📄 SCRS

Acute appendicitis

Acute appendicitis ultrasound case study

♡

Reporting Panel

♡

Appendix Pathology

♡

View detailed

USG

Acute appendicitis ultrasound case study

CASE–1

Clinical History

A 24-year-old patient presented with acute right lower quadrant abdominal pain, fever, nausea, vomiting, and loss of appetite. On clinical examination, there was localized tenderness at McBurney's point with guarding. The patient was referred for abdominal ultrasound to evaluate suspected acute appendicitis.

Ultrasound Findings

Ultrasound examination demonstrates a blind-ending, non-compressible tubular structure arising from the cecum in the right iliac fossa measuring approximately 8.5 mm in maximal outer diameter. The appendiceal wall is thickened with preserved mural stratification. Increased periappendiceal echogenic fat is noted, consistent with surrounding inflammatory changes. Color Doppler demonstrates increased mural vascularity (hyperemia). A small amount of periappendiceal free fluid is present. No appendicolith, periappendiceal abscess, perforation, or phlegmon is identified.

Ultrasound of the right iliac fossa. A non-compressible blind-ending tubular structure measuring greater than 6 mm with periappendiceal inflammatory fat changes and increased Color Doppler vascularity is demonstrated, consistent with acute appendicitis.

Report Line

A blind-ending, non-compressible tubular structure arising from the cecum measures approximately 8.5 mm in maximal diameter with mural thickening and increased Color Doppler vascularity. Mild periappendiceal inflammatory fat changes and a small amount of adjacent free fluid are present. No appendicolith, periappendiceal abscess, perforation, or phlegmon is identified. Sonographic findings are consistent with acute uncomplicated appendicitis.

Impression

Features are consistent with acute uncomplicated appendicitis with associated mild periappendiceal inflammatory changes. No sonographic evidence of perforation or periappendiceal abscess.

Recommendation

Urgent surgical consultation is recommended. Correlation with clinical findings and laboratory investigations (CBC, CRP, and inflammatory markers) is advised. If ultrasound findings are equivocal or complications are suspected, contrast-enhanced CT abdomen and pelvis (or MRI in pregnancy) should be considered for further evaluation. Prompt surgical management should be guided by the treating surgeon.

Key Learning Points

• The normal appendix measures ≤6 mm in maximal outer diameter and is compressible.
• Acute appendicitis typically appears as a non-compressible blind-ending tubular structure measuring >6 mm.
• Increased periappendiceal fat echogenicity and Color Doppler hyperemia are important secondary signs of inflammation.
• An appendicolith appears as an echogenic focus with posterior acoustic shadowing and increases the risk of perforation.
• Periappendiceal fluid, abscess, phlegmon, or loss of mural integrity suggests complicated appendicitis.
• Ultrasound is the preferred first-line imaging modality in children, young adults, and pregnant patients.
• CT abdomen has the highest diagnostic accuracy when ultrasound findings are inconclusive or complications are suspected.

📄 SCRS

Intestinal ascariasis

Intestinal ascariasis ultrasound case study

♡

Reporting Panel

♡

Colun Pathology

♡

View detailed

USG

Intestinal ascariasis ultrasound case study

CASE–1

Clinical History

A 28-year-old patient presented with intermittent colicky abdominal pain, abdominal distension, nausea, vomiting, poor appetite, and passage of worms in the stool. The patient was referred for abdominal ultrasound to evaluate suspected intestinal ascariasis and exclude bowel obstruction.

Ultrasound Findings

Ultrasound examination demonstrates multiple elongated linear echogenic tubular structures within the lumen of the small bowel, some showing a central longitudinal anechoic tube ("inner tube" or "railway track" sign), consistent with Ascaris lumbricoides. Mild fluid-filled bowel loops are present without significant bowel wall thickening. No evidence of bowel obstruction, bowel perforation, intussusception, free intraperitoneal fluid, or localized abscess is identified. No worms are visualized within the biliary tree on the current examination.

Ultrasound of the small bowel. Multiple elongated echogenic tubular structures with a central anechoic channel ("railway track" or "inner tube" sign) are visualized within the bowel lumen, consistent with intestinal ascariasis.

Report Line

Multiple elongated echogenic tubular structures with central longitudinal anechoic channels are demonstrated within the lumen of the small bowel, consistent with intestinal Ascaris lumbricoides infestation. No evidence of bowel obstruction, perforation, intussusception, free intraperitoneal fluid, or localized abscess is identified. No sonographic evidence of biliary ascariasis is seen on the current examination.

Impression

Features are consistent with intestinal ascariasis (Ascaris lumbricoides infestation) without sonographic evidence of bowel obstruction or other acute complications.

Recommendation

Clinical correlation and stool examination for ova and parasites are recommended. Appropriate antihelminthic therapy (e.g., albendazole or mebendazole) should be initiated as clinically indicated. Follow-up ultrasound may be considered if symptoms persist or if complications such as bowel obstruction or biliary migration are suspected.

Key Learning Points

• Ascaris lumbricoides is the most common intestinal helminth affecting humans.
• On ultrasound, intestinal worms appear as elongated echogenic tubular structures with a central anechoic tube ("inner tube" or "railway track" sign).
• Multiple worms may produce the "bag of worms" appearance within dilated bowel loops.
• Ultrasound is useful for detecting living worms and associated complications such as bowel obstruction, intussusception, or biliary ascariasis.
• Stool microscopy remains the standard laboratory test for confirming intestinal ascariasis.
• Albendazole or mebendazole are the first-line antihelminthic treatments.
• Heavy worm infestation may lead to intestinal obstruction, volvulus, perforation, pancreatitis, or biliary obstruction requiring urgent management.

📄 SCRS

Colitis

Colitis ultrasound case study

♡

Reporting Panel

♡

Colun Pathology

♡

View detailed

USG

Colitis ultrasound case study

CASE–1

Clinical History

A 45-year-old patient presented with lower abdominal pain, diarrhea, fever, rectal urgency, and intermittent passage of blood-tinged stools. The patient was referred for abdominal ultrasound to evaluate suspected colonic inflammation and exclude other causes of acute abdomen.

Ultrasound Findings

Ultrasound examination demonstrates diffuse circumferential wall thickening involving the ascending, transverse, descending, and sigmoid colon with preserved mural stratification. The affected colonic segments demonstrate increased mural vascularity on Color Doppler (hyperemia). Mild surrounding pericolic fat stranding and a few reactive mesenteric lymph nodes are noted. Small-volume free intraperitoneal fluid is present within the pelvis. No focal colonic mass, bowel obstruction, abscess, perforation, or pneumoperitoneum is identified.

Ultrasound of the colon. Diffuse circumferential colonic wall thickening with preserved mural stratification, increased mural vascularity, and mild surrounding inflammatory fat changes. These sonographic findings are suggestive of colitis.

Report Line

Diffuse circumferential wall thickening involving multiple segments of the colon with preserved mural stratification and increased mural vascularity is demonstrated. Mild surrounding pericolic inflammatory fat changes, reactive mesenteric lymph nodes, and a small amount of pelvic free fluid are present. No evidence of bowel obstruction, perforation, abscess, pneumoperitoneum, or focal colonic mass is identified. Sonographic findings are suggestive of diffuse colitis.

Impression

Features are suggestive of diffuse colitis with associated mild pericolic inflammatory changes, reactive mesenteric lymphadenopathy, and minimal free intraperitoneal fluid.

Recommendation

Clinical correlation with laboratory investigations including CBC, CRP, ESR, stool routine examination, stool culture, and inflammatory markers is recommended. Gastroenterology consultation is advised. Colonoscopy with biopsy should be considered where clinically indicated to determine the underlying etiology. Contrast-enhanced CT abdomen may be performed if complications such as perforation, abscess formation, toxic megacolon, or ischemic colitis are suspected.

Key Learning Points

• Colitis is characterized by inflammation of the colon due to infectious, inflammatory, ischemic, or other causes.
• Ultrasound typically demonstrates circumferential colonic wall thickening (>4 mm) with preserved mural stratification and increased Color Doppler vascularity during active inflammation.
• Mild pericolic fat inflammation, reactive mesenteric lymph nodes, and small-volume free fluid may accompany active colitis.
• Ultrasound is useful as an initial imaging modality but cannot reliably distinguish infectious from inflammatory or ischemic colitis.
• Colonoscopy with biopsy remains the gold standard for definitive diagnosis of many forms of colitis.
• Contrast-enhanced CT is indicated when severe disease or complications such as perforation, abscess, or toxic megacolon are suspected.
• Persistent bloody diarrhea, severe abdominal pain, fever, or systemic toxicity requires urgent evaluation and management.

Diffuse peritonitis (generalized peritoneal inflammation)

📄 SCRS

Diffuse peritonitis

Diffuse peritonitis ultrasound case study

♡

Reporting Panel

♡

Peritoneal Pathology

♡

View detailed

USG

Diffuse peritonitis ultrasound case study

CASE–1

Clinical History

A 52-year-old patient presented with severe diffuse abdominal pain, abdominal distension, fever, nausea, vomiting, and generalized abdominal tenderness with guarding. The patient was referred for abdominal ultrasound to evaluate suspected generalized peritoneal inflammation and exclude intra-abdominal collections or bowel perforation.

Ultrasound Findings

Ultrasound examination demonstrates diffuse thickening and increased echogenicity of the peritoneal lining throughout the abdomen with generalized inflammatory changes involving the mesenteric fat. Mild diffuse free intraperitoneal fluid is present between bowel loops and within the pelvis. Multiple bowel loops demonstrate mild reactive wall thickening with preserved mural stratification. No localized abscess, bowel obstruction, or definite pneumoperitoneum is identified on the current examination. Color Doppler demonstrates increased vascularity of the inflamed peritoneum and adjacent mesentery.

Ultrasound of the abdomen. Diffuse thickening and increased echogenicity of the peritoneal lining with generalized mesenteric inflammatory changes and small-volume free intraperitoneal fluid. These sonographic findings are suggestive of diffuse peritonitis (generalized peritoneal inflammation).

Report Line

Diffuse thickening and increased echogenicity of the peritoneal lining are demonstrated throughout the abdomen with generalized inflammatory changes involving the mesenteric fat. Moderate free intraperitoneal fluid is noted between bowel loops and within the pelvis. Mild reactive bowel wall thickening is present without evidence of localized abscess, bowel obstruction, or definite pneumoperitoneum on the current examination. Sonographic findings are suggestive of diffuse peritonitis.

Impression

Features are suggestive of diffuse peritonitis (generalized peritoneal inflammation) with associated mild free intraperitoneal fluid and diffuse mesenteric inflammatory changes. No localized intra-abdominal abscess is identified on the current examination.

Recommendation

Urgent clinical and surgical evaluation is recommended. Correlation with laboratory investigations including CBC, CRP, ESR, serum lactate, blood cultures, and renal function tests is advised. Contrast-enhanced CT abdomen and pelvis should be performed to determine the underlying cause and evaluate for bowel perforation, ischemia, abscess, or other intra-abdominal pathology. Prompt treatment should be initiated based on the clinical diagnosis.

Key Learning Points

• Diffuse peritonitis represents generalized inflammation of the peritoneal cavity and is a potentially life-threatening condition.
• Ultrasound may demonstrate diffuse peritoneal thickening, increased echogenicity of the mesenteric fat, free intraperitoneal fluid, and reactive bowel wall thickening.
• Color Doppler often shows increased vascularity of the inflamed peritoneum and adjacent mesentery.
• Common causes include bowel perforation, severe intra-abdominal infection, postoperative peritonitis, pancreatitis, pelvic inflammatory disease, tuberculosis, and peritoneal dialysis-related infection.
• Ultrasound is useful for detecting free fluid and inflammatory changes but has limited sensitivity for identifying the exact source of peritonitis.
• Contrast-enhanced CT is the imaging modality of choice for determining the underlying cause, disease extent, and associated complications.
• Diffuse peritonitis requires urgent medical and often surgical management because delayed treatment is associated with significant morbidity and mortality.

📄 SCRS

Enterocolitis

Enterocolitis ultrasound case study

♡

Reporting Panel

♡

bowel Pathology

♡

View detailed

USG

Enterocolitis ultrasound case study

CASE–1

Clinical History

A 38-year-old patient presented with acute abdominal pain, diarrhea, nausea, vomiting, low-grade fever, and abdominal cramps. The patient was referred for abdominal ultrasound to evaluate suspected bowel inflammation and exclude other causes of acute abdomen.

Ultrasound Findings

Ultrasound examination demonstrates diffuse circumferential wall thickening involving multiple small bowel loops and the ascending/transverse colon with preserved mural stratification. Increased mural vascularity is noted on Color Doppler (hyperemia). Mild adjacent mesenteric fat echogenicity and a few reactive mesenteric lymph nodes are present. Trace free fluid is noted within the pelvis. No bowel obstruction, abscess, perforation, pneumoperitoneum, or appendiceal abnormality is identified.

Ultrasound of the bowel. Diffuse bowel wall thickening involving the small bowel and colon with preserved mural stratification, increased mural vascularity, and mild adjacent mesenteric inflammatory changes. These sonographic findings are suggestive of enterocolitis.

Report Line

Diffuse circumferential wall thickening involving multiple small bowel loops and segments of the colon with preserved mural stratification and increased mural vascularity is noted. Mild adjacent mesenteric inflammatory changes, reactive mesenteric lymph nodes, and trace pelvic free fluid are present. No bowel obstruction, perforation, abscess, or pneumoperitoneum is identified. Sonographic findings are suggestive of enterocolitis.

Impression

Features are suggestive of acute enterocolitis involving the small bowel and colon, with associated mild mesenteric inflammatory changes and reactive mesenteric lymphadenopathy.

Recommendation

Clinical correlation with symptoms and laboratory investigations (CBC, CRP, ESR, stool routine examination, stool culture, and inflammatory markers) is recommended. Appropriate hydration and medical management should be instituted. Contrast-enhanced CT abdomen may be considered if symptoms worsen or if bowel ischemia, inflammatory bowel disease, perforation, abscess, or obstruction is clinically suspected. Gastroenterology consultation is advised in persistent or recurrent cases.

Key Learning Points

• Enterocolitis is characterized by inflammation involving both the small intestine and colon.
• Ultrasound commonly demonstrates diffuse bowel wall thickening (>3 mm) with preserved mural stratification and increased Color Doppler vascularity.
• Reactive mesenteric lymph nodes, increased mesenteric fat echogenicity, and small-volume free fluid are common associated findings.
• Infectious enterocolitis is the most common cause, although inflammatory bowel disease and ischemia should also be considered.
• Ultrasound is useful as an initial imaging modality but cannot reliably determine the underlying etiology.
• CT abdomen is more sensitive for evaluating disease extent and detecting complications such as perforation, abscess, or obstruction.
• Persistent symptoms, gastrointestinal bleeding, severe abdominal pain, or systemic toxicity warrant further evaluation with CT and/or colonoscopy.

📄 SCRS

Gastritis

Gastritis ultrasound case study

♡

Reporting Panel

♡

Stomach Pathology

♡

View detailed

USG

Gastritis ultrasound case study

CASE–1

Clinical History

A 42-year-old patient presented with recurrent epigastric pain, burning sensation, dyspepsia, nausea, early satiety, and postprandial discomfort. The patient was referred for abdominal ultrasound to evaluate upper abdominal pain and exclude hepatobiliary or pancreatic pathology.

Ultrasound Findings

Ultrasound examination demonstrates mild diffuse circumferential thickening of the gastric antral wall with preserved mural stratification and mild mucosal edema. The stomach contains a small amount of fluid. No focal gastric mass, ulcer crater, perigastric collection, gastric outlet obstruction, or free intraperitoneal air is identified. The liver, gallbladder, pancreas, spleen, and biliary tree appear unremarkable on the current examination.

Ultrasound of the stomach. Mild diffuse thickening of the gastric antral wall with preserved mural stratification and mild mucosal edema is demonstrated. These sonographic findings are suggestive of gastritis in the appropriate clinical setting.

Report Line

Mild diffuse circumferential thickening of the gastric antral wall with preserved mural stratification and mild mucosal edema is noted. No focal gastric mass, perigastric collection, gastric outlet obstruction, or free intraperitoneal air is identified. Sonographic findings are suggestive of gastritis.

Impression

Features are suggestive of mild gastritis involving the gastric antrum. No sonographic evidence of gastric perforation or other acute upper abdominal abnormality is identified.

Recommendation

Clinical correlation with symptoms and laboratory findings is recommended. Upper gastrointestinal endoscopy is advised for definitive evaluation and to assess for gastritis, peptic ulcer disease, or other mucosal pathology. Correlation with Helicobacter pylori testing is recommended where clinically indicated. Medical management with acid suppression therapy should be guided by the treating physician.

Key Learning Points

• Ultrasound has limited sensitivity for diagnosing gastritis because it cannot directly evaluate the gastric mucosa.
• Mild gastric wall thickening with preserved mural stratification may be seen in inflammatory gastritis but is nonspecific.
• The normal distended gastric wall measures approximately 3–5 mm; greater thickness may indicate inflammation or other pathology.
• Upper gastrointestinal endoscopy is the gold standard for diagnosing gastritis and obtaining biopsy when required.
• Helicobacter pylori infection is a common cause of chronic gastritis.
• Ultrasound is primarily valuable for excluding hepatobiliary, pancreatic, or other upper abdominal diseases presenting with similar symptoms.
• Persistent pain, gastrointestinal bleeding, anemia, weight loss, or recurrent vomiting should prompt early endoscopic evaluation.

📄 SCRS

Duodenogastritis

Duodenogastritis ultrasound case study

♡

Reporting Panel

♡

Stomach Pathology

♡

View detailed

USG

Duodenogastritis ultrasound case study

CASE–1

Clinical History

A 45-year-old patient presented with recurrent epigastric pain, postprandial fullness, nausea, bilious vomiting, dyspepsia, and upper abdominal discomfort. The patient was referred for abdominal ultrasound to evaluate the stomach and proximal duodenum and to exclude other hepatobiliary or pancreatic pathology.

Ultrasound Findings

Ultrasound examination demonstrates mild circumferential wall thickening involving the gastric antrum and proximal duodenum with preserved mural stratification. Mild mucosal edema is noted. The stomach contains a small amount of fluid with echogenic intraluminal contents suggestive of bile reflux. No focal mass lesion, ulcer crater, perforation, perigastric collection, or gastric outlet obstruction is identified. The liver, gallbladder, pancreas, and biliary tree appear unremarkable on the current examination.

Ultrasound of the stomach and proximal duodenum. Mild circumferential wall thickening with preserved mural stratification involving the gastric antrum and proximal duodenum, along with echogenic intragastric bile reflux, is suggestive of duodenogastritis.

Report Line

Mild circumferential wall thickening involving the gastric antrum and proximal duodenum with preserved mural stratification and mild mucosal edema is noted. Echogenic intragastric contents are suggestive of bile reflux. No focal gastric or duodenal mass, perforation, perigastric collection, or gastric outlet obstruction is identified. Sonographic findings are suggestive of duodenogastritis.

Impression

Features are suggestive of duodenogastritis with mild inflammatory thickening of the gastric antrum and proximal duodenum, associated with probable bile reflux.

Recommendation

Clinical correlation with upper gastrointestinal symptoms is recommended. Upper gastrointestinal endoscopy is advised for definitive evaluation of gastritis, duodenitis, bile reflux, or peptic ulcer disease. Correlation with Helicobacter pylori testing and appropriate medical management is recommended. Contrast-enhanced CT abdomen may be considered if symptoms persist or complications are suspected.

Key Learning Points

• Duodenogastritis refers to inflammation involving the gastric antrum and proximal duodenum, frequently associated with bile reflux.
• Ultrasound may demonstrate mild wall thickening and mucosal edema but has limited sensitivity for evaluating mucosal disease.
• Echogenic intragastric fluid may suggest reflux of bile into the stomach.
• Upper gastrointestinal endoscopy remains the gold standard for diagnosing gastritis and duodenitis.
• Helicobacter pylori infection, bile reflux, NSAID use, and alcohol are common etiological factors.
• Ultrasound is primarily useful for excluding hepatobiliary, pancreatic, or other upper abdominal pathology that may mimic gastritis.
• Persistent symptoms, gastrointestinal bleeding, weight loss, or anemia warrant prompt endoscopic evaluation.

📄 SCRS

Enteitis

Enteitis ultrasound case study

♡

Reporting Panel

♡

Bowel Pathology

♡

View detailed

USG

Enteitis ultrasound case study

CASE–1

Clinical History

A 32-year-old patient presented with acute abdominal pain, diarrhea, nausea, vomiting, and low-grade fever. The patient was referred for abdominal ultrasound to evaluate suspected bowel inflammation and exclude other causes of acute abdomen.

Ultrasound Findings

Ultrasound examination demonstrates segmental circumferential thickening of the small bowel wall involving the terminal ileum with preserved mural stratification. The affected bowel loops show increased vascularity on Color Doppler (hyperemia). Mild adjacent mesenteric fat echogenicity and a few reactive mesenteric lymph nodes are noted. Trace free fluid is present within the right iliac fossa. No bowel dilatation, abscess, perforation, or appendiceal abnormality is identified.

Ultrasound of the small bowel. Segmental bowel wall thickening with preserved mural stratification and increased Color Doppler vascularity is demonstrated, consistent with enteritis. Mild surrounding mesenteric inflammatory changes and reactive lymph nodes are also noted.

Report Line

Segmental circumferential thickening of the small bowel with preserved mural stratification and increased mural vascularity is noted. Mild adjacent mesenteric inflammatory changes, reactive mesenteric lymph nodes, and minimal free fluid are present. No evidence of bowel obstruction, perforation, or localized abscess. Sonographic findings are consistent with enteritis.

Impression

Features are consistent with acute enteritis involving the small bowel, with associated mild mesenteric inflammatory changes and reactive mesenteric lymphadenopathy.

Recommendation

Clinical correlation with history, physical examination, and laboratory findings (CBC, CRP, ESR, and stool examination/culture where indicated) is recommended. Adequate hydration and appropriate medical treatment should be instituted. CT abdomen with contrast may be considered if symptoms worsen or if complications such as obstruction, perforation, abscess formation, or inflammatory bowel disease are suspected.

Key Learning Points

• Enteritis commonly appears on ultrasound as segmental bowel wall thickening (>3 mm) with preserved mural stratification.
• Color Doppler typically demonstrates increased mural vascularity due to active inflammation.
• Reactive mesenteric lymph nodes and increased echogenicity of adjacent mesenteric fat are common associated findings.
• Small-volume free intraperitoneal fluid may be present in acute inflammatory bowel disease.
• Ultrasound is useful for evaluating bowel inflammation without radiation exposure, particularly in young patients.
• CT enterography or MR enterography may be required if Crohn's disease or complications are suspected.
• Clinical correlation is essential to differentiate infectious enteritis from inflammatory bowel disease or ischemic bowel disease.