Case Study

Focal Fatty Sparing

Focal Fatty Sparing is a benign imaging finding characterized by localized areas of normal liver parenchyma within a diffusely fatty infiltrated liver. These regions appear relatively hypoechoic compared with the surrounding steatotic liver and commonly occur adjacent to the gallbladder fossa, porta hepatis, or falciform ligament. Recognition of focal fatty sparing is important because it may mimic focal hepatic lesions such as tumors or metastases, although it demonstrates normal vascular architecture and lacks mass effect.

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Whole Abdomen & Pelvis Sonography

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Technique: Examination performed using a convex 3.5–5 MHz transducer. Longitudinal and transverse planes of the abdomen were evaluated. Color Doppler assessment of hepatic and portal vessels was performed. Pelvic and post-void images were obtained. Patient was fasting for 6–8 hours.
Prior studies: No prior imaging available.
Clinical history: Routine sonographic evaluation.

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Liver: Liver appears enlarged and demonstrates diffuse increased echogenicity consistent with fatty infiltration. A focal hypoechoic area is seen adjacent to the gallbladder fossa / periportal region, maintaining normal vascular architecture and without mass effect, consistent with focal fatty sparing. No focal hepatic mass lesion is identified. Intrahepatic biliary radicles are not dilated. Portal vein is normal in caliber with normal hepatopetal flow. Gall Bladder: Gall bladder is normal in size, shape, and echotexture. No calculus, mass, or sludge is seen. Wall thickness is normal. Common Bile Duct (CBD): CBD is normal in course and caliber throughout its visualized length. Pancreas: Pancreas is normal in size, shape, and echotexture. Main pancreatic duct is not dilated. No focal mass or calcification is seen. Spleen: Spleen is normal in size, shape, and echotexture. Splenic vein appears normal. No focal lesion or calcification is seen. Right Kidney: Right kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen. Left Kidney: Left kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen. Rt. Ureter: Right ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen. Lt. Ureter: Left ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen. Urinary Bladder: Urinary bladder is adequately distended. Wall thickness appears normal. No intraluminal mass or debris is seen. Post-void residual urine is insignificant. Prostate: Prostate volume is within normal limits. Echotexture appears homogeneous. Free Fluid: No free fluid is seen in the abdomen or pelvis.

Other Observations: No abdominal lymphadenopathy identified. Visualized bowel loops are unremarkable. Appendix is not visualized; no sonographic evidence of acute appendicitis. Bilateral inguinal regions are unremarkable without hernia or significant lymphadenopathy.

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Measurement Summary:

Liver: 159 mm	Spleen: 102 mm
RK: 98 mm	LK: 106 mm
Prostate: 14.5 mL

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Impression: Diffuse fatty liver with focal fatty sparing with hepatomegaly.
No focal hepatic mass lesion identified.br Otherwise unremarkable ultrasound study of the abdomen and pelvis.

Recommendation: Clinical correlation advised.

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Kindly Note:

• Kindly intimate us regarding any typographical errors and submit the report for correction within 7 days.

Limitations / Technical Factors: Ultrasound evaluation may not detect subtle bowel or early parenchymal abnormalities. Correlation with clinical findings is recommended.

• This report and accompanying images are not valid for medico-legal purposes.

Focal Fatty Sparing – Ultrasound Diagnosis and Scanning Technique

1. Focal fatty sparing refers to:
A. Focal liver abscess
B. Area of normal liver within a fatty liver
C. Hepatic cyst
D. Metastatic lesion

2. Focal fatty sparing is most commonly seen in:
A. Normal liver
B. Cirrhotic liver
C. Diffuse hepatic steatosis
D. Polycystic liver disease

3. On ultrasound, focal fatty sparing appears:
A. More hypoechoic than surrounding fatty liver
B. Completely anechoic
C. Markedly calcified
D. Strongly shadowing

4. A common location for focal fatty sparing is:
A. Around the gallbladder fossa
B. Renal cortex
C. Pancreatic tail
D. Splenic hilum

5. Another frequent site is:
A. Urinary bladder
B. Porta hepatis region
C. Adrenal gland
D. Appendix

6. A key feature suggesting focal fatty sparing is:
A. Mass effect on vessels
B. Distortion of liver capsule
C. Normal vessels traversing the area
D. Thick calcified rim

7. Color Doppler typically shows:
A. Chaotic neovascularity
B. No blood flow
C. Normal vascular pattern
D. Arteriovenous malformation

8. Focal fatty sparing may mimic:
A. Hepatic tumor or metastasis
B. Kidney stone
C. Pleural effusion
D. Ovarian cyst

9. The absence of which feature supports focal fatty sparing?
A. Portal veins
B. Mass effect
C. Normal parenchymal architecture
D. Blood flow

10. Correct recognition of focal fatty sparing helps:
A. Avoid unnecessary biopsy or follow-up
B. Diagnose gallstones
C. Confirm cirrhosis
D. Detect ascites

Answer Key:

1-B, 2-C, 3-A, 4-A, 5-B,
6-C, 7-C, 8-A, 9-B, 10-A

Case Study

Beaver Tail Liver

Beaver Tail Liver is an uncommon anatomical variant in which the left hepatic lobe extends laterally across the upper abdomen, often partially or completely surrounding the spleen. This elongated configuration may mimic splenic pathology or perisplenic collections on imaging studies. Recognition of this benign morphological variant is important to avoid diagnostic confusion and inadvertent injury during abdominal trauma assessment or surgical procedures.

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Whole Abdomen & Pelvis Sonography

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Technique: Examination performed using a convex 3.5–5 MHz transducer. Longitudinal and transverse planes of the abdomen were evaluated. Color Doppler assessment of hepatic and portal vessels was performed. Pelvic and post-void images were obtained. Patient was fasting for 6–8 hours.
Prior studies: No prior imaging available.
Clinical history: Routine sonographic evaluation.

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Liver: Liver is normal in size and echotexture with elongated lateral extension of the left hepatic lobe wrapping around the spleen, consistent with Beaver Tail Liver (normal anatomical variant). No focal lesion such as mass, cyst, or abscess is seen. Intrahepatic biliary radicles are not dilated. Portal vein is normal in caliber with normal hepatopetal flow.
Gall Bladder: Gall bladder is normal in size, shape, and echotexture. No calculus, mass, or sludge is seen. Wall thickness is normal.
Common Bile Duct (CBD): CBD is normal in course and caliber throughout its visualized length.
Pancreas: Pancreas is normal in size, shape, and echotexture. Main pancreatic duct is not dilated. No focal mass or calcification is seen.
Spleen: Spleen is normal in size, shape, and echotexture. Splenic vein appears normal. No focal lesion or calcification is seen.
Right Kidney: Right kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen.
Left Kidney: Left kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen.
Rt. Ureter: Right ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen.
Lt. Ureter: Left ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen.
Urinary Bladder: Urinary bladder is adequately distended. Wall thickness appears normal. No intraluminal mass or debris is seen. Post-void residual urine is insignificant.
Prostate: Prostate volume is within normal limits. Echotexture appears homogeneous.
Free Fluid: No free fluid is seen in the abdomen or pelvis.

Other Observations: No abdominal lymphadenopathy identified. Visualized bowel loops are unremarkable. Appendix is not visualized; no sonographic evidence of acute appendicitis. Bilateral inguinal regions are unremarkable without hernia or significant lymphadenopathy.

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Measurement Summary:

Liver Rt Lobe: 139 mm	Liver Lt Lobe: 92 mm	Spleen: 109 mm
RK: 114 mm	LK: 117 mm
Prostate: 13 mL

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Impression: Beaver Tail Liver (elongated left hepatic lobe), a normal anatomical variant. No focal hepatic lesion. Otherwise unremarkable ultrasound study of the abdomen and pelvis.

Recommendation: Clinical correlation advised.

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Limitations / Technical Factors: Ultrasound evaluation may not detect subtle bowel or early parenchymal abnormalities. Correlation with clinical findings is recommended.

• This report and accompanying images are not valid for medico-legal purposes.

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Beaver Tail Liver MCQ Quiz

1. Beaver Tail Liver is:
A. A hepatic tumor
B. A congenital cyst
C. An elongated left hepatic lobe extending around the spleen
D. A gallbladder anomaly

2. Beaver Tail Liver primarily involves:
A. Right hepatic lobe
B. Left hepatic lobe
C. Caudate lobe
D. Quadrate lobe

3. On ultrasound, the extended lobe usually demonstrates:
A. Normal liver echotexture
B. Large calcifications
C. Multiple cysts
D. Gas echoes

4. Beaver Tail Liver may be mistaken for:
A. Splenic mass or perisplenic pathology
B. Renal stone
C. Pleural effusion
D. Pancreatic pseudocyst

5. The best ultrasound approach to evaluate this variant is:
A. Pelvic scan only
B. Thyroid scan
C. Left upper quadrant and intercostal scanning
D. Cardiac apical view

6. A key feature confirming Beaver Tail Liver is:
A. Separation from the liver
B. Fluid-filled appearance
C. Continuity with normal liver parenchyma
D. Presence of calcified walls

7. Color Doppler typically demonstrates:
A. Absence of blood flow
B. Normal hepatic and portal vessels within the extension
C. Chaotic neovascularity
D. Splenic infarction

8. During scanning, the transducer should be positioned to assess:
A. The neck region
B. The left upper abdomen near the spleen
C. Only the pelvis
D. Only the gallbladder

9. The clinical importance of recognizing Beaver Tail Liver is to:
A. Diagnose cirrhosis
B. Diagnose hepatitis
C. Avoid misdiagnosis of splenic or abdominal pathology
D. Detect gallstones

10. Beaver Tail Liver is generally considered:
A. Malignant lesion
B. Normal anatomical variant
C. Hepatic abscess
D. Metastatic disease

Answer Key:

1-C, 2-B, 3-A, 4-A, 5-C,
6-C, 7-B, 8-B, 9-C, 10-B

Case Study

Riedel’s Lobe

Riedel’s Lobe is a normal anatomical variant characterized by a tongue-like inferior projection of the right hepatic lobe, most commonly extending from segments V and VI. It may mimic hepatomegaly or an abdominal mass on clinical examination but represents a benign morphological variation without pathological significance.

Whole Abdomen & Pelvis Sonography

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Technique: Examination performed using a convex 3.5–5 MHz transducer. Longitudinal and transverse planes of the abdomen were evaluated. Color Doppler assessment of hepatic and portal vessels was performed. Pelvic and post-void images were obtained. Patient was fasting for 6–8 hours.
Prior studies: No prior imaging available.
Clinical history: Routine sonographic evaluation.

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Liver: Liver is normal in echotexture with a prominent tongue-like inferior projection of the right hepatic lobe consistent with Riedel's lobe (normal anatomical variant). No focal lesion such as mass, cyst, or abscess is seen. Intrahepatic biliary radicles are not dilated. Portal vein is normal in caliber with normal hepatopetal flow.
Gall Bladder: Gall bladder is normal in size, shape, and echotexture. No calculus, mass, or sludge is seen. Wall thickness is normal.
Common Bile Duct (CBD): CBD is normal in course and caliber throughout its visualized length. Pancreas: Pancreas is normal in size, shape, and echotexture. Main pancreatic duct is not dilated. No focal mass or calcification is seen.

Spleen: Spleen is normal in size, shape, and echotexture. Splenic vein appears normal. No focal lesion or calcification is seen.
Right Kidney: Right kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen.
Left Kidney: Left kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen.
Rt. Ureter: Right ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen.
Lt. Ureter: Left ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen.
Urinary Bladder: Urinary bladder is adequately distended. Wall thickness appears normal. No intraluminal mass or debris is seen. Post-void residual urine is insignificant.
Prostate: Prostate volume is within normal limits. Echotexture appears homogeneous.
Free Fluid: No free fluid is seen in the abdomen or pelvis.

Other Observations: No abdominal lymphadenopathy identified. Visualized bowel loops are unremarkable. Appendix is not visualized; no sonographic evidence of acute appendicitis. Bilateral inguinal regions are unremarkable without hernia or significant lymphadenopathy.

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Measurement Summary:

Liver: 136 mm	Spleen: 95 mm
RK: 106 mm	LK: 112 mm
Prostate: 21 mL

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Impression: Prominent Riedel's lobe of the liver (normal anatomical variant). No focal hepatic lesion. Otherwise unremarkable ultrasound study of the abdomen and pelvis.

Recommendation: Clinical correlation advised.

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Limitations / Technical Factors: Ultrasound evaluation may not detect subtle bowel or early parenchymal abnormalities. Correlation with clinical findings is recommended.

• This report and accompanying images are not valid for medico-legal purposes.

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Riedel's Lobe MCQ Quiz

1. Riedel’s lobe is:
A. Liver cyst
B. Hepatic tumor
C. Tongue-like extension of right lobe
D. Gallbladder anomaly

2. Riedel’s lobe most commonly arises from:
A. Right hepatic lobe
B. Left hepatic lobe
C. Caudate lobe
D. Quadrate lobe

3. On ultrasound, Riedel’s lobe usually has:
A. Anechoic appearance
B. Calcification
C. Mixed cystic-solid pattern
D. Normal liver echotexture

4. Riedel’s lobe may be mistaken for:
A. Renal stone
B. Hepatomegaly or abdominal mass
C. Pleural effusion
D. Pancreatitis

5. The best scan plane to demonstrate its inferior extension is:
A. Thyroid transverse
B. Pelvic sagittal
C. Longitudinal/subcostal liver scan
D. Cardiac apical view

6. A key feature confirming Riedel’s lobe is:
A. Separate from liver
B. Fluid-filled structure
C. Calcified margin
D. Continuity with liver parenchyma

7. Color Doppler typically shows:
A. Normal hepatic vessels
B. No blood flow
C. Chaotic neovascularity
D. Portal vein thrombosis

8. During scanning, the transducer should be extended:
A. Toward the neck
B. Inferiorly below right costal margin
C. Only across the spleen
D. To the pelvis only

9. The main importance of recognizing Riedel’s lobe is:
A. Diagnose cirrhosis
B. Diagnose hepatitis
C. Avoid misdiagnosis as a mass
D. Detect ascites

10. In most cases Riedel’s lobe is considered:
A. Malignant lesion
B. Congenital normal variant
C. Abscess
D. Metastatic disease

Answer Key:

1-C, 2-A, 3-D, 4-B, 5-C,
6-D, 7-A, 8-B, 9-C, 10-B

Diagnostic Sonography

• 🎓 Ultrasonic
Search results will show here
• 1: Abdominal Ultrasound 1
• 2: Obstetric & Fetal 2
• 3: TVS 3
• 4: Perineal & Groin USG 4
• 5: Scrotum 5
• 6: Penis 6
• 7: Breast 7
• 8: Thorax 8
• 9: Dorsal Wall 9
• 10: Neck USG 10
• 11: Upper Limb USG 11
• 12: Lower Limb USG 12
• 13: Interventional USG 13
• 14: Neonatal / Pediatric USG 14
• 15: Cardiac (Echo) 15
• 16: Vascular / Angiology 16
• 17: Musculoskeletal (MSK) 17
• 18: Ophthalmic 18
• 19: Cheek / Buccal 19
• 20: Nasal & PNS 20
• 21: Spine 21
• 22: NCV (Nerve Conduction Study) 22
• 🎓 X-Ray
• Chapter 4: A-mode 4
• Chapter 5: B-mode 5
• Case study
• Chapter 6: Machine Checklist 6

i

Chapter 1: Abdominal Ultrasound

📖 1. Liver

Normal Variant

1. Riedel’s Lobe
2. Beaver Tail Liver
3. Focal Fatty Sparing
4. Focal Fatty Infiltration
5. Accessory Hepatic Lobe
6. Diaphragmatic Slip Impression
7. Prominent Portal Vein Radicles
8. Mild Lobulated Liver Surface
9. Recessed Gallbladder Fossa
10. Agenesis of Left Hepatic Lobe
11. Hypoplastic Right Lobe
12. Prominent Fissure for Ligamentum Teres

📖 2. Gall Bladder

1. Cholelithiasis
2. Acute Cholecystitis
3. Chronic Cholecystitis
4. Gallbladder Polyp
5. Biliary Sludge
6. Gallbladder Carcinoma

📖 3. CBD (Common Bile Duct)

1. Choledocholithiasis
2. CBD Dilatation
3. CBD Stricture
4. Cholangitis
5. Choledochal Cyst
6. Obstructive Jaundice

📖 4. Spleen

1. Splenomegaly
2. Splenic Cyst
3. Splenic Abscess
4. Splenic Infarction
5. Splenic Trauma
6. Splenic Tumor

📖 5. Pancreas

1. Acute Pancreatitis
2. Chronic Pancreatitis
3. Pancreatic Pseudocyst
4. Pancreatic Carcinoma
5. Pancreatic Mass
6. Pancreatic Calcification

📖 6. Kidneys

1. Renal Calculus
2. Hydronephrosis
3. Renal Cyst
4. Pyelonephritis
5. Renal Abscess
6. Renal Cell Carcinoma

📖 7. Ureter

1. Ureteric Calculus
2. Hydroureter
3. Ureteric Stricture
4. Ureterocele
5. Ureteric Tumor

📖 8. Adrenal Glands

1. Adrenal Adenoma
2. Adrenal Hyperplasia
3. Pheochromocytoma
4. Adrenal Hemorrhage
5. Adrenal Metastasis

📖 9. Abdominal Aorta & IVC

1. Abdominal Aortic Aneurysm
2. Aortic Dissection
3. Aortic Thrombus
4. IVC Thrombosis
5. IVC Dilatation

📖 10. Stomach

1. Gastric Wall Thickening
2. Gastric Outlet Obstruction
3. Gastric Tumor
4. Hiatal Hernia

📖 11. Small Bowel

1. Enteritis
2. Small Bowel Obstruction
3. Intussusception
4. Crohn Disease

📖 12. Colon

1. Colitis
2. Diverticulitis
3. Colon Carcinoma
4. Inflammatory Bowel Disease

📖 13. Appendix

1. Acute Appendicitis
2. Appendicular Abscess
3. Appendicolith
4. Appendiceal Mucocele

📖 14. Peritoneum

1. Ascites
2. Peritonitis
3. Peritoneal Carcinomatosis
4. Mesenteric Collection

📖 15. Retroperitoneum

1. Retroperitoneal Fibrosis
2. Lymphadenopathy
3. Retroperitoneal Mass
4. Hematoma

📖 16. Abdominal Wall

1. Umbilical Hernia
2. Incisional Hernia
3. Rectus Sheath Hematoma
4. Abdominal Wall Abscess

📖 17. CEUS for Renal Masses

1. Complex Renal Cyst
2. Renal Cell Carcinoma
3. Oncocytoma
4. Angiomyolipoma

📖 18. CEUS for Liver Tumors

1. Hepatocellular Carcinoma
2. Hemangioma
3. Focal Nodular Hyperplasia
4. Liver Metastasis

📖 19. Urinary Bladder

1. Bladder Calculus
2. Cystitis
3. Bladder Tumor
4. Bladder Diverticulum

📖 20. Prostate

1. BPH
2. Prostatitis
3. Prostate Cancer
4. Prostatic Calcification

📖 21. Uterus

1. Fibroid Uterus
2. Adenomyosis
3. Endometrial Hyperplasia
4. Endometrial Carcinoma

📖 22. Ovary

1. Simple Ovarian Cyst
2. Hemorrhagic Cyst
3. PCOS
4. Ovarian Tumor

📖 23. Adnexa

1. Hydrosalpinx
2. Tubo-Ovarian Abscess
3. Ectopic Pregnancy
4. Adnexal Mass

📖 24. Female Groin & Perineum

1. Inguinal Hernia
2. Bartholin Cyst
3. Perineal Abscess
4. Soft Tissue Mass

1

Chapter 2: Obstetric & Fetal

2

Chapter 3: TVS

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3

Chapter 4: Perineal & Groin USG

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4

Chapter 5: Scrotum

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5

Chapter 6: Penis

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6

Chapter 7: Breast

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7

Chapter 8: Thorax

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8

Chapter 9: Dorsal Wall

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9

Chapter 10: Neck USG

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10

Chapter 11: Upper Limb USG

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11

Chapter 12: Lower Limb USG

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12

Chapter 13: Interventional USG

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13

Chapter 14: Neonatal / Pediatric USG

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14

Chapter 15: Cardiac (Echo)

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15

Chapter 16: Vascular / Angiology

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16

Chapter 17: Musculoskeletal (MSK)

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17

Chapter 18: Ophthalmic

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18

Chapter 19: Cheek / Buccal

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19

Chapter 20: Nasal & PNS

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20

Chapter 21: Spine

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21

Chapter 22: NCV (Nerve Conduction Study)

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22

Leiomyosarcoma Back Lump (Dorsal Wall Ultrasound)

Leiomyosarcoma – Back Lump (Dorsal Wall Ultrasound)

Dorsal wll Ultrasound Case Study Case Study No: R-33

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Dorsal Wall Ultrasound

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Technique: Real-time ultrasound examination of the dorsal wall was performed using a high-frequency linear transducer (7–12 MHz). Detailed grayscale and Doppler assessment of the posterior soft tissue structures was carried out in longitudinal and transverse planes.
Clinical indication: Progressive dorsal wall swelling / Pain / Suspicion of aggressive soft tissue neoplasm.

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Location: Large soft tissue lesion is noted along the right lateral dorsal wall, involving the deep soft tissue and intermuscular plane.

Soft Tissue Mass: An ill-defined heterogeneous predominantly hypoechoic mass is identified measuring approximately 7.2 × 4.5 cm. The lesion demonstrates irregular infiltrative margins with extension into adjacent soft tissue structures. Internal Characteristics: Areas of internal necrosis are noted within the lesion. Marked heterogeneity of internal echotexture is present. Vascularity: Moderate to marked internal vascularity is demonstrated on Doppler imaging. Adjacent Structures: Infiltration into adjacent soft tissue and intermuscular planes is noted. No definite calcification is identified on current sonographic evaluation.

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Impression: Features are suspicious for leiomyosarcoma involving the dorsal wall soft tissues.

Recommendation: Urgent MRI is recommended for staging and assessment of local extent. Histopathological confirmation is essential. Oncological referral is advised.

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Kindly Note:

Limitations / Technical Factors:
Ultrasound evaluation has limited capability in assessing the complete extent of deep soft tissue tumors and adjacent osseous involvement.
MRI correlation is recommended for comprehensive staging and treatment planning.
• This report is not valid for medico-legal purposes.

Angioleiomyoma Back Lump (Dorsal Wall Ultrasound)

Angioleiomyoma – Back Lump (Dorsal Wall Ultrasound)

Dorsal wll Ultrasound Case Study Case Study No: R-32

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Dorsal Wall Ultrasound

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Technique: Real-time ultrasound examination of the dorsal wall was performed using a high-frequency linear transducer (7–12 MHz). Detailed grayscale and Doppler assessment of the superficial soft tissues was carried out in longitudinal and transverse planes.
Clinical indication: Painful dorsal wall swelling / Palpable soft tissue lesion / Vascular soft tissue mass evaluation.

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Location: A focal soft tissue lesion is noted along the right lateral dorsal wall within the subcutaneous plane adjacent to vascular structures.

Soft Tissue Lesion: A well-defined hypoechoic solid lesion is identified measuring approximately 2.4 × 1.3 cm. The lesion appears homogeneous with smooth and well-circumscribed margins. Echotexture: Internal echotexture appears uniform without cystic degeneration, calcification, or necrotic component. Vascularity: Prominent internal vascularity is demonstrated on Doppler imaging, suggestive of vascular smooth muscle origin. Adjacent Structures: No surrounding edema, fascial disruption, or infiltration into adjacent soft tissues is identified.

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Impression: Features are suggestive of angioleiomyoma in the dorsal wall.

Recommendation: Clinical correlation is advised. Surgical excision may be considered, especially if painful. Histopathological confirmation is recommended.

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Kindly Note:

Limitations / Technical Factors:
Ultrasound evaluation may have limitations in complete tissue characterization and assessment of microscopic extension.
Further imaging or histopathological evaluation may be required depending on clinical suspicion.
• This report is not valid for medico-legal purposes.

Leiomyoma Back Lump (Dorsal Wall Ultrasound)

Leiomyoma – Back Lump (Dorsal Wall Ultrasound)

Dorsal wll Ultrasound Case Study Case Study No: R-31

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Dorsal Wall Ultrasound

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Technique: Real-time ultrasound examination of the dorsal wall was performed using a high-frequency linear transducer (7–12 MHz). Detailed assessment of the superficial and deep soft tissues was carried out in longitudinal and transverse planes with grayscale and Doppler evaluation.
Clinical indication: Palpable dorsal wall swelling / Localized pain / Soft tissue lesion evaluation.

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Location: A focal soft tissue lesion is noted along the right lateral dorsal wall within the subcutaneous plane.

Soft Tissue Lesion: A well-defined oval hypoechoic solid lesion is identified measuring approximately 3.0 × 1.5 cm. The lesion appears homogeneous with smooth and well-circumscribed margins. Echotexture: Internal echotexture appears uniform without cystic degeneration, calcification, or necrotic component. Vascularity: Minimal to no significant internal vascularity is noted on Doppler imaging. Adjacent Structures: No surrounding edema, fascial disruption, or infiltration into adjacent soft tissues is identified.

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Impression: Features are suggestive of leiomyoma in the dorsal wall.

Recommendation: Clinical correlation is advised. Follow-up evaluation may be considered if symptomatic or increasing in size.

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Kindly Note:

Limitations / Technical Factors:
Ultrasound evaluation may have limitations in characterization of certain soft tissue lesions and deep tissue extension.
Further imaging or histopathological correlation may be required depending on clinical findings.
• This report is not valid for medico-legal purposes.

Liposarcoma (High-Grade Undifferentiated) Back Lump (Dorsal Wall Ultrasound)

Liposarcoma (High-Grade Undifferentiated) – Back Lump (Dorsal Wall Ultrasound)

Dorsal wll Ultrasound Case Study Case Study No: R-29

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Dorsal Wall Ultrasound

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Technique: Real-time ultrasound examination of the dorsal wall was performed using a high-frequency linear transducer (7–12 MHz). Detailed grayscale and Doppler evaluation of the posterior soft tissue structures was carried out in longitudinal and transverse planes.
Clinical indication: Rapidly enlarging dorsal wall swelling / Pain / Suspicion of aggressive soft tissue neoplasm.

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Location: Large soft tissue lesion is noted along the right lateral dorsal wall, involving the deep soft tissue and intermuscular plane.

Soft Tissue Mass: A large ill-defined heterogeneous predominantly hypoechoic mass is identified measuring approximately 9.2 × 5.6 cm. The lesion demonstrates irregular infiltrative margins with extension into adjacent soft tissue structures. Internal Characteristics: Marked internal heterogeneity is noted with areas of necrosis and hemorrhagic change. Loss of normal surrounding fat planes is evident. Vascularity: Prominent internal vascularity is demonstrated on Doppler imaging. Adjacent Structures: Infiltration into adjacent soft tissue and intermuscular planes is noted. No definite calcification is identified on current sonographic evaluation.

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Impression: Features are highly suspicious for high-grade undifferentiated liposarcoma involving the right lateral dorsal wall.

Recommendation: Urgent MRI is recommended for staging and assessment of local extent. CT scan may be required for metastatic workup. Histopathological confirmation is mandatory. Immediate oncological referral is advised.

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Kindly Note:

• Kindly report any typographical errors and submit for correction within 7 days.
Limitations / Technical Factors:
Ultrasound evaluation has limited capability in assessing complete tumor extent, deep tissue involvement, and metastatic disease.
MRI / CT correlation is essential for comprehensive staging and management planning.
• This report is not valid for medico-legal purposes.

Liposarcoma (Low-Grade Myxoid, Recurrent) Back Lump (Dorsal Wall Ultrasound)

Liposarcoma (Low-Grade Myxoid, Recurrent) – Back Lump (Dorsal Wall Ultrasound)

Dorsal wll Ultrasound Case Study Case Study No: R-29

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Dorsal Wall Ultrasound

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Technique: Real-time ultrasound examination of the dorsal wall was performed using a high-frequency linear transducer (7–12 MHz). Detailed evaluation of the posterior soft tissue structures was carried out in longitudinal and transverse planes with grayscale and Doppler assessment.
Clinical indication: Post-operative swelling / Suspected recurrence of soft tissue neoplasm / Pain at previous surgical site.

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Location: Lobulated soft tissue lesion is noted along the right lateral dorsal wall, involving the deep soft tissue and intermuscular plane at the site of prior surgery.

Soft Tissue Mass: A heterogeneous predominantly hypoechoic lobulated mass is identified measuring approximately 7.8 × 4.3 cm. The lesion demonstrates myxoid appearance with areas of cystic change and multiple internal septations. Margins & Extension: Margins appear partially ill-defined with extension along adjacent fascial planes. No definite osseous involvement is appreciated on sonographic evaluation. Vascularity: Mild to moderate internal vascularity is noted on Doppler imaging. Calcification / Necrosis: No calcification is seen within the lesion. Focal cystic / myxoid degenerative areas are present.

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Impression: Features are suggestive of recurrent low-grade myxoid liposarcoma involving the right lateral dorsal wall at the previous surgical site.

Recommendation: MRI is strongly recommended for assessment of local extent and recurrence. Comparison with previous imaging studies is advised. Histopathological confirmation is essential. Oncological referral is recommended.

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Kindly Note:

Limitations / Technical Factors:
Ultrasound evaluation may be limited in assessing the complete extent of deep soft tissue tumors and adjacent osseous or neural involvement.
MRI correlation is recommended for comprehensive characterization and treatment planning.
• This report is not valid for medico-legal purposes.

Liposarcoma Back Lump (Dorsal Wall Ultrasound)

Liposarcoma – Back Lump (Dorsal Wall Ultrasound)

Dorsal wll Ultrasound Case Study Case Study No: R-28

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Dorsal Wall Ultrasound

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Technique: Real-time ultrasound examination of the dorsal wall was performed using a high-frequency linear transducer (7–12 MHz). Detailed evaluation of the posterior thoraco-lumbar soft tissues was carried out in longitudinal and transverse planes. Gray-scale and Doppler assessment were performed.
Clinical indication: Back swelling / Palpable soft tissue mass / Pain / Suspicion of neoplastic lesion.

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Skin & Subcutaneous Tissue: Overlying skin appears maintained. Subcutaneous tissue demonstrates a large heterogeneous soft tissue lesion in the dorsal wall region.

Soft Tissue Mass: Large deep-seated heterogeneous soft tissue mass is noted showing mixed echogenicity with irregular hyperechoic (fatty) and hypoechoic solid components. Margins appear ill-defined / lobulated. Internal Characteristics: Areas of internal necrosis and cystic degeneration are noted within the lesion. No definite calcification is identified on sonographic evaluation. Vascularity: Increased internal vascularity is demonstrated on color Doppler examination. Adjacent Structures: Possible infiltration into adjacent soft tissue and muscle planes is noted. Further cross-sectional imaging correlation is advised.

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Impression: Features are suspicious for liposarcoma involving the dorsal wall soft tissues. Large heterogeneous deep-seated lesion with mixed fatty and solid components, internal vascularity, and possible adjacent infiltration is noted.

Recommendation: Correlation with MRI and histopathological evaluation is strongly recommended for further characterization and staging.

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Kindly Note:

• Kindly report any typographical errors and submit for correction within 7 days.
Limitations / Technical Factors:
Ultrasound evaluation has limited capability in assessing the full extent of deep soft tissue tumors and osseous involvement.
MRI / CT correlation may be required for complete lesion characterization and surgical planning.
• This report is not valid for medico-legal purposes.

Fibrolipomatous Hamartoma Back Lump (Dorsal Wall Ultrasound)

Fibrolipomatous Hamartoma – Back Lump (Dorsal Wall Ultrasound)

Dorsal wll Ultrasound Case Study Case Study No: R-27

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Dorsal Wall Ultrasound

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Technique: Real-time ultrasound examination of the dorsal wall / involved peripheral nerve was performed using a high-frequency linear transducer (7–12 MHz). Detailed evaluation of the soft tissue and visualized nerve structures was carried out in longitudinal and transverse planes. Gray-scale and Doppler assessment were performed.
Clinical indication: Soft tissue swelling / Suspected nerve lesion / Tingling sensation / Pain / Numbness / Palpable mass.

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Soft Tissue / Nerve: Enlarged peripheral nerve is noted showing hypoechoic nerve fascicles separated by abundant echogenic fibrofatty tissue, producing characteristic “cable-like / coaxial cable” appearance on longitudinal and transverse scans. Common involvement of the median nerve is noted. Echotexture: Internal architecture demonstrates fibrofatty infiltration with preserved fascicular pattern. No cystic degeneration or calcification is seen. Compressibility: Lesion appears non-compressible on probe pressure examination. Vascularity: No significant internal vascularity is noted on Doppler evaluation. Adjacent Structures: No invasion into adjacent muscle planes, vessels, or surrounding soft tissues is identified.

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Impression: Findings are consistent with fibrolipomatous hamartoma of nerv. Characteristic enlarged nerve with fibrofatty infiltration and “coaxial cable” appearance is noted

Recommendation: Clinical correlation is advised. MRI may be considered for further characterization and extent evaluation, if clinically indicated.

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Kindly Note:

• Kindly report any typographical errors and submit for correction within 7 days.
Limitations / Technical Factors:
Ultrasound evaluation may be limited for deep-seated nerve lesions and adjacent osseous structures.
Clinical correlation and MRI may be required for complete assessment depending on clinical suspicion.
• This report is not valid for medico-legal purposes.