Ovarian complex cyst. What could it be? A googly case.

Here are the ultrasound scan and color Doppler ultrasound images, both transabdominal and endocavity scans. 

There's obviously a cyst in the left ovary. 

But what can we say about the diagnosis?

Firstly, it's a complex cyst. Note the multiple septations. The transabdominal ultrasound scan suggests a possible hemorrhagic cyst. Indeed, the clinical diagnosis was similar. 

But the endocavity scan suggests something more than this.

Those septae are pretty thick. Also just observe the vessels within the septations. Not a likely finding in a hemorrhagic cyst. 

More along the lines of a serous cystadenoma. 

Final diagnosis: early stages of a serous cystadenoma of the left ovary. 

For more on this visit:

Ovarian serous cystadenoma, sonography

Strange looking papillary muscle?

This young adult male had history of epigastric pain. 

A quick echo study showed this strange looking mass in the left ventricle. 

What could it be?

Further echocardiography images show it to be the papillary muscle. A hypertrophied papillary muscle. 

Here's the axial view and another PLAX view. 

The color Doppler ultrasound image shows it to be papillary muscle again. 

Hypertrophied papillary muscle may be just an incidental finding. It may also be associated with chronic rheumatic mitral valve disease or a relatively unknown condition called Fabry disease. 

Further evaluation is advised. 

For more on this visit:

Echocardiography and sonography of CVS

Multiple liver masses, known case of hepatoma

Multiple echogenic liver masses in a known case of hepatoma. 

Multi-focal hepatoma is characterized by multiple echogenic liver masses on sonography. 

The hepatoma masses are of varying sizes, as seen on the ultrasound images above. 

Color Doppler ultrasound shows multiple areas of neo-vascularity with large vessels surrounding the liver masses. 

But observe the two lower images 👆.

Internal vascularity is present within the masses. 

Final diagnosis: multi-focal hepatoma or hepatocellular carcinoma. 

Differential diagnosis:

Possibilities include liver metastasis and focal nodular hyperplasia. 

For more on this visit:

Sonography of liver

A case of bilateral adnexal masses

Patient of dysmenorrhoea. 

Transabdominal ultrasound done:

Uterus appears normal. 

But sweeping transeversely shows bilateral adnexal complex cysts. Ground glass appearance internally. 

Color Doppler ultrasound shows no internal vascularity. 

Diagnosis: the ultrasound findings of these images are typical of bilateral endometrioma of the ovaries. 

Endometrioma is a relatively more severe form of endometriosis. Surgery may be necessary. 

For more on this visit:

Sonography of ovaries

Just a corpus luteal cyst

This right ovary showed a simple cyst, on transabdominal ultrasound. 

Poorly filled bladder. So tried a endocavity scan. 

Uterus showed a thickened endometrium. 14 mm. Possibly a decidual reaction. 

Let's have a look at the right ovary. 

A right ovarian cyst of 2.5 cms or so. But that nodule within had be concerned. Could it be a live ectopic pregnancy?

No internal vascularity. But a ring 💍 if fire 🔥 present. So chances are that this is corpus luteal cyst. 

Final diagnosis: corpus luteal cyst with possibly an early pregnancy. Advised follow up ultrasound to confirm if complete abortion or pregnancy in progress. 

For more on this visit:

Ovary sonography

Supernumerary testis or something ominous

A mass like structure below the testis on sonography. 

Appearance on ultrasound suggests possibility of supernumerary testis as the echogenicity and echotexture are similar to testicular parenchyma. 

Ultrasound mages courtesy of Dr Golam. 

For more on this topic:

Testis ultrasound imaging

Dirofilariasis, a rare subcutaneous infestation

This is a pretty rare infestation. It's called dirofilariasis. Filarial roundworms migrate to the subcutaneous plane in this patient with formation of a cystic complex lesion in the thigh. 

Sometimes, live dirofilarial worms may be seen, forming the dirofilariasis worm dance. 

What is the differential diagnosis:

It may be difficult to differentiate such a lesion from cysticercosis.

The dirofilarial dance sign if present is diagnostic. 

Images courtesy of Dr Golam. 

For more on this visit:

Musculoskeletal ultrasound

Bicornuate uterus with viable pregnancy

This uterus has a problem.

There are 2 horns in the uterus, bicornuate uterus. 

But the left horn or cornu, horn 1 shows a viable fetus. 

The right horn or cornu, horn 2 is empty, but shows a decidual reaction. 

(Images courtesy of Dr Golam).

Diagnosis: bicornuate uterus with viable pregnancy. 

For more visit:

Early pregnancy ultrasound

Nuchal cord, aorta, nasal bone 2nd trimester fetus

Nasal bone at 17 weeks:

Aorta nicely imaged:

Nuchal cord at 17 weeks:

Nuchal cord at early 2nd trimester pregnancy pregnancy doesn’t appear significant. However, it remains a cause for anxiety for the mother. 

Colonic wall thickening, likely colitis

Ultrasound imaging can be pretty effective in the diagnosis of colon pathology. 

Here, ultrasound images show thickened colon walls. 

Colitis is the most probable diagnosis. 

(Images courtesy: Dr Golam)

For more visit:

Colon sonography

Huge complex cystic mass abdomen, what could it be?

This female patient has a huge complex mass, primarily cystic in nature. 

It appears primarily cystic but with poor vascularity. 

Origin of this mass extending from liver to pelvis is likely ovarian. However, hydatid disease also can't be excluded. 

Diagnosis: mucinous cystadenoma or cystadenocarcinoma

2nd possibility: hydatid cysts 

CT scan confirmation needed.

( images courtesy: Dr Golam)

For more on this visit:

Sonography of ovarian mass

Normal fetal echocardiography, foramen ovale and all that

I've managed to catch the foramen ovale ovale and flow across it in these B mode ultrasound and color Doppler images of the 4 chamber view in a late 3rd trimester fetus:

See below:

B mode fetal heart 4 chambers show foramen ovale pretty clearly. This fetus was really cooperative 😊.

The flow is from the right atrium to the left atrium as you may see in the color Doppler ultrasound images below:

I also managed a reasonably decent 3 vessel view:

One of the tricky things about fetal echo is that you don't always get the best views of everything. The 4 chambers was class, but 3 vessel view was passable 😉.

For more on normal fetal cardiac anatomy:

Normal fetal echocardiography

Fetal Echo in cardiac anomalies

Large lipoma or something more ominous?

This patient had a soft tissue mass in the leg. No pain or tenderness. 

Ultrasound using high frequency probe revealed a soft tissue mass within the subcutaneous plane. 

Here are some panoramic views:

What we found:

Indeed the mass has the lobulation and echogenicity of a fatty tissue, or lipoma. 

 We  did some color Doppler ultrasound and found a few small vessels passing into the mass.

The color and power Doppler ultrasound are not unusual, but a large soft tissue mass like a lipoma would usually have little or no vascularity. 

Let's have a look at the spectral Doppler ultrasound:

Again nothing out of the way. There are both low amplitude flow waveforms, both arterial and venous. 

Finally we concluded that this mass is indeed a lipoma. 

Final diagnosis: lipoma.

Have advised further investigation like MRI scan to confirm and rule out malignancy.

For more visit:

Sonography of lipoma