Portal cavernoma Vs portal biliopathy- a sonographic case study

This elderly male patient had generalized discomfort in the abdomen with vague pain in the epigastrium. No h/o alcoholism.

Useful reading : 1) Sonoworld article on portal cavernoma

  2)Radiopedia article on cavernous transformation of the portal vein

 3) MRI in portal biliopathy

4) RSNA - radiology article portal biliopathy

Severe left internal carotid artery stenosis:

This patient has the right hemiplegia following a cerebrovascular accident involving the left parietal lobe. Color Doppler imaging of the carotid tree shows severe stenosis, 80 to 90%, involving the left internal carotid artery close to its origin from the common carotid artery.
The colour Doppler image below shows the internal diameter of the left internal carotid artery is less than 3 mm near its origin. This is definitely abnormal and shows severe stenosis.

spectral Doppler trace of the left common carotid artery appears relatively normal.

however, the left internal carotid artery shows a definite evidence of severe stenosis with peak systolic velocity reaching up to 224 cm/s suggesting greater than 90% stenosis at this level. The normal peak velocity of flow at the internal carotid artery should be less than an and 120 cm/s.

the video below shows the characteristic spectral waveform seen in this case. The characteristic high pitch sound of the Doppler waveform and high velocity flow at the site of left internal carotid artery stenosis can be appreciated.

For more on this topic: http://www.ultrasound-images.com/vascular.htm#Internal_Carotid_artery_occlusion

A case of painful left scrotal mass

This middle aged male patient has a left scrotal mass which is tender and painful. What do you opine?
The mass showed plenty of mobile particulate matter and is located on the upper pole of the left testis.

Answer: this is a case of left scrotal abscess with the purulent collection being within the left tunica vaginalis sac. Aetiology of this left scrotal collection appears to be tuberculous in origin. This can explain the lack of significant vascularity within the left scrotum and the left testes.
See similar lesions at: http://www.ultrasound-images.com/scrotal-infections.htm

what is your diagnosis of this cystic lesion?

This middle aged woman had a history of fibroid of the uterus diagnosed a few years before. Now she presented with discomfort in the pelvic region. Ultrasound images of the uterus taken both transabdominally and via the transvaginal route are shown below:

Firstly, determine the location of this lesion and then try to arrive at a diagnosis based on the history and the ultrasound pictures shown above.
Answer: this cystic lesion is a cystic degeneration of an earlier or pre-existing fibroid of the uterus.
Cystic degeneration of the fibroid is a known medical entity and is a form of necrosis of the solid tumor matter within the fibroid.
For more on fibroids: http://www.ultrasound-images.com/uterus.htm
Also: http://cochinblogs.blogspot.in/2010/11/fibroids-of-uterus-leiomyoma.html
Also this article on cystic change in fibroid by IJRI

Quiz- fetal kidneys in 34 weeks pregnancy

What do you opine on this 34 week old fetus? Specifically, what is your diagnosis on observing the ultrasound images of the fetal kidneys?

The answer: this fetus shows bilateral enlarged echogenic kidneys which form a major part of the volume of the abdomen. Minute cystic areas are also seen within the kidneys of this fetus if one scrutinises the images carefully. These findings are consistent with a diagnosis of autosomal recessive polycystic kidneys of the fetus.
For more on this visit: http://www.ultrasound-images.com/fetal-urogenital.htm#Fetal_polycystic_kidneys_%28autosomal_recessive_polycystic_kidney_disease-_ARPKD%29

Quiz- a case of abdominal and pelvic pain

This is a 19 year old, unmarried female patient with history of pelvic pain. Her LMP was 3 weeks ago.
What do you opine based on these ultrasound images of the pelvis? Her liver, spleen and kidneys, pancreas showed normal appearances.Click on the images to view full size: