Cobblestoning describes a characteristic ultrasonographic pattern of subcutaneous tissue in which multiple hypoechoic (fluid-filled) or hyperechoic (edematous) septations and fat lobules create a surface that resembles cobblestones. It is a nonspecific sign that indicates interstitial fluid, inflammation, or edema within the subcutaneous fat planes.

Sonographic Features

Heterogeneous subcutaneous fat with multiple rounded hypoechoic areas separated by echogenic fibrous septa.
Increased thickness of the subcutaneous layer compared with the contralateral side or normative values.
Altered echotexture: loss of normal uniform fat echogenicity and increased fluid tracking along septa.
Dynamic appearance may change with probe compression or patient position; Doppler may show increased vascularity if inflammation is present.

Common Sites

Lower limbs — anterior/posterior shins and calves (cellulitis, lymphedema).
Periorbital and facial subcutaneous tissues (inflammatory/edematous states).
Abdominal wall and groin (postoperative edema, cellulitis).
Breast and axillary fat in mastitis or post-procedural changes.

Differential Diagnosis

Cellulitis — cobblestoning with increased skin/subcutaneous thickness and hyperemia on color Doppler.
Lymphedema — diffuse cobblestoning often bilateral and chronic, may show thickened septa without marked hyperemia.
Necrotizing fasciitis — may show cobblestoning early, but look for fascial plane fluid, gas (hyperechoic foci with shadowing), and lack of perfusion.
Traumatic fat stranding and contusion — history of injury and focal distribution.
Postoperative/Postsurgical edema — localized cobblestoning adjacent to surgical sites or drains.

Cobblestoning — Related Pathologies

Bacterial cellulitis — acute infection causing interstitial edema and hyperemia; responds to antibiotics.
Lymphedema — chronic lymphatic insufficiency with persistent subcutaneous thickening and septal fibrosis.
Venous stasis/edema — commonly in the lower legs with dependent pitting edema and skin changes.
Inflammatory panniculitis (e.g., erythema nodosum) — may show nodular subcutaneous changes with variable vascularity.
Early necrotizing soft-tissue infection — requires urgent assessment; cobblestoning alone is not diagnostic but should prompt evaluation for deeper fluid, gas, and systemic signs.

Clinical Pearls

Compare with the contralateral side and correlate with clinical signs (erythema, warmth, pain, fever).
Use compression and color Doppler: increased blood flow supports cellulitis; absence of flow with deep fluid collections raises concern for necrotizing infection.
When in doubt, document and recommend clinical correlation or repeat imaging — ultrasound is excellent for superficial assessment but limited for deep fascial evaluation.

11🎓 Educational Integration

Diagnostic Sonography

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📘 Table of Contents

🎓 Curriculum & Learning Outcomes 🎓 Assessment & Feedback

12📝 Reporting elements

Diagnostic Sonography

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📘 Table of Contents

📝 Report Structure 📝 Common Phrases 📝 Templates

Ultrasound Case Study — Subtopic Header Card Example

Ultrasound Report Structures

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Abdominal Ultrasound Report — Template

Patient & Exam Details

Patient Name: ___________________________

ID / Age / Sex: ___________________________

Indication: ___________________________

Technique: ___________________________

Findings

Liver: Normal size (14.0 cm MCL). Homogeneous echotexture. No focal lesion identified.

Gallbladder: Well distended. Single echogenic focus 6 mm with posterior acoustic shadowing — consistent with calculus. No wall thickening or pericholecystic fluid.

Pancreas: Visualized portion appears unremarkable. Study limited by bowel gas.

Spleen: Normal size and texture; measures 11.2 cm.

Kidneys: Right kidney 10.8 cm, left kidney 11.0 cm. No hydronephrosis.

Ascites: No free fluid identified.

Impression / Conclusion

1. Cholelithiasis — single 6 mm gallstone within gallbladder.
2. No sonographic evidence of acute cholecystitis (no wall thickening or pericholecystic fluid).
3. Liver and spleen dimensions within expected limits; no focal hepatic lesion detected.

Recommendations

Correlate with LFTs.
Consider surgical referral if symptomatic.

Limitations

Pancreas partially obscured by bowel gas; full pancreatic evaluation limited.

Ultrasound Case Study — Subtopic Header Card Example

Common Phrases for Ultrasound Reporting

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Standardized Ultrasound Reporting Phrases

Ultrasound reports must communicate findings clearly and uniformly across all organ systems. The following are standard reporting phrases categorized by anatomical region and context.

1. Abdominal Ultrasound

Liver is normal in size and echotexture; no focal lesions identified.
Gallbladder appears well-distended; no stones or wall thickening seen.
Pancreas is normal in contour; no peripancreatic fluid collection.
Spleen measures within normal limits and shows homogeneous texture.
Both kidneys are normal in size and corticomedullary differentiation.

2. Pelvic Ultrasound

Uterus is anteverted, normal in size, and shows homogeneous myometrium.
Endometrial thickness is within normal range for menstrual phase.
Ovaries are visualized with normal follicular pattern.
No adnexal mass or free fluid seen in the pouch of Douglas.

3. Obstetric Ultrasound

Single live intrauterine gestation with cardiac activity noted.
Fetal biometry corresponds to gestational age of 22 weeks 3 days.
Placenta is anterior, grade I, and not low-lying.
Amniotic fluid index is within normal limits.

4. Vascular Ultrasound

Common carotid artery shows normal intimal thickness and flow pattern.
No evidence of plaque formation or stenosis.
Portal vein is patent with normal hepatopetal flow.
Inferior vena cava is of normal caliber and shows normal phasic variation.

5. Thyroid Ultrasound

Thyroid gland is normal in size and echotexture.
No focal nodule or cyst detected.
No evidence of cervical lymphadenopathy.

6. Breast Ultrasound

Breast parenchyma appears homogeneous with normal ductal pattern.
No focal mass or cystic lesion identified.
Axillary region shows no abnormal lymph node enlargement.

7. Musculoskeletal Ultrasound

Tendons appear continuous with normal fibrillar pattern.
No evidence of effusion or synovial thickening.
Muscles are normal in bulk and echotexture.

Summary

Using standardized phrases ensures uniformity and professionalism in ultrasound reporting. Consistent terminology improves interpretation, communication, and medico-legal clarity.

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Ultrasound Case Study — Subtopic Header Card Example

📝 Templates

Abdomen
📝 Whole abdomen Male (W/A M)
📝 Whole abdomen Female (W/A F)
📝 Upper abdomen Female (U/A F)
📝 Upper abdomen Male (U/A M)
📝 Lower abdomen Male (L/A M)
📝 Lower abdomen Female (L/A F) or Pelvis
📝 KUB Male
📝 KUB Female

Follicle monetaring
📝 CD1
📝 CD2
📝 CD3 Dominant folicle
📝 CD4 No follicular grath
📝 CD4 Rupture follicle
📝 CD4 Not rupture fllicle

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TVS

📝 TVS
📝 TVS Early Pregnancy
📝 TVS Third Trimester

Whole Abdomen Ultrasound — Male | 28-Oct-2025

Whole Abdomen Ultrasound — Male

Exam: Whole abdomen & pelvis | Study date: 28-Oct-2025

Patient & Exam Details

Patient name: John

Patient ID / Age / Sex: 123456 · 34 y · M

Referrer: Dr. S. Sharma

Clinical history: RUQ pain

Prior studies: No prior available / Prior US dated DD-MMM-YYYY

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.

Findings (Organ by organ)

Liver: Size: 140 mm (MCL). Echotexture: homogeneous. No discrete focal lesion identified in the visualized liver. Intrahepatic biliary radicles not dilated.

Gallbladder & biliary tract: Gallbladder well distended. Lumen is echo-free. No pericholecystic fluid. Common bile duct (CBD) diameter: 4.5 mm (measured at porta hepatis) — 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: Size: 112 mm (polar length). Homogeneous echotexture. No focal lesion identified.

Right kidney: Size: 108 mm. Preserved corticomedullary differentiation. No hydronephrosis or renal calculi identified.

Left kidney: Size: 110 mm. 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: <20 mL (if measured).

Prostate (transabdominal assessment): Prostate volume estimated: 25 mL (transabdominal estimation) — within expected limits for age. 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.

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 and colon: 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

No sonographic evidence of abnormalities. No free intra-abdominal fluid detected.

Recommendations

Correlate with clinical status.

Limitations / Technical factors

Study partially limited by overlying bowel gas which impeded full visualization of the pancreas.
Prostate volume estimated transabdominally; transrectal ultrasound yields more accurate prostate measurements.
No color/spectral abnormality identified in assessed vessels; vascular duplex not included in this study unless specifically requested.

Whole Abdomen & Pelvis — Mini Book-Style Report

Whole Abdomen & Pelvis Ultrasound Report

Technique, findings, and impression — focused sonographic summary

Exam: Whole abdomen & pelvis

Fasting: 6–8 hours • Probe: Convex 3.5–5 MHz

This study comprises longitudinal and transverse scans of the upper abdomen with color Doppler evaluation of portal and hepatic vessels, and pelvic images obtained including post-void assessment. Prior studies: No prior available / Prior US dated DD-MMM-YYYY. Clinical history: RUQ Pain.

Technique

Convex 3.5–5 MHz probe; longitudinal and transverse planes of the upper abdomen.
Color Doppler evaluation of portal vein and hepatic vessels.
Pelvic and post-void images obtained. Fasting: 6–8 hours.

Findings

Liver	Size: 140 mm (MCL). Echotexture: homogeneous. No discrete focal lesion identified in the visualized liver. Intrahepatic biliary radicles not dilated.
Gallbladder & biliary tract	Gallbladder well distended. Lumen is echo-free. No pericholecystic fluid. Common bile duct (CBD) diameter: 2.9 mm (measured at porta hepatis) — 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	Size: 112 mm (polar length). Homogeneous echotexture. No focal lesion identified.
Right kidney	Size: 108 mm. Preserved corticomedullary differentiation. No hydronephrosis or renal calculi identified.
Left kidney	Size: 110 mm. 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.
Uterus	Anteverted, normal size [80 x 30 x 45 mm] and myometrial echotexture. Endometrial thickness: 8 mm (secretory phase). No focal lesion.
Ovaries	Bilateral ovaries demonstrated normal in size and preserved echotexture. No cyst or mass lesion.
Ascites / free fluid	No free fluid identified in the hepatorenal recess, Morrison's pouch, or pelvis.
Abdominal aorta	Visualized abdominal aorta measures normal in diameter (proximal). No aneurysmal dilatation or mural thrombus seen.
Lymph nodes	No evidence of abdominal lymphadenopathy. 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	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	Normal layered architecture and echotexture. No evidence of hernia, mass lesion, edema, or localized collection. Subcutaneous tissues and musculature appear normal.
Other	Linear 7.5–10 MHz probe used for small parts of abdomen. No evidence of abdominal lymphadenopathy.

Impression / Conclusion

No sonographic evidence of abnormalities identified.
No free intra-abdominal fluid detected.

Recommendations

Correlate with clinical status.

Limitations / Technical factors

Study partially limited by overlying bowel gas which impeded full visualization of the pancreas.
Endometrial phase correlation recommended.
No Doppler abnormalities noted.

Upper Abdomen (Female) — Mini Book-Style Report

Upper Abdomen Ultrasound Report — Female

Focused sonographic evaluation of hepatobiliary, pancreatic, splenic, and renal systems

Exam: Upper abdomen (female)

Fasting: 6–8 hours • Probe: Convex 3.5–5 MHz

This examination includes longitudinal and transverse scans of the upper abdomen with color Doppler evaluation of portal and hepatic vessels. Prior studies: No prior available / Prior US dated DD-MMM-YYYY. Clinical history: RUQ Pain.

Technique

Convex 3.5–5 MHz probe; longitudinal and transverse planes of upper abdomen.
Color Doppler used for hepatic and portal venous flow assessment.
Patient fasting for 6–8 hours for optimal visualization.

Findings

Liver	Size: 140 mm (MCL). Echotexture homogeneous. No focal lesion identified. Intrahepatic biliary radicles not dilated. Portal vein patent with normal hepatopetal flow.
Gallbladder & biliary tract	Gallbladder well distended with echo-free lumen. No wall thickening or pericholecystic fluid. Common bile duct (CBD) measures 2.9 mm — within normal limits. No intrahepatic biliary dilatation.
Pancreas	Head and body visualized with preserved contour. No focal mass or ductal dilatation. Examination partially limited by overlying bowel gas.
Spleen	Size: 112 mm. Homogeneous echotexture. No focal lesion identified.
Right kidney	Size: 108 mm. Preserved corticomedullary differentiation. No hydronephrosis or calculi.
Left kidney	Size: 110 mm. Normal corticomedullary differentiation. No hydronephrosis, calculus, or mass.
Abdominal aorta	Visualized segments appear normal in caliber. No aneurysmal dilatation or mural thrombus.
IVC	Inferior vena cava visualized; shows normal caliber and phasic flow.
Free fluid / Ascites	No free fluid in hepatorenal or perisplenic recesses.
Additional comments	No abnormal focal lesions in visualized portions of the abdominal wall or adjacent soft tissues.

Impression / Conclusion

Normal sonographic appearance of the upper abdominal organs.
No hepatobiliary, pancreatic, splenic, or renal abnormality detected.
No intra-abdominal free fluid.

Recommendations

Correlate with clinical and laboratory findings as indicated. Consider follow-up ultrasound if symptoms persist or biochemical abnormalities arise.

Limitations / Technical factors

Examination partially limited by overlying bowel gas obscuring full pancreatic tail visualization.
Study performed in fasting state for optimal evaluation.

Upper Abdomen (Male) — Mini Book-Style Report

Upper Abdomen Ultrasound Report — Male

Focused sonographic evaluation of hepatobiliary, pancreatic, splenic, renal, and vascular structures

Exam: Upper abdomen (male)

Fasting: 6–8 hours • Probe: Convex 3.5–5 MHz

This ultrasound examination includes longitudinal and transverse scans of the upper abdomen, with color Doppler evaluation of the hepatic and portal venous systems. Prior studies: No prior available / Prior US dated DD-MMM-YYYY. Clinical history: Epigastric or RUQ Pain.

Technique

Convex 3.5–5 MHz probe; longitudinal and transverse planes of the upper abdomen.
Color Doppler used for assessment of hepatic, portal, and splenic vasculature.
Patient fasting for 6–8 hours for optimal visualization of hepatobiliary structures.

Findings

Liver	Size: 140 mm (MCL). Homogeneous echotexture, normal contour. No focal lesion seen. Intrahepatic biliary radicles not dilated. Portal vein patent with normal hepatopetal flow.
Gallbladder & biliary tract	Gallbladder well distended with echo-free lumen. Wall normal thickness. No calculi or pericholecystic fluid. Common bile duct (CBD) measures 3.0 mm — within normal limits. No intrahepatic biliary dilatation.
Pancreas	Head and body visualized with normal echotexture. No focal mass or ductal dilatation. Pancreatic tail partially obscured by bowel gas.
Spleen	Size: 115 mm. Homogeneous echotexture. No focal lesion or splenomegaly.
Right kidney	Size: 108 mm. Preserved corticomedullary differentiation. No hydronephrosis, mass, or renal calculi.
Left kidney	Size: 110 mm. Preserved corticomedullary differentiation. No hydronephrosis, mass, or stone.
Abdominal aorta	Visualized segment normal in caliber and wall definition. No aneurysm or mural thrombus.
IVC	Inferior vena cava patent with normal caliber and phasic flow pattern.
Free fluid / Ascites	No free fluid in hepatorenal recess (Morrison’s pouch) or perisplenic region.
Other observations	No focal abdominal wall lesion. No enlarged lymph nodes or abnormal masses seen in the visualized retroperitoneum.

Impression / Conclusion

Normal sonographic appearance of the upper abdominal organs.
No hepatobiliary, pancreatic, splenic, or renal abnormality identified.
No free intraperitoneal fluid detected.

Recommendations

Clinical correlation advised. Consider follow-up ultrasound or further evaluation if symptoms persist or biochemical abnormalities are detected.

Limitations / Technical factors

Study limited by bowel gas obscuring pancreatic tail and portions of retroperitoneum.
Fasting protocol adhered to for optimal hepatobiliary visualization.

Lower Abdomen (Male) — Mini Book-Style Report

Lower Abdomen Ultrasound Report — Male

Focused sonographic assessment of urinary bladder, prostate, seminal vesicles, and pelvic structures

Exam: Lower abdomen (male)

Probe: Convex 3.5–5 MHz & linear 7.5–10 MHz (as needed)

This study includes transabdominal sonographic evaluation of the lower abdomen focusing on urinary bladder, prostate, and pelvic structures. Pre- and post-void bladder assessment was performed. Prior studies: No prior available / Prior US dated DD-MMM-YYYY. Clinical history: Lower abdominal pain / LUTS.

Technique

Transabdominal scans obtained using 3.5–5 MHz convex probe.
Pre-void and post-void bladder images acquired; prostate and seminal vesicles evaluated through a filled bladder window.
Color Doppler used as needed for vascular assessment.

Findings

Urinary bladder	Well distended. Wall thickness normal. No intraluminal mass, calculus, or debris. Post-void residual urine: Negligible / Nil.
Prostate	Size: Approx. 32 x 25 x 28 mm (volume ~12 cc). Echotexture homogeneous. No focal mass or calcification. Capsule intact. Median lobe not prominent.
Seminal vesicles	Visualized symmetrically. Normal size and echotexture. No dilatation or cystic change.
Pelvic structures	No evidence of pelvic mass or abnormal collection. No free fluid in pelvis. Visualized bowel loops appear unremarkable.
Lymph nodes	No significant pelvic lymphadenopathy. Visualized nodes small and oval with preserved fatty hilum.
Vascularity	Color Doppler assessment shows normal flow within prostate and periprostatic vessels.

Impression / Conclusion

Normal sonographic appearance of urinary bladder, prostate, and seminal vesicles.
No intravesical mass, calculus, or abnormal post-void residual volume.
No pelvic free fluid or lymphadenopathy detected.

Recommendations

Clinical correlation advised. If obstructive symptoms persist, consider transrectal ultrasound (TRUS) for detailed prostate evaluation or uroflowmetry as indicated.

Limitations / Technical factors

Study limited to transabdominal approach. TRUS may better delineate prostate zonal anatomy.
Bladder evaluation performed with adequate distension for optimal visualization.

Lower Abdomen / Pelvis (Female) — Mini Book-Style Report

Lower Abdomen / Pelvis Ultrasound Report — Female

Focused sonographic assessment of uterus, ovaries, adnexa, and pelvic structures

Exam: Lower abdomen / pelvis (female)

Probe: Convex 3.5–5 MHz • Transabdominal (TA) approach

Transabdominal sonography of the pelvis was performed through a well-distended urinary bladder window. Evaluation included uterus, endometrium, ovaries, adnexa, and pelvic cavity. Prior studies: No prior available / Prior US dated DD-MMM-YYYY. Clinical history: Pelvic pain / menstrual irregularity.

Technique

Transabdominal ultrasound performed with 3.5–5 MHz probe.
Pelvic organs evaluated in longitudinal and transverse planes.
Bladder filled adequately for optimal visualization. Color Doppler used for adnexal vascularity when indicated.

Findings

Urinary bladder	Adequately distended. Wall appears smooth and thin. No intraluminal mass or calculus. Post-void residual: Nil.
Uterus	Anteverted, normal in size (Approx. 80 x 35 x 45 mm). Myometrium shows homogeneous echotexture. Endometrial thickness 8 mm — appears within secretory phase limits. No focal myometrial or endometrial lesion.
Right ovary	Visualized; measures approximately 28 x 18 mm. Normal follicular pattern. No cyst or mass lesion identified.
Left ovary	Visualized; measures approximately 30 x 20 mm. Normal echotexture with follicles seen. No cyst or mass lesion.
Adnexa	No adnexal mass or abnormal lesion seen. No features suggestive of torsion.
Cul-de-sac	No free fluid detected in the pouch of Douglas (POD).
Pelvic soft tissues	Unremarkable. No localized collection or lymphadenopathy visualized.

Impression / Conclusion

Normal sonographic appearance of the uterus and ovaries.
No adnexal mass or pelvic free fluid detected.
Endometrial thickness appropriate for phase of menstrual cycle.

Recommendations

Correlate with menstrual cycle phase and clinical symptoms. If further evaluation is required, a transvaginal ultrasound (TVS) is recommended for higher resolution of uterine and adnexal structures.

Limitations / Technical factors

Examination limited by bowel gas and patient bladder filling status.
Small adnexal cysts may not be visualized transabdominally; consider TVS when clinically indicated.

KUB (Male) — Mini Book-Style Report

KUB Ultrasound Report — Male

Sonographic evaluation of kidneys, ureters, and urinary bladder

Exam: KUB (Kidneys, Ureters & Bladder) — Male

Probe: Convex 3.5–5 MHz • Linear 7.5–10 MHz (as needed)

Sonographic evaluation of the kidneys, ureters, and urinary bladder was performed in longitudinal and transverse planes. The prostate was also assessed through the filled bladder window. Prior studies: No prior available / Prior US dated DD-MMM-YYYY. Clinical history: Flank pain / Dysuria / Hematuria.

Technique

Convex 3.5–5 MHz transducer used for longitudinal and transverse planes.
Linear probe used for focused bladder wall or superficial region evaluation when required.
Color Doppler applied to assess ureteric jets and renal vascularity.

Findings

Right kidney	Size: 108 mm. Normal cortical echogenicity and corticomedullary differentiation. No hydronephrosis, calculus, or mass lesion. Renal outline smooth.
Left kidney	Size: 110 mm. Preserved cortical thickness and echotexture. No hydronephrosis or renal calculi. No focal lesion identified.
Ureters	Both ureters not dilated in the visualized segments. No evidence of ureteric calculus or peristaltic abnormality. Ureteric jets noted bilaterally on color Doppler.
Urinary bladder	Well distended. Wall thickness normal and smooth. No intraluminal mass, calculus, or debris. Post-void residual urine: Negligible / Nil.
Prostate	Visualized through bladder window. Size: Approx. 32 x 25 x 28 mm (Volume ~12 cc). Echotexture homogeneous. No focal lesion or calcification.

Impression / Conclusion

Normal sonographic appearance of both kidneys, ureters, and urinary bladder.
No hydronephrosis, calculus, or focal renal lesion identified.
Prostate within normal limits for age and volume.

Recommendations

Correlate with renal function tests and urine analysis. Repeat ultrasound advised if symptoms persist or hematuria recurs.

Limitations / Technical factors

Ureters partially visualized due to overlying bowel gas.
Study performed with adequate bladder distension for optimal evaluation.

KUB (Female) — Mini Book-Style Report

KUB Ultrasound Report — Female

Sonographic evaluation of kidneys, ureters, and urinary bladder

Exam: KUB (Kidneys, Ureters & Bladder) — Female

Probe: Convex 3.5–5 MHz • Linear 7.5–10 MHz (as needed)

Transabdominal ultrasound of the kidneys, ureters, and urinary bladder was performed in longitudinal and transverse planes. The uterus and adnexa were also screened through the bladder window where possible. Prior studies: No prior available / Prior US dated DD-MMM-YYYY. Clinical history: Flank pain / Recurrent UTI / Dysuria.

Technique

Convex 3.5–5 MHz probe used for abdominal survey.
Longitudinal and transverse scans obtained; color Doppler used for renal vascularity and ureteric jets.
Bladder imaged pre- and post-void to assess wall, residual volume, and pelvic structures.

Findings

Right kidney	Size: 105 mm. Normal cortical echogenicity and corticomedullary differentiation. No hydronephrosis, calculus, or mass lesion. Renal outline smooth.
Left kidney	Size: 108 mm. Preserved cortical thickness and echotexture. No hydronephrosis or renal calculi. No focal lesion identified.
Ureters	Visualized segments not dilated. No evidence of calculus or obstruction. Bilateral ureteric jets seen on color Doppler.
Urinary bladder	Adequately distended. Wall appears smooth and regular. No intraluminal mass, debris, or calculus. Post-void residual: Nil.
Pelvic screening	Uterus and adnexa visualized through filled bladder window; appear unremarkable. No pelvic free fluid detected.

Impression / Conclusion

Normal sonographic appearance of kidneys, ureters, and urinary bladder.
No hydronephrosis, calculus, or obstructive uropathy detected.
Pelvic organs appear within normal limits on transabdominal screening.

Recommendations

Correlate with urinalysis and renal function tests. If recurrent symptoms persist, consider dedicated pelvic ultrasound or CT urography for further evaluation.

Limitations / Technical factors

Study limited by bowel gas and bladder filling status.
Small ureteric calculi may be missed due to limited acoustic window; CT KUB recommended if clinically indicated.

Follicular Monitoring — Day 1 (No Follicle Seen)

Follicular Monitoring — Day 1

Baseline scan: No dominant follicle seen

Exam: Transvaginal Ultrasound (TVS)

Cycle Day: 2 / 3 • Probe: 5–9 MHz

A baseline transvaginal sonographic examination was performed to assess uterine and ovarian morphology at the start of the menstrual cycle. Both ovaries were visualized clearly. No dominant follicle or cystic lesion was seen at this stage.

Findings

Uterus	Anteverted, normal in size and shape. Myometrium homogeneous. No focal lesion.
Endometrium	Thickness: 4 mm. Appears thin and regular, consistent with early proliferative phase.
Right ovary	Visualized; measures 28 x 18 mm. Multiple small antral follicles seen (2–4 mm). No dominant follicle or cyst noted.
Left ovary	Visualized; measures 30 x 20 mm. Few small follicles seen (3–5 mm). No dominant follicle or cystic lesion.
Adnexa / POD	No adnexal mass or free fluid in the pouch of Douglas.

Impression / Conclusion

No dominant follicle or cyst seen in either ovary on baseline scan.
Endometrial thickness and uterine morphology are normal for early proliferative phase.

Recommendations

Repeat follicular monitoring is recommended after 2–3 days to assess follicular development and endometrial response.

Follicular Monitoring — Day 2

Follicular Monitoring — Day 2–3

Early follicular follow-up scan

Exam: TVS (Transvaginal Ultrasound)

Cycle Day: 2–3 • Probe: 5–9 MHz

Repeat transvaginal sonography to monitor follicular development from baseline. Both ovaries and endometrium assessed; color Doppler used selectively for adnexal vascularity and corpus luteum evaluation when required.

Findings

Uterus	Position and size within expected limits. Myometrium homogeneous.
Endometrium	Thickness: 4–5 mm (early proliferative).
Right ovary	Size: xx x xx mm. Multiple small antral follicles present (approx. 2–6 mm). No dominant follicle (>10 mm) identified.
Left ovary	Size: xx x xx mm. Multiple small follicles (approx. 2–6 mm). No dominant follicle identified.
Adnexa / POD	No adnexal mass or free fluid.

Impression

No dominant follicle identified on cycle Day 2–3.
Multiple small antral follicles seen bilaterally — consistent with early follicular phase.

Recommendations

Repeat follicular scan in 48–72 hours for monitoring. Correlate with estradiol level if stimulation or ovulation induction protocol in place.

Follicular Monitoring — Day 3 (Dominant Follicle Seen)

Follicular Monitoring — Day 3

Early follicular monitoring — dominant follicle identified

Exam: TVS (Transvaginal Ultrasound)

Cycle Day: 3 • Probe: 5–9 MHz

Focused transvaginal sonography performed to evaluate follicular development. A dominant follicle is identified — measurements and perifollicular vascularity are recorded below. Endometrium and adnexa assessed.

Findings

Uterus	Anteverted/retroverted (specify). Size and myometrial echotexture within expected limits. No focal myometrial lesion.
Endometrium	Thickness: __ mm. Pattern: trilaminar / homogeneous — consistent with early proliferative phase.
Dominant follicle	Location: Right / Left. Mean diameter: __ mm (measured as average of three orthogonal measurements). Shape: round, thin-walled, anechoic. Perifollicular flow: increased / normal / low on color Doppler (PI/RI if measured: __).
Contralateral ovary	Multiple small antral follicles (2–8 mm). No secondary dominant follicle identified.
Adnexa / Cul-de-sac	No complex adnexal mass. Small physiologic free fluid in POD: present / absent.

Impression

Dominant follicle on the [Right/Left] measuring __ mm — consistent with early dominant selection.
Contralateral ovary with multiple small antral follicles appropriate for cycle phase.
Endometrial thickness __ mm, pattern appropriate for early follicular phase.

Recommendations

If monitoring for natural conception or ART: repeat scan in 24–48 hours to follow follicular growth and perifollicular vascularity. Consider serum LH/estradiol or trigger timing when follicle reaches clinic-specific threshold (commonly ≥18 mm). Correlate with clinical protocol.

Limitations / Technical factors

Measurements subject to inter-observer variability; use mean of orthogonal diameters for accuracy.
Acoustic shadowing or patient discomfort may limit complete assessment of ovarian cortex or adjacent structures.

Follicular Monitoring — Day 4 (No Follicular Growth)

Follicular Monitoring — Day 4

Follow-up scan — No interval follicular growth observed

Exam: TVS (Transvaginal Ultrasound)

Cycle Day: 4 • Probe: 5–9 MHz

Follow-up transvaginal sonography was performed to evaluate interval follicular growth and endometrial development. Comparison made with Day 3 scan. No significant increase in follicular size or number was noted.

Findings

Uterus	Anteverted, normal in size and echotexture. No focal lesion.
Endometrium	Thickness: __ mm. Pattern remains early proliferative with no significant interval change from previous scan.
Right ovary	Multiple small follicles (2–6 mm) seen. No interval growth or dominant follicle formation compared to Day 3.
Left ovary	Multiple small follicles (2–5 mm) seen. No dominant follicle or cystic lesion identified.
Adnexa / POD	No adnexal mass. No free fluid in the pouch of Douglas.

Impression

No interval follicular growth noted since previous scan.
Both ovaries show multiple small follicles — no dominant follicle identified on Day 4.
Endometrial thickness unchanged and appropriate for early phase.

Recommendations

Continue monitoring. Repeat scan after 2–3 days to assess follicular recruitment and growth response. Correlate with hormonal profile (E2, LH, FSH) if part of ovulation induction cycle.

Comments

Absence of follicular growth at this stage may represent delayed follicular recruitment. Ensure patient compliance with stimulation regimen, if applicable.

Follicular Monitoring — Day 4 (Ruptured Follicle)

Follicular Monitoring — Day 4

Post-ovulatory assessment — ruptured follicle (suggestive)

Exam: TVS (Transvaginal Ultrasound)

Cycle Day: 4 • Probe: 5–9 MHz

Targeted transvaginal sonography performed to evaluate recent follicular rupture and early post-ovulatory changes. Comparison with prior scan (Day 3) was used where available.

Findings

Dominant follicle	Previously identified dominant follicle (__ mm) is now collapsed/irregular in contour consistent with rupture. Anechoic cavity reduced in size or replaced by heterogeneous echoes.
Pouch of Douglas (Cul-de-sac)	Small to moderate free fluid in the POD: present — anechoic/complex fluid measuring approximately __ mm / cc, consistent with post-ovulatory peritoneal fluid.
Corpus luteum	Early luteinization of the follicular remnant / corpus luteum formation noted in the affected ovary: thickened wall and increased peripheral vascularity on color Doppler (if present).
Contralateral ovary	Multiple small follicles present. No secondary dominant follicle identified.
Endometrium	Thickness: __ mm. Pattern consistent with early luteal/ peri-ovulatory changes.

Impression / Conclusion

Findings consistent with recent follicular rupture on the [Right/Left] ovary (collapsed follicle, irregular cavity).
Free fluid in the pouch of Douglas supports recent ovulation/rupture.
Early corpus luteum appearance in the affected ovary.

Recommendations

Correlate with serum LH/progesterone levels if required. No invasive intervention indicated for routine post-ovulatory fluid unless clinical pain or hemodynamic instability is present. If monitoring for assisted reproduction, plan timing of procedures according to clinic protocol.

Limitations / Technical factors

Small amounts of free fluid can be physiological post-ovulation — correlate clinically.
Measurement of fluid and subtle luteal changes subject to interobserver variability.
If significant pelvic pain or heavy bleeding occurs, consider further evaluation (repeat ultrasound or clinical review).

Follicular Monitoring — Day 4 (Dominant Follicle Intact)

Follicular Monitoring — Day 4

Follow-up scan — dominant follicle intact, no sonographic evidence of rupture

Exam: TVS (Transvaginal Ultrasound)

Cycle Day: 4 • Probe: 5–9 MHz

Focused transvaginal sonography performed to assess interval follicular development and to look for signs of rupture. Comparison made with prior scan (if available). The previously identified dominant follicle remains intact with no sonographic features to suggest rupture.

Findings

Dominant follicle	Location: Right / Left. Mean diameter: __ mm (mean of orthogonal measurements). Follicle contour rounded and intact; contents anechoic. No internal echoes or collapse to suggest rupture.
Perifollicular vascularity	Perifollicular flow on color Doppler: increased / normal / low. No abnormal vascular pattern.
Pouch of Douglas (Cul-de-sac)	No free fluid identified in the POD — no sonographic evidence of post-ovulatory fluid.
Contralateral ovary	Multiple small antral follicles present (2–6 mm). No secondary dominant follicle.
Endometrium	Thickness: __ mm. Pattern: trilaminar / homogeneous — appropriate for peri-ovulatory/early follicular phase as clinically indicated.

Impression

Dominant follicle on the [Right/Left] measuring __ mm — intact with no sonographic features of rupture observed on Day 4.
No free fluid in the pouch of Douglas to suggest recent ovulation.
Contralateral ovary with multiple small follicles; endometrium appropriate for cycle phase.

Recommendations

Continue monitoring — repeat transvaginal scan in 24–48 hours to document follicular growth or rupture. Correlate with serum LH and estradiol if timing of ovulation is being targeted for intercourse, IUI or ART. Consider trigger when follicle reaches clinic-specific threshold (commonly ≥18 mm) and clinical protocol permits.

Limitations / Technical factors

Small volumes of blood or loculated fluid may be occult on ultrasound — clinical correlation recommended if symptoms arise.
Follicular measurements have inter-observer variability; use mean of orthogonal diameters for best accuracy.

Transvaginal Sonography (TVS) — Mini Book-Style Report

Transvaginal Sonography (TVS) Report

High-resolution evaluation of uterus, endometrium, ovaries, and adnexa

Exam: TVS (Transvaginal Ultrasound)

Probe: Endovaginal 5–9 MHz • Non-invasive, high-frequency scan

Transvaginal sonography was performed with a high-frequency endovaginal transducer for detailed evaluation of the uterus, endometrium, cervix, ovaries, and adnexa. The urinary bladder was kept empty to optimize visualization. Prior studies: No prior available / Prior US dated DD-MMM-YYYY. Clinical history: Pelvic pain / Infertility / Irregular bleeding.

Technique

Endovaginal ultrasound performed using 5–9 MHz probe in sagittal and transverse planes.
Focused assessment of uterine contour, endometrial thickness, and adnexal morphology.
Color and spectral Doppler used to assess ovarian and endometrial vascularity where indicated.

Findings

Uterus	Anteverted, measures approximately 78 x 35 x 45 mm. Myometrium homogeneous with normal echotexture. No fibroid or focal lesion detected.
Endometrium	Thickness 8 mm, appearing trilaminar and consistent with secretory phase. No focal polypoid lesion or abnormal vascularity.
Cervix	Normal length and echotexture. No Nabothian cyst or cervical lesion identified.
Right ovary	Visualized; measures approximately 30 x 20 mm. Multiple small follicles noted, largest measuring 8 mm. No cyst or solid lesion.
Left ovary	Visualized; measures approximately 28 x 18 mm. Normal follicular pattern. No cyst or mass lesion.
Adnexa	No adnexal mass or collection seen. No evidence of torsion or abnormal vascularity.
Cul-de-sac	No free fluid detected in the pouch of Douglas (POD).

Impression / Conclusion

Normal uterus and endometrium for the reported phase of menstrual cycle.
Both ovaries normal in size and echotexture with physiological follicles.
No adnexal mass or pelvic free fluid.

Recommendations

Correlate with menstrual cycle phase and hormonal profile. Follow-up or follicular study may be advised in infertility or ovulatory dysfunction cases.

Limitations / Technical factors

Scan limited by patient tolerance or acoustic shadowing from bowel gas.
Endometrial thickness varies with cycle phase; correlation with LMP advised.

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Diagnostic sonography

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Sonographic Features

Common Sites

Differential Diagnosis

Cobblestoning — Related Pathologies

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Patient & Exam Details

Findings

Impression / Conclusion

Standardized Ultrasound Reporting Phrases

1. Abdominal Ultrasound

2. Pelvic Ultrasound

3. Obstetric Ultrasound

4. Vascular Ultrasound

5. Thyroid Ultrasound

6. Breast Ultrasound

7. Musculoskeletal Ultrasound

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