A large PUJ calculus

This adult male patient had a large left pelvi-ureteral junction calculus. 

The ultrasound findings are described below:

• Ultrasound findings:
  • A large, echogenic calculus measuring 2 x 1 cms is seen at the left pelvi-ureteral junction.
  • The calculus is causing moderate hydronephrosis of the left kidney.
  • There is no evidence of obstruction of the ureter distal to the calculus.
  • A prominent acoustic shadow is present. 
  • Color Doppler ultrasound revealed absence of twinkle artefact. Twinkle artefact is not always present even in such a large calculus. 
  • It is important to image the kidney and the calculus in both long section and transverse section also. This helps get a multidimensional view of the renal stone. 
• Prognosis:
  • The prognosis for this condition is generally good.
  • In most cases, the calculus will pass spontaneously within a few weeks.
  • If the calculus does not pass spontaneously, it can be treated with minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy.
• Management:
• The initial management of this condition is usually conservative.
• This may involve pain medication, antibiotics, and increased fluid intake.
• If the calculus does not pass spontaneously within a few weeks, then more invasive treatment may be necessary.
• The specific treatment approach will be determined by the size and location of the calculus, as well as the patient's individual medical history.

Ultrasound images are shown below:

What are the chances of this calculus spontaneously being ejected?

The chances of a 2x1 cm renal calculus passing down spontaneously are low, estimated to be around 5%. This is because the stone is larger than 1 cm and is lodged at the pelvi-ureteral junction, which is a narrow part of the ureter where stones are more likely to get stuck.

If the stone does not pass spontaneously, it may require treatment, such as:

* Medications to help break up the stone

* Ureteroscopy, a procedure in which a thin tube with a camera is inserted into the ureter to remove the stone

* Percutaneous nephrolithotomy, a procedure in which a small incision is made in the back and a tube is inserted into the kidney to remove the stone

The best course of treatment for a 2x1 cm renal calculus will depend on the individual patient's circumstances and the doctor's assessment.

Here are some additional information:

* The size of the stone is the most important factor in determining whether it will pass spontaneously. Stones smaller than 5 mm are more likely to pass than stones larger than 10 mm.

* The location of the stone can also affect the chances of it passing spontaneously. Stones that are lodged in the ureter are less likely to pass than stones that are still in the kidney.

* Other factors that can affect the chances of a stone passing spontaneously include the patient's age, health, and activity level.

It is important to see a doctor to discuss your treatment options.

For more visit: 

Ultrasound imaging of renal calculi

Uterine AVM following medical termination of pregnancy

Uterine arterio venous malformations or AVM are a known complication of medical procedures including MTP or medical termination of pregnancy. 

This is one such case. 

Ultrasound images are shown below:

Ultrasound imaging and color Doppler and spectral Doppler ultrasound findings in this case:

Greyscale ultrasound:

    * Well-defined, vascular lesion with a characteristic "honeycomb" appearance.

    * The lesion is located in the posterior wall of the uterus, but it can also be found in other areas of the uterus.

    * The lesion may be small or large, and it may be single or multiple.

Color Doppler ultrasound:

    * The lesion shows intense vascularity with multiple tortuous vessels.

    * There is often high-velocity, low-resistance blood flow within the lesion.

    * The blood flow may be turbulent, and there may be areas of reversed flow.

Spectral Doppler ultrasound:

    * The spectral Doppler waveform shows high peak systolic velocity (PSV) and low resistive index (RI).

    * The waveform may be biphasic or monophasic.

    * There may be areas of reversed flow.

These findings are not specific for uterine AVM, and they can be seen with other conditions, such as leiomyoma, adenomyosis, and endometrial hyperplasia. However, the combination of these findings is highly suggestive of uterine AVM.

In addition to ultrasound, other imaging studies that can be used to diagnose uterine AVM include:

*Computed tomography (CT) angiography:

    * This is a more detailed imaging study that can provide information about the size, location, and extent of the lesion.

* Magnetic resonance imaging (MRI) angiography:

    * This is another detailed imaging study that can provide information about the size, location, and extent of the lesion.

The differential diagnoses for uterine AVM on ultrasound include:

*Retained products of conception (RPOC): This is when tissue from a pregnancy remains in the uterus after a miscarriage or abortion. It can cause a hypervascular mass on ultrasound.

* Gestational trophoblastic disease (GTD): This is a group of diseases that can develop after a pregnancy. It can cause a hypervascular mass on ultrasound.

*Hemangioma: This is a benign tumor made of blood vessels. It can cause a hypervascular mass on ultrasound.

* Postpartum uterine pseudoaneurysm: This is a blood clot that forms in an artery in the uterus after childbirth. It can cause a hypervascular mass on ultrasound.

*Subinvolution of the placental bed: This is a condition where the placenta does not completely detach from the uterus after childbirth. It can cause a hypervascular mass on ultrasound.

It is important to distinguish between uterine AVM and these other conditions, as the treatment for each condition is different. Color Doppler ultrasound can be used to help make the diagnosis.

Key features that can help distinguish between uterine AVM and the other conditions:

*Uterine AVM typically has a complex appearance with multiple vessels, while RPOC, GTD, hemangioma, postpartum uterine pseudoaneurysm, and subinvolution of the placental bed are more likely to have a simple appearance with a single vessel.

Images in this case are courtesy of Ms. Regina Rachael. 

* Uterine AVM typically has high-velocity flow, while RPOC, GTD, hemangioma, postpartum uterine pseudoaneurysm, and subinvolution of the placental bed are more likely to have low-velocity flow.

* Uterine AVM is often associated with a history of uterine trauma, while RPOC, GTD, hemangioma, postpartum uterine pseudoaneurysm, and subinvolution of the placental bed are not typically associated with a history of uterine trauma.

Management and prognosis:

The management of uterine AVM depends on the severity of the bleeding and the patient's desire for future fertility. In some cases, expectant management may be appropriate. This involves monitoring the patient's bleeding and treating any symptoms that occur.

In other cases, more aggressive treatment may be necessary. This may include uterine artery embolization, hysterectomy, or medical therapy.

Uterine artery embolization is a minimally invasive procedure that involves injecting small particles into the uterine arteries to block the blood flow to the AVM. This can be a very effective treatment for uterine AVM and can help to reduce or stop the bleeding.

Hysterectomy is the surgical removal of the uterus. This is a more drastic treatment option, but it may be necessary in cases of large or recurrent uterine AVMs.

Medical therapy may be used to treat uterine AVM in women who want to preserve their fertility. This may include the use of hormonal therapy or antifibrinolytic agents.

The prognosis for women with uterine AVM is generally good. With appropriate treatment, most women will be able to control their bleeding and live normal lives. However, there is a small risk of recurrence, even after successful treatment.

Ultrasound images in this case are courtesy of Ms Regina Rachael. 

For more information on this visit:

Sonography of uterine pathology

Cervical hydrops, what's that

A 35 year old female patient with history of feeling of bloated abdomen with discomfort. 

She has 2 children delivered by cesarean section and currently tested negative for pregnancy. 

History of scanty menses last time. 

Ultrasound images show these findings:

What are the sonographic findings?

There's obviously a fluid-filled cervix. The distended cervical canal measures 4 x 2 x 1.5 cms. There's also some extension of the collection into the lower uterus. 

Details are below:

The term for a cervical canal distended with fluid is cervical hydrops. It is a condition in which there is an accumulation of fluid in the cervical canal. This can be caused by a number of factors, including:

Cervical stenosis: This is a narrowing of the cervical canal that can make it difficult for fluid to drain from the uterus. This is the most likely diagnosis in this patient. 

Infection: An infection in the cervix or uterus can also cause fluid to build up.

Endometriosis: This is a condition in which tissue that normally lines the uterus grows outside of the uterus. This can also cause fluid to build up in the cervical canal.

Tumor: A tumor in the cervix or uterus can also cause fluid to build up.

What are the common symptoms of cervical hydrops?

Cervical hydrops is often asymptomatic, but it can sometimes cause symptoms such as:

Vaginal discharge: The discharge may be clear, white, or bloody.

Pain: The pain may be mild or severe.

Pressure: There may be a feeling of pressure in the pelvis.

Bloating of abdomen feeling. 

Final diagnosis: cervical hydrops with mild hydrometra (fluid in endometrial cavity).

The likely etiology in this case is cervical stenosis. Cervical stenosis is a narrowing of the cervical canal, which is the opening at the bottom of the uterus. This can cause a buildup of fluid in the uterus, which can lead to a bulky uterus. The normal endometrium and the absence of a mass in the cervix suggest that the stenosis is not caused by a tumor or other growth.

Here are some other possible causes of cervical stenosis:

* Infection: Cervical stenosis can be caused by an infection, such as chlamydia or gonorrhea.

* Surgery: Cervical stenosis can be a side effect of surgery, such as a hysterectomy or a cesarean section.

* Radiation therapy: Cervical stenosis can be a side effect of radiation therapy for cancer.

Management:

In most cases, cervical stenosis is not a cause for concern. It can be treated with medication or surgery. However, if cervical stenosis is causing symptoms or if there is a concern that it may be cancerous, it is important to have it treated.

Prognosis in this case:

The prognosis for cervical stenosis in a 35-year-old female is generally good. With treatment, most women are able to live normal, healthy lives.

The management of cervical stenosis in this case will depend on the severity of the stenosis and the symptoms that the woman is experiencing. If the stenosis is mild and the woman is not experiencing any symptoms, then no treatment may be necessary. However, if the stenosis is causing symptoms, then treatment may be necessary.

Treatment:

There are two main types of treatment for cervical stenosis:

Medication: Medications can be used to help relax the muscles in the cervix and widen the cervical canal. This can help to relieve symptoms and make it easier for menstrual blood to pass.

Surgery: Surgery can be used to widen the cervical canal. This is usually done by inserting a dilator into the cervix and gradually widening it over time. In some cases, a small incision may be made in the cervix to widen it.

The type of treatment that is best for a woman will depend on the severity of her stenosis and her individual preferences.

Here are some of the things that a 35-year-old female can do to manage cervical stenosis:

Take medications: medications to help relax the muscles in the cervix, it is important to take them as prescribed.

Use dilators. If the doctor prescribes dilators, it is important to use them regularly. This will help to keep the cervical canal widened and prevent the stenosis from getting worse.

Avoid activities that put pressure on the cervix. Activities such as heavy lifting and vigorous exercise can put pressure on the cervix and make the symptoms worse.

For more info on this visit:

Ultrasound imaging of the uterus

Case of lower segment uterine contraction, follow up ultrasound

The patient has a history of preterm deliveries, which puts her at an increased risk for preterm labor in this pregnancy. The ultrasound findings of lower segment uterine contraction is concerning for preterm labor. Vaginal progesterone tablets are being used to try to prevent preterm labor.

The follow-up ultrasound scan showed that the cervix is still 3.8 cm long, but there is no funneling present. This is a good sign, as funneling is a sign that the cervix is starting to dilate. However, the lower segment of the uterus still appears contracted. This could be a sign that the patient is still at risk for preterm labor.

The patient's healthcare provider will need to continue to monitor her closely for signs of preterm labor. If the patient starts to have contractions, or if the cervix starts to dilate or efface, she will need to be treated for preterm labor.

Here are some things the patient can do to help reduce her risk of preterm labor:

• Get regular prenatal care.
• Take her prenatal vitamins.
• Eat a healthy diet.
• Get enough sleep.
• Avoid smoking and drinking alcohol.
• Manage her stress levels.

If the patient has any concerns about her pregnancy, she should talk to her healthcare provider.

Ultrasound images are shown below:

The cervix appears lengthy due to full bladder below:

Uterine contraction lower segment:

TVS  scan shows contraction of lower segment:

Correct measurement of cervix:

Persistent lower segment uterine contractions (LUS contractions) in the second trimester of pregnancy: can have a significant impact on cervical length and uterocervical angle. These contractions can lead to an increase in cervical length, which can make it more difficult to determine if a woman is at risk for preterm labor. Additionally, LUS contractions can cause the uterocervical angle to decrease, which can also increase the risk of preterm labor.

The exact reason why LUS contractions occur in the second trimester is not fully understood. However, it is thought that they may be due to hormonal changes or to the stretching of the uterus as the fetus grows.

Significance:

In most cases, LUS contractions are not a cause for concern. However, if they are persistent or if they are accompanied by other symptoms such as vaginal bleeding or cramping, it is important to see a doctor.

Here are some of the potential implications of persistent LUS contractions in the second trimester:

• Increased risk of preterm labor
• Difficulty determining if a woman is at risk for preterm labor
• Decreased uterocervical angle
• Increased risk of preterm birth

Here are some of the things that your doctor may do to assess your risk for preterm labor:

• Ask you about your medical history and your pregnancy history
• Perform a physical examination
• Order ultrasound tests to measure your cervical length and uterocervical angle
• Order blood tests to check your hormone levels

If your doctor determines that you are at risk for preterm labor, they may recommend that you:

• Take bed rest
• Avoid certain activities
• Take medication to prevent preterm labor

With proper care, most women who experience persistent LUS contractions in the second trimester are able to carry their babies to term.

For more visit: Sonography of cervix in pregnancy

Large thyroid mass in young adult female

This 20 years old female patient had a visible right neck swelling. 

Ultrasound imaging was done which revealed:

Ultrasound and color Doppler imaging findings in this case:

Ultrasound: The mass is large, solid, and wider than tall. It is mildly inhomogeneous in echotexture, meaning that it has a slightly different echogenicity (brightness) throughout. There are no calcifications within the mass.

Color Doppler: The mass shows moderate internal vascularity, meaning that there is a moderate amount of blood flow within the mass. This is a nonspecific finding, and it can be seen in both benign and malignant thyroid nodules.

The ultrasound and color Doppler imaging findings in this case are consistent with a benign thyroid nodule, such as a thyroid adenoma. However, the findings are not definitive, and a fine-needle aspiration biopsy (FNAB) is usually needed to make a definitive diagnosis.

Here is a table summarizing the ultrasound and color Doppler imaging findings in this case:

The differential diagnoses for a 20-year-old female patient with a large solid mass of 2 x 2.5 x 4 cms filling the entire right lobe of thyroid include:

* Thyroid adenoma: This is the most likely diagnosis, especially given the patient's age. Thyroid adenomas are benign tumors that can grow to a large size. They are usually non-functional, meaning that they do not produce excess thyroid hormone.

*Thyroid malignancy: This is a less likely diagnosis, but it is still possible. Thyroid cancer is more common in older adults, but it can occur in younger people as well. The ultrasound findings of moderate internal vascularity and no calcifications are more consistent with a benign tumor, but they are not definitive.

* Lymphoma: This is a rare diagnosis, but it is still possible. Lymphoma can involve the thyroid gland, and it can present as a large solid mass.

*Metastatic cancer: This is also a rare diagnosis, but it is possible. Metastatic cancer to the thyroid gland can occur from other cancers, such as lung cancer or breast cancer.

Final diagnosis: thyroid adenoma 

Either papillary or follicular thyroid adenoma. 

TIRADS grade for this case is 3:

The Thyroid Imaging Reporting and Data System (TIRADS) is a system used to grade thyroid nodules based on their ultrasound characteristics. The TIRADS grades range from 1 to 5, with 1 being the lowest risk and 5 being the highest risk.

The criteria for TIRADS 3 are as follows:

Size:Greater than or equal to 1 cm but less than or equal to 4 cm.

Shape: Irregular or lobulated.

Echotexture: Hypoechoic or isoechoic.

Calcifications: None.

Vascularity: Moderate.

The patient in this case meets all of the criteria for TIRADS 3, so her nodule would be graded as 3. This means that the nodule has a slightly increased risk of being cancerous, but it is still more likely to be benign.

The management approach for a 20-year-old female patient with this large solid mass of 2 x 2.5 x 4 cms filling the entire right lobe of thyroid will depend on the final diagnosis. If the diagnosis is a thyroid adenoma, the patient may be monitored with ultrasound every 6-12 months. If the diagnosis is thyroid cancer, the patient will need surgery to remove the tumor. The prognosis for thyroid cancer is generally good, especially if the cancer is caught early.

Further investigations:

The following are some additional tests that may be ordered to help make the diagnosis:

* Thyroid function tests: These tests will measure the levels of thyroid hormone in the blood.

* Fine-needle aspiration biopsy: This is a procedure in which a needle is inserted into the mass to remove a small sample of tissue. The tissue sample is then examined under a microscope to look for cancer cells.

* Thyroid nuclear scan: This is a test that uses radioactive iodine to image the thyroid gland. The scan can help to determine the size and location of the mass, and it can also help to determine if the mass is taking up iodine, which is a characteristic of thyroid cancer.

The prognosis: for a 20-year-old female patient with this large solid mass of 2 x 2.5 x 4 cms filling the entire right lobe of thyroid depends on the final diagnosis. If the diagnosis is a thyroid adenoma, the prognosis is excellent. If the diagnosis is thyroid carcinoma, the prognosis depends on the stage of the cancer and the patient's age and overall health. However, the prognosis for thyroid carcinoma is generally good, especially if the cancer is caught early.

For more on this topic visit:

Ultrasound images of thyroid

Sonography of thyroid disease

Hashimoto's thyroiditis induced severe atrophy of thyroid

This elderly female patient had history of tiredness and lethargy. She was a known case of Hashimoto's thyroiditis and on daily Thyroxine 150 mcg tablet.

The ultrasound imaging findings are consistent with severe atrophy of the thyroid gland in a patient with long-standing Hashimoto's thyroiditis. The patient's thyroid gland is so small that the left lobe is only 5 x 7 mm in size, and the right lobe and isthmus are not visible. This is a typical finding in patients with Hashimoto's thyroiditis, as the autoimmune attack on the thyroid gland eventually leads to its destruction.

The patient has been taking thyroxine 150 mcg tablet daily for the past 10 years, which has helped to keep her thyroid hormone levels in the normal range. However, she may need to have her dose of thyroxine adjusted in the future, as her thyroid gland continues to atrophy.

It is important for the patient to continue to see her doctor regularly so that her thyroid hormone levels can be monitored and her dose of thyroxine can be adjusted as needed. She should also be aware of the symptoms of hypothyroidism, such as fatigue, weight gain, and cold intolerance, and report any changes in her symptoms to her doctor.

Some additional information about Hashimoto's thyroiditis:

• Hashimoto's thyroiditis is an autoimmune disease that causes the body's immune system to attack the thyroid gland.
• The thyroid gland is a small gland in the neck that produces hormones that regulate metabolism.
• Hashimoto's thyroiditis is the most common cause of hypothyroidism, which is a condition in which the thyroid gland does not produce enough hormones.
• The symptoms of Hashimoto's thyroiditis can vary, but they often include fatigue, weight gain, cold intolerance, and dry skin.
• There is no cure for Hashimoto's thyroiditis, but it can be managed with medication.

Prognosis and management:

The prognosis and management of an elderly woman on 150 mcg of thyroxine tablet daily with severe atrophy of thyroid gland will depend on a number of factors, including the woman's overall health, the severity of her hypothyroidism, and how well she responds to treatment.

In general, the prognosis for elderly people with hypothyroidism is good. With proper treatment, most people are able to live normal, active lives. However, some elderly people may be more susceptible to the complications of hypothyroidism, such as heart disease, stroke, and osteoporosis.

The management of hypothyroidism in elderly people is similar to the management in younger people. The goal of treatment is to replace the thyroid hormone that the body is not producing. This is usually done with a daily dose of levothyroxine (thyronorm). The dosage may need to be adjusted over time to achieve the desired level of thyroid hormone in the blood.

In the case of an elderly woman with severe atrophy of the thyroid gland, she may need a higher dose of levothyroxine than a younger person with the same level of hypothyroidism. She may also need to be monitored more closely for side effects of treatment, such as heart palpitations and anxiety.

With proper treatment, this elderly patient with severe atrophy of the thyroid gland can live a long and healthy life. However, it is important to work closely with a doctor to monitor her condition and adjust her medication as needed.

Here are some additional tips for managing hypothyroidism in elderly people:

• Take medication on time, every day.
• Have blood levels checked regularly to make sure your dosage is correct.
• Be aware of the signs and symptoms of hypothyroidism, and report any changes to physician. 
• Take care of overall health by eating a healthy diet, exercising regularly, and getting enough sleep.

For more visit: Ultrasound imaging of thyroid

Also: Sonography of thyroid

Particulate matter in urinary bladder

Asymptomatic male patient. Urinary bladder shows moderate amount of particulate matter, freely floating in it.

The kidneys appears normal. Bladder walls are normal. 

Final diagnosis: asymptomatic patient with urinary bladder particles. Most likely cause, dehydration. Insufficient intake of fluids. 

Urinary crystals: are one of the commonest causes of particulate matter in urine. 

Urinary crystals can sometimes be seen on ultrasound imaging of the urinary bladder. These crystals can appear as small, echogenic particles that move freely within the urine. They are often associated with urinary tract infections (UTIs), but they can also be seen in people without UTIs.

The exact cause of urinary crystals: is not always known, but they are thought to be caused by a combination of factors, including:

* Dehydration: most likely in this case. This is the commonest cause in asymptomatic patients. 

* High levels of certain minerals in the urine, such as calcium, oxalate, and uric acid

* Certain medications, such as indinavir (Crixivan)

* Medical conditions, such as gout and cystinuria

Further tests:

In this case, a urinalysis to check for a UTI is advised.  Also recommended other tests, such as a urine culture, to rule out other possible causes of the crystals.

In most cases, urinary crystals are not a cause for concern. However, if they are associated with a UTI, they can increase the risk of kidney stones. In this case, it may be recommended to increase fluid intake and make changes to diet to help prevent the formation of kidney stones.

Here are some additional details about urinary crystals and ultrasound imaging:

* The type of crystals that are seen on ultrasound can vary depending on the underlying cause. For example, calcium oxalate crystals are the most common type of crystal seen in people with UTIs.

* The size of the crystals can also vary. Small crystals are more likely to be seen on ultrasound than large crystals.

* The location of the crystals can also vary. Crystals that are located in the bladder wall are more likely to be associated with a UTI than crystals that are located in the urine itself.

More details are below:

• Ultrasound findings: Particulate matter in the urinary bladder appears as mobile, echogenic (bright) foci on ultrasound. The particles can vary in size and shape, and they may be single or multiple. They often settle in the dependent portion of the bladder, and they may move with changes in position.
• Causes: There are many possible causes of urinary bladder particulate matter, including:
  • Urinary tract infection (UTI): UTI is the most common cause of particulate matter in the bladder. The bacteria in a UTI can break down red blood cells, which can form clumps that appear as particulate matter on ultrasound.
  • Hematuria: Hematuria, or blood in the urine, can also cause particulate matter in the bladder. The blood cells can clump together and appear as echogenic foci on ultrasound.
  • Inflammation: Inflammation of the bladder, such as cystitis, can also cause particulate matter in the bladder. The inflammation can cause cells and debris to shed into the urine, which can appear as particulate matter on ultrasound.
  • Drugs: Some medications, such as indinavir and pentamidine, can precipitate out of the urine and form particulate matter in the bladder.
  • Malignancy: In rare cases, particulate matter in the bladder can be a sign of malignancy. However, this is usually accompanied by other symptoms, such as pain, hematuria, and urinary frequency.
• Differential diagnoses: The differential diagnoses for urinary bladder particulate matter include:
  • Urinary tract infection (UTI): As mentioned above, UTI is the most common cause of particulate matter in the bladder. Other symptoms of UTI, such as pain, fever, and urgency, may be present.
  • Hematuria: Hematuria, or blood in the urine, can also cause particulate matter in the bladder. Other symptoms of hematuria, such as pain, urgency, and clots in the urine, may be present.
  • Inflammation: Inflammation of the bladder, such as cystitis, can also cause particulate matter in the bladder. Other symptoms of cystitis, such as pain, urgency, and frequency, may be present.
  • Drugs: Some medications, such as indinavir and pentamidine, can precipitate out of the urine and form particulate matter in the bladder. Other symptoms of drug-induced cystitis, such as pain, urgency, and frequency, may be present.
  • Malignancy: In rare cases, particulate matter in the bladder can be a sign of malignancy. However, this is usually accompanied by other symptoms, such as pain, hematuria, and urinary frequency.
• Management: The management of urinary bladder particulate matter depends on the underlying cause. If the particulate matter is due to a UTI, then antibiotics will be prescribed. If the particulate matter is due to hematuria, then the underlying cause of the hematuria will need to be addressed. If the particulate matter is due to inflammation, then anti-inflammatory medications may be prescribed. If the particulate matter is due to drugs, then the medication may need to be changed. If the particulate matter is due to malignancy, then further testing, such as cystoscopy, may be necessary.

In asymptomatic patients, the management of urinary bladder particulate matter is usually conservative. The patient may be monitored with repeat ultrasounds to see if the particulate matter resolves. If the particulate matter does not resolve, then further testing may be necessary to determine the underlying cause.

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Urinary bladder ultrasound

Contraction of lower uterine segment and not funneling

A 2nd trimester pregnancy underwent sonography for discharge PV.

Ultrasound imaging was done and showed these findings:

Before contraction of lower segment of uterus, there is no suggestion of funneling. 

Over a period of 10 minutes there's apparently "funneling" in this region. 

However the cervical length is at 3.7 cms and apparently normal. 

Note also: the thickening of lower segment uterine myometrium due to contraction. 

All these point to: contraction of lower segment of uterus and rule out funneling of cervix. 

So how to distinguish between true funneling from lower uterine segment contraction:

Distinguishing between a contraction of the uterus and funneling of the cervix on ultrasound imaging can be challenging. However, there are certain characteristics that can help differentiate between the two in a 2nd trimester pregnancy. 

1. Contraction of the uterus: 

A contraction of the uterus is typically associated with temporary tightening and relaxation of the uterine muscle. It can cause a transient change in the shape of the uterus, but it doesn't involve the cervix itself. When evaluating an ultrasound image, look for the following signs:

- Irregular shape: Contractions may cause the uterus to appear irregularly shaped with areas of increased and decreased thickness.

- Transient changes: The alterations in the uterine shape due to contractions are often temporary, and the uterus should return to its normal appearance after the contraction subsides.

- Absence of funneling: Funneling of the cervix is not typically associated with contractions of the uterus. The cervix should remain closed and maintain its normal shape.

2. Funneling of the cervix: 

Cervical funneling refers to the opening and shortening of the cervical canal, which may indicate a potential risk for preterm labor. When assessing an ultrasound image, consider the following characteristics:

- Beak-like appearance: Funneling of the cervix can present as a dilated and shortened cervical canal with a beak-like appearance. It may appear as a "funnel" or "v" shape in the ultrasound image.

- Structural changes: Unlike contractions, funneling of the cervix is more likely to persist and can be observed consistently throughout the ultrasound examination.

- Cervical length measurement: Cervical length is an essential parameter evaluated during ultrasound scans. Funneling is often associated with a shorter cervical length, which indicates an increased risk of preterm labor.

Management:

Funneling of the cervix and contraction of the lower segment of the uterus are two different conditions that can occur during pregnancy. Funneling is a thinning and opening of the cervix, while contraction of the lower segment of the uterus is a tightening of the muscles in the lower part of the uterus. Both conditions can increase the risk of preterm birth, but they are managed differently.

Funneling of the cervix: is often treated with a cervical cerclage, which is a stitch that is placed around the cervix to help keep it closed. Cerclages are typically placed between 16 and 24 weeks of gestation.

Contraction of the lower segment: of the uterus is often treated with bed rest and medication to relax the muscles in the uterus. In some cases, a tocolytic medication may be used to stop contractions.

The management of these conditions will depend on the severity of the condition, the woman's risk factors for preterm birth, and her overall health. It is important to work with a healthcare provider to develop a treatment plan that is right for you.

Here are some additional information:

Funneling of the cervix: is a common condition that occurs in about 10% of pregnancies. It is more common in women who have had a previous preterm birth, a short cervix, or a history of cervical surgery. Funneling is usually not a sign of preterm labor, but it can increase the risk of preterm birth.

Contraction of the lower segment of the uterus:

 is a less common condition that occurs in about 1% of pregnancies. It is more common in women who have had a previous preterm birth, a multiple pregnancy, or a history of uterine fibroids. Contraction of the lower segment of the uterus can cause preterm labor.

Remember that these observations are general guidelines, and an accurate diagnosis can only be made by a qualified healthcare professional who can take into account the complete clinical picture, including symptoms and additional diagnostic tests if necessary.

For more on this topic visit:

Funneling of cervix in pregnancy