Ultrasound imaging of popliteal vein thrombosis

This is a rather puzzling case. 54 year old male patient with right calf pain.
The right femoral vein shows this highly pulsatile nature (observe those spectral Doppler waveforms).
Perhaps they can be explained by the transmitted pulsations of the adjacent femoral artery. But I am not fully convinced. Those pulsations were seen even in the GSV (great saphenous vein). See images below:
The right femoral artery:

The right GSV (great saphenous vein): There is no normal venous flow pattern- only a spiky pulsation- more arterial in nature:

The right femoral vein:

Normal compressibility of the right femoral vein:

The femoral vein and artery in long section color Doppler flow:

Spectral Doppler trace of the right femoral vein- again that pattern

I tried augmentation by compressing below the calf- weak augmentation of the femoral vein:

And now the right popliteal vein:
The upper half of the popliteal vein shows good flow on color Doppler imaging:

Spectral waveform- normal flow in upper part of popliteal vein:

Strong venous waveforms again in the upper half of the popliteal vein:

The lower half of the popliteal vein shows a different picture with a partial thrombosis likely. There is almost no flow in this part of the vein. The thrombosis of the popliteal vein can explain the calf pain.

 Comparing the upper half and lower part of the affected popliteal vein- normal flow in the upper half vs poor or no flow in the lower part. That echogenic matter in the lower part is possibly the thrombus!

Sonography of right renal mass:

This huge right renal (upper pole) or suprarenal mass measured 8 x 7 x 12 cms. approximately. Looking at the ultrasound images, it looks like an echogenic homogenous mass. Is it a renal angiomyolipoma or a suprarenal tumor?

It (the tumor) sure looks poorly vascular...Even with very low PRF settings, I could barely see any vessels.
For more on renal angiomyolipoma see: http://www.ultrasound-images.com/kidneys.htm#Renal_angiomyolipoma_-%28AML%29_of_right_kidney

Right inguinoscrotal hernia

This elderly male patient has a large Rt. inguino-scrotal swelling with all the typical signs of an inguinoscrotal hernia.
The ultrasound images show a "mass" within a large fluid with bowel and mesentery suspended above the right testis. This is a typical finding in male indirect inguinal or inguinoscrotal hernia.

The right testis appears to be normal in size and shape despite the huge hernial sac compressing it.
See a similar ultrasound case at:
http://www.ultrasound-images.com/scrotum.htm#Indirect_inguinal_hernia_forming_large_Right_scrotal_swelling

A case of obstructive jaundice

This is an elderly male diagnosed clinically as obstructive jaundice.
The CBD and intrahepatic biliary tree appear dilated. The pancreas was poorly visualized due to bowel gas.
What is your opinion? I could not spot any calculus in the Common bile duct (CBD). So I must presume the obstruction to the CBD must be in the pancreas. :-)
(Click on the images to view full size).

Pedunculated fibroid of uterus:

This fibroid is connected to the fundus of the uterus by a thin but obvious stalk or peduncle.
Ultrasound images of this pedunculated fibroid are shown below. Vessels supplying the fibroid are visualized in the color Doppler image:

Quiz- ultrasound imaging of adult female patient

This married lady has 5 weeks amenorrhoea. She complains of pain in the pelvis but has no history of bleeding per vagina. Ultrasound images of the pelvis are shown below. What is your diagnosis? Her urine tested positive for pregnancy.
Uterus- transabdominal image:

Transvaginal images of uterus and right adnexa are shown (just above) and below:
                                               


                                                                

Color Doppler images of the right adnexal region below:
The color Doppler image below shows the "leash sign".. so typical of an ectopic pregnancy. This sign suggests that instead of the ring of fire, there is a leash of vessels leading to the ectopic sac (on color Doppler imaging).