Tuesday, November 23, 2010

A small vascular lesion behind the thyroid

This color Doppler ultrasound image of the left lobe of the thyroid raised more queries than answers.
The lesion only 4 mm. in size. But located in a typical location in posterior aspect of the upper pole of left lobe of thyroid.

Markedly vascular lesions in this location are usually parathyroid adenomas. The gray scale ultrasound image suggests a solid lesion, thus suggestive of an adenoma of the parathyroid gland.

Such a highly vascular lesion can also suggest a possibility of an Arterio-venous malformation of the thyroid or the parathyroid. This is where this color Doppler ultrasound video might help (see below): this video shows a transverse section through the left lobe.

This color Doppler video clip below shows a long section of the left lobe of thyroid. The lesion is seen posteriorly.

See: http://www.ultrasound-images.com/thyroid.htm for more.
Specifically about parathyroid adenomas- visit:

Wednesday, November 17, 2010

Pedunculated cervical polyp- Ultrasound videos:

Polyps (small outgrowths) are known to occur in the cervical canal (the lumen of the lower third of the uterus), anytime from puberty to menopause. However, they are rare in menopausal women and even rarer in puberty. They are common in women over the age of 20 years and who have had children.
What is the cause of cervical polyps? It is believed that cervical polyps are the result of long term insult or inflammation of the lining (mucosa) of the cervical canal. Also, changes in estrogen levels can also cause polypoid growths to form in the cervical canal (endo-cervix).
What are the main symptoms of a polyp in the cervix? The common presenting symptoms are pain in the lower pelvis, vagina, discharge from the vagina- mucous or blood, irregular and painful menses etc.
What are the types of cervical polyps? The common types of polyps of the cervix are the sessile polyps (which have no stalk are seen as small projections from the endo-cervical lining). The rarer type is the pedunculated polyp of the cervix. This type of pedunculated cervical polyp has a long stalk connecting the growth to the lining  of the cervix. It may project into the vagina, and be confused with a endometrial polyp (a polyp of the body of the uterus) or small fibroid.
One the methods of diagnosing a cervical polyp is by ultrasound and color Doppler imaging of the uterus, best seen on transvaginal ultrasound (inserting the ultrasound probe via the vagina).
Present case (pedunculated polyp of the cervix):
This woman is an unusual case in that she is in the perimenopausal age (47 years) and has severe pain  in the lower pelvis with irregular menses.
This is what we saw on transvaginal ultrasound imaging (see sagittal section ultrasound video clip below):
 There is an elongated hyperechoic (bright) mass within the cervical canal (arrows).
 Power Doppler ultrasound video shows large feeder blood vessels supplying the mass (growth). This is a typical appearance. (See sagittal section Power Doppler video clip above).
Color Doppler ultrasound video clip (below) further confirms the highly vascular nature of the growth in the cervical lumen. It is elongated and fills the length of the cervix.
We performed a transverse section ultrasound imaging of the cervix, and this is what we saw (see the color Doppler video clip below):

The feeder vessels are seen entering and coursing through the entire polyp within the cervix.
Can such growths of the cervical lumen be cancerous? Generally, cervical polyps are benign (almost 99 % of polyps of the cervix are non cancerous). However, the highly vascular nature of the growth in this case, warrants further examination, at least a PAP smear and a study of the specimen after surgery is also advisable. 
 For further reading on this topic see this article on: Ultrasound imaging of Cervical polyps
For more ultrasound images of this case and more on imaging of the uterus, see:

Tuesday, November 16, 2010

Mucosal edema of bladder following recent passage of calculus:

This patient underwent ultrasound imaging to rule out urinary stones. This is what we found in the urinary bladder:
The urinary bladder mucosa shows marked edema around the region of the left ureteric orifice (opening of left ureter into the urinary bladder). So could this be a malignancy or polyp of the bladder mucosa? Fortunately this patient gave a history of passing a calculus (stone) the same day. This suggests that the "mass" appearance in the left wall of the bladder is mucosal edema (mucosa is the inner lining of the urinary bladder), due to the stone being lodged in the left vesico-ureteric junction (distal end of left ureter).
Here are the ultrasound images of the same case:
The lesion is seen clearly. But the appearance is very similar to that of a bladder malignancy.
Color Doppler ultrasound image shows no significant vascularity (blood flow) within the mass (lump) (arrows). This again suggests a more benign nature of the mass.
The kidneys show small echogenic foci (one in each kidney) suggestive of renal calculi, with no backpressure  changes.
For more bladder related diseases and ultrasound study of these cases see:

Thursday, November 11, 2010

Multiple Nabothian cysts of the cervix

This middle aged woman presented with irregular menses. Transvaginal ultrasound (see video clip above) shows multiple cysts of the cervix (transverse section of the cervix). This is the typical appearance of Nabothian cysts of the cervix. Nabothian cysts are also called mucinous retention cysts or Nabothian follicles of the cervix and are usually of little clinical significance unless complicated by infection or if they become unusually large. Most such cysts usually disappear without medical treatment. 
Here is a sagittal section ultrasound video of the same cervix (transvaginal):

As stated above, these Nabothian cysts of the cervix do not appear ominous in any way. However, the cause of this patient's complaints appear to be due to (see ultrasound images below):

The endometrium (the inner lining of the uterus) is seen to be markedly thickened (at 13 mm.). On color Doppler imaging of the uterus (both transabdominal and transvaginal), the endometrium does not show any vascular areas or increased blood flow within any part of it. This kind of thickening of the endometrium is called endometrial hyperplasia and needs further investigation. A pap smear of the cervical fluid showed some degree of squamous metaplasia. This patient needs to be monitored and might need treatment for the hyperplastic changes in the endometrium. 
For more ultrasound and color Doppler images of uterine pathology see:

Wednesday, November 10, 2010

Unusual bilateral ectopic fused kidneys:

The left and right kidneys appear to be ectopic with some degree of fusion of both kidneys, anterior to the mid line- the right kidney being located somewhere just below the liver and anterior to the spine; the left kidney located just behind the urinary bladder.
Have a look at this ultrasound video clip, panning from the bladder to the liver showing both kidneys, in the sagittal and oblique sagittal planes.


Some more ultrasound videos of the bilateral ectopic kidneys follow....
The left kidney is seen below- posterior to the urinary bladder in this B-mode ultrasound video (gray scale):


Have a look at the ectopic right kidney, located anterior to the spine, in this right parasagittal section ultrasound video clip:
Note the empty right renal fossa with the right kidney in an abnormal position.
Now the transverse section through the right kidney- see below:

References: http://www.springerlink.com/content/92207432001l2538/
S-shaped fusion of kidneys
Crossed renal ectopia (good article)
Pictorial display of various kidney fusion anomalies 
It is possible that the kidneys seen above may a variant of S-shaped or L-shaped fusion anomaly of the kidneys.

Friday, November 5, 2010

Normal Gallbladder variants- Phrygian cap:

The Phrygian cap shape of the gallbladder (Gall Bladder) is a known variant. See ultrasound image below:


The gallbladder shows a septate appearance in this image. But is this really a septate gallbladder? See ultrasound video clip below:
Still not sure? See the ultrasound video clip below:
The commonest cause for the"septate" appearance of the gallbladder is the Phrygian cap anatomical variant. For more on this topic see: http://www.ultrasound-images.com/gall-bladder.htm  The best method to demonstrate this variant of the GB is to unfold the gallbladder, by angling the probe to the length of the gallbladder- this displays the "cap" formed by the GB fundus. (See ultrasound picture below)-

The picture above shows the "unfolded" view of the gallbladder, with the Phrygian cap (arrow) clearly.

Thursday, November 4, 2010

Bowel mass- sigmoid carcinoma:

This middle aged male adult patient has a mass just above the urinary bladder. Ultrasound video clip of the mass is seen in sagittal section:
The mass shows an echogenic central area with hypoechoic, surrounding soft tissue area. This is called the "target sign" and is typical of colonic malignancy.
 Yet another sagittal ultrasound video clip shows the mass with the thickened sigmoid colon walls. Also note the absence of normal layered appearance of the normal large bowel.
This color Doppler ultrasound video shows the sigmoid colon mass to be poorly vascular. The mass has all the appearances of a sigmoid carcinoma.
 The close proximity of the mass to the urinary bladder (upper pelvis) and target sign are an indication of the mass originating from the sigmoid colon. The liver appeared normal. Close follow up and CT scan imaging are needed to rule out lymph node spread.
See more ultrasound images and description of this case at:

Tuesday, November 2, 2010

Double J -ureteric stent (ureteral stent):


This longitudinal section ultrasound video of the right kidney shows persistent mild hydronephrosis, despite the presence of the double J stent (DJ stent or ureteral stent) in the right ureter.

 The above ultrasound video shows the transverse section of the hydronephrotic right kidney with the upper end of the ureteral stent in the distended renal pelvis.
Reference: http://en.wikipedia.org/wiki/Ureteric_stent 
See the following link for article and images of ureteral stent:
See: http://cochinblogs.blogspot.com/2010/04/ultrasound-imaging-of-ureteral-stent.html 

Focal epididymitis:

This color Doppler ultrasound video shows a long section of the right testis- observe the lower pole.

The right tail of epididymis definitely appears inflamed. Now observe this transverse section color Doppler video clip through the right testis panning from the upper to the lower poles.


 There is a small right hydrocele which outlines the head and body of the right epididymis. The diagnosis in this case is focal right epididymitis involving primarily the tail.
Here is the still ultrasound image of the affected right testis:
And the color Doppler image of the same case: (right testis and epididymis):

And the still ultrasound image of the normal left testis (above).
For more on this topic see: http://www.ultrasound-images.com/scrotal-infections.htm