A different sonographic approach to pick up ureteric calculi:

This is an ultrasound image of a distal ureteric calculus. What makes it so special is that it was diagnosed by transvaginal scan. Dr. Gunjan Puri, MD, Surat, India finds this approach, helps detect ureteric calculi which are difficult to pick up by transabdominal scan. Color doppler helps confirm the diagnosis with the typical twinkling sign.
You can see more such ultrasound images of the urinary tract at:http://drjoea.googlepages.com/urinarytract

The mystery of the periprostatic vessels:

Whilst doing a TRUS (Transrectal Ultrasound scan) for the prostate, seminal vesicles, etc., I have often come across these large, anechoic, tubular structures (V) on either side of the lateral lobes of the prostate. After reading extensively on the topic, I have found few answers. In this transverse section, the tubes (V) are seen well.
Note the inhomogenous echotexture of the prostate, with some hyperechoic area in the left side of the inner gland s/o chronic prostatitis. The patient was a young man with history of chronic dysuria and lower abdominal pain.























On sagittal section, the structures can be traced anteriorly and inferiorly.. definitely not the ureters.









Oblique transverse sections show the vessels communicating with their counterpart from the other side. Obviously these are vessels, most likely to be the periprostatic venous plexus.

The periprostatic veins communicating freely anterior to the prostate.

Diagnosis: prostatitis with dilatated periprostatic veins.

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

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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.