrasound images of liqor / amniotic fluid pathology visit:
http://www.ultrasound-images.com/amniotic-fluid.htm

Have a look at another sonographic video showing these particles dancing in the amniotic fluid:

A nice e-book and sonographic atlas on scrotal calculi

2009-12-18T10:39:00.004+05:30

I have published a nice e-book on scrotal calculi.
It is actually an ultrasound atlas of high resolution images of calcifications/ scrotal pearls.
Check this link: https://www.regnow.com/softsell/nph-softsell.cgi?item=16637-4
This e-book is in MS Power Point format...

In case you wish to get the e-book in PDF format gp to this link:
https://www.regnow.com/softsell/nph-softsell.cgi?item=16637-6
All you need to open this e-book on scrotal calculi in PDF format is adobe reader (a free download from www.adobe.com

Sonography of penile AVM:

2009-12-06T20:38:00.002+05:30

This ultrasound/ Color Doppler image shows multiple vessels in the glans penis and adjacent part of the penis in a middle aged male patient. This patient presented with post coital bleeding from the penis. Such a case and Color Doppler study presenting such appearances are either hardly available or known in medical literature. I have presented more Ultrasound and Color Doppler images of this very rare case at: http://www.ultrasound-images.com/penis.htm
The images show the presence of both arterial and venous flow pattern in the mesh of of vessels
in the glans penis. This is a typical appearance of arterio-venous malformation of the penis.

Some neat ultrasound videos of normal fetal heart

2009-11-24T18:09:00.007+05:30

These short sonographic videos of the fetal heart show the 4 chambers clearly.
(LA= left atrium, RA= right atrium, LV= left ventricle,
RV= right ventricle).

These ultrasound video clips show the beating heart of a late 3rd trimester fetus (34 weeks gestational age).
For images, video clips of fetal heart see this link:
http://www.ultrasound-images.com/normal-anatomy.htm
For ultrasound images of fetal heart pathology and congenital anomalies of the fetal heart click this link:
http://www.ultrasound-images.com/fetal-heart.htm

New additions to my website:

2009-11-14T16:40:00.002+05:30

Just added some nice ultrasound images and links on renal cell carcinoma to my web site at:
http://www.ultrasound-images.com/kidneys.htm
Also an interesting addition to a rare congenital anomaly in a 2nd trimester fetus:
see- http://www.ultrasound-images.com/fetal-face-and-neck.htm
The fetal face shows a proboscis with hypotelorism, part of a series of anomalies in this pregnancy.
Joe.

Fibroadenoma and fibroadenosis of breast:

2009-11-13T07:19:00.003+05:30

On http://www.ultrasound-images.com/breast.htm
I have just posted some nice sonographic images of a rather gray area in the field of breast imaging. There is almost no radiological literature on the subject of fibroadenosis of the breast, both on the internet and in print. At the link above are ultrasound images of both fibroadenoma and fibroadenosis of breast. What I have gathered is that fibroadenosis is a more or less "normal" nodularity of the breast which is usually self limiting (can disappear over a period of a few weeks to months). Clinically fibroadenosis may cause a little tenderness in the breast, with or without palpable nodules (which may be visualized on sonography). However, fibroadenoma of breast is a well established clinical and radiological entity. Fibroadenoma presents as a palpable (often "slippery") small nodule, well seen on ultrasound.
Here is a typical image of fibroadenoma.... (see above).

Another case of ectopia cordis:

2009-09-17T08:36:00.005+05:30

This is one of the best cases of ectopia cordis I have seen. The short ultrasound (sonographic) video of ectopia cordis shows the pulsating heart, outside the thoracic cavity, in both B-mode and Color Doppler imaging. Ultrasound video courtesy of Dr. Dilraj Gandhi, MD, India.

Placental calcification

2009-08-27T22:17:00.005+05:30

Calcification of placenta is a sign of normal degenerative changes taking place in the placenta. This usually happens in the 3rd trimester and is usually of little or no clinical significance. However, if seen earlier (2nd trimster) it might signify placental aging and abnormal degenerative changes. In the ultrasound video attached, there is extensive calcium deposition of the placenta on the maternal surface, (or basal part). Such calcific changes of the placenta do not indicate any placental pathology. See: sonography of placenta for more images and cases.

Hydrocephalus in fetus: aqueductal stenosis:

2009-08-22T20:53:00.007+05:30

Hydrocephalus is a common disease during intrauterine life. Almost 20 % of fetal hydrocephalus is caused by aqueductal stenosis. In the ultrasound image and sonographic video of the fetal head, above, the lateral ventricles and the upper part of the aqueduct of Sylvius (or cerebral aqueduct) are markedly dilated. The 4th ventricle does not appear to be enlarged suggesting obstruction to CSF flow at the level of the cerebral aqueduct. This is called aqueductal stenosis. Other causes of hydrocephalus include Dandy Walker malformation. Ultrasound image and video of aqueductal stenosis are courtesy of Dr. Martin Horenstein, Argentina.

For more such images of fetal brain see: http://www.ultrasound-images.com/fetal-brain.htm

Sonography in cervical insufficiency:

2009-07-01T21:29:00.009+05:30

This ultrasound image of gravid uterus shows the cervix measuring 1.1 cms. in length (shortening) with dilatation (3mm.) of the internal os. The image was taken using the transvaginal route, using a Toshiba Xario ultrasound system. Dilatation with effacement of the cervix are diagnostic of cervical insufficiency. The management in this case would mean cervical cerclage.
See: Clinical aspects of cervical insufficiency (free article)
Image courtesy of Dr. Gunjan Puri, India.

From the virtual 3D image to real life size models of the fetus

2009-07-01T19:24:00.013+05:30

Just saw this interesting link: http://www.dailymail.co.uk/sciencetech/article-1195703/The-stunning-new-technology-allows-parents-hold-life-size-model-unborn-child.html
It seems a PhD student Jorge Lopes has found a method to create 3D life size plaster models of the fetus as seen on 3D Ultrasound and MRI imaging. The replicas can help the mother identify and bond more intensely with the baby in the womb. Maybe, in the not too distant future, we may see Obstetricians and radiologists prepare plaster models, as easily as thermal print images of the fetus!!

An aften ignored setting during sonography:

2009-06-13T08:48:00.010+05:30

One of the most prominent settings control on any ultrasound machine is the gain knob. Yet, this happens to be one of the most unused. This knob in conjunction with the TGC or Depth gain is very useful. A good example is the female child. Here, transabdominal ultrasound to image the ovaries and small uterus can be a real pain. But lower the gain or Depth gain, and you should be able to see the ovaries, even if very small. It works in most cases.

Observe the images of the thyroid here:
With high gain settings, the margins of the thyroid and fine detail are lost. With too low gain, most of the thyroid becomes poorly visible. Optimal gain settings show both internal and marginal details. Another observation: when Color Doppler imaging is switched on, the overall gain goes down.. the gain has to be increased to compensate for this.

Sonography of fetal kidneys with Autosomal recessive Polycystic kidney disease

2009-06-09T08:29:00.005+05:30

This fetal kidney shows typical features of ARPKD (autosomal recessive polycystic kidney disease) also called infantile polycystic kidney disease. This congenital disease of the kidney can be present from as early as fetal stage and may be detected as late as in childhood.
The fetal kidneys in this case show minute cysts with grossly hyperechoic kidneys.
Read more at: http://www.ultrasound-images.com/fetal-urogenital.htm

Sedimenting echoes in urinary bladder:

2009-06-06T15:46:00.010+05:30

Sediment producing echogenic debris in the urinary bladder can be caused by a number of factors.
Excessive amounts of Phosphate crystals in the urine is one cause. It can also be due to pyuria or pyogenic material in the urine secondary to urinary tract infection; sometimes it may be caused by hematuria (blood in urine) or chyluria following filariasis. Other causes include uricosuria (uric acid excess) or increase in oxalate crystals. This ultrasound image shows debris in the distended urinary bladder, gravitating to the dependent part.
This ultrasound image is courtesy of Dr. Ravi Kadasne, UAE.
For more sonographic images of the urinary bladder visit: http://www.ultrasound-images.com/urinary-bladder.htm
Case-2:
Here is a nice real time B-mode ultrasound video clip showing freely mobile particles in the urinary bladder:

This patient has active urinary tract infection with cystitis. The particulate matter in the urinary bladder are the result of debris- both pyogenic material and phosphate crystals floating within the urine.

This is a still image of the same case (as the video above):

Fine particles are seen throughout the urine in the bladder.

Ultrasound video of ectopia cordis

2009-04-30T14:40:00.007+05:30

This sonographic video shows a fetus with severe kyphoscoliosis and pulsating fetal heart lying almost outside the fetal thorax. Note the close relation between the fetal heart and fetal bladder.

The fetal abdomen shows almost no contents. The aborted fetus showed omphalocele with ectopia cordis. There was only a thin transparent membrane overlying the fetal heart, lying almost entirely outside the thorax.

Bicornuate uterus with pregnancy

2009-04-18T07:02:00.010+05:30

These transvaginal sonographic images show a bicornuate uterus with an early gestation sac in the right horn (cornu). Ultrasound images also show decidual tissue in the left horn. These patients can have normal pregnancy to full term, but must be carefully followed, as some may undergo a miscarriage.
Images courtesy of Dr. Jaydeep Gandhi, Mumbai, India.
Reference: http://www.ultrasound-images.com/early-pregnancy.htm
(more images and details)

Ultrasound images of retrocaecal appendix

2008-09-21T08:39:00.008+05:30

the fluid filled caecum is easily visualized

the normal appendix (long section) seen posterior to the caecum

the appendix in cross section lying posterior to the caecum (retrocaecal appendix).
All 3 images taken using a Philips IU22 ultrasound system, courtesy of Dr. Ravi Kadasne, UAE.
For more images of the appendix, visit our website at:
http://www.ultrasound-images.com/appendix.htm

Intratesticular varicocele

2008-08-01T15:10:00.003+05:30

Intratesticular varicocele is the presence of a dilated vein within the testes, usually with coexisting extratesticular varicocele. In these nice ultrasound and color doppler images, Shlomo Gobi, Israel demonstrates an intratesticular varicocele of the left testes. The affected vessel (seen on color flow images) shows typical venous spectral flow pattern and reflux on Valsalva manoevre. The patient, in this case also had an extratesticular varicocele (not shown in these images). See the link: http://drjoea.googlepages.com/scrotum for more on this topic.
Also see: http://www.ultrasound-images.com/scrotum.htm for sonographic images and ultrasound case studies of the scrotum.
Images in this case are taken using an ATL HDI 3000 color doppler machine.

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Ultrasound imaging in colitis:

2008-07-26T12:08:00.002+05:30

This is a nice ultrasound image of colitis in a child. Observe the grossly thickened wall of the caecum and the associated mesenteric lymph node enlargement. This child also had other findings including round worm infestation and appendicitis.

See: http://www.ultrasound-images.com/colon.htm (for full case and more ultrasound images).

Image courtesy of Dr. Gunjan Puri, Surat, India.

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Gastric wall thickening

2008-07-24T15:22:00.000+05:30

These ultrasound images of the stomach wall show considerable thickening of the pyloric wall (13 to 16 mm. thickness). Such thickening of stomach wall is seen in infiltrative lesions sucha s adenocarcinoma of the stomach and lymphoma. Images courtesy of Dr. Ravi Kadasne, UAE.
For more images of the stomach and GIT visit: http://www.ultrasound-images.com/git.htm

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Focal fatty change of liver:

2008-07-21T15:55:00.004+05:30

Focal fatty change of the liver is caused by the combined effect of steatosis with hepatic ischemia. This ultrasound image shows a typical focal fatty infiltration of the right lobe of liver. Note the absence of mass effect which distinguishes focal fatty change from other space occupying lesions of the liver. Image courtesy of Dr. ravi Kadasne, UAE. The ultrasound machine used here is the IU 22 from Philips.

Reference: http://www.ncbi.nlm.nih.gov/pubmed/7350047

Also see the link: http://www.ultrasound-images.com/metabolic.htm for more sonographic images of fatty liver and other hepatic metabolic diseases.

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Nephrocalcinosis

2008-07-03T17:25:00.001+05:30

In this newest page of my gallery of ultrasound images, I have added some pictures of nephrocalcinosis in neonate. Check: http://www.ultrasound-images.com/ped-abdomen.htm
The images are self explanatory and show a relatively common problem in neonates following long term (weeks or months) of parenteral therapy besides certain medications. On another page, I describe the same disease in adults (see: http://www.ultrasound-images.com/renal-calculi.htm ). But it is in neonates that the pathology is so clearly evident on sonography, the reason being the better visualization of the pediatric abdomen and also the extent of involvement of the kidneys. In fact, it is often difficult to distinguish nephrocalcinosis from renal calculi, so dense is the extent of calcification.
Editor.

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An update of the newest additions to my website

2008-06-30T14:43:00.001+05:30

Dear readers,

Just added a nice case, of pelvic kidney in a neonate at: http://www.ultrasound-images.com/ped-abdomen.htm The child had an imperforate anus with suspected recto-uterine fistula. Placed the high resolution ultrasound probe on the pelvis and saw a pelvic kidney, the left kidney not being seen in the left renal fossa. A clear example of renal ectopia! I have added 7 ultrasound images for this case of pelvic kidney at the link above. This page is freshly created and devoted to pediatric abdomen. What was interesting was that the pelvic kidney appeared round or oval in shape, suggestive of some degree of malrotation of the renal axis.

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A sonographic atlas of the appendix-in ebook format

2008-06-26T22:19:00.000+05:30

Here is a great (e-book) Atlas of sonographic images (version 1.0) of the appendix in Microsoft Power Point (.pps format). Covering almost all major pathologies of the appendix, this will be useful as a guide to normal and the abnormal appendix. It contains more than 25 high resolution ultrasound images, all of which are well labelled and captioned, leaving little to the imagination. Among the topics covered in this e-book are 1) normal appendix 2) acute appendicitis 3) chronic appendicitis 4) subhepatic and pelvic locations of the appendix 5) perforation 6) color doppler imaging of the appendix 7) appendicolith etc. It can be downloaded instantly for a mere $ 5.0 via secure site.
Or perhaps you might want to download another version 2.0 of this sonographic Atlas priced at a mere $ 7.0 at this secure site. This e-book (version 2.0) is in .pdf (adobe acrobat reader) format and can be downloaded at:
https://www.regnow.com/softsell/nph-softsell.cgi?item=16637-3
Adobe reader can be downloaded for free from http://www.adobe.com/
Version 2.0 contains more than 40 high res ultrasound images of appendicular pathology.

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Gall bladder sludge in neonate:

2008-06-22T19:43:00.001+05:30

These ultrasound images of a neonatal abdomen show a large amount of dense sludge in the gall bladder. Such sludge formation in neonates is often seen following parenteral nutrition and is usually self resolving.
Reference: http://www.jultrasoundmed.org/cgi/content/abstract/6/5/243
Visit the page: http://www.ultrasound-images.com/pediatric.htm for ultrasound images of pediatric and neonatal diseases. At present I have added a few cases of neonatal intracranial/ germinal matrix hemorrhage and its complications, notably porencephaly. There is also a nice case of inguinal hernia containing ovary.

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A web page of ultrasound images of renal calculi (kidney stones)

2008-06-22T09:55:00.002+05:30

Just added some great images of renal calculi (commonly known as kidney stones)..from the usual to the unusual staghorn calculi. Just visit: http://www.ultrasound-images.com/renal-calculi.htm Staghorn calculi or triple phosphate calculi can be silent until they reach phenomenal proportions like this calculus which occupied half of the kidney. Luckily, in the case described at the link above, there was only mild hydronephrosis of the affected kidney.
Editor.
http://www.ultrasound-images.com/index.html

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Multinodular goiter

2008-06-08T09:33:00.001+05:30

These ultrasound images of a middle aged female patient reveal: a) multiple solid nodules of varying sizes in both lobes of the thyroid gland b) coarsening of the echotexture of the thyroid gland c) cystic lesions scattered throughout the gland d) diffuse increase in size of the thyroid.

e) color doppler imaging reveals moderate augmentation of the vascularity of the thyroid. These findings suggest multinodular goiter of the thyroid. For more ultrasound images of thyroid pathology, visit: http://www.ultrasound-images.com/thyroid.htm

-- Editor

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Cystic lesions of the thyroid

2008-06-07T14:27:00.001+05:30

Thyroid cyst with nodule within it:

Ultrasound images of the thyroid revealed a large cystic lesion with an irregular solid nodule along the margin of the cyst. Doppler imaging shows absence of significant vascularity in the nodule. This means that the nodule may be formed by debris within the cystic mass, typically seen in colloid cysts of the thyroid. For more such interesting ultraound images and case studies of the thyroid, visit: http://www.ultrasound-images.com/thyroid.htm
Images courtesy of Dr. Ravi Kadasne, UAE.
---Editor.

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Ultrasound images of retrosternal goiter

2008-05-31T14:43:00.002+05:30

Xray images show a large rounded opacity in the upper mediastinum.

Ultrasound images of the thyroid show a huge gland, with inhomogenous appearance and calcification, extending to the retrosternal region. The thyroid measures more than 5 x 8 cms. These images by Mr. Shlomo Gobi of Israel were taken using the endocavity probe to better visualize the retrosternal extension of the thyroid goiter. Xray images show the goiter in the retrosternal region. You can view more such intersting ultrasound images of thyroid diseases at:
http://www.ultrasound-images.com/thyroid.htm

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Interesting ultrasound images of the thyroid:

2008-05-16T10:55:00.000+05:30

I have added some really nice sonographic images of the thyroid in my ultrasound image gallery.
See: http://www.ultrasound-images.com/thyroid.htm Among the cases (and ultrasound pictures) I have discussed here are: 1) multinodular goitre 2) Hashimoto's thyroiditis 3) thyrotoxicosis 4) hemithyroidectomy 5) sublingual thyroid. The last is a rare enitity and I have added 6 high res. images of this lesion.
Hashimoto's thyroiditis is a common condition that afflicts a large percentage of the populace here in S. India.
---Editor

Endometrial hyperplaisa in a child

2008-04-26T10:32:00.000+05:30

These ultrasound images of the uterus in a 12 yr. old female child with intermittent bleeding per vagina reveal- a) markedly thickened endometrium (3.3 cms). b) color doppler images reveal vascularity within the thickened endometrium. These images suggest endometrial hyperplasia (benign) in a child. The cause is presumably, increased oestrogen activity. Images courtesy of Dr. Richa Dikshit, India.
Visit: http://www.ultrasound-images.com/pediatric.htm for interesting pediatric and neonatal sonography images.

Fetus nibbling its own cord

2008-03-27T11:40:00.001+05:30

The fetus is seen nibbling the umbilical cord in this 3D ultrasound image courtesy of Dr. Arun Mahajan, Delhi, India.

A few moments later the cord falls away.

For more such images visit:

http://www.ultrasound-images.com/amusing-pics.htm

Some interesting sonographic images:

2007-11-21T14:43:00.000+05:30

There is a whole load of ultrasound images added to my site at:
http://www.ultrasound-images.com/ The site has been pepped up with a new look and easy to use interface. I have added a search box on the home page to sift through the contents of the site. I wanted to add a slide show option for the images but found it problematic. As before, all images are free to view.
1) At the page: http://www.ultrasound-images.com/fetus-general.htm is a case of IUFD with Spalding’s sign. Many books these days simply don’t have images of this sign.
2) At http://www.ultrasound-images.com/early-pregnancy.htm , there is nice case of bicornuate uterus with a gestation sac in one cornu.
3) At http://www.ultrasound-images.com/fetal-brain.htm : I have added a rare image of Vein of Galen aneurysm.
4) At: http://www.ultrasound-images.com/fetal-heart.htm : there are new cases of fetal cardiac anomalies including AVSD and pericardial mass. I hope to add some nice fetal echo videos to this section, but need a little help to edit mpg videos. Can somebody help me?
There are plenty more pictures but, I’ll tell you later.
JOE ANTONY, MD.

Announcing my new ultrasound images website:

2007-10-04T14:58:00.000+05:30

Hi all,
After having observed the runaway success of my older site (the ultrasound gallery) at: http://drjoea.googlepages.com/ I have now shifted the action to my new 200 GB capacity site at:
http://www.ultrasound-images.com/ The main features of the new web site is:
1) plenty of byte space.. you can expect loads of free high resolution sonographic images here, plus ultrasound videos when I get them.
2) More bandwidth for web access.
3) Faster download times
I have added a couple of cases already. See:
a) http://www.ultrasound-images.com/fetal-brain.htm where I discuss a fetal anomaly, Dandy-Walker malformation.
b) http://www.ultrasound-images.com/musculoskeletal.htm where I have a case of Medial Cruciate ligament injury.
Dr.Joe Antony, MD.

Viral fever epidemic in Kerala

2007-09-19T22:06:00.000+05:30

Kerala is once again in the grip of a viral fever. This time the situation is worse than last year (2006). All the more mysterious is the fact that most lab tests are negative for most known pathogens (viruses) and the cause is presumed to be chikungunya virus. Then why are tests for chikungunya negative. Possibly, this time (May to Sep 2007), the virus is a mutated sub-strain. Worst is the distribution of the epidemic; whole villages and towns in the rural areas are affected, sparing almost no one. Surprisingly, children are relatively spared with the elderly worst affected. As before, most patients have symptoms of severe bodyache, low grade fever and joint pain and swelling.
Treatment:
1) bed rest
2) Meftal 500 mg (oral) -2 to 3 times a day is found to be VERY effective in controlling the joint pain and bodyache. (Meftal- is mefenamic acid with paracetamol). Caution: not be taken on empty stomach. May cause gastritis.
3) plenty of fluids
Note: Please consult your physician before starting treatment.

18th September- update

2007-09-18T19:13:00.000+05:30

Have a look at some of the best 3D images of Cleft palate (with cleft lip) available on the internet at: http://drjoea.googlepages.com/obstetric-3 This is 3D sonography at its best. Also added to the free gallery: a new page on lesions of the pancreas at: http://drjoea.googlepages.com/pancreas The first case here is one on pancreatitis.
Dr. Joe Antony, MD

Update- 13th september 2007

2007-09-13T20:14:00.000+05:30

At the link: http://drjoea.googlepages.com/nice-pictures
I have added a few images of a nice case of a hypertrophied clitoris in a female fetus. Also, an amusing picture of fetal activity..(check it out).

Update for 11th september 2007:

2007-09-11T21:25:00.000+05:30

At the link: http://drjoea.googlepages.com/nice-pictures I have created a new page on my free ultrasound gallery that deals with interesting, amusing and insightful sonographic images. Enjoy..and good scanning to all fellow imagers.
And, here are some nice pictures from Dr. Vikas Arora, India. They show that the fetus often aspirates and regurgitates fluid from the nose and mouth.

Ultrasound images large varicocele

2007-09-11T14:10:00.000+05:30

This 45 yr. old male patient had loss of libido. Ultrasound images show a large varicocele of the left side.

The veins measured 5.2 mm. in the supine position!

You can view more sonographic and color doppler images at:
http://drjoea.googlepages.com/scrotum

Updates for 9th September 2007:

2007-09-09T16:27:00.000+05:30

Check: http://drjoea.googlepages.com/musculoskeletal for ultrasound images of Achilles tendonitis.
Also have a look at the images posted at:
http://drjoea.googlepages.com/obstetric-3 where I present a case of fetal abdominal cyst.
As usual, you'll find free high resolution images.
Dr. Joe Antony, MD.

Sonography of deep vein thrombosis:

2007-09-04T20:09:00.000+05:30

Check out some lovely and self-explanatory, color doppler and gray-scale ultrasound images of Deep vein thrombosis at: http://drjoea.googlepages.com/vascular These images are well labelled and of the highest resolution. The added text describes the various techniques used to diagnose thrombosis.
Dr. Joe Antony, MD.