Clinical History:
A 42-year-old male presented with acute onset right flank pain
radiating to the groin, associated with nausea and hematuria.
Clinical suspicion of renal/ureteric calculus was raised.
Ultrasound examination was advised for evaluation of
urinary tract obstruction.
Fig-1.
Ultrasound image of the right kidney demonstrates a
hyperechoic focus with posterior acoustic shadowing,
measurese of 14.7 mm in maximum diameter withinthe renal pelvis consistent with a renal calculus.
No dilatation of the pelvicalyceal system may is seen,
Fig-1.1
Ultrasound image of the right kidney demonstrates a
hyperechoic focus with posterior acoustic shadowing on color Doppler showing "Twinkling artifact"
measurese of 14.7 mm in maximum diameter withinthe renal pelvis consistent with a renal calculus.
No dilatation of the pelvicalyceal system may is seen,
Key diagnostic ultrasound signs:
a- Hyperechoic focus within kidney/ureter b- Posterior acoustic shadowing c- Twinkling artifact on Doppler d- Hydronephrosis (if obstructive) e- Dilated ureter (in ureteric calculus)
Hyperechoic Focus:
Renal stones appear as bright echogenic foci due to high acoustic impedance.
Posterior Shadowing:
A clean acoustic shadow behind the stone confirms calcification.
Twinkling Artifact:
Color Doppler may show twinkling artifact, improving detection.
Clinical Correlation:
Patients typically present with flank pain, hematuria, nausea.
Clinical History:
A 2-year-old child presented with intermittent abdominal pain, vomiting,
and episodes of crying with drawing up of the legs. Parents reported
possible passage of blood-stained stool (currant jelly stool).
Ultrasound examination was requested to evaluate for suspected
intestinal obstruction or intussusception.
Step-ii
Imaging
Fig-1.
Transverse ultrasound image of the abdomen demonstrates the
classic "target sign" (also known as the doughnut sign),
characterized by multiple concentric echogenic and hypoechoic rings.
This appearance represents telescoping of one bowel segment
into another, consistent with intestinal intussusception.
Step-iii
Diagnosis
Key diagnostic ultrasound signs:
a- Target sign / doughnut sign in transverse section b- Pseudokidney sign in longitudinal section c- Concentric bowel wall layers d- Mesenteric fat and vessels dragged inside bowel lumen
Why Intussusception?
Target Sign Appearance:
The most characteristic ultrasound feature is the
target or doughnut sign, formed by concentric rings of
invaginated bowel segments.
Telescoping of Bowel:
One segment of intestine (intussusceptum) slides into the adjacent
segment (intussuscipiens), producing layered bowel wall appearance.
Pseudokidney Sign:
On longitudinal imaging, the intussuscepted bowel resembles
a kidney-shaped mass due to bowel wall edema and mesenteric fat.
Mesenteric Fat Within Lesion:
Mesenteric fat and vessels may be seen within the intussusception,
confirming telescoping bowel loops.
Clinical Correlation:
Children often present with intermittent abdominal pain,
vomiting, and occasionally currant jelly stool.
Possible conditions that may mimic intussusception on imaging include:
• Small bowel mass
• Enlarged lymph nodes
• Bowel wall edema from enteritis
• Meckel's diverticulum acting as lead point
Step-v
Documentation
Findings:
A well-defined bowel-within-bowel configuration is visualized in the
right abdomen demonstrating the classic target sign on transverse
scan and pseudokidney sign on longitudinal scan. Mesenteric fat
and vessels are noted within the lesion. These findings are consistent
with intestinal intussusception.
Conclusion:
Ultrasound findings are highly suggestive of
ileocolic intussusception.
Recommendation:
Urgent pediatric surgical consultation is advised.
Air or contrast enema reduction under fluoroscopic guidance
may be considered as the first-line treatment.
SCRS End Page
End of Case Study
You have reached the end of this Intussusception – Ultrasound Case Study (Target Sign).
Content is intended for educational, training, and clinical reference only.
Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled
“Intussusception – Target Sign on Ultrasound” has been prepared solely
for educational and academic purposes.
The imaging findings, measurements, and interpretations are intended for
learning and demonstration only.
Definitive diagnosis requires clinical correlation, surgical evaluation,
and appropriate specialist consultation.
Author: ____________________ Name: R. K. Mouj [Radio-imaging Technologist] Domain: Diagnostic Sonography & Pediatric Radiology Platform: SonoAcademy Supervisor / Guide: Department Radiologist Department: Radiology
Clinical History:
A 55-year-old male referred for ultrasound examination of the urinary bladder for diagnostic evaluation symptoms to include (hematuria, dysuria, frequency, pain).
Step-ii
Imaging
Fig-1.
Ultrasound image of the urinary bladder shows an irregular echogenic intraluminal mass arising from the bladder wall, demonstrating internal vascularity on color Doppler. Findings are suggestive of a papillary urothelial carcinoma (bladder tumour).
Step-iii
Diagnos
Fig-2.Key point- a-Exophytic / papillary mass b-Vascular flow within lesion (rules out clot) c-Projects into lumen d-Arises from bladder wall
Why Papillary Urothelial Carcinoma?
This lesion is suspected to be papillary urothelial carcinoma because it shows the classic ultrasound characteristics of this tumor type:
Papillary / Polypoid Appearance- The mass projects into the bladder lumen rather than thickening the wall diffusely.
Papillary tumors grow as finger-like or frond-like projections, which appear as an intraluminal echogenic mass on ultrasound.
Attachment to Bladder Wall- The lesion arises from the bladder wall, a typical origin of urothelial tumors.
Internal Vascularity on Color Doppler- Presence of internal blood flow confirms that this is a solid, viable tumor, not a clot or debris. Papillary urothelial carcinomas are usually vascular, unlike blood clots (which show no flow).
Irregular Surface but Preserved Bladder Lumen- Early or papillary tumors often show irregular margins without complete wall destruction. This appearance fits papillary carcinoma rather than infiltrative muscle-invasive disease.
Typical Clinical Correlation- Most patients present with painless hematuria, which is the hallmark symptom of papillary urothelial carcinoma.
✔ Fixed intraluminal bladder mass
✔ Arises from the bladder wall
✔ Irregular papillary surface
✔ Internal vascularity on Color Doppler
Bladder polyp
✖ Usually small and smooth
✖ Minimal or absent Doppler vascularity
✖ Typically benign
Blood clot
✖ No internal vascularity
✖ Often mobile or changes position
✖ Not attached to the bladder wall
Sludge / debris
✖ Non-vascular
✖ Gravity dependent and mobile
✖ Settles in the dependent portion of the bladder
Inflammatory pseudotumor
✖ Ill-defined mass or focal wall thickening
✖ Lacks typical papillary architecture
✖ Variable or minimal vascularity
Step-iv
Differential Diagnosis
Bladder polyp
Fig-3.
A bladder polyp is a benign mucosal growth arising from the bladder wall.
It is usually small, smooth, and well-defined. Doppler study typically
shows little or no internal vascularity. Polyps are fixed to the bladder
wall but lack aggressive features.
Blood clot
Fig-4.
A blood clot or hematoma represents intravesical hemorrhage rather than a true mass.
It has no internal vascularity on color Doppler and often changes position
with patient movement or bladder filling. Blood clots are not attached
to the bladder wall.
Sludge / debris
Fig-5.
Sludge or debris consists of cellular material, pus, or blood products
within the urine. It is non-vascular, gravity dependent, and mobile,
settling in the dependent portion of the bladder. It does not form a true
mass and lacks wall attachment.
Inflammatory pseudotumor
Fig-6.
An inflammatory pseudotumor is a benign inflammatory lesion that can
mimic a neoplasm. It usually presents as focal bladder wall thickening
or an ill-defined mass. Vascularity may be variable, but papillary
architecture is typically absent.
Step-v
Documentation
Findings:
An exophytic papillary mass is visualized arising from the urinary bladder wall,
measuring approximately 45 × 34 mm. The lesion projects into the bladder
lumen and appears fixed at its point of attachment. Internal vascular flow is
demonstrated on color Doppler imaging, confirming the solid nature of the lesion
and excluding an intravesical blood clot. The surrounding bladder wall at the
site of origin shows focal involvement.
Conclusion:
Exophytic papillary intraluminal bladder mass arising from the bladder wall with
internal vascularity, favoring a papillary urothelial tumor
[? papillary urothelial carcinoma (TCC)].
Recommendation:
Urology consultation is advised. Cystoscopic evaluation with biopsy or
transurethral resection is recommended for histopathological confirmation.
Further staging workup may be considered based on histology.
SCRS End Page
End of Case Study
You have reached the end of this Urinary Bladder Tumor – Ultrasound Case Study.
Content is intended for educational, training, and clinical reference only.
Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled
“Exophytic Papillary Bladder Mass on Ultrasound” has been prepared solely
for educational and academic purposes.
The imaging findings, measurements, and interpretations are intended for
learning and demonstration only.
Definitive diagnosis requires clinical correlation, cystoscopic evaluation,
histopathological confirmation, and appropriate specialist consultation.
Author: ____________________ Name: R. K. Mouj [Radio-imaging Technologist] Domain: Diagnostic Sonography & Uro-Radiology Platform: SonoAcademy Supervisor / Guide: Department Radiologist Department: Radiology
Fig-1. rENAL shows Single tiny echogenic focus (~2 mm) noted in mid calyx without definite posterior acoustic shadowing -consistent with microlithiasis.
Whole abdomen & pelvis sonography
Technique:Convex 3.5–5 MHz probe; longitudinal and transverse planes of upper abdomen; color Doppler evaluation of portal vein and hepatic vessels; pelvic and post-void images obtained. Fasting: 6–8 hours. Prior studies: No prior available Clinical history: Right Flank Pain
Findings Liver:Normal in size. Echotexture homogeneous. No discrete focal lesion identified in the visualized liver. Intrahepatic biliary radicles not dilated.
Gallbladder & biliary tract:Gallbladder well distended. Wall normal. Lumen is echo-free. No pericholecystic fluid. Common bile duct (CBD) diameter within expected limits for age. No intrahepatic biliary dilatation. Pancreas: Pancreatic head and body partially visualized; contour preserved; no focal mass seen in the visualized portion. Examination limited by overlying bowel gas. Spleen:Normal polar length. Homogeneous echotexture. No focal lesion identified.
Right kidney:Size: Normal. Preserved corticomedullary differentiation. No hydronephrosis. Single tiny echogenic focus (~2 mm) noted in mid calyx without definite posterior acoustic shadowing -consistent with microlithiasis.
Left kidney:Size: Normal. Preserved corticomedullary differentiation. No hydronephrosis. No renal mass or stone detected.
Urinary bladder:Adequately distended pre-void. Wall smooth; no intraluminal mass or debris. Post-void residual: nil. Prostate (transabdominal assessment):Prostate volume — 31.1 mL -Enlaeged. Gland appears homogeneous with no discrete focal lesion visualized. For detailed prostate evaluation, consider transrectal ultrasound (TRUS) if clinically indicated.
Abdominal aorta:Visualized abdominal aorta measures normal in diameter (proximal). No aneurysmal dilatation or mural thrombus seen. Ascites / free fluid:No free fluid identified in the hepatorenal recess, Morrison's pouch, or pelvis. Measurement Summary
Liver: 146 mm (MCL)
Spleen: 109 mm (Bipolar length)
Rt. Kidney: 90 mm Length)
Left Kidney: 87 mm
Prostate Vol:31.1 mL
Other observations: Linear 7.5–10 MHz probe, longitudinal and transverse planes of small parts of abdomen.
No evidence of abdominal lymphadenopathy. The para-aortic, mesenteric, porta hepatis, and iliac regions show no enlarged or abnormal lymph nodes. Any visualized lymph nodes are oval, with preserved fatty hilum and normal echotexture.
Bowel: Demonstrate normal wall thickness and preserved wall layering. No abnormal dilatation, thickening, or pericolic fluid noted. Peristalsis is normal. No evidence of obstruction, mass, or inflammatory bowel changes.
Abdominal wall: Demonstrates normal layered architecture and echotexture. No evidence of hernia, mass lesion, edema, or localized collection. Subcutaneous tissues and musculature appear normal..
Impression / Conclusion:
• Right renal Calyceal microlithiasis – a single tiny echogenic focus in right renal calyx.k
• Prostatomegaly (BPH Grade 1) – prostate enlarged, measuring Echotexture appears ___ (homogeneous/heterogeneous) with no focal lesion. Mild median lobe impression (absent).
Recommendations:
• Adequate hydration advised.
• Clinical correlation for urinary symptoms (LUTS).
• Consider uroflowmetry ± PSA depending on age and clinical indication.
• Routine follow-up ultrasound as clinically recommended.
Limitations / Technical factors
Study partially limited by overlying bowel gas, which obscured complete evaluation of the pancreas.
Prostate volume assessed transabdominally; TRUS (transrectal ultrasound) provides more accurate evaluation of gland volume and zonal anatomy.
No color or spectral Doppler abnormalities detected in the assessed renal vessels. A detailed renal vascular duplex study is not included unless specifically requested.
Ultrasound Templates — Fixed
📄 Right renal single Calyceal microlithiasis & prostatomegaly (BPH Grade-I)
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