Color Doppler study of severe arterial stenosis

This elderly lady has long standing diabetes with severe ischemic changes including gangrene of the left foot.
Color and spectral Doppler ultrasound study shows decreased flow in the arterial tree, increasing in severity from the femoral artery down to the arterial tree of the left leg.
This is the spectral Doppler pattern we observed in the left femoral artery- The most obvious finding- loss of triphasic waveform replaced by biphasic waves with spectral broadening:

The left popliteal artery showed monophasic flow (50 to 75 % stenosis- moderate grade) with spectral broadening and mild dampening of flow:

The arteries of the left leg show marked dampening with monophasic flow. The severe degree of stenosis has caused the spectral waveform to look similar to that of venous flow (this suggests 75 to 98 % stenosis):
Left posterior tibial artery:

Left anterior tibial artery:

Left peroneal artery:

For more on this topic: http://www.ultrasound-images.com/vascular-doppler-2/

Amazing new 3D fetal ultrasound images

The arrival of higher end machines using sophisticated 3D and 4D imaging methods has resulted in very realistic 3D images of fetuses:
This 3D ultrasound image (courtesy of Jill Schoonhoven Beithon) of a 15 week fetus shows amazing detail using GE HD live technology:

Some spectacular 3D images of fetal face and fingers (courtesy Dr. Ravi Kadasne), using the Philips Iu-22 system:

 

Fetal 3D-ultrasound images at 10 weeks

Just some nice 3D ultrasound images of 10 week old fetus. The fetal limb buds and umbilical cord are are visualized in these 3D sonographic images.

Quiz- a case of metrorrhagia in adolescent:

This 15 year old female adolescent has metrorrhagia (irregular menses). What are your findings based on these ultrasound images? Fig-1 and 2: B- mode ultrasound images-sagittal section of the uterus:

 Fig-3: Color Doppler image of the uterus:

Fig-4:Ultrasound images of the ovaries:

Answer: these images suggest endometrial hyperplasia due to unopposed estrogenic activity.

Fibroid complicating a possible ectopic gestation

This young lady has bleeding P/V with a history of  6 weeks amenorrhoea. Ultrasound images are shown below- the top few images being transabdominal ultrasound images, followed by endocavity sonography.
A large mass is seen above the uterine fundus- is it a pedunculated fibroid?

Note the presence of fluid in the cul de sac: see below:

It gets more intriguing as the fluid is echogenic in the transvaginal ultrasound images below suggesting bloody matter in the cul de sac and left adnexal regions. Is there a left adnexal mass within the thickened left Fallopian tube? The mass above the fundus looks like a typical fibroid, possibly pedunculated. The uterine cavity is empty with no sign of a gestation sac. Is the fluid the result of an ectopic in the left fallopian tube or is it due to ruptured hemorrhagic cyst?

Transvaginal color Doppler images of this patient show limited vascularity around and in the left adnexal mass which measures 2 cms. in size:

For more on sonography of ectopic pregnancy visit:
http://www.ultrasound-images.com/early-pregnancy.htm#Right_ectopic_pregnancy

Quiz- early gestation sac with what else

This is a 7 week gestation with a viable embryo seen in the intrauterine gestation sac. But what else do you find? And what is that posterior to the uterus? (These ultrasound images were taken with a Philips HD 15 ultrasound system):

Diabetic gangrene of the left foot- arterial doppler

Left femoral artery spectral doppler tracing- shows pulsus bigeminus (pairs of heartbeats with the 2nd pulse weaker than the first, followed by a long pause).
The spectral doppler trace itself shows normal waveform.

The left popliteal artery- dampened waveform- moderate stenosis

Left posterior tibial artery

Left peroneal artery

Left anterior tibial artery. All the arteries below the left knee show significant dampening of flow s/o moderately severe stenosis of the left anterior and posterior tibial arteries and peroneal artery.