Carcinoma of urinary bladder on TRUS

Often carcinoma of the urinary bladder can mimic an enlarged prostate (usually the median lobe). The projecting median lobe of prostate can often appear bilobed or even polypoid on Transrectal ultrasound scan (TRUS). Carefully imaging the entire prostate and checking for continuity of the prostate and the mass can help verify the exact origin of the mass in question.
  This case study just highlights this dilemma. The patient, an elderly male had a mass or rather a pair of masses located very close to the bladder neck. On TRUS the prostate appeared small and showed no direct continuity with the masses. The ultrasound and color Doppler video clips demonstrates this very well.

PCO in adolescents

This 15 year old female child has irregular menses. The question is - can Polycystic ovary disease be seen at such a young age?
I believe the answer is yes!
Both ovaries show a volume of 10 cc. (definitely enlarged) and multiple small follicles (each of less than 7 mm.).
Ultrasound image of the uterus:

Image of the ovaries showing multiple small follicles:

Left ovary- note the large size and "string of pearls"
sign of follicles:

Right ovary also showing changes of PCO in this child:

Power Doppler image- both ovaries- PCO:

Visit: http://www.ultrasound-images.com/ovaries.htm#Polycystic_ovaries_%28polycystic_ovary_disease-_PCOD

Name the part of the fetus in this ultrasound video:

This is a part of the fetal head. Can you name the part of the fetus we are focusing on?
Hint: the baby is actively doing something...

Sonography of Wharton duct calculus- video:

Ultrasound video clip shows the dilated duct of submandibular salivary gland (also called the Wharton duct).

  
This patient was a young adult male with typical history of pain in the left sublingual region whilst eating. There was also accompanying swelling of the left submandibular region with pain there when eating.
The ultrasound video clip shows the dilated submandibular salivary gland duct, measuring 4 mm.! Despite my best efforts with the small parts high frequency probe I could not detect the stone in the Wharton duct.
This was how the left submandibular salivary gland looked like:

There is a mild swelling of the left submandibular salivary gland compared to the right side.

The Wharton duct is clearly seen to be considerably dilated (ultrasound image above).

How can I be sure that the tubular structure shown in previous image is the Wharton duct? I switched on the color Doppler flow imaging and found (see image above), that this was indeed the Wharton duct and not a blood vessel.

I tried my best to find the terminal part of the duct with the stone in it, but failed. Finally I used the TV (endocavity) probe and managed to find the stone in the distal end of the Wharton duct.
For more on this topic visit: http://www.ultrasound-images.com/salivary-glands.htm#Calculus_in_left_Whartons_duct

Color Doppler imaging of the uterine artery

Color Doppler ultrasound and spectral Doppler imaging of the uterine artery is an important part of any obstetric Doppler imaging. The uterine arteries of both sides must be visualized first on color flow imaging, by tracing these vessels as they cross the external iliac artery and vein of each side. The uterine artery can sometimes be elusive for the novice; the trick I use, is to trace the full length of the external iliac vessels from the inguinal region upwards in long axes. This leads to a strange, but prominent artery crossing the iliac artery and vein in an oblique X manner- this is the uterine artery. Spectral Doppler trace will confirm the nature of the uterine artery. (The color Doppler video clip above shows the Right uterine artery in a 14 week old gestation).
When should the uterine artery be imaged? The uterine artery must be imaged from as early as 11- 14 weeks onwards to rule out/ predict a high risk pregnancy. 
Normal PI values at 11 to 13 weeks are usually greater than 2.5. However, lower PI and RI values may be seen on the ipsilateral side as the placenta (ie: if the placenta is located to the right lateral region of the uterus, the right uterine artery would have far lower PI and RI values than the left uterine artery).
The spectral Doppler trace below shows normal values in a 24 week old pregnancy:

With values of PI= 0.76 and RI of 0.5, this uterine artery is normal for 24 weeks.











Bifurcation of the uterine artery (normal anatomical variants of the uterine artery):

 

This patient showed a division (bifurcation) of the right uterine artery (see color Doppler video above), with both vessels seen crossing over the external iliac vessels of that side. The uterine artery is known to divide or in some cases to be duplicated on one or both sides. Both branches of the uterine artery on the right side are seen to lead to the parent vessel in the video above.  

References:
                 1) Uterine artery Doppler study in ICSI (intra-cytoplasmic sperm injection) pregnancies (free article)
                 2)  Doppler Study uterine artery of 17 to 24 weeks gestation in advanced maternal age
                 3)  Role of uterine artery Doppler in determining those women at risk of placental insufficiency -   this is an excellent article from centrus.com
                4) http://www.ultrasound-images.com/fetus-general.htm#Color_Doppler_imaging_of_the_uterine_artery

Retained placenta- Ultrasound video

  

This ultrasound video clip shows a echogenic, heterogenous endometrial mass in the uterus after delivery a few days ago. The patient had a history of inability to deliver the placenta. In view of such a history, and the large size of the mass in the endometrial cavity, this is a clear evidence of retained placenta.

For more details of this case of retained placenta visit:
http://www.ultrasound-images.com/placenta.htm#Retained_products_of_conception/_retained_placenta
References: http://www.jultrasoundmed.org/content/19/1/7.full.pdf

Ultrasound imaging of normal deep veins

 
The normal deep veins of the lower limb- the femoral and popliteal veins are usually studied to rule out deep venous thrombosis. One of the various methods of ruling out clot formation (thrombosis) in the deep veins is the application of mild pressure with the ultrasound probe on the deep vein. This method is called compression and the method is called testing the compressibility of the deep vein.
This ultrasound video clip (above) shows the femoral vein (FEM V.) and the popliteal vein (POPL V.), after probe pressure is applied to determine whether complete collapse of the veins is possible. The end stage shows total apposition of the walls of the vein as pressure is applied. This confirms the absence of thrombus (clot) within the vein. This testing of the normal compressibility of the femoral and popliteal veins must be done along the full extent of the deep veins. As one goes downwards along the course of the femoral vein to the mid thigh, this may be difficult due to the femoral vein entering the adductor canal.
   At this stage the sonologist may try looking for normal augmentation of flow by pressure on the calf muscles. A sharp augmentation spike on spectral doppler trace means there is no thrombus along the course of the deep veins till the calf.
For more on this topic visit: color Doppler and ultrasound study of the deep veins of lower limb.