Normal Chest X-Ray PA view
📄 SCRS
NORMAL
CXR-PA VIEW
Understanding a Healthy Chest X-Ray Appearance
L
Normal Chest X-Ray (PA View)
CASE–1
Clinical History
Routine chest radiograph performed for baseline evaluation.
Findings
PA chest radiograph demonstrates normal cardiac size and mediastinal contours.
Both lungs are adequately expanded and clear. No focal consolidation, collapse,
pleural effusion, or pneumothorax is identified. Hilar structures appear normal.
Costophrenic angles are preserved. No acute osseous abnormality is evident on
the visualized thorax.
Impression
Normal PA chest radiograph. No active cardiopulmonary abnormality.
Key Learning Points
- Normal cardiomediastinal silhouette.
- Clear lung fields.
- Sharp costophrenic angles.
- No pleural effusion.
- No pneumothorax.
X-Ray Case Study
🩻 X-RAY
CHEST
📂 NORMAL & BASIC VIEWS
📂 AIR-SPACE / ALVEOLAR DISEASES
1 📄 Lobar Pneumonia
2 📄 Bronchopneumonia
3 📄 Aspiration Pneumonia
4 📄 Pulmonary Edema – Cardiogenic
5 📄 Pulmonary Edema – ARDS
6 📄 Pulmonary Hemorrhage
7 📄 Right Middle Lobe Pneumonia
8 📄 Left Lower Lobe Pneumonia
9 📄 Lingular Consolidation
10 📄 Posterior Basal Consolidation
📂 TUBERCULOSIS & INFECTIVE DISEASES
11 📄 Primary Pulmonary Tuberculosis
12 📄 Post-Primary Tuberculosis
13 📄 Fibro-Cavitary Tuberculosis
14 📄 Cavitary Pulmonary Tuberculosis
15 📄 Miliary Tuberculosis
16 📄 Active Pulmonary Tuberculosis
17 📄 Healed Pulmonary Tuberculosis
18 📄 Tuberculoma
19 📄 Endobronchial Tuberculosis
20 📄 Tuberculous Pleural Effusion
21 📄 MDR Tuberculosis
22 📄 XDR Tuberculosis
23 📄 Post-Tubercular Fibrosis
24 📄 Destroyed Tubercular Lung
25 📄 Tuberculous Bronchiectasis
26 📄 Disseminated Tuberculosis
27 📄 Paravertebral Abscess
28 📄 Apical Fibrotic Tuberculosis
📂 AIRWAY & OBSTRUCTIVE LUNG DISEASES
29 📄 COPD with Hyperinflation
30 📄 Emphysema
31 📄 Bullous Lung Disease
32 📄 Bronchiectasis
33 📄 Endobronchial Obstruction
34 📄 Acute Bronchitis
35 📄 Chronic Bronchitis
36 📄 Asthmatic Bronchitis
37 📄 Bronchiolitis
38 📄 Small Airway Disease
39 📄 Foreign Body Aspiration
📂 COLLAPSE / VOLUME LOSS
40 📄 Lobar Collapse
41 📄 Segmental Collapse
42 📄 Complete Lung Collapse
43 📄 Atelectatic Band
44 📄 Middle Lobe Atelectasis
📂 INTERSTITIAL / CHRONIC LUNG DISEASE
45 📄 Interstitial Lung Disease
46 📄 Pulmonary Fibrosis
47 📄 Honeycomb Lung
48 📄 Sarcoidosis
49 📄 Pneumoconiosis
50 📄 Silicosis
📂 CARDIAC & VASCULAR PATHOLOGY
51 📄 Cardiomegaly
52 📄 Congestive Cardiac Failure
53 📄 Pulmonary Venous Hypertension
54 📄 Pulmonary Arterial Hypertension
55 📄 Pericardial Effusion
56 📄 Aortic Unfolding
57 📄 Aortic Aneurysm
58 📄 Left Atrial Enlargement
59 📄 Right Atrial Enlargement
📂 PLEURAL DISEASES
60 📄 Pleural Effusion
61 📄 Massive Pleural Effusion
62 📄 Loculated Pleural Effusion
63 📄 Empyema
64 📄 Pleural Thickening
65 📄 Pleural Plaque
66 📄 Pneumothorax
67 📄 Tension Pneumothorax
68 📄 Hydropneumothorax
📂 MEDIASTINAL / HILAR PATHOLOGY
69 📄 Mediastinal Widening
70 📄 Mediastinal Mass
71 📄 Hilar Lymphadenopathy
72 📄 Pneumomediastinum
73 📄 Thymoma
74 📄 Retrosternal Goiter
75 📄 Neurogenic Tumor
76 📄 Hiatal Hernia
📂 LUNG MASSES & NEOPLASMS
77 📄 Solitary Pulmonary Nodule
78 📄 Bronchogenic Carcinoma
79 📄 Metastatic Lung Nodules
80 📄 Pancoast Tumor
📂 TRAUMA & CHEST WALL
81 📄 Rib Fracture
82 📄 Flail Chest
83 📄 Pulmonary Contusion
84 📄 Hemothorax
85 📄 Surgical Emphysema
86 📄 Clavicle Fracture
87 📄 Sternal Fracture
88 📄 Vertebral Collapse
89 📄 Chest Wall Mass
📂 DIAPHRAGM & SUBDIAPHRAGMATIC
90 📄 Elevated Hemidiaphragm
91 📄 Diaphragmatic Eventration
92 📄 Diaphragmatic Hernia
93 📄 Free Air Under Diaphragm
94 📄 Subphrenic Abscess
📂 ICU LINES / DEVICES / POSTOPERATIVE
95 📄 Endotracheal Tube Position
96 📄 Central Venous Catheter
97 📄 Intercostal Drainage Tube
98 📄 Nasogastric Tube Position
99 📄 Pacemaker / ICD
100 📄 Surgical Clips
101 📄 Post-Lobectomy Changes
102 📄 Postoperative Chest Changes
📂 OTHER / NON-SPECIFIC
103 📄 No Acute Cardiopulmonary Abnormality
104 📄 Indeterminate Chest Lesion
Focal Fatty Infiltration
Case Study
Focal Fatty Infiltration
Focal Fatty Infiltration is a benign imaging finding characterized by localized deposition of fat within a specific region of the liver while the remaining hepatic parenchyma appears relatively normal. These areas are typically hyperechoic on ultrasound and are commonly located adjacent to the falciform ligament, gallbladder fossa, porta hepatis, or subcapsular regions. Recognition of focal fatty infiltration is important because it may simulate focal hepatic masses; however, it usually demonstrates geographic margins, preserved vascular architecture, and absence of mass effect, helping differentiate it from true hepatic lesions.
Whole Abdomen & Pelvis Sonography
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.
Liver: Liver demonstrates mildly increased echogenicity. Shows multiples focal geographic hyperechoic area is seen within the hepatic parenchyma, without mass effect or distortion of adjacent vascular structures, consistent with focal fatty infiltration. 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.
Measurement Summary:
| Liver: 142 mm | Spleen: 97 mm |
| RK: 92 mm | LK: 90 mm |
| Prostate: 7.5 mL |
Impression: Focal fatty infiltration of the liver. No focal hepatic mass lesion identified. Otherwise unremarkable ultrasound study of the abdomen and pelvis.
Recommendation: Clinical correlation advised.
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 Infiltration – MCQs
1. What is focal fatty infiltration?
A. Localized hepatic calcification
B. Localized deposition of fat within the liver
C. Liver abscess formation
D. Portal vein thrombosis
2. Focal fatty infiltration most commonly occurs in:
A. Completely normal liver
B. Diffuse fatty liver disease
C. Polycystic liver disease
D. Hepatic trauma
3. On ultrasound, focal fatty infiltration usually appears:
A. Hypoechoic
B. Anechoic
C. Hyperechoic relative to normal liver
D. Calcified
4. A common location for focal fatty infiltration is:
A. Adjacent to the falciform ligament
B. Renal cortex
C. Splenic hilum
D. Pancreatic tail
5. Focal fatty infiltration is generally considered:
A. Malignant
B. Infective
C. Benign
D. Traumatic
6. Which structure is commonly associated with focal fatty infiltration?
A. Coronary ligament
B. Falciform ligament
C. Broad ligament
D. Ureter
7. Focal fatty infiltration may mimic:
A. Hepatic mass lesion
B. Renal stone
C. Gallstone
D. Pancreatitis
8. Recognition of focal fatty infiltration helps avoid:
A. Portal hypertension
B. Misdiagnosis of a liver tumor
C. Ascites
D. Splenomegaly
9. Focal fatty infiltration characteristically demonstrates:
A. Significant mass effect
B. Distortion of vessels
C. Preserved vascular architecture
D. Extensive calcification
10. Focal fatty infiltration most commonly affects which organ?
A. Kidney
B. Pancreas
C. Liver
D. Spleen
📝 Focal Fatty Infiltration – Answer Sheet
1. __________
2. __________
3. __________
4. __________
5. __________
6. __________
7. __________
8. __________
9. __________
10. __________
Correct Answers
1. B, 2. B, 3. C, 4. A, 5. C, 6. B, 7. A, 8. B, 9. C, 10. C
Focal Fatty Sparing
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.
Whole Abdomen & Pelvis Sonography
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.
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.
Measurement Summary:
| Liver: 159 mm | Spleen: 102 mm |
| RK: 98 mm | LK: 106 mm |
| Prostate: 14.5 mL |
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.
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
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
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
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
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
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
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
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
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
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
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
1-B, 2-C, 3-A, 4-A, 5-B,
6-C, 7-C, 8-A, 9-B, 10-A
Beaver Tail Liver
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.
Whole Abdomen & Pelvis Sonography
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.
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.
Measurement Summary:
| Liver Rt Lobe: 139 mm | Liver Lt Lobe: 92 mm | Spleen: 109 mm |
| RK: 114 mm | LK: 117 mm | |
| Prostate: 13 mL |
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.
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.
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
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
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
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
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
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
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
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
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
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
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
1-C, 2-B, 3-A, 4-A, 5-C,
6-C, 7-B, 8-B, 9-C, 10-B
Riedel’s Lobe
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
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.
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.
Measurement Summary:
| Liver: 136 mm | Spleen: 95 mm |
| RK: 106 mm | LK: 112 mm |
| Prostate: 21 mL |
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.
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.
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 Ultrasound Case Study
📁 ULTRASOUND
ABDOMEN
📂 Liver
📄 Fatty Liver
📄 Hepatomegaly
📄 Cirrhosis
📄 Liver Cyst
📄 Liver Abscess
📂 Gallbladder
📄 Gall Stone
📄 Cholecystitis
📄 GB Sludge
📄 GB Polyp
📄 CBD Dilatation
📂 Kidney
📄 Renal Stone
📄 Hydronephrosis
📄 Renal Cyst
📄 Medical Renal Disease
📄 Pyelonephritis
📂 Spleen & Pancreas
📄 Splenomegaly
📄 Splenic Cyst
📄 Pancreatitis
📄 Pancreatic Mass
📄 Ascites
Leiomyosarcoma Back Lump (Dorsal Wall Ultrasound)
Leiomyosarcoma – Back Lump (Dorsal Wall Ultrasound)
Dorsal wll Ultrasound Case Study
Case Study No: R-33
Dorsal Wall Ultrasound
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.
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.
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.
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
Dorsal Wall Ultrasound
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.
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.
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.
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
Dorsal Wall Ultrasound
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.
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.
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.
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.
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