Saturday, October 16, 2010

Transrectal ultrasound videos- seminal vesicles and vas deferens:

This video shows the left vas deferens as it merges with the left seminal vesicle to form the ejaculatory duct:
                                                                        See: http://www.ultrasound-images.com/prostate.htm for more on this topic. This includes normal sonographic anatomy during TRUS (transrectal ultrasound) imaging for the prostate, seminal vesicles, vas deferens and the ejaculatory ducts. Of these the prostate is the largest and most obvious structure seen. In the oblique coronal plane, whilst angling the transrectal/ endocavity ultrasound probe upwards, one sees the 2 seminal vesicles seen resembling a bow tie. Further tilting the probe upwards reveals the vas deferens - 2 narrow tubes joining the seminal vesicles. The ejaculatory ducts are often difficult to see unless dilated due to pathology.                   

                                                                            
The above endocavity (transrectal) ultrasound video shows the right vas deferens merging similarly with the right seminal vesicle.
The ultrasound video clip below visualizes the seminal vesicles and vas of both sides:

                                  
And finally, imaging the prostate from the apex (or lower tip) and sweeping upwards towards the seminal vesicles. This way one sees almost every region of interest in TRUS study.
                                                                 Another important view is the sagittal section of the prostate which shows the posterior urethra or prostatic urethra as it is known. This view is also important to show potential calculi within the prostatic urethra, as also prostatic cysts in relation to it. Pressure on this part of the urethra can cause mild to severe urinary symptoms, usually caused by either of the pathologies mentioned above.

Friday, October 15, 2010

An Unusual cortical cyst of kidney- ultrasound video:

       
This cortical cyst is a rather unusual location in the left kidney- it occupies a central part (the middle third) of the kidney extending from the outer cortex to the renal pelvis. This appearance can mimic a calyceal diverticulum or caliectasis.
 The ultrasound image above shows the renal cortical cyst in transverse and longitudinal axes. Read more on this at: http://www.ultrasound-images.com/kidneys.htm 
And this is what a typical cortical cyst of the kidney looks like:
There is mild pelvicalyceal dilatation of the left kidney, due to pressure effect from the large left renal cortical cyst in the upper pole. I have seen renal cortical cysts from 0.5 cms. to 8 cms. in size. These cysts need to be monitored closely for signs of rupture, infection and malignancy.
  
 This color Doppler video clip of the same patient shows vessels curving around the rim of the cortical cyst of the left kidney.
Case-2:
A typical cortical cyst of the left kidney ( a very large one):

An ultrasound video clip of this large cyst in left kidney- it measures 6 to 7 cms. in diameter!
It is not unusual for renal cortical cysts to reach this size. Fortunately, there is no evidence of infection, hemorrhage or septation within this cystic lesion. But it needs to be periodically monitored for complications.

Wednesday, October 13, 2010

Complex kidney cysts (an ultrasound video study):

                                                                          
Case-1:Sagittal section ultrasound video clip showing the complex nature of the right renal cyst. This cyst is small and septate (fine septations). Note the presence of small calcifications in the lower part of the cyst.
Same case as above- another ultrasound video clip:
                                                                            
This cyst was seen in a middle aged male patient and was an incidental finding. CT scan reports suggest this is a Bosniak category 2 complex renal cyst. Indeed the ultrasound findings did not change over a period of time, nor did the cyst increase in size. This complex renal cyst measures 1.7 cms. in size.                                          
Case-2:
                                                                        The above ultrasound video clip shows a larger complex cyst in the left kidney of an elderly male patient. Again, the cyst might fit in with a Bosniak category-2 complex renal cyst. This renal cyst shows fine (but thicker than those in case-1 above) membranous partitions and a few calcifications along the cyst wall.                                                                                          
                                                                       This 2nd renal ultrasound video clip shows that there is a 2nd smaller cyst adjacent to the larger cyst. This one also shows few calcific lesions along the wall. These appearances suggest a benign nature of these complex cysts of the left kidney.                                                                                                                                   
                                                                          
 The above color Doppler video clip of the left kidney (same case-2) shows no significant vessels along the walls of the cysts or in the septae within them, again confirming the benign nature of these lesions.                    Read more at: http://www.kidneycancerinstitute.com/kidney-cyst.html
Also view ultrasound images of renal cysts and cystic diseases of kidneys at:
  http://www.ultrasound-images.com/kidneys.htm

Friday, October 8, 2010

A difficult mid-ureteric calculus:















This patient had right flank pain since a few months. But was not sure if he had a renal stone (calculus). The bladder ultrasound image appears normal.
















The left kidney is normal. But not the right kidney- shows moderate hydronephrosis (back-pressure changes). The stone must be lower down somewhere....A difficult job to find this calculus, somewhere in the right ureter.. in a moderately obese patient.
















Persistence and dogged determination to find the culprit, works. Sustained graded compression over the right flank, shows the dilated right ureter and the 17 mm. calculus in mid ureter.


Recorded an ultrasound video clip of the right mid ureteric calculus (arrows).
  See: http://www.ultrasound-images.com/ureteric-calculi.htm for more on this topic.

Wednesday, September 29, 2010

Popliteal vein thrombus- Color Doppler ultrasound video clip:

                                                                               This color Doppler video clip shows the thrombus (arrows), clearly, in transverse section of the vessel.
                                                                       And this- a Color Doppler video clip of the same vessel in longitudinal section.
See:  http://www.ultrasound-images.com/vascular.htm (for more on this case). On that page, you should find more color Doppler images of this case and details of how to image the veins of the lower limb. The interesting and indeed intriguing part of this case is the particulate movement within the thrombus- possibly fibrotic strands within it. This suggests that the thrombus is old or chronic, maybe a month or more old. 

Thursday, September 23, 2010

Cystic duct- ultrasound video:

                                                                             Color Doppler video clip showing the normal cystic duct as it emerges from the gall bladder to merge with the common bile duct. The portal vein is seen adjacent to the cystic duct.                                                       See: http://en.wikipedia.org/wiki/Cystic_duct  for more.                                                                           Also:   http://radiographics.rsna.org/content/21/1/3/F1.expansion                                                                
 The color Doppler image above shows the cystic duct clearly. PV= portal vein.

Wednesday, September 22, 2010

Color Doppler video- simple cyst of testis:

This male patient underwent sonography of the scrotum for left testicular pain. The color Doppler video clip of the left testis shows a simple cyst of the upper pole of left testis. In addition, the patient has a large, grade 3 varicocele of the left scrotum (see video below). The cause of the left scrotal pain is in all probability, the varicocele, the cystic lesion of the testis being only an incidental finding.
                                                                                                                                                                                                                                   
Here are the still images demonstrating the simple testicular cyst:














The above ultrasound image shows a transverse section through the upper pole.  
 This is a long section color Doppler image of left testis with the non vascular anechoic lesion seen in the upper pole, clearly a cyst.