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).

Carotid Doppler- format or template- carotid plaque

Color Doppler ultrasound study of the carotid arteries was done:

Template for color Doppler study- carotid plaque

  

	RT. CCA	RT. ICA	RT. ECA	LT. CCA	LT. ICA	LT. ECA
Normal PSV (reference) cms./sec	< 100	54-88	77-115	<100	54-88	77-115
PSV Cms/sec.	87	38	49	69	52	68
EDV End diast. vel. (cms./sec.)	24	8	2	13	22	12
ICA/CCA PSV ratio (normal= <2)
% of stenosis
PLAQUE APPEARANCE					1.7 mm. Plaque
IMT (intima medial thickness). Normal= <0.9 mm.	0.7 mm.			0.8 mm.

	RT. VERTEBRAL ART.	LT. VERTEBRAL ART.
PSV (cms./sec)
DIRECTION	Antegrade	Antegrade

OPINION:

USG scan suggests –  No evidence of stenosis in carotid arteries, vertebral arteries of both sides.

Normal intima-medial thickness seen in common carotid arteries.

Normal flow seen in carotid and vertebral arteries.

A small plaque of 1.7 mm. thickness seen in 2 mm. area of the lateral aspect of the left internal carotid artery close to origin. No significant stenosis is present.

SUGGEST: clinical correlation and follow up.

CT or MRI angiography may be done to confirm these findings.

Carotid Doppler ultrasound report format or template:

Ultrasound and color Doppler study of the carotid arteries was done:

  

	RT. CCA	RT. ICA	RT. ECA	LT. CCA	LT. ICA	LT. ECA
Normal PSV  (reference) cms./sec	< 100	54-88	77-115	<100	54-88	77-115
PSV Cms/sec.	97	47	70	68	53	74
EDV End diast. vel. (cms./sec.)	46	28	16	25	32	12
ICA/CCA PSV ratio (normal= <2)
% of stenosis	Nil.	nil	nil	nil	nil	Nil
PLAQUE APPEARANCE	Nil	nil	Nil	nil	nil	Nil
IMT (intima medial thickness). Normal= <0.9 mm.	1.0 mm.			0.7 mm.

	RT. VERTEBRAL ART.	LT. VERTEBRAL ART.
PSV (cms./sec)
DIRECTION	Antegrade	Antegrade

OPINION:

USG scan suggests –  No evidence of stenosis in carotid arteries, vertebral arteries of both sides.

Normal intima-medial thickness seen in carotid arteries.

Normal flow seen in carotid and vertebral arteries.

SUGGEST: clinical correlation and follow up.

CT or MRI angiography may be done to confirm these findings.

REFERENCE:

CRITERIA FOR CAROTID STENOSIS :

PSV:

·  Normal: ICA PSV <125 cm/s and no plaque or intimal thickening is visible.

·  <50% stenosis: ICA PSV <125 cm/s and plaque or intimal thickening is visible.

·  50-69% stenosis: ICA PSV is 125-230 cm/s and plaque is visible.

·  >70% stenosis to near occlusion: ICA PSV >230 cm/s and visible plaque and lumen narrowing are seen      

Report format or template- Doppler ultrasound atrophic kidney

Ultrasound and color Doppler report template/ format of atrophic left kidney

 

1)KIDNEYS:

RT.--    8.4 x 4.0 cms ;

LT.--    4.9 x 3.2 cms  ;

Left kidney appears normal. No pelvicalyceal dilation is seen.

Rt. Kidney appears small and atrophic with very poor vascularity.

3 to 4 small caluli of 2 to 5 mm. are seen in right kidney.

Renal parenchymal thickness: Lt.-   1.9 cms          Rt.—1.0 cms

Perirenal spaces are normal.

2) COLOR DOPPLER IMAGING:

A) Renal parenchymal flow:

(Intrarenal vasculature)

Lt: normal.

Rt: very poor vasularity seen in whole of right kidney.

B) Segmental arterial flow:

1) Any damping of spectral tracing: marked dampening of flow seen in right kidney.

2) RI (normal is < 0.7): Lt: 0.7

                                      Rt: 0.4

C) Renal arterial flow:

1) RI (RESISTANCE INDEX) –renal arteries

Lt: 0.6

Rt: Rt. renal artery is not visualized clearly.

2) PEAK SYSTOLIC VELOCITY (PSV) (renal artery): (NORMAL = 74-127 cms./sec).

LT: 38 to 40

RT: not visualized.

3) Width= Lt. renal artery-- 0.6 cms. (near hilum).

              Right renal artery-- ??. (near hilum)

4) RAR (RENAL ART PSV/AORTIC PSV. Normal RAR is <3.3):

Lt--

Rt--

5) Spectral waveform pattern of renal arteries:

Lt-- normal.

Rt-- ??

6) Any evidence of AV fistulae or malformation:

Nil.

URINARY BLADDER:

Distension—normal

Any trabeculation: no evidence of trabeculation seen.

Calculus: no calculus is present

Diverticulum: no diverticulum is seen.

Liver shows mild fatty change.

Pancreas, gall bladder and spleen appear normal.

OPINION:

COLOR DOPPLER scan suggests –

• Left kidney/ left renal artery appear normal. No pelvicalyceal dilation is seen.
• Rt. Kidney appears small and atrophic with very poor vascularity.
• 3 to 4 small caluli of 2 to 5 mm. are seen in right kidney.
• Very poor vasularity seen in whole of right kidney.
• Marked dampening of flow seen in right kidney
• Rt. renal artery is not visualized clearly.

SUGGEST: clinical correlation and follow up.

CT or MR angiography of the renal arteries should be done to confirm these findings.

Ultrasound report template- color Doppler kidneys and renal artery

COLOR DOPPLER/ POWER DOPPLER REPORT

ULTRASOUND and DOPPLER IMAGING of the KIDNEYS was done.

 

1)KIDNEYS:

LT.--    10.3 x 5.5 cms ;

RT.--    9.5 x 4.7 cms  ;

Both kidneys appear normal. No pelvicalyceal dilation is seen.

Renal parenchymal thickness: Lt.-   1.9 cms          Rt.—1.7 cms

Perirenal spaces are normal.

Renal cysts--

2) COLOR DOPPLER IMAGING:

A) Renal parenchymal flow:

(Intrarenal vasculature)

Lt:-- normal.

Rt:-- normal.

B) Segmental arterial flow:

1) Any damping of spectral tracing:

2) RI (normal is < 0.7): Lt:

                                      Rt:

C) Renal arterial flow:

1) RI (RESISTANCE INDEX) –renal arteries

Lt: 0.47

Rt: 0.55

2) PEAK SYSTOLIC VELOCITY (PSV) (renal artery): (NORMAL = 74-127 cms./sec).

LT:

RT:

3) Width= Lt. renal artery: 0.6 cms. (near hilum).

              Right renal artery: 0.58 cms. (near hilum)

4) RAR (RENAL ART PSV/AORTIC PSV. Normal RAR is <3.3):

Lt:

Rt:

5) Spectral waveform pattern of renal arteries:

Lt: normal.

Rt: normal.

6) Any evidence of AV fistulae or malformation:

Nil.

URINARY BLADDER:

Distension—normal

Any trabeculation: no evidence of trabeculation seen.

Calculus: no calculus is present

Diverticulum: no diverticulum is seen.

Liver shows mild fatty change.

Pancreas, gall bladder and spleen appear normal.

OPINION:

COLOR DOPPLER scan suggests –

• Both kidneys appear normal. Urinary bladder appears normal.
• The visualized parts of the renal arteries (near renal hilum) appear normal.
• Normal intrarenal vasculature is noted.
• RAR (renal/aortic ratio), PSV of renal arteries and RI of intrarenal (segmental) arteries appear normal.  
• SUGGEST: clinical correlation and follow up.
• CT or MR angiography of the renal arteries should be done to confirm these findings.
  Note:
  (REFERENCE: RENAL ART. STENOSIS:
  If PSV in renal art > 200cms./sec)
  If RI in both kidneys differ by more than >0.05à Stenosis in Kid with lower RI).