Have the products of conception been evacuated in this spontaneous abortion

Transabdominal ultrasound shows almost complete evacuation of the products of conception. But what is that anechoic area in the fundus of uterus?

We did a transvaginal ultrasound to check it out. 

Just minimal fluid in the endometrial cavity. Not unusual after a complete abortion. 

Color Doppler ultrasound further confirms no abnormal vascularity in the uterus. 

Final diagnosis:

Complete abortion with no residual products of conception.

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Early pregnancy ultrasound

Is that a liver mass or even liver cancer ?

These are the ultrasound images of the liver. What is that hypoechoic lesion mainly in the left lobe of the organ? 

We radiologists are taught very early to think of the most ominous possibilities when we see 👀 a liver lesion. 

Is it a hepatic carcinoma or metastasis?

Looks like a well defined lesion, no mass effects on surrounding tissue. 

Also, the liver is echogenic or hyperechoic. So fatty liver is present. 

The lesion in question could be an area without fatty change. 

Let's look at the color Doppler image:

No vascularity within the lesion. 

That confirms our diagnosis. 

Final diagnosis: fatty liver with focal fatty sparing.

(Images courtesy: Dr Golam)

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Sonography of liver

PFIC liver, progressive familial intrahepatic cholestasis. What's that ?

An extremely rare congenital disease of the biliary system affecting the liver is called PFIC or progressive familial intrahepatic cholestasis.

This is characterized by increasing failure of the liver to excrete bile into the biliary tree. 

The result is increasing degrees of liver disease. 

The end stage of PFIC is liver cirrhosis and liver failure. 

This symptomatic patient came with some of the early symptoms including pruritus or itching of the skin. Biliary salts depositing in the skin is the cause. 

Ultrasound images show echogenic liver. Not too different from early fatty liver or grade 1 fatty liver. 

Being in the early stages of the disease, the above ultrasound images show nothing to suspect PFIC. 

Had a more detailed look at the portal vein. The diameter of the portal vein: 12.6 mm. Looks like a borderline dilation of the portal vein. Nothing unusual again. 

The spectral Doppler ultrasound of the portal vein is also essentially normal. 

Conclusion: early liver disease consistent with mild fatty liver. PFIC or progressive familial intrahepatic cholestasis was diagnosed by other lab tests including liver biopsy. 

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Sonography of liver

Renal Calculus caught on ultrasound, confirmed on CT

Calculus in lower pole of left kidney. Pretty strong acoustic shadow. 

Not much of a twinkle artefact on color Doppler. 

Coronal cut on CT scan confirmed the kidney stone. Nowadays, most urologists prefer to confirm by computed tomography before any surgery. A pretty wise measure too.

For more on renal calculi visit:

Sonography in renal calculi disease

What could be wrong with these ovaries?

Patient of menstrual disorders. 

Transabdominal ultrasound showed slightly enlarged ovaries. 

TVS ultrasound scan showed these findings:

Ovarian enlargement obvious. 

But those follicles are not normal either. 

The ovaries are definitely enlarged at 16 and 18 cc. Anything more than 10 cc is definitely in favor of polycystic ovaries. 

Peripheral follicles and small follicles are also supportive of PCOD. 

Final diagnosis:

PCOD in young woman 👧. 

She definitely needs expert medical management. 

Renal Doppler in hypertension

This patient had severe hypertension. 

Renal Doppler ultrasound is essential to rule out renal artery stenosis. 

Let's see 👀 what we found:

Renal arteries diameter measurements are normal:

Caliber of both renal arteries is in normal range. 6 to 7 mm width. 

Let's have a look at arterial flow in both kidneys.

The intrarenal flow appears normal. 

Now let's have a look at renal arterial spectral Doppler in both kidneys:

Both renal arteries show normal waveform. High diastolic low resistance flow confirms 👍 healthy flow through renal arteries. 

Let's have a look at the segmental arteries of both kidneys. 

Looks like healthy normal flow parameters in the segmental arteries too.

Final diagnosis: 

Normal color and spectral Doppler ultrasound of both kidneys. 

He'll need to be investigated further to find the cause of hypertension. 

Multiple findings in this breast ultrasound

Another strange case. There are multiple findings in the breasts in this sonographic study. 

1st:

Both breasts showed prominent mammary ducts. Without proper history, the sonographic appearances are bizarre 😳 to say the least 🙄. 

The reason for dilated mammary ducts is:

She's lactating. 

2nd finding:

The above ultrasound image showed what looked like a hypoechoic mass. But it's pretty much posteriorly placed. Also rotate the transducer. It's elongated. 

Answer: it's a costal cartilage. A normal finding. 

3rd finding: this is not normal 😐:

The ultrasound images above show an anechoic mass lesion and it's pretty large. 

A large simple cyst. 

Here's another ultrasound image:

A simple cyst is no big deal. So long as it doesn't get complicated with hemorrhagic changes or infection 😕. Now infection can cause a breast abscess. 

The prominent mammary ducts are also seen to the right of the ultrasound image. 

4th finding:

A moderately large mass, but this one is hypoechoic and not anechoic. That means it is a solid mass. It's oval and well defined. 

Non vascular. These are typical of only one lesion: fibroadenoma breast 🙄. 

Final diagnosis:

Fibroadenoma breast with breast cyst in lactating breasts.

An intriguing story of a strange cyst

This right ovary showed a cyst on transabdominal ultrasound:

A simple cyst or something more to it?

Color Doppler ultrasound image showed no internal vascularity. Few vessels around it. But observe the solid area to the right. Could it be an intramural nodule or debris? Could it be a clot from internal hemorrhage?

So we did an endocavity TVS scan.

TVS scan showed internal debris and typical fibrinous strands. Few vessels around the rim on color Doppler ultrasound again.

Final diagnosis: 

Hemorrhagic cyst ovary.

Have advised follow up ultrasound after 4 weeks. Hemorrhagic cyst should resolve. 

An ultrasound tale of the lower urinary tract

Elderly male, started with prostatomegaly:

grade 2 BPH 

Consequences are more than a little problematic:

A pretty large vesical calculus. 

Needs surgery for sure.  

Multiple abscesses spleen, sonography

This spleen appears mildly enlarged with minute cystic areas.

Color Doppler ultrasound of the spleen shows increased vascularity. 

Among the diagnostic possibilities:

Multiple abscesses 

Miliary Kochs 

Metastasis is also a remote possibility.