📄 SCRS

Jarcho–Levin spectrum
Spondylocostal dysostosis

Jarcho–Levin spectrum / Spondylocostal dysostosis ultrasound case study

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Reporting Panel

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Fetal Pathology

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Jarcho–Levin spectrum / Spondylocostal dysostosis ultrasound case study

CASE–1

Clinical History

A fetus was referred for detailed anomaly scan due to suspected skeletal abnormality and abnormal fetal spine/thoracic configuration on routine antenatal ultrasound. The examination was performed to evaluate the fetal spine, thoracic cage, ribs, brain ventricles, neural tube, and associated limb anomalies.

Ultrasound Findings

Ultrasound examination demonstrates a thoracic myelomeningocele with posterior spinal defect involving the thoracic vertebrae. Multiple thoracic vertebral segmentation anomalies are noted. The thoracic cage appears markedly shortened and small, with absent/fused ribs causing severe thoracic hypoplasia. Severe communicating hydrocephalus is present with marked dilatation of the lateral ventricles. Unilateral talipes equinovarus (clubfoot) is also demonstrated. The overall findings suggest a complex fetal anomaly involving the spine, thoracic cage, ribs, central nervous system, and lower limb.

Fetal ultrasound. Severe communicating hydrocephalus is demonstrated with marked dilatation of the fetal ventricular system. Associated thoracic spinal defect with myelomeningocele, thoracic vertebral anomalies, short hypoplastic thorax with absent/fused ribs, and unilateral talipes equinovarus are also noted. Findings are suggestive of Jarcho–Levin spectrum / Spondylocostal Dysostosis with associated neural tube defect.

Fetal ultrasound cross-section. A posterior spinal defect is seen with a cystic sac protruding from the fetal back, consistent with myelomeningocele. The lesion contains neural elements and is associated with abnormal posterior vertebral arch formation.

Fetal ultrasound. Abnormal thoracic spine curvature with irregular thoracic vertebral alignment is demonstrated, consistent with thoracic scoliosis. Associated vertebral segmentation defects and abnormal rib morphology may be seen in Jarcho–Levin spectrum / Spondylocostal Dysostosis.

Fetal ultrasound. The thoracic cage appears markedly shortened and narrowed with absent and fused ribs, resulting in a severely hypoplastic thorax. These findings are characteristic of Jarcho–Levin spectrum / Spondylocostal Dysostosis and are associated with an increased risk of thoracic insufficiency and pulmonary hypoplasia.

Fetal ultrasound. The fetal foot demonstrates persistent medial deviation and plantar flexion, consistent with unilateral talipes equinovarus (clubfoot). The affected foot is maintained in an abnormal inwardly rotated position relative to the lower leg, a characteristic sonographic appearance of congenital clubfoot.

Report Line

A thoracic myelomeningocele is identified in association with multiple thoracic vertebral segmentation anomalies. The thoracic cage is markedly shortened with absent/fused ribs, resulting in severe thoracic hypoplasia. Severe communicating hydrocephalus is present. Unilateral talipes equinovarus (clubfoot) is also demonstrated. The constellation of findings is consistent with Jarcho–Levin spectrum / Spondylocostal Dysostosis associated with complex neural tube defect and severe thoracic insufficiency.

Impression

Features are consistent with Jarcho–Levin spectrum / Spondylocostal Dysostosis with thoracic vertebral segmentation anomalies, short hypoplastic thorax, absent/fused ribs, thoracic myelomeningocele, severe communicating hydrocephalus, and unilateral talipes equinovarus.

Recommendation

Detailed fetal anomaly survey and fetal neurosonography are recommended. Fetal MRI may be considered for better assessment of the neural tube defect, spinal involvement, and associated intracranial abnormalities. Fetal echocardiography and genetic counseling are advised. Correlation with aneuploidy screening and consideration of molecular genetic testing are recommended. Prognosis should be discussed with the parents due to severe thoracic hypoplasia and associated central nervous system anomaly.

Key Learning Points

• Jarcho–Levin spectrum / Spondylocostal Dysostosis is characterized by vertebral segmentation defects and rib anomalies.
• A short, hypoplastic thorax with absent or fused ribs may result in severe thoracic insufficiency.
• Thoracic myelomeningocele represents an associated neural tube defect.
• Severe communicating hydrocephalus may occur with complex spinal and neural tube abnormalities.
• Talipes equinovarus may be seen as an associated limb deformity.
• Assessment should include the spine, ribs, thoracic circumference, brain ventricles, kidneys, heart, and limbs.
• Fetal MRI and genetic counseling may help in further evaluation and parental counseling.

CKD/Renal failure/ chronic medical renal disease

📄 SCRS

CKD
Renal failure

Renal failure ultrasound case study

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Reporting Panel

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Renal Pathology

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USG

CKD/Renal Failure ultrasound case study

CASE–1

Clinical History

An 85-year-old patient with a known history of chronic kidney disease (CKD)/renal failure on maintenance hemodialysis (6 dialysis sessions) presented for follow-up ultrasound evaluation. The patient has a history of left ureteric Double-J (DJ) stent placement for urinary tract obstruction. Ultrasound was performed to assess the left kidney and stent position.

Ultrasound Findings

Ultrasound examination demonstrates a small left kidney with increased cortical echogenicity and poor corticomedullary differentiation, consistent with chronic medical renal disease. A linear hyperechoic tubular structure is visualized within the left renal pelvis extending into the calyceal system, consistent with an indwelling Double-J (DJ) ureteric stent. No definite renal calculus is identified. Mild fullness of the pelvicalyceal system may be present. No perinephric collection is seen.

Ultrasound of the left kidney. The linear hyperechoic structure within the left renal pelvis/calyceal system represents an indwelling Double-J (DJ) ureteric stent. Sonographic features are consistent with a ureteric stent in situ in a patient with chronic kidney disease.

Report Line

The left kidney appears small with diffusely increased cortical echogenicity and loss of corticomedullary differentiation, consistent with chronic medical renal disease. A linear hyperechoic tubular structure is visualized within the left renal pelvis/calyceal system, consistent with an indwelling Double-J ureteric stent. No definite renal calculus or perinephric collection is identified. Sonographic findings are consistent with CKD with left DJ ureteric stent in situ.

Impression

Features are consistent with chronic kidney disease (CKD) involving the left kidney with an indwelling left Double-J (DJ) ureteric stent in situ.

Recommendation

Clinical correlation with renal function tests and dialysis status is recommended. Urology follow-up is advised to assess stent patency and determine the need for timely stent exchange or removal. Correlation with previous imaging and clinical findings is recommended. Non-contrast CT KUB may be considered if stent encrustation, migration, or recurrent obstruction is suspected.

Key Learning Points

• Chronic kidney disease typically demonstrates small kidneys with increased cortical echogenicity and poor corticomedullary differentiation.
• A Double-J ureteric stent appears as a linear hyperechoic tubular structure within the renal collecting system and ureter on ultrasound.
• Ultrasound confirms the presence and approximate position of the stent but has limited ability to assess stent patency.
• Long-term indwelling stents require periodic exchange to prevent encrustation, obstruction, and infection.
• Patients on maintenance hemodialysis require regular nephrology and urology follow-up.
• CT KUB is more sensitive for detecting stent encrustation, migration, or associated urinary calculi.
• Clinical symptoms such as flank pain, fever, or recurrent urinary tract infection should raise suspicion for stent-related complications.

Commmon bile duct stent (CBD stent)/ indwelling CBD stent

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CBD Stant
Commmon bile duct stent

Commmon bile duct stent ultrasound case study

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Reporting Panel

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CBD Pathology

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USG

Commmon bile duct stent ultrasound case study

CASE–1

Clinical History

A 58-year-old patient with a history of ERCP and common bile duct stent placement presented for follow-up ultrasound evaluation. The patient has a history of obstructive jaundice secondary to choledocholithiasis/biliary stricture. Ultrasound was performed to assess stent position and biliary dilatation.

Ultrasound Findings

Ultrasound examination demonstrates a linear echogenic tubular structure within the common bile duct, consistent with an indwelling CBD stent. The common bile duct measures approximately ____ mm in diameter. Mild residual intrahepatic biliary radicle dilatation may be present. No definite intraductal calculus is identified. The gallbladder is unremarkable/contains calculi as clinically applicable. No pericholecystic fluid or sonographic evidence of acute cholecystitis is seen.

The yellow arrows are indicating a linear echogenic structure within the extrahepatic common bile duct (CBD), consistent with an indwelling CBD stent.

Report Line

A linear echogenic tubular structure is visualized within the common bile duct, consistent with an indwelling CBD stent. The common bile duct measures approximately ____ mm in diameter. Mild residual intrahepatic biliary ductal dilatation is noted. No definite intraductal calculus or pericholecystic fluid is identified. Sonographic findings are consistent with CBD stent in situ.

Impression

Features are consistent with CBD stent in situ with mild residual biliary dilatation. No definite sonographic evidence of recurrent choledocholithiasis.

Recommendation

Clinical and laboratory correlation, including liver function tests, is recommended. Correlation with previous ERCP findings is advised. Follow-up with the treating gastroenterologist is recommended for assessment of stent patency and timely stent exchange or removal as clinically indicated. MRCP or repeat ERCP may be considered if recurrent biliary obstruction is suspected.

Key Learning Points

• A CBD stent appears as a linear echogenic tubular structure within the common bile duct on ultrasound.
• Stents are commonly placed during ERCP for biliary obstruction due to choledocholithiasis, benign strictures, or malignant obstruction.
• Mild residual common bile duct or intrahepatic biliary dilatation may persist after stent placement.
• Ultrasound is useful for assessing biliary dilatation and confirming the presence of a CBD stent but has limited ability to evaluate stent patency.
• Recurrent biliary dilatation, cholangitis, or jaundice should raise suspicion for stent occlusion or migration.
• MRCP or ERCP may be required when stent dysfunction is suspected.
• Plastic CBD stents require scheduled exchange or removal to reduce the risk of obstruction and infection.

Choledocolithiasis (CBD calculus)

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CBD Stone
Choledocolithiasis (CBD calculus)

Choledocfolithiasis ultrasound case study

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Reporting Panel

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CBD Pathology

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Choledocolithiasis (CBD calculus) ultrasound case study

CASE–1

Clinical History

A 52-year-old patient presented with intermittent right upper quadrant abdominal pain, jaundice, and dyspepsia. There was no history of recent abdominal trauma. Ultrasound was performed for evaluation of suspected biliary obstruction.

Ultrasound Findings

Ultrasound examination demonstrates a dilated common bile duct measuring approximately >5 mm. An echogenic intraluminal focus measuring approximately 4.4 mm is identified within the distal common bile duct, producing posterior acoustic shadowing, consistent with a calculus. Mild intrahepatic biliary radicle dilatation is noted. The gallbladder may contain calculi without evidence of acute cholecystitis. No pericholecystic fluid is seen.

Report Line

Common bile duct is dilated, measuring approximately ____ mm in diameter. An echogenic calculus measuring approximately ____ mm is visualized within the distal common bile duct, producing posterior acoustic shadowing. Mild intrahepatic biliary ductal dilatation is present. No sonographic evidence of acute cholecystitis is identified. Sonographic features are suggestive of choledocholithiasis.

Impression

Features are consistent with choledocholithiasis with CBD dilatation.

Recommendation

Clinical and laboratory correlation including liver function tests is recommended. MRCP or endoscopic ultrasound (EUS) may be considered for further evaluation if required. ERCP is recommended for confirmation and therapeutic stone extraction when clinically indicated. Surgical consultation should be considered in appropriate clinical settings.

Key Learning Points

• Choledocholithiasis refers to the presence of one or more calculi within the common bile duct.
• Ultrasound findings include a dilated common bile duct with an echogenic intraductal calculus producing posterior acoustic shadowing.
• Intrahepatic biliary ductal dilatation commonly accompanies distal biliary obstruction.
• Gallstones are frequently associated with choledocholithiasis.
• Ultrasound may occasionally fail to detect small distal CBD stones due to overlying bowel gas.
• MRCP and endoscopic ultrasound provide excellent non-invasive evaluation when ultrasound findings are equivocal.
• ERCP remains the gold standard for both diagnosis and therapeutic removal of common bile duct stones.

📄 SCRS

Gall bladder
Adenomyomatosis

Gall bladder adenomyomatosis ultrasound case study

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Reporting Panel

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Gall bladder Pathology

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USG

Gall bladder adenomyomatosis ultrasound case study

CASE–1

Clinical History

A 48-year-old patient presented with intermittent right upper quadrant abdominal pain and dyspepsia. There was no history of fever, jaundice, or weight loss. Ultrasound was performed for evaluation of hepatobiliary symptoms.

Ultrasound Findings

Ultrasound examination demonstrates a focal area of gallbladder wall thickening involving the fundal region, Multiple tiny intramural cystic spaces (Rokitansky–Aschoff sinuses) are noted within the thickened wall, producing characteristic comet-tail (ring-down) reverberation artifacts. The remaining gallbladder wall is normal in thickness. No intraluminal calculus, pericholecystic fluid, or sonographic Murphy's sign is identified. The common bile duct is normal in caliber.

Report Line

A focal area of gallbladder wall thickening is seen involving the fundal region, measuring approximately ____ mm in thickness. Multiple tiny intramural cystic spaces with associated comet-tail reverberation artifacts are identified, consistent with Rokitansky–Aschoff sinuses. No gallstones, pericholecystic fluid, or biliary ductal dilatation is noted. Sonographic features are suggestive of focal adenomyomatosis of the gallbladder.

Impression

Features are consistent with focal adenomyomatosis of the gallbladder .

Recommendation

Clinical correlation is recommended. In asymptomatic patients, no specific treatment is usually required. Surgical consultation may be considered if symptoms persist or if imaging findings are atypical. Follow-up ultrasound or MRI may be performed when differentiation from gallbladder neoplasm is clinically indicated.

Key Learning Points

• Gallbladder adenomyomatosis is a benign hyperplastic condition characterized by proliferation of the mucosa and muscular layer.
• Focal adenomyomatosis most commonly involves the gallbladder fundus.
• Rokitansky–Aschoff sinuses appear as tiny intramural cystic spaces on ultrasound.
• Comet-tail (ring-down) reverberation artifact is a characteristic sonographic feature.
• The condition is usually asymptomatic and is often detected incidentally.
• Absence of an irregular mass, liver invasion, significant vascularity, or regional lymphadenopathy favors a benign diagnosis.
• MRI may be useful when ultrasound findings are atypical or malignancy cannot be confidently excluded.

📄 SCRS

Anterior
Abdominal wall lipoma

Anterior abdominal wall lipoma ultrasound case study

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Reporting Panel

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Ventral wall Pathology

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Anterior abdominal wall lipoma ultrasound case study

CASE–1

Clinical History

A 45-year-old patient presented with a slowly growing, painless swelling in the epigastric region of the anterior abdominal wall. The swelling has been present for several months to years with no history of trauma, infection, or constitutional symptoms. Clinical examination revealed a soft, mobile, non-tender subcutaneous lump.

Ultrasound Findings

Ultrasound examination demonstrates a well-defined, oval, encapsulated, homogeneous echogenic soft tissue lesion within the subcutaneous plane of the anterior abdominal wall in the epigastric region. The lesion is oriented parallel to the skin surface and contains fine internal linear echogenic striations. No calcification, cystic degeneration, surrounding edema, or invasion of the underlying musculature is identified. Color Doppler demonstrates no significant internal vascularity.

Report Line

A well-defined encapsulated homogeneous echogenic lesion is seen within the subcutaneous plane of the anterior abdominal wall in the epigastric region, measuring approximately ____ × ____ × ____ mm. The lesion demonstrates fine internal linear echogenic striations with no significant internal vascularity on color Doppler. No underlying muscular invasion or surrounding inflammatory changes are noted. Ultrasound features are suggestive of a lipoma.

Impression

Features are consistent with a Anterior abdominal wall Lipoma

Report Line

A well-defined encapsulated homogeneous echogenic lesion is seen within the subcutaneous tissue of the right flank region of the anterior abdominal wall, measuring approximately ____ × ____ × ____ mm. The lesion demonstrates fine internal linear echogenic striations with no significant internal vascularity on color Doppler imaging. No extension into the underlying abdominal wall musculature is identified. Sonographic features are suggestive of a benign lipoma.

Impression

Features are consistent with a subcutaneous plane of the right flank region of the anterior abdominal wall Lipoma,

Recommendation

Clinical correlation is recommended. Surgical consultation may be considered if the lesion is symptomatic, increasing in size, cosmetically concerning, or if histopathological confirmation is required after excision. Follow-up ultrasound may be performed if interval growth or atypical features develop.

Key Learning Points

• Lipoma is the most common benign soft tissue tumor of the anterior abdominal wall.
• Typical ultrasound appearance is a well-defined, encapsulated, homogeneous echogenic lesion with fine linear internal striations.
• The lesion usually lies within the subcutaneous fat and is oriented parallel to the skin surface.
• Color Doppler typically demonstrates absent or minimal internal vascularity.
• Absence of irregular margins, marked vascularity, calcification, or deep tissue invasion favors a benign lipoma.
• Rapid increase in size, pain, heterogeneous echotexture, or infiltrative margins should prompt further evaluation with MRI or tissue diagnosis.
• Symptomatic or enlarging lipomas are usually treated by surgical excision.

📄 SCRS

Anterior
Abdominal wall edema

Anterior abdominal wall edema ultrasound case study

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Reporting Panel

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Ventral wall Pathology

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USG

Anterior abdominal wall edema ultrasound case study

CASE–1

Clinical History

A 52-year-old patient presented with diffuse anterior abdominal wall swelling, pain, erythema, and localized tenderness. There may be a history of cellulitis, trauma, postoperative changes, obesity, renal failure, heart failure, hypoalbuminemia, or generalized edema. Ultrasound was requested to evaluate the soft tissue swelling and exclude abscess formation.

Ultrasound Findings

Ultrasound examination of the anterior abdominal wall demonstrates diffuse thickening of the subcutaneous tissues with increased echogenicity. Prominent hypoechoic fluid separating the subcutaneous fat lobules produces a characteristic cobblestone appearance. Mild diffuse subcutaneous edema is present without evidence of a discrete fluid collection or abscess. The underlying abdominal wall musculature and fascial planes appear preserved. Color Doppler demonstrates mildly increased vascularity within the inflamed subcutaneous tissues without focal hypervascular mass.

Report Line

Diffuse subcutaneous soft tissue thickening is seen involving the anterior abdominal wall with prominent hypoechoic fluid interposed between the fat lobules, producing a characteristic cobblestone appearance. No focal fluid collection or drainable abscess is identified. Mild increased vascularity is demonstrated on color Doppler examination. Findings are consistent with diffuse anterior abdominal wall edema with cellulitic changes.

Impression

Features are consistent with diffuse anterior abdominal wall subcutaneous edema demonstrating a characteristic cobblestone pattern, suggestive of cellulitis. No sonographic evidence of a drainable abscess is identified.

Key Learning Points

• Cobblestoning represents edema fluid tracking between subcutaneous fat lobules.
• The cobblestone appearance is a classic ultrasound feature of cellulitis.
• Diffuse subcutaneous edema may occur secondary to infection, trauma, postoperative changes, heart failure, renal disease, or hypoalbuminemia.
• Color Doppler commonly demonstrates increased vascularity in cellulitis.
• Ultrasound is highly sensitive for differentiating cellulitis from abscess.
• Absence of a focal fluid collection indicates no drainable abscess.
• Serial ultrasound can be used to monitor treatment response.

Recommendation

Clinical and laboratory correlation is recommended. Appropriate antibiotic therapy should be considered if cellulitis is clinically suspected. Follow-up ultrasound may be performed if symptoms worsen or if abscess formation is suspected. Cross-sectional imaging (CT or MRI) may be considered when deep soft tissue infection or necrotizing fasciitis is a concern.

Fatty liver /Deffuse Hepatic steatosis (Grade 1, 2, 3, i ii iii)

📄 SCRS

Hepatic steatosis
(Fatty Liver)

Hepatic steatosis ultrasound case study

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Reporting Panel

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Liver Pathology

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USG

Septated pleural effusion ultrasound case study

CASE–1

Clinical History

A 45-year-old patient was referred for abdominal ultrasound due to abnormal liver function tests, obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, or incidental fatty liver detected on previous imaging. The patient may be asymptomatic or complain of mild right upper quadrant discomfort or fatigue.

Ultrasound Findings

Ultrasound examination demonstrates a mildly enlarged liver measuring approximately 155 mm at the midclavicular line (MCL). The liver shows diffusely increased echogenicity compared with the right renal cortex, consistent with diffuse fatty infiltration (Grade I hepatic steatosis). Mild posterior beam attenuation is present with preserved visualization of the intrahepatic vessels and diaphragm. The hepatic echotexture is otherwise homogeneous with smooth liver margins. No focal hepatic lesion or intrahepatic biliary dilatation is identified. The portal vein demonstrates normal hepatopetal flow on Color Doppler examination.

Report Line

The liver is mildly enlarged, measuring approximately 155 mm at the midclavicular line (MCL). Diffuse mild increase in hepatic echogenicity is noted compared with the right renal cortex, consistent with Grade I hepatic steatosis (fatty liver). Mild posterior beam attenuation is present with preserved visualization of the intrahepatic vessels and diaphragm. No focal hepatic lesion or intrahepatic biliary dilatation is identified. Portal venous flow is normal on Color Doppler imaging.

Impression

Mild hepatomegaly with Diffuse mild hepatic steatosis (Fatty Liver Grade I).

CASE–2

Clinical History

A 45-year-old patient was referred for abdominal ultrasound due to abnormal liver function tests, obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, or incidental fatty liver detected on previous imaging. The patient may be asymptomatic or complain of mild right upper quadrant discomfort or fatigue.

Ultrasound Findings

Ultrasound examination demonstrates a mildly enlarged liver measuring approximately 155 mm at the midclavicular line (MCL). The liver shows diffusely increased echogenicity compared with the right renal cortex, consistent with Grade II hepatic steatosis. Moderate posterior beam attenuation is present with mildly reduced visualization of the intrahepatic vessels and diaphragm. The hepatic echotexture is homogeneous with smooth liver margins. No focal hepatic lesion or intrahepatic biliary dilatation is identified. The portal vein demonstrates normal hepatopetal flow on Color Doppler examination.

Report Line

The liver is mildly enlarged, measuring approximately 155 mm at the midclavicular line (MCL). Diffuse moderate increase in hepatic echogenicity is noted compared with the right renal cortex, consistent with Grade II hepatic steatosis (fatty liver). Moderate posterior beam attenuation is present with mildly reduced visualization of the intrahepatic vessels and diaphragm. No focal hepatic lesion or intrahepatic biliary dilatation is identified. Portal venous flow is normal on Color Doppler imaging.

Impression

Mild hepatomegaly with diffuse moderate hepatic steatosis (Fatty Liver Grade II).

CASE–3

Clinical History

A 45-year-old patient was referred for abdominal ultrasound due to abnormal liver function tests, obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, or incidental fatty liver detected on previous imaging. The patient may be asymptomatic or complain of mild right upper quadrant discomfort, fatigue, or features suggestive of advanced hepatic steatosis.

Ultrasound Findings

Ultrasound examination demonstrates a mildly enlarged liver measuring approximately 155 mm at the midclavicular line (MCL). The liver shows marked diffuse increase in echogenicity compared with the right renal cortex, consistent with Grade III hepatic steatosis. Marked posterior beam attenuation is present with poor visualization of the intrahepatic portal venous walls, hepatic veins, and diaphragm due to severe fatty infiltration. The hepatic echotexture is diffusely coarse but homogeneous. The liver margins remain smooth. No focal hepatic lesion or intrahepatic biliary dilatation is identified. The portal vein demonstrates normal hepatopetal flow on Color Doppler examination.

Report Line

The liver is mildly enlarged, measuring approximately 155 mm at the midclavicular line (MCL). There is marked diffuse increase in hepatic echogenicity compared with the right renal cortex, consistent with Grade III hepatic steatosis (fatty liver). Marked posterior acoustic beam attenuation is present with poor visualization of the intrahepatic vessels and diaphragm. No focal hepatic lesion or intrahepatic biliary dilatation is identified. Portal venous flow is normal on Color Doppler imaging.

Impression

Mild hepatomegaly with diffuse severe hepatic steatosis (Fatty Liver Grade III).

Key Learning Points

• Grade I hepatic steatosis is characterized by mild diffuse increase in hepatic echogenicity with preserved visualization of the diaphragm and intrahepatic vessels.
• Hepatomegaly commonly accompanies diffuse fatty infiltration, particularly in metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD).
• Ultrasound is the preferred first-line imaging modality for detecting fatty liver and assessing liver size.
• Common risk factors include obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, alcohol use, and non-alcoholic fatty liver disease (NAFLD).
• Color Doppler usually demonstrates normal portal venous flow in uncomplicated fatty liver.
• Grade I steatosis is potentially reversible with weight loss, dietary modification, regular exercise, and control of metabolic risk factors.
• Ultrasound cannot reliably differentiate simple steatosis from steatohepatitis or accurately stage hepatic fibrosis; further evaluation may be required when clinically indicated.

Recommendation

Clinical and laboratory correlation is recommended. Correlation with liver function tests, fasting blood glucose, HbA1c, and lipid profile should be considered. Lifestyle modification including weight reduction, regular exercise, and dietary changes is advised. Follow-up ultrasound may be performed after 6–12 months or earlier if clinically indicated. Consider elastography if there is clinical suspicion of hepatic fibrosis.