Hyperechoic fetal kidneys

This 22 week old fetus shows bilateral hyperechoic enlarged kidneys:

 

The above ultrasound video clip shows a transverse section through the fetal kidneys. Observe the relative increase in echogenicity of the fetal kidneys, making it a little more echogenic than the adjacent fetal liver.

  

 The above ultrasound video shows a good view of the left fetal kidney. The kidney is difficult to visualize due to its hyperechoic nature.
This color Doppler ultrasound video clip below shows relatively poor flow in the affected left fetal kidney (coronal section):

  

 

The above color Doppler ultrasound video clip shows the fetal right kidney, with similar features as the left kidney. Color Doppler brings out the kidney into better view, by showing the renal arteries.

  This lady also has another child with suspected autosomal recessive polycystic kidney disease (ARPCKD).

Here are some of the still ultrasound and color Doppler images of this same fetus:

Clearly the images and ultrasound video clips above suggest a autosomal recessive polycystic kidney disease in this 22 week old fetus. No definite cystic areas are seen in the kidneys, but the other features are suggestive of this congenital disease of the kidneys. Observe the liqor and the urinary bladder (both appearing normal), suggesting that despite the serious nature of the renal disease, there is relatively normal kidney function at present.
See this link for more on this topic:
http://www.ultrasound-images.com/fetal-urogenital.htm#Fetal_polycystic_kidneys_%28autosomal_recessive_polycystic_kidney_disease-_ARPKD%29
You might also find these links useful: http://www.sonoworld.com/fetus/page.aspx?id=1519
                                                         http://radiographics.rsna.org/content/20/3/837.full 

Sonography of renal sinus lipomatosis

This middle aged patient presented with non specific complaints and we did a routine abdominal ultrasonography on him. This is what we found on ultrasound imaging of the kidneys:

Both kidneys showed echogenic matter within the region of the renal sinuses- and this was more prominent in the left kidney. The large echogenic mass like appearance in the lower part of the left renal sinus prompted us to think that this could be angiomyolipoma, one of the more common entities in the kidney. However, further imaging showed that this hyperechoic deposit was almost totally within the confines of the renal sinuses. Besides the lesions were bilateral.
 See ultrasound video clips below:

 

Further observe the vessels within the renal sinus of the left kidney in this color Doppler ultrasound video clip below:

 

The most obvious diagnosis based on these ultrasound images and video clips is renal sinus lipomatosis.

The uniformly homogenous appearance of the fatty tissue in the renal sinus suggests lipomatosis rather than any more ominous masses/ malignancies of the renal sinus. These ultrasound findings are suggestive of a grade -1 renal sinus lipomatosis of both kidneys.

References: http://www.jultrasoundmed.org/cgi/reprint/21/9/993 (free excellent article with images)

For more ultrasound/ color Doppler images of this case see:

http://www.ultrasound-images.com/kidneys.htm#Renal_sinus_lipomatosis

Subependymal cysts:

This neonate has a relatively large subependymal cyst close to the caudato-thalamic groove (ie the groove between the caudate nucleus and thalamus) of the fetal brain. Ultrasound videos taken in both the sagittal and coronal sections help confirm this diagnosis. The ultrasound video clip below shows a coronal section of the neonatal brain with the lesion displayed well.

 

The ultrasound video clip below shows a sagittal section through the neonatal brain displaying the subependymal cyst. The video clip pans from the lateral to the medial aspect of the neonatal brain, with focus on the subependymal cyst.

Still ultrasound images of this same neonatal brain are shown below: (see coronal images below):

This supendymal cyst is almost 7 to 8 mm. in dimension and needs careful follow up ultrasound imaging.
Parasagittal section image below shows another view of the subependymal cyst:

Visit:
http://www.ultrasound-images.com/pediatric.htm#Another_complication_of_subependymal_hemorrhage-_subependymal_cysts for more information and images of similar cases.

Blunt trauma to testes with rupture:

This 25 yr. old male came to me with a history of severe blunt injury to the left scrotum. On inquiring further, he reported that the part of a heavy machine hit him squarely without causing any bleeding. However, the left scrotum was moderately swollen and markedly painful.
Ultrasound imaging of the scrotum revealed (see ultrasound video clip below):

 Observe the large hypoechoic (dark) inhomogenous area in the left testis. This is a typical appearance of an intratesticular hematoma. But is that all? The right half of the video shows partial rupture of the outer covering of the left testis (tunica albuginea). Do we see anything more? There is some spillage of the lateral part of the testicular parenchyma outside the confines of the testicular capsule.
See some more color Doppler ultrasound videos of this testicular trauma- below:

Observe normal vascularity (blood flow) of the main testicular tissue (in the above long section of the left testis). This is a good sign and shows that the injured left testis is viable and does not need to be removed surgically. However, the lower pole of the left testis does show vessels entering the tissue that has spilled out of the capsule of the testis. This confirms that seminiferous tubules from the testis have been pushed out of the rupture site (of the left testicular fibrous capsule). In addition, there is a moderately large hemorrhagic fluid collection in the left scrotum (left hematocele).
Visit this link to read more on this topic:
http://www.ultrasound-images.com/acute-scrotum.htm#Testicular_trauma_%28rupture_of_testes_or_fracture_testes%29:_
We have one more color Doppler ultrasound video (this time a transverse section of the left testis):

 

Observe the linear strip of tissue hanging (or floating) within the hematocele in the left scrotum. This could be left testicular tissue with part of the body of the left epididymis.

Here are the ultrasound/ color Doppler images of this case of testicular trauma:

This last image is a transverse section section of the testis showing the site of rupture of the tunica albuginea, using Power Doppler imaging. The intratesticular hematoma is also seen.

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:
http://www.ultrasound-images.com/thyroid.htm#Parathyroid_adenoma

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:
http://www.ultrasound-images.com/uterus.htm

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:
http://www.ultrasound-images.com/urinary-bladder.htm