TRUS (transrectal ultrasonography) is a well established method of imaging of the prostate and seminal vesicles. So how good is this method at imaging of the urinary bladder in the male patient? The answer can be seen below: This elderly male (70 years) patient had a history of chronic retention of urine due to benign hypetrophy of the prostate. He presented with severe hematuria for which routine sonography of the abdomen suggested multiple small calculi in the urinary bladder. There was also moderate enlargement of the prostate. TRUS ultrasonogaphy revealed the true nature of the calculi and their exact number and size more effectively than the transabdominal ultrasound.
The ultrasound images below show the urinary bladder to contain at least 4 to 6 stones (calculi) each of 4 to 7 mm. size. A precise evaluation of the size of the prostate and the degree of intravesical enlargement is also possible on Transrectal ultrasound study (see image below).
The conclusion - transrectal ultrasound imaging is an excellent tool to image small urinary bladder stones that may be hidden from view or inadequately visualized on routine transabdominal ultrasound.
Can anyone identify the structure (arrowed) in this ultrasound video of the neck. What does it show and what is the event that is happening? You may send your replies in the comments section, below.
OK folks- the answer is out: this sonographic video clip shows peristaltic activity within the cervical esophagus (the part of the esophagus extending from the glottis to the thorax). One can see echogenic (bright) particles (air bubbles and fluid) going down the lumen of the esophagus as the patient swallows.
In addition, further ultrasound video imaging shows (see below) some degree of reflux as fluid from the fundus of stomach (the upper part), regurgitates upwards into the lower part of the food pipe (esopahgus).
This lady had undergone a total thyroidectomy (surgical removal of the entire thyroid). Hence, the thyroid gland is not visualized in these clips.
This ultrasound image shows grossly thickened wall of the large bowel (colon) in long section. The colonic wall thickness is a massive 1.1 cms. The anechoic line within the bowel represents the lumen. Note the diffuse increase in large bowel wall thickness, suggesting large area of involvement.
And the above Power Doppler ultrasound image of the same area shows hyperemia in addition. Clearly, this patient has a chronic inflammatory bowel pathology. The differentials in this case include- ulcerative colitis, Chrohn disease and also acute conditions like infective enteritis/ colitis. This patient had h/o diarrhea and bleeding per rectum with passage of mucus and pus. The clinical history, favors an infective etiology. A barium enema would be helpful as also colonoscopy. (ultrasound images are courtesy of Dr. Vikas Shukla, MD, India).
See: http://www.ultrasound-images.com/colon.htm for more images and description. on this topic.
The above color Doppler ultrasound video clip shows the normal upper part of the abdominal aorta withe 1st branch in the abdomen- the celiac artery, pointing almost perpendicularly from the anterior surface of the aorta. The aortic branch just below is the superior mesenteric artery, descending downwards.
The above Doppler video shows the celiac artery with the 2 main branches of this vessel- the branch heading towards the right being the common hepatic artery and the artery heading leftwards being the splenic artery. For more images and details on this topic visit: http://www.ultrasound-images.com/vascular.htm
This patient has multiple small calculi (each of 3 to 4 mm.) in the gall bladder. She tried various conservative remedies, despite which there has been no success.
Case-2: showing motion of calculi within distended Gall bladder:
Ultrasound image shows one calculus in the gall bladder, in the dependent part, close to the neck. Not sure about the number of gall bladder stones....So what do we do?
Ultrasound video clip shows what looked like a single stone in the gall bladder are in fact two separate and relatively large calculi. Observe the motion of the two gall bladder stones floating from the neck to fundus as patient turns from supine to left lateral posture.
And later, as the patient turns to the supine position from the left lateral posture, the stones are seen moving from the fundus to GB neck.
Conclusion: postural change can help visualize hidden gall bladder calculi.
Case-3: large gallbladder calculus:
Ultrasound image shows a large calculus (1.5 cms.) near the neck of gallbladder. Two questions arise here: is this a solitary calculus and is this a sludge ball or a calculus?
Ultrasound video clip above shows this is a single large calculus (seen moving from fundus of gallbladder to the neck, as patient rotates). Also not the strong acoustic shadow of the calculus, ruling out a biliary sludge ball.
And this video shows this whopper of a GB calculus dancing all the way from the neck of gall bladder to the fundus:
Another case of fine gall bladder calculi and biliary sludge in a 5 year old child:
It is pretty difficult to say clearly if those fine echoes in the gall bladder are sludge or calculi. Perhaps it is a mixture of both.
I posted another ultrasound video clip of this case via you tube. The difference in the imaging quality is striking.
The ultrasound image above shows distended gall bladder with abundant echoes within it (same case).
This patient had a large cystic mass on the anterior abdominal wall. Sonography of the lesion showed a hypoechoic, inhomogenous mass with no flow on color Doppler imaging. The above ultrasound images show the "mass" suggestive of a jelly like material within the lesion; these appearances are diagnostic of sebaecous cyst (epidermoid cyst). The neck or outlet of the sebaceous cyst is also visible in these ultrasound images. Obstruction of the outlet near the neck of the cyst due to dirt or keratinous material is the cause of the obstruction and formation of the epidermoid cyst. (These ultrasound images are courtesy of Mr. Shlomo Gobi, Israel.)
References: http://www.ultrasound-images.com/musculoskeletal.htm (free ultrasound images/ case study of epidermoid cysts).
This color Doppler ultrasound video clip of the normal fetal heart, shows the flow across the foramen ovale, from the right atrium to the left atrium (seen in red). RA= right atrium, LA= left atrium, LV= left ventricle, RV= right ventricle. This was a normal 3rd trimester fetus.
This B-mode ultrasound video clip shows the fetal heart in a 4 chamber view, with the the foramen ovale in the interatrial septum. Note the valve of the foramen ovale bulging into the left atrium as blood gushes from the fetal right atrium to left atrium. As pressure builds in the left atrium, after birth, the valve leaflet of the foramen ovale presses against the foramen, and closes this opening.
Another video clip of the normal mobility of the fetal foramen ovale valve (see below). The arrow heads point to the foramen ovale valve.
For more images and material on normal fetal heart, and cardiac anomalies visit:
