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.

HR MSK US-Shoulder joint.--Rotator cuff injuries and degenerative changes

SUB DELTOID BURSITIS AND BICEPS TENOSYNOVITIS

TENOSYNOVITIS OF THE  BICEPS TENDON.

INFLAMMED SYNOVIAL SHEATH WITH COMMUNICATEING TO THE JOINT SPACE.

BILATERAL CHRONIC DIFFUSE NON COMPRESSIBLE THICKENING  OF

THE BICEPS TENDON SYNOVIAL SHEATH..

BILATERAL SUPRASPINATUS  SYNOVIAL HYPERTROPHY

TRANS SCAN OF SHOULDER SHOWS HETEROGENOUS ANECHOIC

SUB ACROMIAL SUB DELTOID BURSA FILLED WITH FLUID.

BURSITIS-
THERE IS MARKED IRREGULAR SYNOVIAL LINING WITH MULTIPLE INTERNAL ECHOES IDENTIFIED WITHIN THE FLUID.THESE INTERNAL ECHOES CORRESPONDS TO PANNUS ,BLOOD OR RICE BODIES
(free corpuscles of synovial origin with a cartilage like appearence)

MSK-HRUS--Achilles tendon rupture

The Achilles tendon is the largest and strongest tendon in the human body, and it is formed from tendinous contributions of the gastrocnemius and soleus muscles. Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute severe pain and loss of plantar flexion power in the foot..

As the strongest tendon of the human body, the Achilles tendon originates from the soleus and gastrocnemius muscles, and inserts onto the posterior calcaneal tuberosity. The tendon is surrounded by a paratenon rather than a synovial sheath. 

  Dynamic evaluation.

 Dynamic imaging is important in evaluation of Achilles tendon tears since hemorrhage, fluid, debris, or scar tissue may fill the gap between torn tendon ends. 

·         Full-thickness tear: 

This disorder is characterized by complete tendon fiber disruption and tendon retraction. 

Sonography is an efficient and accurate way to assess the Achilles tendon. Advantages of sonographic evaluation include cost,

 widely available equipment, ease of contralateral comparison, 

and the ability to image during joint motion.