📄 SCRS

Renal Cell Carcinoma (RCC)

Renal Cell Carcinoma (RCC) ultrasound case study

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Reporting Panel

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Renal Pathology

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USG

Renal Cell Carcinoma (RCC) ultrasound case study

SN	Case Name	Report Line
1	Renal Cell Carcinoma (RCC)	View Report Line
2	Cystic RCC	View Report Line
3	RCC with renal vein invasion	View Report Line
4	RCC with inferior vena cava (IVC) extension	View Report Line
	Mimic RCC on Ultrasound
5	Angiomyolipoma	View Report Line
6	Oncocytoma	View Report Line
7	Complex Renal Cyst	View Report Line
8	Renal Abscess	View Report Line
9	Xanthogranulomatous Pyelonephritis	View Report Line
10	Multifocal Renal Cell Carcinoma	View Report Line
11	Bilateral Renal Cell Carcinoma	View Report Line
12	Recurrent Renal Cell Carcinoma	View Report Line
13	Metastatic Renal Cell Carcinoma	View Report Line
14	Clear Cell Renal Cell Carcinoma	View Report Line
15	Papillary Renal Cell Carcinoma	View Report Line
16	Chromophobe Renal Cell Carcinoma	View Report Line
17	Unclassified Renal Cell Carcinoma	View Report Line

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CASE–1
Right Renal Cell Carcinoma (RCC)

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Clinical History

A 62-year-old male presented with intermittent right flank pain and painless hematuria for two months. The patient also reported unintentional weight loss and generalized weakness. Ultrasound examination of the abdomen with Color Doppler was performed to evaluate the right kidney.

Ultrasound Findings

Ultrasound examination demonstrates a heterogeneous solid mass arising from the upper/mid pole of the right kidney, measuring approximately 6.8 × 5.9 × 5.6 cm. The lesion is predominantly heterogeneous with mixed echogenicity and contains small central hypoechoic areas consistent with necrosis. The mass produces focal outward bulging of the renal contour with partial distortion of the corticomedullary architecture. Color Doppler demonstrates internal vascularity within the lesion. No definite calcification is identified. There is no hydronephrosis. The right renal vein and inferior vena cava appear patent without sonographic evidence of tumor thrombus. The left kidney appears normal.

Renal ultrasound. Longitudinal sonographic image demonstrates a heterogeneous solid mass arising from the right kidney with internal Color Doppler vascularity, highly suspicious for renal cell carcinoma (RCC).

Report Line

A heterogeneous vascular solid mass measuring approximately 6.8 × 5.9 × 5.6 cm is identified arising from the upper/mid pole of the right kidney. Internal Color Doppler vascularity and small central necrotic areas are present. No sonographic evidence of right renal vein or inferior vena cava invasion is identified on the current examination. Findings are highly suspicious for renal cell carcinoma (RCC).

Impression

Heterogeneous vascular solid mass arising from the right kidney, highly suspicious for renal cell carcinoma (RCC).
No sonographic evidence of right renal vein or inferior vena cava tumor thrombus on the current examination.

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Recommendation

Contrast-enhanced CT or MRI of the abdomen and pelvis using a dedicated renal mass protocol is recommended for lesion characterization, local staging, and assessment for renal vein or inferior vena cava invasion. Urology consultation is advised for further evaluation and management. CT chest should be considered for metastatic staging. Histopathological confirmation following surgical excision or biopsy should be obtained when clinically indicated.

Key Learning Points

• Renal cell carcinoma (RCC) is the most common primary malignant renal tumor in adults.
• On ultrasound, RCC usually appears as a heterogeneous solid renal mass with variable echogenicity.
• Color Doppler typically demonstrates internal vascularity, helping distinguish RCC from simple renal cysts.
• Larger tumors commonly demonstrate areas of necrosis, hemorrhage, or cystic degeneration.
• Ultrasound should assess for renal vein and inferior vena cava (IVC) tumor thrombus, which significantly affects staging and surgical planning.
• Contrast-enhanced CT or MRI is the imaging modality of choice for characterization and staging of RCC.
• Differential diagnoses include oncocytoma, angiomyolipoma, complex renal cyst (Bosniak III/IV), renal abscess, and xanthogranulomatous pyelonephritis.

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CASE–2
Cystic Renal Cell Carcinoma (RCC)

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Clinical History

A 59-year-old male presented with intermittent painless hematuria and right flank discomfort for three months. Ultrasound examination of the abdomen with Color Doppler was performed for evaluation of a complex right renal cyst detected on previous imaging.

Renal ultrasound. Longitudinal sonographic image demonstrates a complex cystic mass with thick septations and vascular mural nodules arising from the right kidney, suspicious for cystic renal cell carcinoma.

Report Line

A complex cystic mass measuring approximately 5.8 × 4.9 × 4.6 cm is identified arising from the right kidney. Thick irregular septations and enhancing mural nodules demonstrate internal Color Doppler vascularity. Findings are highly suspicious for cystic renal cell carcinoma (Bosniak IV lesion). No sonographic evidence of renal vein or inferior vena cava invasion is identified.

Impression

Complex Bosniak IV cystic lesion of the right kidney, highly suspicious for cystic renal cell carcinoma.

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CASE–3
Renal Cell Carcinoma (RCC) with Renal Vein Invasion

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Clinical History

A 65-year-old male presented with intermittent painless hematuria, right flank pain, and progressive weight loss over four months. Ultrasound examination of the abdomen with Color Doppler was performed to evaluate a suspected right renal mass and assess for vascular invasion.

Ultrasound Findings

Ultrasound demonstrates a heterogeneous solid mass arising from the upper and mid pole of the right kidney, measuring approximately 7.5 × 6.4 × 6.1 cm. The lesion demonstrates mixed echogenicity with central hypoechoic areas representing necrosis and shows prominent internal Color Doppler vascularity. An echogenic intraluminal tumor thrombus is identified extending into the right renal vein, resulting in partial luminal expansion. Color Doppler demonstrates internal vascular flow within the thrombus, consistent with tumor thrombus. No sonographic extension into the inferior vena cava is identified on the current examination. The left kidney appears normal.

Renal ultrasound with Color Doppler. Longitudinal sonographic image demonstrates a heterogeneous vascular mass arising from the right kidney with an echogenic tumor thrombus extending into the right renal vein. Internal Doppler flow within the thrombus is consistent with renal vein invasion by renal cell carcinoma.

Report Line

A heterogeneous vascular solid mass measuring approximately 7.5 × 6.4 × 6.1 cm is identified arising from the upper/mid pole of the right kidney. An echogenic expansile thrombus extends into the right renal vein and demonstrates internal Color Doppler vascularity, consistent with tumor thrombus. No sonographic evidence of extension into the inferior vena cava is identified on the current examination. Findings are highly suggestive of renal cell carcinoma with right renal vein invasion.

Impression

Heterogeneous vascular right renal mass highly suspicious for renal cell carcinoma (RCC) with tumor thrombus involving the right renal vein.
No sonographic evidence of inferior vena cava extension on the current examination.

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Inferior vena cava (IVC) thrombosis

Inferior vena cava (IVC) thrombosis ultrasound case study

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Reporting Panel

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IVC Pathology

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USG

Inferior vena cava (IVC) thrombosis ultrasound case study

SN	Case Name	Report Line
1	Partial Inferior Vena Cava (IVC) Thrombosis	View Report Line
2	Complete Inferior Vena Cava (IVC) Thrombosis	View Report Line
3	Infrarenal Inferior Vena Cava (IVC) Thrombosis	View Report Line
4	Juxtarenal Inferior Vena Cava (IVC) Thrombosis	View Report Line
5	Suprarenal Inferior Vena Cava (IVC) Thrombosis	View Report Line
6	Retrohepatic Inferior Vena Cava (IVC) Thrombosis	View Report Line
7	Suprahepatic Inferior Vena Cava (IVC) Thrombosis	View Report Line
8	Cavoatrial Thrombus (IVC Thrombus Extending into the Right Atrium)	View Report Line
9	Primary (Idiopathic) Inferior Vena Cava (IVC) Thrombosis	View Report Line
10	Secondary Inferior Vena Cava (IVC) Thrombosis	View Report Line
11	Post-traumatic Inferior Vena Cava (IVC) Thrombosis	View Report Line
12	IVC Thrombosis Associated with an IVC Filter	View Report Line
13	Bland (Non-tumor) Inferior Vena Cava (IVC) Thrombus	View Report Line
14	Tumor Thrombus of the Inferior Vena Cava (IVC)	View Report Line
15	Acute Inferior Vena Cava (IVC) Thrombosis	View Report Line
16	Subacute Inferior Vena Cava (IVC) Thrombosis	View Report Line
17	Chronic Inferior Vena Cava (IVC) Thrombosis	View Report Line

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CASE–1
Inferior Vena Cava (IVC) Thrombus

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Clinical History

A 56-year-old male presented with bilateral lower limb swelling and dull abdominal discomfort. There was no history of recent trauma. Ultrasound with Color Doppler examination of the abdomen was performed to evaluate the inferior vena cava for suspected venous thrombosis.

Ultrasound Findings

Ultrasound examination demonstrates an echogenic intraluminal filling defect within the inferior vena cava (IVC), consistent with IVC thrombus. The involved segment of the IVC is mildly distended and demonstrates partial absence of color Doppler flow around the thrombus with markedly reduced venous flow on spectral Doppler. The thrombus appears adherent to the vessel wall without evidence of internal vascularity. No extension into the hepatic veins or right atrium is identified on the current examination. The abdominal aorta appears normal.

Abdominal vascular ultrasound. Longitudinal Color Doppler sonographic image demonstrates an echogenic thrombus within the inferior vena cava (IVC) producing a partial intraluminal filling defect with reduced Color Doppler flow, consistent with IVC thrombosis.

Report Line

An echogenic intraluminal thrombus is identified within the inferior vena cava (IVC), producing partial luminal obstruction with markedly reduced Color Doppler flow. No internal vascularity is demonstrated within the thrombus. No sonographic evidence of extension into the hepatic veins or right atrium is identified on the current examination.

Impression

Inferior vena cava (IVC) thrombosis with partial luminal obstruction.
No sonographic evidence of thrombus extension into the hepatic veins or right atrium.

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Recommendation

Correlate with the patient's clinical presentation and coagulation profile. Contrast-enhanced CT or MR venography may be performed to determine the full extent of thrombosis and evaluate for an underlying cause such as malignancy or venous compression. Prompt vascular medicine or vascular surgery consultation is recommended for anticoagulation and further management. Assessment for lower extremity deep vein thrombosis and pulmonary embolism should also be considered when clinically indicated.

Key Learning Points

• IVC thrombosis appears as an echogenic intraluminal filling defect with partial or complete absence of Color Doppler flow.
• The affected IVC may appear dilated and non-compressible, although direct compression is often limited because of its retroperitoneal location.
• Color and spectral Doppler demonstrate reduced or absent venous flow depending on the degree of obstruction.
• Ultrasound should evaluate for extension into the iliac veins, renal veins, hepatic veins, and right atrium.
• Common causes include deep vein thrombosis extension, malignancy, hypercoagulable states, pregnancy, trauma, and indwelling IVC filters or catheters.
• CT or MR venography is useful for defining the extent of thrombus and identifying the underlying etiology.
• Differential diagnoses include tumor thrombus (especially renal cell carcinoma), bland thrombus, congenital IVC anomalies, and flow-related Doppler artifacts.

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Abdominal aortic aneurysm
(AAA)

Abdominal aortic aneurysm (AAA) ultrasound case study

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Reporting Panel

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Abdominal ayorta Pathology

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USG

Abdominal aortic aneurysm (AAA) ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Infrarenal abdominal aortic aneurysm (AAA)	View Report Line
2	Suprarenal abdominal aortic aneurysm (AAA)	View Report Line
3	Juxtarenal abdominal aortic aneurysm (AAA)	View Report Line
4	Pararenal abdominal aortic aneurysm (AAA)	View Report Line
5	Aortoiliac aneurysm	View Report Line
	Based on Etiology
6	Degenerative (Atherosclerotic) abdominal aortic aneurysm (AAA)	View Report Line
7	Inflammatory abdominal aortic aneurysm (AAA)	View Report Line
8	Mycotic (Infected) abdominal aortic aneurysm (AAA)	View Report Line
9	Traumatic abdominal aortic aneurysm	View Report Line
10	Pseudoaneurysm (False Aneurysm) of the abdominal aorta	View Report Line
	Based on Integrity
11	Intact abdominal aortic aneurysm (AAA)	View Report Line
12	Leaking abdominal aortic aneurysm (AAA)	View Report Line
13	Ruptured abdominal aortic aneurysm (AAA)	View Report Line

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CASE–1
Abdominal Aortic Aneurysm (AAA)

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Clinical History

A 68-year-old male presented with a history of pulsatile abdominal fullness and intermittent abdominal discomfort. Ultrasound examination of the abdominal aorta was performed to evaluate for aneurysmal dilatation.

Ultrasound Findings

Ultrasound examination demonstrates a fusiform dilatation of the infrarenal abdominal aorta, measuring 4.8 × 4.5 cm in maximum transverse diameter. The aneurysmal sac contains eccentric mural thrombus with a central patent lumen demonstrating normal color Doppler flow. The aneurysm extends over a length of approximately 6.2 cm. No evidence of aneurysmal rupture, periaortic hematoma, or free intraperitoneal fluid is identified. The bilateral common iliac arteries are of normal caliber.

Abdominal aortic ultrasound. Transverse sonographic image demonstrates a fusiform infrarenal abdominal aortic aneurysm with eccentric mural thrombus surrounding a patent central lumen.

Report Line

Fusiform aneurysmal dilatation of the infrarenal abdominal aorta measuring approximately 4.8 × 4.5 cm is noted, containing eccentric mural thrombus with a patent central lumen. No sonographic evidence of aneurysm rupture or periaortic hematoma is identified.

Impression

Infrarenal abdominal aortic aneurysm (AAA) No sonographic evidence of rupture.

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Recommendation

Correlate clinically and with cardiovascular risk factors. Vascular surgery consultation is recommended. Periodic ultrasound surveillance is advised for aneurysms less than 5.5 cm in diameter. Urgent evaluation is indicated if there is rapid aneurysm enlargement, severe abdominal or back pain, or suspicion of aneurysm rupture.

Key Learning Points

• Abdominal aortic aneurysm (AAA) is defined as an abdominal aortic diameter of 3.0 cm or greater.
• Most AAAs occur in the infrarenal abdominal aorta.
• Ultrasound is the preferred screening and surveillance modality because it is rapid, accurate, and non-invasive.
• Mural thrombus is commonly present within larger aneurysms.
• Color Doppler demonstrates a patent central lumen with surrounding thrombus.
• The risk of rupture increases significantly when the aneurysm diameter exceeds 5.5 cm or shows rapid interval growth.
• Differential diagnoses include aortic ectasia, pseudoaneurysm, penetrating atherosclerotic ulcer, and aortic dissection.

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CASE–2
Suprarenal Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a fusiform suprarenal abdominal aortic aneurysm with eccentric mural thrombus surrounding a patent central lumen.

Report Line

Fusiform aneurysmal dilatation of the suprarenal abdominal aorta measuring approximately 4.8 × 4.5 cm is noted, containing eccentric mural thrombus with a patent central lumen. The aneurysm is located above the origins of both renal arteries. No sonographic evidence of aneurysm rupture or periaortic hematoma is identified.

Impression

Suprarenal abdominal aortic aneurysm (AAA) with eccentric mural thrombus.
No sonographic evidence of rupture.

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CASE–3
Juxtarenal Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a fusiform juxtarenal abdominal aortic aneurysm with eccentric mural thrombus surrounding a patent central lumen.

Report Line

Fusiform aneurysmal dilatation of the juxtarenal abdominal aorta measuring approximately 4.8 × 4.5 cm is noted, containing eccentric mural thrombus with a patent central lumen. The aneurysm extends to the level of the renal artery origins without involving the renal arteries. No sonographic evidence of aneurysm rupture or periaortic hematoma is identified.

Impression

Juxtarenal abdominal aortic aneurysm (AAA) with eccentric mural thrombus.
No sonographic evidence of rupture.

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CASE–4
Pararenal Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a fusiform pararenal abdominal aortic aneurysm with eccentric mural thrombus surrounding a patent central lumen and involvement of the renal artery origin.

Report Line

Fusiform aneurysmal dilatation of the pararenal abdominal aorta measuring approximately 4.9 × 4.6 cm is noted, containing eccentric mural thrombus with a patent central lumen. The aneurysm involves the origin of one renal artery. No sonographic evidence of aneurysm rupture, periaortic hematoma, or retroperitoneal collection is identified.

Impression

Pararenal abdominal aortic aneurysm (AAA) involving the renal artery origin with eccentric mural thrombus.
No sonographic evidence of rupture.

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CASE–5
Aortoiliac Aneurysm

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a fusiform abdominal aortic aneurysm extending into the common iliac arteries (aortoiliac aneurysm) with eccentric mural thrombus surrounding a patent central lumen.

Report Line

Fusiform aneurysmal dilatation of the distal abdominal aorta measuring approximately 5.2 × 4.9 cm is noted, containing eccentric mural thrombus with a patent central lumen. The aneurysm extends into the bilateral common iliac arteries, consistent with an aortoiliac aneurysm. No sonographic evidence of aneurysm rupture, periaortic hematoma, or retroperitoneal collection is identified.

Impression

Aortoiliac aneurysm involving the distal abdominal aorta and bilateral common iliac arteries with eccentric mural thrombus.
No sonographic evidence of rupture.

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CASE–6
Degenerative (Atherosclerotic) Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Transverse sonographic image demonstrates a fusiform infrarenal abdominal aortic aneurysm with eccentric mural thrombus and diffuse calcified atherosclerotic plaques involving the aneurysmal wall.

Report Line

Fusiform aneurysmal dilatation of the infrarenal abdominal aorta measuring approximately 5.0 × 4.7 cm is noted. The aneurysm contains eccentric mural thrombus with a patent central lumen. Multiple calcified atherosclerotic plaques are seen along the aortic wall, consistent with a degenerative (atherosclerotic) abdominal aortic aneurysm. No sonographic evidence of rupture or periaortic hematoma is identified.

Impression

Degenerative (atherosclerotic) infrarenal abdominal aortic aneurysm (AAA) with eccentric mural thrombus and diffuse calcified atherosclerotic plaque formation.
No sonographic evidence of rupture.

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CASE–7
Inflammatory Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Transverse sonographic image demonstrates a fusiform infrarenal abdominal aortic aneurysm with marked circumferential wall thickening, surrounding hypoechoic inflammatory soft tissue (periaortic cuff), and eccentric mural thrombus.

Report Line

Fusiform aneurysmal dilatation of the infrarenal abdominal aorta measuring approximately 5.1 × 4.8 cm is noted with circumferential aneurysmal wall thickening, surrounding hypoechoic periaortic inflammatory soft tissue, and eccentric mural thrombus with a patent central lumen. The findings are consistent with an inflammatory abdominal aortic aneurysm. No sonographic evidence of aneurysm rupture or periaortic hematoma is identified.

Impression

Inflammatory abdominal aortic aneurysm (AAA) with circumferential wall thickening, periaortic inflammatory soft tissue, and eccentric mural thrombus.
No sonographic evidence of rupture.

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CASE–8
Mycotic (Infected) Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a saccular abdominal aortic aneurysm with an irregular thickened wall, surrounding periaortic inflammatory soft tissue, and eccentric mural thrombus, suspicious for a mycotic (infected) aneurysm.

Report Line

An irregular saccular aneurysmal dilatation of the abdominal aorta measuring approximately 4.6 × 4.3 cm is identified. The aneurysm demonstrates a thick irregular wall, eccentric mural thrombus, and surrounding periaortic inflammatory soft tissue. A patent central lumen is present on Color Doppler examination. The sonographic findings are highly suggestive of a mycotic (infected) abdominal aortic aneurysm. No definite sonographic evidence of rupture is identified.

Impression

Mycotic (infected) abdominal aortic aneurysm (AAA) with irregular aneurysmal wall, eccentric mural thrombus, and surrounding periaortic inflammatory changes.
No sonographic evidence of rupture.

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CASE–9
Traumatic Abdominal Aortic Aneurysm

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a focal saccular aneurysmal dilatation arising from the abdominal aorta with an irregular disrupted aortic wall, surrounding eccentric mural thrombus, and a patent central lumen following blunt abdominal trauma.

Report Line

A focal saccular aneurysmal dilatation measuring approximately 4.2 × 3.9 cm is identified arising from the abdominal aorta. The lesion demonstrates an irregular disrupted aortic wall, eccentric mural thrombus, and a patent central lumen on Color Doppler examination. The imaging features, in the appropriate clinical setting, are consistent with a traumatic abdominal aortic aneurysm. No sonographic evidence of active extravasation, rupture, or periaortic hematoma is identified.

Impression

Traumatic abdominal aortic aneurysm with focal saccular dilatation and eccentric mural thrombus.
No sonographic evidence of rupture.

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CASE–10
Pseudoaneurysm (False Aneurysm) of the Abdominal Aorta

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a saccular pseudoaneurysm arising from the abdominal aorta through a narrow neck, with turbulent bidirectional blood flow within the aneurysmal sac (yin-yang appearance on Color Doppler).

Report Line

A 4.1 × 3.8 cm saccular pseudoaneurysm is identified arising from the abdominal aorta through a narrow communicating neck. Color Doppler demonstrates turbulent bidirectional ("yin-yang") flow within the aneurysmal sac, with a characteristic to-and-fro waveform at the neck on spectral Doppler. The pseudoaneurysm is contained by surrounding soft tissues without sonographic evidence of free rupture or retroperitoneal hematoma.

Impression

Pseudoaneurysm (false aneurysm) of the abdominal aorta arising through a narrow neck, demonstrating characteristic Color and Spectral Doppler findings.
No sonographic evidence of free rupture.

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CASE–11
Intact Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Transverse sonographic image demonstrates a fusiform infrarenal abdominal aortic aneurysm with eccentric mural thrombus surrounding a patent central lumen. The aneurysmal wall is intact without evidence of leakage or rupture.

Report Line

Fusiform aneurysmal dilatation of the infrarenal abdominal aorta measuring approximately 4.9 × 4.6 cm is noted, containing eccentric mural thrombus with a patent central lumen. The aneurysmal wall appears intact. No sonographic evidence of periaortic hematoma, retroperitoneal fluid collection, leakage, or rupture is identified.

Impression

Intact infrarenal abdominal aortic aneurysm (AAA) with eccentric mural thrombus.
No sonographic evidence of aneurysm leakage or rupture.

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CASE–12
Leaking Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a fusiform infrarenal abdominal aortic aneurysm with eccentric mural thrombus, adjacent periaortic hypoechoic hematoma, and focal discontinuity of the aneurysmal wall, suggestive of a contained leak.

Report Line

Fusiform aneurysmal dilatation of the infrarenal abdominal aorta measuring approximately 5.8 × 5.4 cm is identified with eccentric mural thrombus and a patent central lumen. A focal defect in the aneurysmal wall is associated with an adjacent periaortic hypoechoic collection/contained hematoma, consistent with a contained leaking abdominal aortic aneurysm. No free intraperitoneal fluid is identified on this examination.

Impression

Leaking infrarenal abdominal aortic aneurysm (AAA) with contained periaortic hematoma, highly suspicious for a contained rupture.
Urgent vascular surgical intervention is recommended.

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CASE–13
Ruptured Abdominal Aortic Aneurysm (AAA)

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Abdominal aortic ultrasound. Longitudinal sonographic image demonstrates a large fusiform infrarenal abdominal aortic aneurysm with eccentric mural thrombus, disruption of the aneurysmal wall, and a large periaortic/retroperitoneal hematoma, consistent with aneurysm rupture.

Report Line

Large fusiform aneurysmal dilatation of the infrarenal abdominal aorta measuring approximately 6.8 × 6.2 cm is identified with eccentric mural thrombus and a patent residual lumen. There is focal disruption of the aneurysmal wall with an extensive periaortic and retroperitoneal hematoma, consistent with a ruptured abdominal aortic aneurysm. Associated free intraperitoneal fluid is noted, highly suggestive of active hemorrhage.

Impression

Ruptured infrarenal abdominal aortic aneurysm (AAA) with extensive retroperitoneal hematoma and sonographic evidence of active hemorrhage.
This is a life-threatening vascular emergency requiring immediate surgical intervention.

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Limy bile
(Milk of Calcium Bile)

Limy bile (Milk of Calcium Bile) ultrasound case study

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Reporting Panel

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Gall bladder Pathology

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USG

Limy bile (Milk of Calcium Bile) ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Limy bile (Milk of Calcium Bile)	View Report Line
2	-	-
3	-	-
4	-	-
5	-	-

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CASE–1
Limy Bile (Milk of Calcium Bile)

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Clinical History

A 48-year-old female presented with recurrent right upper abdominal pain, particularly after meals. There was no history of jaundice or fever. Ultrasound examination of the hepatobiliary system was performed to evaluate suspected gallbladder pathology.

Ultrasound Findings

Ultrasound examination demonstrates a dependent echogenic material within the gallbladder lumen, producing dense posterior acoustic shadowing. The echogenic material layers dependently and changes position with patient movement, consistent with limy bile (milk of calcium bile). The gallbladder wall is normal in thickness without pericholecystic fluid. No intraluminal soft tissue mass is identified. The common bile duct is normal in caliber, and there is no evidence of intrahepatic biliary dilatation.

Gallbladder USG image. Longitudinal sonographic image demonstrates dependent echogenic milk of calcium bile (limy bile) within the gallbladder lumen producing dense posterior acoustic shadowing, without evidence of an intraluminal soft tissue mass.

Report Line

Dependent highly echogenic material producing dense posterior acoustic shadowing is noted within the gallbladder lumen, demonstrating positional layering, consistent with limy bile (milk of calcium bile). No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilatation is identified.

Impression

Limy bile (Milk of Calcium Bile) within the gallbladder.
No sonographic evidence of acute cholecystitis.

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Recommendation

Correlate with the patient's clinical symptoms and liver function tests. Surgical consultation may be considered in symptomatic patients or when associated with gallstones or chronic cholecystitis. Asymptomatic patients may be managed conservatively with clinical follow-up.

Key Learning Points

• Limy bile (milk of calcium bile) is a rare condition caused by precipitation of calcium carbonate within the gallbladder.
• Ultrasound demonstrates dependent echogenic material with dense posterior acoustic shadowing.
• The echogenic material typically layers dependently and changes position with patient movement.
• The gallbladder wall is often normal unless associated with chronic cholecystitis.
• Most cases are associated with cystic duct obstruction and may coexist with gallstones.
• CT typically demonstrates high-attenuation calcium-containing bile within the gallbladder.
• Differential diagnoses include gallstones, biliary sludge, porcelain gallbladder, emphysematous cholecystitis, and gallbladder neoplasm with calcification.

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Follicular cyst

Follicular cyst ultrasound case study

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Reporting Panel

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Ovarian Pathology

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View detailed

USG

Follicular cyst ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Lt. Ovarian Follicular cyst	View Report Line
2	-	-
3	-	-
4	-	-
5	-	-

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CASE–1
Left Ovarian Follicular Cyst

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Clinical History

A 26-year-old female presented with intermittent lower abdominal pain and menstrual irregularity. Pelvic ultrasound was performed for evaluation of the adnexa.

Ultrasound Findings

Ultrasound examination demonstrates a well-defined thin-walled unilocular anechoic cyst within the left ovary. The cyst demonstrates posterior acoustic enhancement without internal septations, mural nodules, papillary projections, or solid components. Color Doppler demonstrates no internal vascularity. The surrounding ovarian stroma is normal with preserved vascularity. The right ovary appears normal. No adnexal mass or free fluid is identified in the pelvis.

Pelvic ultrasound. Transverse sonographic image demonstrates a 19 × 20 mm simple follicular cyst within the left ovary, appearing as a thin-walled anechoic lesion with posterior acoustic enhancement and no internal solid component or vascularity.

Report Line

A 36 × 32 mm thin-walled unilocular anechoic cyst is identified within the left ovary, demonstrating posterior acoustic enhancement without internal septations, mural nodules, papillary projections, or internal vascularity. The appearance is consistent with a simple left ovarian follicular cyst.

Impression

Simple left ovarian follicular cyst.

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Recommendation

Correlate with the patient's menstrual history and clinical symptoms. In premenopausal women, a simple follicular cyst measuring less than 5 cm is typically physiological and usually resolves spontaneously. Follow-up pelvic ultrasound in 6–12 weeks may be considered if the cyst persists, enlarges, or symptoms continue. Gynecological consultation is recommended if complications such as torsion, rupture, or persistent enlargement are suspected.

Key Learning Points

• Follicular cysts are the most common physiological ovarian cysts in women of reproductive age.
• They appear as a thin-walled, unilocular, anechoic cyst with posterior acoustic enhancement.
• There should be no internal septations, mural nodules, papillary projections, or solid components.
• No internal vascularity is seen on Color Doppler, although normal peripheral ovarian stromal vascularity may be present.
• Most simple follicular cysts measuring <5 cm resolve spontaneously over one or two menstrual cycles.
• Large, persistent, or symptomatic cysts warrant follow-up imaging and possible gynecological evaluation.
• Differential diagnoses include corpus luteum cyst, hemorrhagic cyst, paraovarian cyst, and benign ovarian neoplasm.

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