Sonography of bilateral renal agenesis in a fetus:

This is yet another case of bilateral renal agenesis.
This case is presented by Dr. Ajit Athale, MD, from Baroda, India. He describes the findings nicely. These images are of a fetus of 28 weeks.
Here we can see the "LYING DOWN" ADRENAL SIGN, the diagnostic finding ofof renal agenesis. In renal agenesis, the adrenals are free to occupy the space left in the renal fossa. So instead of being horizontal & being contoured frombelow by the upper pole of kidneys, they become vertical and flat, literally, plate like. This flattening of the adrenals is an indirect sign that the kidneys did not develop in the flanks. In fact, even on postmortem, I (Dr. Ajit) have seen pathologists mistaking gross specimen of discoid shaped adrenals as kidneys in case of bilateral renalagenesis, only to be corrected later on- by microscopy.This sign is of particular importance when one is notsure as to presence or absence of kidneys.Sometimes domes of diaphragm can masquerade as upperpoles of kidneys, especially when fetus is breathing (as shown in one of my pictures).This fetus also had club foot.

For more on this topic and view some more ultrasound images of renal agenesis, please visit my gallery of ultrasound images at:
http://drjoea.googlepages.com/obstetric-2

Your Ad Here

An unusually good image of a copper-T-IUCD:

This coronal section transvaginal ultrasound scan image of the copper-T, an IUCD that is commonly used in India, beats everything I have seen before. Image by Dr. Gunjan Puri, Surat, India. The T- shape is seen very well. Lovely image of an IUCD, Dr.Gunjan.

The case for sonohysterography:

For some time, sonohysterography was considered essential to diagnose endometrial polyps. Until, high resolution ultrasound and endovaginal probes challenged that assumption with stunning images on routine ultrasound scan. These images by Dr. Allen Worrall, Alaska, USA, show an instance, wherein, sonohysterography may well be advisable, to confirm the presence of a doubtful polyp

A comparison of sonographic features of intrauterine contraceptive devices (IUCD’s):

The Mirena IUCD

Mirena IUCD used in USA

Copper - T, IUCD

The copper- T, IUCD used in India.

Dr. Allen Worrall, of Fairbanks Clinic, Alaska, USA has this to say about IUCD or IUDs:
The hormone-containing Mirena IUCD is quite popular in the US now. It has a somewhat different sonographic signature than other IUCDs. (in the US, IUD mostly stands for IntraUterine Device). The presence and location of the Mirena IUCD is mostly from its acoustic shadow - you tend not to see the actual echo of the device very well.

This case is interesting because as I (Dr. Allen) scanned the uterus transversely, starting at the cervix, I could see the string as a bright echo with hardly any shadow, then suddenly there was no echo but an intense shadow, representing the shaft of the IUCD. The Mirena has two curved arms at the top that are supposed to extend out when the IUCD is properly positioned. On transverse view of the upper part of the uterus I could see that the arms were properly deployed.

This patient had this IUCD or IUD only for a few weeks and was complaining of cramps and bleeding. The doctor who put the IUD in wanted to be sure it was in proper position. I reported that it was OK.

This IUD was put in place because the patient was complaining of excessively heavy menses, and the Mirena IUD, because of its hormone content often results is less bleeding. Interesting to me, who can remember when IUDs had the reputation of causing abnormal, excessive, prolonged bleeding. Now they are used to treat those symptoms.
Images courtesy of Dr. Allen Worrall and Dr. Joe Antony.

The case of the knotty cord:

The umbilical cord connects the placenta (and thus the mother) to the baby. Occassionally, the cord can get knotted, presenting a real danger to the baby, by strangulation of its lifeline. We present a case of knot of the cord, diagnosed prenatally by color doppler imaging. The post delivery snaps confirm the presence of true knot of the cord. Images courtesy of Dr. Gidda Ramaiah, India. Check this link for pics and description: http://drjoea.googlepages.com/obstetric-2

On the importance of first trimester sonography:

Dr. Allen Worrall of Alaska, USA, has this to say about the role of the early first trimesterultrasound scan. The First ultrasound always sets the gestational age. Subsequent ultrasounds determine the growth of the baby. You never change a due date based on a second or third ultrasound (assuming in all cases of course that the first ultrasound was done correctly, by someone who knows what they are doing, and using a machine that accurately makes the measurements).

Why is the first ultrasound always the most accurate in determining gestational age? Because we use the size of the baby to determine gestational age, and we do not all weigh exactly the same at birth. The closer we get to term, the more our "genetic heritage" is manifesting itself to make us small, average, or large. Or to put it another way: at around 8-10 weeks gestation we all are about the same size for a given gestational age. At 34-36 weeks gestation some of us are going to be small for our gestational age, some of us are going to be just about the size expected for our gestational age, and some of us are going to be large for our gestational age.

Mean Sac Diameter (MSD) is not as accurate as CRL. MSD is best used at very early gestational age when all you can see is the yolk sac, perhaps a heart beat, but you really cannot see the embryo yet. We are talking about 5w and a few days, by high resolution transvaginal scan.

From me: that was beautiful; you could not have put it better.