Large myometrial cyst

A myometrial cyst in the posterior wall of the uterus following repeated surgical removal of fibroids could potentially be a seroma. 

A seroma is a collection of clear fluid that can accumulate in the body as a result of surgery or injury. It often appears as a cystic or fluid-filled structure on imaging studies like ultrasound. Seromas typically contain serous fluid, which is a clear, yellowish fluid that can accumulate in spaces left by surgery or tissue removal.

Case study of a patient with seroma of posterior wall of uterus:

This is a case of a female patient with history of repeated myomectomy for uterine fibroids:

Findings:

Cystic area of 1 x2 cms in posterior wall of uterus.

Absence of vascularity within the cystic lesion rules out AVM or hemangioma.

History of repeated myomectomy suggests a possible seroma of the myometrium. 

What is a seroma of the uterus?

Seromas can develop as part of the normal healing process after surgery. They are more common in surgeries where tissue has been dissected or removed, such as myomectomy. In our case, a seroma has formed within the myometrial tissue in the posterior wall of the uterus, which appears as a cystic area on ultrasound imaging.

What are the symptoms of seroma of uterus?

The symptoms of a myometrial cystic area following myomectomy can vary depending on the size and location of the cyst. Some women may experience no symptoms at all, while others may have pain, bleeding, or irregular periods.

How is this diagnosed?

The diagnosis of a myometrial cystic area following myomectomy is usually made with an ultrasound or MRI scan. The cyst may be filled with fluid or blood.

Treatment:

The treatment of a myometrial cystic area or seroma following myomectomy depends on the size and symptoms of the cyst. Small cysts that are not causing any symptoms may be monitored over time. Larger cysts or cysts that are causing symptoms may need to be removed surgically.

Prognosis:

The prognosis for a myometrial cystic area following myomectomy is usually good. Most cysts are benign and can be successfully treated. However, it is important to see a doctor if you have any concerns about a myometrial cystic area.

Here are some additional things to keep in mind about myometrial cystic areas or seroma following myomectomy:

* They are more likely to occur in women who have had multiple myomectomies.

* They are also more likely to occur in women who have adenomyosis, a condition in which endometrial tissue grows into the myometrium.

* The risk of developing a myometrial cystic area following myomectomy is low, but it is important to be aware of the possibility.

Sonographic atlas of uterine fibroids

Sonography of uterine fibroids ebook India

A Bosniak grade 2F renal cyst

 Bosniak grade of the renal cortical cyst: II F.

This patient has an incidental finding on ultrasound, of a 2 cms size renal cyst with moderately thick cyst wall calcifications and multiple thin septations. 

Color Doppler imaging doesn't show internal vascularity. 

The Bosniak classification system is a widely used system for classifying renal cysts based on their appearance on imaging tests. A Bosniak II F cyst is a minimally complicated cyst that has thin septations that are less than 1 mm thick. However, there are some thick calcifications. These cysts are considered to be benign and have a low risk of malignancy with follow up ultrasound necessary. 

In our case, the cyst is 2 cm in size, which is larger than the 1 cm cutoff for a Bosniak I cyst. However, the septations are thin (less than 2 mm) and the wall calcifications are small (3 mm). These features are consistent with a Bosniak II F cyst.

It is important to note that the Bosniak classification system is not perfect and cannot definitively rule out malignancy.

Note: ultrasound imaging in conjunction with contrast CT scan is essential in an accurate grading of the renal cyst.

Here is a table of the Bosniak classification system:

* Prognosis: The prognosis of a Bosniak grade 2F renal cyst is generally good. The risk of malignancy is low, at around 3%. However, there is a small risk of the cyst progressing to malignancy, so it is important to have regular follow-up imaging.

* Management: The management of a Bosniak grade 2F renal cyst is typically observation. This means that the patient will have regular follow-up imaging, such as ultrasound or CT scan, to monitor the cyst for any changes. If the cyst grows or changes in appearance, then surgery may be recommended to remove it.

Some additional things to keep in mind about the management:

* The frequency of follow-up imaging is not standardized, but it is generally recommended to have imaging every 1 year.

* Other factors that may be considered when deciding on the management of a Bosniak grade 2F renal cyst include the patient's age, health status, and preferences.

* If surgery is recommended, the type of surgery will depend on the size and location of the cyst. 

For more information on this topic visit:

Ultrasound imaging of kidneys

Bosniak classification for renal cysts

Hemorrhagic Ovarian Cyst in a Young Adult Female

Hemorrhagic ovarian cysts are a common cause of acute pelvic pain in young women. They are typically caused by a ruptured blood vessel within the cyst. The ultrasound imaging findings of a hemorrhagic ovarian cyst can vary depending on the stage of bleeding.

Ultrasound imaging findings of hemorrhagic cysts:

In the early stages of bleeding, the cyst may appear as a simple cyst with an echogenic rim. As the bleeding progresses, the cyst may become more heterogeneous with internal echoes. The echoes may have a lace-like or reticular appearance, which is sometimes described as a "fish net" pattern.

In some cases, the cyst may contain a solid clot. The clot may be mobile or attached to the cyst wall. The cyst wall may be thickened and irregular.

Differential diagnoses:

The ultrasound imaging findings of a hemorrhagic ovarian cyst can be similar to those of other conditions, such as an ovarian neoplasm or an ectopic pregnancy. Therefore, it is important to obtain a complete clinical history and perform other imaging tests, such as a pelvic CT scan or MRI, to confirm the diagnosis.

The treatment of a hemorrhagic ovarian cyst depends on the size and severity of the bleeding. In most cases, the cyst will resolve on its own without treatment. However, if the cyst is large or causing significant pain, it may need to be surgically removed.

Some additional points about hemorrhagic ovarian cysts:

* They are most common in women between the ages of 20 and 40.

* They are often associated with ovulation.

* They are usually benign, but there is a small risk of malignancy.

* The symptoms of a hemorrhagic ovarian cyst can include:

    * Acute pelvic pain

    * Nausea and vomiting

    * Fever

    * Vaginal bleeding

This kindle ebook may be useful 

Sonography of uterine fibroids ebook

Dystrophic Calcifications in the Uterus of a 60-Year-Old Female

Ultrasound Imaging Findings:

1. Calcific Deposits: Multiple areas of calcification are visible within the uterine walls, evident as hyperechoic or bright spots on ultrasound.

2. Distribution: The calcifications are dispersed unevenly throughout the uterine tissue, and their size and density can vary.

3. Shadowing Effect: The calcific deposits may cast posterior acoustic shadows, limiting visualization of structures located behind them.

4. Texture Alterations: The calcified areas can cause changes in the overall texture of the uterine walls, leading to irregularities in the echo patterns.

Ultrasound images shown below:

Causes of uterine calcifications:

The most common cause of uterine myometrial calcifications in elderly females is aging. As women age, their arteries become less elastic and more prone to calcification. This can happen in any artery in the body, including those in the uterus.

Other possible causes of uterine myometrial calcifications:

* Fibroids: Fibroids are benign tumors that can develop in the uterus. As fibroids grow, they can calcify.

* Endometriosis: Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside of the uterus. This tissue can also calcify.

* Pelvic inflammatory disease (PID): PID is an infection of the female reproductive organs. It can cause scarring and inflammation in the uterus, which can lead to calcification.

* Radiation therapy: Radiation therapy can damage the tissues of the uterus, which can lead to calcification.

Significance:

1. Dystrophic Calcification: This type of calcification occurs in degenerated or damaged tissue and is typically benign. In this case, the calcifications may result from previous trauma, inflammation, or cellular degeneration within the uterus.

2. Exclusion of Pathology: The absence of other pathologies suggests that the dystrophic calcifications are likely the primary focus of concern. However, thorough clinical assessment is essential to rule out other potential causes.

3. Potential Symptomatology: Depending on the location and size of the calcifications, the patient may experience mild discomfort or pain. However, in the absence of active disease processes, symptoms are usually minimal.

Prognosis:

1. Benign Nature: Dystrophic calcifications in the uterus are typically non-cancerous and pose a low risk of malignancy.

2. Long-Term Outlook: The presence of calcifications may not significantly impact the patient's quality of life or overall health. Asymptomatic cases may require no immediate intervention.

3. Monitoring: Regular follow-up ultrasounds and clinical assessments are advisable to track any changes in the calcified areas or the patient's symptoms.

4. Treatment: Surgical removal of calcifications is generally unnecessary unless they cause persistent discomfort or interfere with other pelvic structures.

In conclusion, the ultrasound imaging findings of multiple areas of dystrophic calcifications in the uterus of a 60-year-old female, along with a small-sized uterus and absence of other pathologies, point towards a benign condition. While the presence of calcifications may cause minor symptoms, their significance lies in their non-malignant nature. Close monitoring and regular check-ups will help ensure the patient's well-being and provide timely intervention if necessary.

Here's a kindle ebook on ultrasound imaging of uterine fibroids 

Kindle ebook on uterine fibroids

Acute Thyroiditis in a Case of MNG

Acute Thyroiditis in a Case of MNG in a Young Adult Female:

Acute thyroiditis is an inflammation of the thyroid gland that can cause pain, tenderness, and swelling in the neck. It can be caused by a number of factors, including infection, autoimmune disease, or radiation exposure.

Acute thyroiditis is also called De Quervains thyroiditis. 

In this case, a young adult female presented with a tender, enlarged thyroid gland. Ultrasound and color Doppler imaging revealed multiple solid and cystic nodules on both sides of the thyroid. The nodules were hypervascular, suggesting that they were inflamed.

The patient was diagnosed with acute thyroiditis in the setting of a multinodular goiter (MNG). MNG is a condition in which the thyroid gland becomes enlarged and develops multiple nodules. It is the most common thyroid disorder in adults.

 Ultrasound and color Doppler imaging findings in this case:

* The thyroid gland was enlarged and heterogeneous in echotexture.

* There were multiple solid and cystic nodules present on both sides of the thyroid.

* The nodules were hypervascular, suggesting that they were inflamed.

Management:

The patient was treated with anti-inflammatory medications and pain relievers. Her symptoms improved over the next few weeks and her thyroid function tests returned to normal.

The prognosis: for patients with acute thyroiditis in the setting of MNG is generally good. Most patients make a full recovery with treatment. However, some patients may experience recurrent episodes of thyroiditis.

.

The prognosis and management for this patient are as follows:

* Prognosis: The prognosis for patients with acute thyroiditis in the setting of MNG is generally good. Most patients make a full recovery with treatment. However, some patients may experience recurrent episodes of thyroiditis.

* Management: The patient was treated with anti-inflammatory medications and pain relievers. Her symptoms improved over the next few weeks and her thyroid function tests returned to normal.

A good ebook available on Amazon Kindle 

Thyroid disease how to live with it

Elderly Patient with Multiple Bilateral Renal Cortical Cysts

Multiple bilateral renal cortical cysts are a common finding in elderly patients. They are typically benign and do not cause any symptoms. However, in rare cases, they can become infected, bleed, or enlarge enough to cause pain or kidney dysfunction.

# Presentation:

The most common presentation of multiple bilateral renal cortical cysts is an incidental finding on imaging studies, such as an ultrasound or CT scan. Patients may also present with symptoms related to complications of the cysts, such as infection, bleeding, or pain.

Ultrasound imaging findings, as well as the Bosniak classification:

*Ultrasound imaging findings of multiple renal cysts:

    * Multiple, round, anechoic (fluid-filled) lesions in the kidneys.

    * The cysts are of different sizes.

    * The cysts have thin walls.

    * The cysts don't  have internal septations.

    * The cysts do not have calcifications.

* Bosniak classification for simple renal cortical cysts:

    * Bosniak I cysts are simple cysts with no internal echoes, septations, or calcifications. They are benign and do not require any further imaging or treatment.

    * Bosniak II cysts are complex cysts with thin septations or calcifications. They are benign in most cases, but may require further imaging or treatment if they are large or growing.

    * Bosniak III cysts are complex cysts with thick septations, irregular borders, or nodularity. They have a higher risk of being malignant and may require surgery.

    * Bosniak IV cysts are cystic masses with features of malignancy, such as solid components, thick septations, and irregular borders. They are almost always malignant and require surgery.

Bosniak grade of this patient: Bosniak 1:

In the case of the elderly patient with multiple bilateral renal cortical cysts, the ultrasound imaging findings are consistent with Bosniak I cysts. This means that the cysts are benign and do not require any further imaging or treatment. 

#Diagnosis:

The diagnosis of multiple bilateral renal cortical cysts is made with imaging studies. Ultrasound is a good initial test for detecting cysts in the kidneys. CT scan is more sensitive than ultrasound for detecting small cysts and can also be used to assess the size and number of cysts, as well as the amount of normal renal parenchyma that is preserved.

#Prognosis:

The prognosis for patients with multiple bilateral renal cortical cysts is generally good. The cysts are typically benign and do not cause any long-term problems. However, in rare cases, the cysts can become infected, bleed, or enlarge enough to cause kidney dysfunction.

#Management:

The management of multiple bilateral renal cortical cysts is generally conservative. Patients are typically monitored with regular imaging studies to assess the size and number of cysts. If the cysts become infected, they may need to be drained or treated with antibiotics. If the cysts bleed, they may need to be embolized or surgically removed. If the cysts enlarge enough to cause kidney dysfunction, they may need to be surgically removed.

Points to Remember:

* Multiple bilateral renal cortical cysts are a common finding in elderly patients.

* They are typically benign and do not cause any symptoms.

* In rare cases, they can become infected, bleed, or enlarge enough to cause pain or kidney dysfunction.

* The diagnosis is made with imaging studies.

* The prognosis is generally good.

* Management is typically conservative, with regular imaging studies and treatment of complications as needed.

For more info about renal ultrasound:

Ultrasound imaging of kidneys

An echogenic liver lesion

15 mm Hemangioma in a Young Adult with Hematemesis

Possible differential diagnoses for an echogenic patch, not showing vascularity, in right lobe liver near gallbladder fossa:

* Hepatic hemangioma: This is the most common benign liver tumor. It is typically a well-defined, homogeneous, echogenic mass that does not show vascularity on ultrasound.

*Focal nodular hyperplasia (FNH): This is a benign liver tumor that is typically < 5 cm in size. It is often hyperechoic on ultrasound and may show some vascularity.

* Metastasis: Metastases to the liver can be echogenic, but they are more likely to be hypoechoic or heterogeneous on ultrasound. They may also show some vascularity.

* Abscess: An abscess in the liver can be echogenic, but it is more likely to be hypoechoic or heterogeneous on ultrasound. It may also show some vascularity.

*Cholesterolosis: Cholesterolosis is a benign condition that causes cholesterol deposits to build up in the liver. It can appear as multiple echogenic foci on ultrasound. 

Final diagnosis: small hemangioma liver 

All about liver hemangioma:

A hemangioma is a benign tumor that is made up of blood vessels. It is the most common type of liver tumor, accounting for up to 70% of all liver tumors. Hemangiomas are typically small and asymptomatic, but they can sometimes grow large enough to cause symptoms, such as pain, abdominal swelling, and jaundice.

In rare cases, hemangiomas can rupture and cause bleeding, which can lead to hematemesis. Hematemesis is the vomiting of blood. It is a serious medical condition that requires immediate medical attention.

A 15 mm hemangioma is considered to be a small hemangioma. It is unlikely to cause any symptoms or complications. However, it is important to monitor the hemangioma for any signs of growth or change.

If a hemangioma is detected on ultrasound imaging, it will appear as an echogenic lesion with no internal vascularity. Echogenic means that the lesion reflects sound waves well, and no internal vascularity means that there are no blood vessels within the lesion.

The prognosis: for a 15 mm hemangioma is excellent. The vast majority of small hemangiomas will never cause any problems and do not require treatment. 

Here are some additional points to note about hemangiomas:

* Hemangiomas are more common in women than in men.

* They are most common in people between the ages of 20 and 50 years old.

* The cause of hemangiomas is unknown.

* Hemangiomas are usually harmless and do not require treatment.

* However, large or symptomatic hemangiomas may require treatment, such as surgery, embolization, or laser therapy.

For more try this kindle ebook:

Assorted ultrasound cases, kindle ebook