Opthalmic ultrasound-Retinopathy of prematurity(ROP)

Retinopathy of prematurity is seen in low birth weight premature infants due to abnormal postnatal growth of retinal vasculature.

ULTRASONOGRAPHY HELPS TO DIFFERENTIATE IT FROM OTHER CAUSES OF LEUKOCORIA.

Ultrasonography reveals bilateral small sized eyes with funnel shaped high reflective membrane attached to the optic disc suggestive of total retinal detachment..

Axial B scan image shows funnel shaped highly reflective membrane inserting into the optic disc.

Accumulation of echoes in the anterior part suggesting the presence of preretinal fibrous tissue.

Axial B scan reveals the exact configaration of the funnel

The B scan image shows packed retrolental echoes with retinal detachment

MSK-HRUS-Forearm intramuscular venous malformation with phlebolith. .

MSK HRUS volar aspect of right forearm reveals an ill defined oval hypoechoic subcuateneous non tender sponge like mass containing intramuscular network of anechoic channels with a well defined hyperechoic mass casting posterior shadow .

left fore arm flexor muscle appears normal.

The mass lession confined to the subcutaeneous plane with a hyperechoic mass casting posterior shadow-s/o phlebolith .
Here the radiographic examination revealed rounded echogenic calcified lession.

Colour doppler application shows few week signals of flow
within the soft tissue mass.

OPTHALMIC ULTRASOUND.Retinopathy of prematurity(ROP)

OPTHALMIC ULTRASOUND.Retinopathy of prematurity(ROP)

Retinopathy of prematurity is seen in low birth weight premature infants due to abnormal postnatal growth of retinal vasculature

ULTRASONOGRAPHY HELPS TO DIFFERENTIATE IT FROM OTHER CAUSES OF LEUKOCORIA.

Ultrasonography reveals bilateral small sized eyes with funnel shaped high reflective membrane attached to the optic disc suggestive of total retinal detachment..

Axial B scan image shows funnel shaped highly reflective membrane inserting into the optic disc.accumulation of echoes in the anterior part suggesting the presence of preretinal fibrous tissue

Axial B scan reveals the exact configaration of the funnel 

The B scan image shows packed retrolental echoes with retinal detachment.

Nuchal cord---Cord around the neck

Nuchal cord -or- Cord around the neck occurs when the umbelical cord becomes wraped around the fetal neck 360 degrees.

Nuchal cords are very common, the incidence of nuchal cord

 increases with advancing gestation from 12% at 24 to 26 

weeks to 37% at term

Most are not associated with perinatal morbidity and mortality.In some fetuses and newborns CAN may cause problems, especially when the cord is tightly wrapped around the neck

The cluster of cardiorespiratory and neurological signs and symptoms associated with unique physical features that occur secondary to tight cord-round-the-neck has been referred to as 'tCAN syndrome' (tight Cord Around the Neck Syndrome) 
A small number of studies have shown that nuchal cord and or tCAN can affect the outcome of delivery and may have long-term effects on the infant  and but as a causative factor for stillbirth it is debatable .

Nuchal cord twice around the neck

It is the unique physical features of tCAN syndrome that 

distinguishes it from birth asphyxia even though there are many 

similarities between these two conditions. 

Umbilical cord abnormalities are considered as one of the 

causative factor for birth asphyxia. 

The manifestation of tCAN symptomatology seems to happen both 

in the presence of normal and depressed AGPAR scores. 

Umbilical cord compression due to tCAN may cause 

obstruction of blood flow first in thin walled umbilical vein, while

 infant’s blood continues to be pumped out of baby through the

 thicker walled umbilical arteries thus causing hypovolemia and

 hypotension resulting in acidosis . Anemia  and mild

 respiratory distress may occur. Some of these infants may also 

have facial and conjuctival petechiae and rarely petechiae of

 the neck and upper part of the chest and skin abrasion of neck

 where the cord was tightly wrapped and facial suffusion 

 all of which can also be seen in some postmortem findings of 

stillbirth infants who had tCAN.

 If born alive, some of these infants may also be

 somewhat obtunded with a low tone and have transient feeding 

difficulties. These findings raise the possibility of transient

 encephalopathy, which may lead to long-term complications.

Intrauterine synechiae-Amniotic sheets visualized in the uterus

The differential diagnosis of reflective intrauterine membranes during pregnancy includes amniotic bands of fetal origin or membranes of combined maternal-fetal origin. While the former have been associated with fetal transverse reduction defects or the lethal amniotic band syndrome, the latter are usually benign and consist of a preexisting uterine septation or synechia around which the fetal membranes fold or become enveloped.

Intra Uterine Synechiae:
(also known as "amniotic sheets" or "amniotic folds")

A synechia is a term meaning an "adhesion", or a fibrous scar. Uterine synechiae have also been referred to as "amniotic sheets" or "amniotic folds". 

Many patients with sonographically demonstrable uterine synechia have clinical history 

of uterine instrumentation or uterine infections to explain scar formation. Most commonly, uterine synechiae are noted as an incidental finding on obstetric sonograms.

 In general, synechiae do not interfere with the development and growth of pregnancy, 

and are rarely associated with any complications.  There is some evidence to suggest that large synechiae may be the cause of malpresentation due to partial compartmentalization of the uterine cavity, and may also be associated with lower birth weight.

Visualization of a band-like structure should not be confused with amniotic band syndrome especially when thorough fetal anatomy survey reveals no structural 

anomalies.

fetal face .nose and lip seen.

normal fetal hand and wrist seen.

coronal view of fetal face with upper limb

Here We present an unusual case in which a patient was noted at 30 weeks' gestation to have an 

intrauterine membrane of undetermined origin, appearing to contain a pulsating vessel

Color Doppler imaging and Doppler flow velocimetry clearly depicted a pulse synchronous with the

maternal heart rate, defining the membrane as amniotic membranes surrounding a preexisting

uterine synechia and not a true amniotic band. 

There is some evidence to suggest that large synechiae may be the cause of 

malpresentation due to partial compartmentalization of the uterine cavity.

There were no obvious structural anomalies seen.

Visualization of a band-like structure should

 not be confused with amniotic band syndrome especially when thorough fetal anatomy

 survey reveals no structural anomalies.

There is some evidence to suggest that large synechiae may be the cause of 

malpresentation due to partial compartmentalization of the uterine cavity 

^{Here the fetus is of 30 weeks gestation  in transeverse lie}

Visualization of a band-like structure should not be confused with amniotic band 

syndrome especially when thorough fetal anatomy survey reveals no structural 

anomalies.

HRUS images of small bowel loops in acute mesenteric infarction.

Long strecth of affected aperistaltic bowel loop with moderate haemoperitoneum.

markedly edematous bowel segment with peri intestinal inflammaton leading to creeping fat  sign.

edematous small bowel segment with marked luminal narrowing

Trans scan of the affected segment with minimal haemoperitoneum and creeping fat sign.
(uniform hyperechoic mass around the bowel loops)

 

Acute intramural intestinal haematoma leading to multiple  homogenous  hypoechoic thickened pockets in the segment
affected with marked luminal narrowing. 

Markedley edematous bowel segment with strong internal echoes caused by the thrombi

--mimics an abscess..

Markedley edematous bowel segment with strong internal echoes and 

multiple hypoechoic pockets mucosa seen 

 

Multiple significantly edematous loops  seen.

TA-USG-images of unruptured Ectopic Pregnancy

Ectopic means out of place.
An ectopic pregnancy  is a condition in which a fertilized egg settles and grows in any location other

than the inner lining of the uterus.

most of  ectopic pregnancies are so-called tubal pregnancies and occur in the Fallopian tube (98%);

however, they can occur in other locations, such as the ovary, cervix, and abdominal cavity.

 An ectopic pregnancy occurs in about one in 50 pregnancies. 

uniformely enlarged uterus with an empty thickened endometrial cavity

decidualisation..

Right adnexal mass with a central hypoechoic area seen.
uterus and right ovary are visualised .

Left ovary .

Ectopic Gestational ring sign.
here rounded cental hypoechoic area with surrounding echogenic rim seen
which is charectaristic of of an ectopic gestational sac.
a tiny yolk sac is also visible

unruptured adnexal mass lession.

Colour doppler sampled over the adnexal mass.

Leaking Abdominal Aortic Aneurysm

LEAKING ABDOMINAL AORTIC ANEURYSM WITH MURAL THROMBUS

An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall. 

As blood passes through the weakened blood vessel,
 the blood pressure causes it to bulge outwards like a balloon.
(image of leaking abdominal aortic aneurysm measuring 9.5x5.6cms with thrombus in long scan)

The abdominal aorta is the largest blood vessel in the body.
 It is roughly the width of a garden hose.
 It transports oxygen-rich blood away from the heart to the rest of the body.

It runs in a straight line down from the heart, through the chest and abdomen before branching off into a network of smaller blood vessels.

 A ruptured abdominal aortic aneurysm can cause massive internal bleeding, which is usually fatal. Four out of five people with a ruptured aortic aneurysm will die as a result.

The most common symptom of a ruptured aortic aneurysm is 

sudden and severe pain in the abdomen.

TRANS SONOGRAM OF ABDOMINAL AORTA SHOWS  MURAL THROMBUS.

. Ultrasonography usually gives a clear picture of the size of an aneurysm.
 Ultrasound has about 98% accuracy in measuring the size of the aneurysm and is safe and noninvasive.The aortic wall has three layers, the tunica adventitia, tunica media, and tunica intima. The layers add strength to the aorta as well as elasticity to tolerate changes in blood pressure. Chronically increased blood pressure causes the media layer to break down and leads to the continuous, slow dilation of the aorta.

LEAKING ABDOMINAL AORTIC ANEURYSM-

Most abdominal aortic aneurysms produce no symptoms and are discovered incidentally when an imaging test of the abdomen  is performed. 

They can also be detected by physical examination when the health care professional feels the 

abdomen and listens for a bruit, the sound made by turbulent blood flow.

Pain is the most common symptom when the aneurysm expands or ruptures.

 It often begins in the central abdomen and radiates to the back or flank. 

Other symptoms can occur depending upon where the aneurysm is located in the aorta and whether nearby structures are affected.

Abdominal aortic aneurysms can remain asymptomatic or produce minimal symptoms for years. 

LEAKING ABDOMINAL AORTIC ANEURYSM INTO THE RETROPERITONEAL SPACE WITH MASSIVE ACUTE INFLAMMATORY REACTION ..
Rapidly expanding abdominal aneurysm can cause sudden onset of severe, steady, and worsening middle abdominal and back or flank pain. Rupture of an abdominal aortic aneurysm can be catastrophic, even lethal, and is associated with abdominal distension,
 a pulsating abdominal mass, due to massive blood loss.