A simple quiz- what is your diagnosis?

What is your diagnosis in this young woman with abdominal pain.
3D ultrasound images are shown below:

the answer is: a large gallbladder calculus located close to its neck.
Here are more images of the same case, the first is a 2-D ultrasound image,
the second is a 3-D Ultrasound image of the same case showing the gallbladder calculus is a large echogenic structure within it.

Sonography of a case of bilateral fetal hydronephrosis

34 week fetus...bilateral fetal hydronephrosis.. the question is , is this pelviureteric junction obstruction or is it posterior urethral valves...
See ultrasound images below: are those two structures the fetal ureter/ hydroureter or are they bowel loops

The fetal bladder....is it a typical keyhole bladder:

Fetal rt. kidney and is that a right hydroureter?

A wee bit of polyhydramnios....

Renal calculus 3D ultrasound image

A 3D ultrasound image of left renal calculus. The calculus is seen in the upper part of the pelvis of left kidney. (Ultrasound image courtesy of Dr. Ravi Kadasne, MD, UAE).

for more on this topic visit: http://www.ultrasound-images.com/renal-calculi/
Also: http://cochinblogs.blogspot.in/2011/04/kidney-stones-renal-calculi-urinary.html

Deep-vein thrombosis- before and after treatment:

This elderly lady had a partial deep vein thrombosis of the distal part of the right femoral vein, and also the anterior tibial vein of the right side. Note the very poor augmentation of the right femoral vein, despite compression of the calf. This suggests a partial obstruction below the knee and also the distal femoral vein. The Anterior Tibial Vein is also not visualised suggesting thrombosis of this vessel.
Colour Doppler ultrasound image showing lack of augmentation of the distal femoral vein:

The right Peroneal vein and the right posterior tibial vein are visualised and show some measure of flow in these colour Doppler ultrasound images:

The right anterior tibial vein is not visualised due to very poor flow in this colour Doppler ultrasound image.

The above colour Doppler ultrasound images were taken before treatment when the patient was symptomatic.
The colour Doppler ultrasound images below show changes after treatment with anticoagulants:

Note the sharp augmentation of flow on calf pressure. These images were taken four days after treatment with anticoagulants. Obviously the thrombosis of the veins has more or less resolved. the right anterior tibial vein also shows some measure of flow ( see image below):

For more on this topic see:
http://www.ultrasound-images.com/vascular.htm#Deep_vein_thrombosis-_thrombus_in_deep_veins_of_lower_limb

Colour Doppler study of Another case of severe arterial disease in chronic diabetes

This elderly lady had gangrene of the left foot. Color Doppler study shows what is obviously a severe stenosis of the entire arterial tree of the left lower limb. In fact, the changes in the femoral artery of the left lower limb, the popliteal artery, the anterior and posterior tibial arteries and the left peroneal artery, all show severe stenosis, as seen on colour Doppler imaging.
This is what we saw when we did a colour Doppler study of the left femoral artery:

The most obvious findingin the colour Doppler images is very poor Doppler signal in the left femoral artery. In addition, the spectral Doppler study shows a marked dampening of flow in the left femoral artery suggestive of severe stenotic changes in this vessel. Note also, the monophasic flow pattern that is observed in the spectral Doppler waveform.

This is what we observed in the rest of the arterial tree of the left lower limb:

 

Again, the left popliteal artery is barely visible in the colour Doppler images and is seen as a thin trickle of flow. Again note the monophasic nature of the flow similar to that seen in venous flow.

The posterior tibial artery shows almost absent flow with severe dampening. Only the anterior tibial shows a relative better flow pattern. This entire Doppler study was done with very low PRF settings, set at the lowest sensitivity level to detect the weakest of flow. This itself shows the extent of and the severity of the disease of the arterial system.
See this link for more on this topic:
http://www.ultrasound-images.com/vascular-doppler-2/#Severe-stenosis-of-Rt-SFA-case-2

Severe oligohydramnios with abnormal Fetal kidneys

Would you call these Fetal kidneys polycystic or would you call them multi-cystic?
Anyway, these kidneys which are very poorly visualised are definitely abnormal and enlarged suggesting a bad prognosis for this patient and the fetus.

for more images of this case visit: http://www.ultrasound-images.com/amniotic-fluid.htm#Severe_oligohydramnios_in_late_2nd_trimester
Also visit: http://www.ultrasound-images.com/fetal-urogenital.htm#Fetal_bilateral_multicystic_kidney_disease
where I discuss, that the ultrasound images of this case are more suggestive of multi-cystic kidney disease of the fetus rather than autosomal recessive polycystic kidney disease.
The points which favour of multicystic dysplastic kidney disease in this fetus, based on  these  ultrasound images, are- relatively larger cysts in the kidneys, compared to the micro cysts that are seen in autosomal recessive polycystic kidney disease, the poorly defined borders of the Fetal kidneys, as opposed to the relatively well defined margins of kidneys in autosomal recessive polycystic kidney disease of the fetus.
It must however be noted that, some of the features of autosomal recessive polycystic kidney disease and multicystic dysplastic disease of the kidneys can overlap resulting in considerable confusion between the sonographic findings of both these diseases. The second link above describes the specific sonographic findings in this case that favour a diagnosis of multicystic dysplastic kidney disease of fetus.

Echogenic Fetal bowel-an intriguing case

This is an intriguing case of a late third trimester pregnancy with the fetus showing a segment of hyperechoic area in the Fetal abdomen. This could be either an area of echogenic Fetal bowel, or some other echogenic focus in the Fetal abdomen. what is surprising is the area of increased echogenicity which seems to include the full thickness of the Fetal intestine.

The ultrasound video of this case is posted below: