Uterine Fibroid ultrasound cases

Diagnostic Sonography • Case Study Atlas

Uterine Fibroids

A structured ultrasound case collection covering common uterine fibroid locations and appearances, including pedunculated subserosal, subserosal, intramural, submucosal, cervical and calcified fibroids.

UTERUSULTRASOUNDCASE SERIES

Case Index

01 Pedunculated Subserosal Fibroid →

02 Subserosal Fibroid →

03 Intramural Fibroid →

04 Submucosal Fibroid →

05 Subserosal Pedunculated Fibroid →

06 Cervical Fibroid →

07 Calcified Uterine Fibroid →

Chapter 01 • Case Study

Pedunculated Subserosal Fibroid

01Clinical History

A patient presents with pelvic heaviness and intermittent lower abdominal discomfort. Ultrasound demonstrates a well-defined, predominantly solid uterine mass projecting from the serosal surface on a stalk.

02Ultrasound Image

Figure 1. Ultrasound image demonstrating features of pedunculated subserosal fibroid.

03Ultrasound Morphology

Feature	Sonographic Description
Location	Pedunculated Subserosal Fibroid involving the uterus.
Size	Measure in three orthogonal dimensions and document in cm.
Shape	Well-defined, round-to-oval or lobulated configuration.
Echogenicity	Variable, commonly hypoechoic or heterogeneous relative to the myometrium.
Margins	Generally well circumscribed.
Vascularity	Assess peripheral and internal vascularity with Color Doppler.
Associated Findings	Assess endometrial cavity distortion, degeneration, calcification, pedicle, and relationship to adjacent structures as applicable.

04Ultrasound Report

Uterus demonstrates a well-defined focal solid mass consistent with pedunculated subserosal fibroid.

Document lesion size, exact uterine location, relationship to the endometrial cavity and serosal surface, and Doppler vascularity.

Assess for associated degeneration, calcification, cystic change, and mass effect where present.

05Impression

Sonographic ImpressionPedunculated subserosal uterine fibroid.

06Recommendation

Correlate with clinical symptoms and gynecologic examination. Document size and location for follow-up comparison when clinically indicated. Consider additional imaging when the lesion is atypical, poorly characterized, or when further anatomical mapping is required.

07Learning Points

Identify the uterine compartment and surface relationship of the fibroid.

Record three-dimensional measurements and describe the lesion's echotexture.

Use Color Doppler to assess vascularity and, in pedunculated lesions, the feeding pedicle.

Assess for endometrial distortion, degeneration, calcification, and mass effect on adjacent structures.

Chapter 02 • Case Study

Subserosal Fibroid

01Clinical History

A patient presents with pelvic pressure and abdominal fullness. Sonography demonstrates a well-defined mass arising from the outer contour of the uterus.

02Ultrasound Image

Figure 1. Ultrasound image demonstrating features of subserosal fibroid.

03Ultrasound Morphology

Feature	Sonographic Description
Location	Subserosal Fibroid involving the uterus.
Size	Measure in three orthogonal dimensions and document in cm.
Shape	Well-defined, round-to-oval or lobulated configuration.
Echogenicity	Variable, commonly hypoechoic or heterogeneous relative to the myometrium.
Margins	Generally well circumscribed.
Vascularity	Assess peripheral and internal vascularity with Color Doppler.
Associated Findings	Assess endometrial cavity distortion, degeneration, calcification, pedicle, and relationship to adjacent structures as applicable.

04Ultrasound Report

Uterus demonstrates a well-defined focal solid mass consistent with subserosal fibroid.

Document lesion size, exact uterine location, relationship to the endometrial cavity and serosal surface, and Doppler vascularity.

Assess for associated degeneration, calcification, cystic change, and mass effect where present.

05Impression

Sonographic ImpressionSubserosal uterine fibroid.

06Recommendation

Correlate with clinical symptoms and gynecologic examination. Document size and location for follow-up comparison when clinically indicated. Consider additional imaging when the lesion is atypical, poorly characterized, or when further anatomical mapping is required.

07Learning Points

Identify the uterine compartment and surface relationship of the fibroid.

Record three-dimensional measurements and describe the lesion's echotexture.

Use Color Doppler to assess vascularity and, in pedunculated lesions, the feeding pedicle.

Assess for endometrial distortion, degeneration, calcification, and mass effect on adjacent structures.

Chapter 03 • Case Study

Intramural Fibroid

01Clinical History

A patient presents with heavy menstrual bleeding and dysmenorrhea. Ultrasound demonstrates a focal myometrial mass.

02Ultrasound Image

Figure 1. Ultrasound image demonstrating features of intramural fibroid.

03Ultrasound Morphology

Feature	Sonographic Description
Location	Intramural Fibroid involving the uterus.
Size	Measure in three orthogonal dimensions and document in cm.
Shape	Well-defined, round-to-oval or lobulated configuration.
Echogenicity	Variable, commonly hypoechoic or heterogeneous relative to the myometrium.
Margins	Generally well circumscribed.
Vascularity	Assess peripheral and internal vascularity with Color Doppler.
Associated Findings	Assess endometrial cavity distortion, degeneration, calcification, pedicle, and relationship to adjacent structures as applicable.

04Ultrasound Report

Uterus demonstrates a well-defined focal solid mass consistent with intramural fibroid.

Document lesion size, exact uterine location, relationship to the endometrial cavity and serosal surface, and Doppler vascularity.

Assess for associated degeneration, calcification, cystic change, and mass effect where present.

05Impression

Sonographic ImpressionIntramural uterine fibroid.

06Recommendation

Correlate with clinical symptoms and gynecologic examination. Document size and location for follow-up comparison when clinically indicated. Consider additional imaging when the lesion is atypical, poorly characterized, or when further anatomical mapping is required.

07Learning Points

Identify the uterine compartment and surface relationship of the fibroid.

Record three-dimensional measurements and describe the lesion's echotexture.

Use Color Doppler to assess vascularity and, in pedunculated lesions, the feeding pedicle.

Assess for endometrial distortion, degeneration, calcification, and mass effect on adjacent structures.

Chapter 04 • Case Study

Submucosal Fibroid

01Clinical History

A patient presents with heavy or prolonged menstrual bleeding. Ultrasound demonstrates a focal lesion immediately adjacent to the endometrial cavity.

02Ultrasound Image

Figure 1. Ultrasound image demonstrating features of submucosal fibroid.

03Ultrasound Morphology

Feature	Sonographic Description
Location	Submucosal Fibroid involving the uterus.
Size	Measure in three orthogonal dimensions and document in cm.
Shape	Well-defined, round-to-oval or lobulated configuration.
Echogenicity	Variable, commonly hypoechoic or heterogeneous relative to the myometrium.
Margins	Generally well circumscribed.
Vascularity	Assess peripheral and internal vascularity with Color Doppler.
Associated Findings	Assess endometrial cavity distortion, degeneration, calcification, pedicle, and relationship to adjacent structures as applicable.

04Ultrasound Report

Uterus demonstrates a well-defined focal solid mass consistent with submucosal fibroid.

Document lesion size, exact uterine location, relationship to the endometrial cavity and serosal surface, and Doppler vascularity.

Assess for associated degeneration, calcification, cystic change, and mass effect where present.

05Impression

Sonographic ImpressionSubmucosal uterine fibroid.

06Recommendation

Correlate with clinical symptoms and gynecologic examination. Document size and location for follow-up comparison when clinically indicated. Consider additional imaging when the lesion is atypical, poorly characterized, or when further anatomical mapping is required.

07Learning Points

Identify the uterine compartment and surface relationship of the fibroid.

Record three-dimensional measurements and describe the lesion's echotexture.

Use Color Doppler to assess vascularity and, in pedunculated lesions, the feeding pedicle.

Assess for endometrial distortion, degeneration, calcification, and mass effect on adjacent structures.

Chapter 05 • Case Study

Subserosal Pedunculated Fibroid

01Clinical History

A patient presents with pelvic discomfort and a sensation of a lower abdominal mass. Ultrasound demonstrates a large exophytic uterine lesion attached by a narrow stalk.

02Ultrasound Image

Figure 1. Ultrasound image demonstrating features of subserosal pedunculated fibroid.

03Ultrasound Morphology

Feature	Sonographic Description
Location	Subserosal Pedunculated Fibroid involving the uterus.
Size	Measure in three orthogonal dimensions and document in cm.
Shape	Well-defined, round-to-oval or lobulated configuration.
Echogenicity	Variable, commonly hypoechoic or heterogeneous relative to the myometrium.
Margins	Generally well circumscribed.
Vascularity	Assess peripheral and internal vascularity with Color Doppler.
Associated Findings	Assess endometrial cavity distortion, degeneration, calcification, pedicle, and relationship to adjacent structures as applicable.

04Ultrasound Report

Uterus demonstrates a well-defined focal solid mass consistent with subserosal pedunculated fibroid.

Document lesion size, exact uterine location, relationship to the endometrial cavity and serosal surface, and Doppler vascularity.

Assess for associated degeneration, calcification, cystic change, and mass effect where present.

05Impression

Sonographic ImpressionPedunculated subserosal uterine fibroid.

06Recommendation

Correlate with clinical symptoms and gynecologic examination. Document size and location for follow-up comparison when clinically indicated. Consider additional imaging when the lesion is atypical, poorly characterized, or when further anatomical mapping is required.

07Learning Points

Identify the uterine compartment and surface relationship of the fibroid.

Record three-dimensional measurements and describe the lesion's echotexture.

Use Color Doppler to assess vascularity and, in pedunculated lesions, the feeding pedicle.

Assess for endometrial distortion, degeneration, calcification, and mass effect on adjacent structures.

Chapter 06 • Case Study

Cervical Fibroid

01Clinical History

A patient presents with pelvic pressure, abnormal uterine bleeding, or urinary symptoms. Ultrasound demonstrates a focal mass centered in the uterine cervix.

02Ultrasound Image

Figure 1. Ultrasound image demonstrating features of cervical fibroid.

03Ultrasound Morphology

Feature	Sonographic Description
Location	Cervical Fibroid involving the uterus.
Size	Measure in three orthogonal dimensions and document in cm.
Shape	Well-defined, round-to-oval or lobulated configuration.
Echogenicity	Variable, commonly hypoechoic or heterogeneous relative to the myometrium.
Margins	Generally well circumscribed.
Vascularity	Assess peripheral and internal vascularity with Color Doppler.
Associated Findings	Assess endometrial cavity distortion, degeneration, calcification, pedicle, and relationship to adjacent structures as applicable.

04Ultrasound Report

Uterus demonstrates a well-defined focal solid mass consistent with cervical fibroid.

Document lesion size, exact uterine location, relationship to the endometrial cavity and serosal surface, and Doppler vascularity.

Assess for associated degeneration, calcification, cystic change, and mass effect where present.

05Impression

Sonographic ImpressionCervical uterine fibroid.

06Recommendation

Correlate with clinical symptoms and gynecologic examination. Document size and location for follow-up comparison when clinically indicated. Consider additional imaging when the lesion is atypical, poorly characterized, or when further anatomical mapping is required.

07Learning Points

Identify the uterine compartment and surface relationship of the fibroid.

Record three-dimensional measurements and describe the lesion's echotexture.

Use Color Doppler to assess vascularity and, in pedunculated lesions, the feeding pedicle.

Assess for endometrial distortion, degeneration, calcification, and mass effect on adjacent structures.

Chapter 07 • Case Study

Calcified Uterine Fibroid

01Clinical History

A patient with a known uterine fibroid presents for follow-up imaging. Ultrasound demonstrates a markedly echogenic lesion with calcific components.

02Ultrasound Image

Figure 1. Ultrasound image demonstrating features of calcified uterine fibroid.

03Ultrasound Morphology

Feature	Sonographic Description
Location	Calcified Uterine Fibroid involving the uterus.
Size	Measure in three orthogonal dimensions and document in cm.
Shape	Well-defined, round-to-oval or lobulated configuration.
Echogenicity	Variable, commonly hypoechoic or heterogeneous relative to the myometrium.
Margins	Generally well circumscribed.
Vascularity	Assess peripheral and internal vascularity with Color Doppler.
Associated Findings	Assess endometrial cavity distortion, degeneration, calcification, pedicle, and relationship to adjacent structures as applicable.

04Ultrasound Report

Uterus demonstrates a well-defined focal solid mass consistent with calcified uterine fibroid.

Document lesion size, exact uterine location, relationship to the endometrial cavity and serosal surface, and Doppler vascularity.

Assess for associated degeneration, calcification, cystic change, and mass effect where present.

05Impression

Sonographic ImpressionCalcified uterine fibroid.

06Recommendation

Correlate with clinical symptoms and gynecologic examination. Document size and location for follow-up comparison when clinically indicated. Consider additional imaging when the lesion is atypical, poorly characterized, or when further anatomical mapping is required.

07Learning Points

Identify the uterine compartment and surface relationship of the fibroid.

Record three-dimensional measurements and describe the lesion's echotexture.

Use Color Doppler to assess vascularity and, in pedunculated lesions, the feeding pedicle.

Assess for endometrial distortion, degeneration, calcification, and mass effect on adjacent structures.

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Vesical Calculus / Bladder Stone ultrasound

Diagnostic Sonography • Case Study Atlas

Vesical Calculus / Bladder Stone

A structured ultrasound case study covering clinical presentation, sonographic morphology, image interpretation, reporting and diagnostic learning points.

URINARY BLADDER ULTRASOUND CASE STUDY

Case Index

01 Vesical Calculus / Bladder Stone →

Chapter 01 • Case Study

Vesical Calculus / Bladder Stone

01 Clinical History

Patient presents with lower urinary tract symptoms such as dysuria, increased urinary frequency, suprapubic discomfort and/or intermittent difficulty in passing urine.

Ultrasound examination of the urinary bladder demonstrates a discrete echogenic calculus within the bladder lumen.

The lesion should be assessed for mobility, posterior acoustic shadowing, size, number and relationship to the bladder wall.

02 Ultrasound Image

Figure 1. Ultrasound image demonstrating an echogenic vesical calculus within the urinary bladder with posterior acoustic shadowing.

03 Ultrasound Morphology

Feature	Sonographic Description
Location	Echogenic calculus located within the urinary bladder lumen.
Appearance	Well-defined hyperechoic or echogenic focus demonstrating conspicuous echogenicity relative to urine.
Posterior Acoustic Shadow	Clean or variable posterior acoustic shadowing may be demonstrated behind the calculus.
Mobility	A freely mobile bladder calculus may change position with patient repositioning. Mobility should be assessed whenever technically possible.
Number	A single calculus or multiple vesical calculi may be identified.
Size	Maximum calculus diameter should be measured in two orthogonal planes whenever possible.
Bladder Wall	Assess the bladder wall for thickening, trabeculation, focal irregularity or associated inflammatory changes.
Bladder Distension	Assessment should consider the degree of bladder distension because inadequate filling can limit evaluation.
Associated Findings	Evaluate for hydronephrosis, upper urinary tract dilatation, urinary retention, prostatic enlargement in appropriate patients and other urinary tract abnormalities.

04 Ultrasound Report

An echogenic calculus is visualized within the urinary bladder lumen, demonstrating posterior acoustic shadowing.

The calculus measures approximately ______ mm in maximum dimension.

The bladder is assessed for wall thickening, trabeculation and other associated abnormalities.

The degree of bladder distension and post-void residual urine, when clinically indicated, should be documented.

The visualized upper urinary tracts should be assessed for associated hydronephrosis or other abnormalities.

05 Impression

Sonographic Impression Vesical calculus / urinary bladder stone identified within the urinary bladder lumen, with posterior acoustic shadowing.

Correlate with urinary symptoms and evaluate for associated urinary tract obstruction, bladder wall changes and underlying predisposing factors where clinically appropriate.

06 Recommendation

Correlate the sonographic finding with the patient's clinical symptoms and laboratory findings where appropriate.

Document the calculus size, number, location, mobility and degree of posterior acoustic shadowing.

Assess the urinary bladder wall and evaluate the upper urinary tract for associated obstruction or hydronephrosis.

Clinical/urological evaluation may be considered depending on calculus size, symptoms, urinary obstruction, recurrent stone disease and the underlying clinical context.

07 Learning Points

A vesical calculus typically appears as a discrete echogenic focus within the urinary bladder.

Posterior acoustic shadowing is an important sonographic feature supporting the presence of a urinary calculus.

Mobility can help distinguish a freely mobile bladder stone from a fixed calcified lesion associated with the bladder wall.

Calculus size and number should be documented because they are clinically relevant.

The bladder wall should be examined for associated thickening, trabeculation or other abnormalities.

Evaluation of the kidneys and ureters is important when associated urinary obstruction or upper urinary tract dilatation is suspected.

Adequate bladder filling improves visualization and characterization of intravesical calculi.

Sonographic findings should be interpreted together with clinical symptoms and other relevant investigations.

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Diagnostic Sonography • Case Study Atlas

Fetal Echogenic Intracardiac Focus (EIF)

A structured ultrasound case collection covering clinical presentation, sonographic morphology, image interpretation, reporting and diagnostic learning points.

SPLEEN ULTRASOUND CASE SERIES

Case Index

01 Fetal Echogenic Intracardiac Focus →

Chapter 01 • Case Study

Fetal Echogenic Intracardiac Focus

01 Clinical History

Routine second-trimester obstetric ultrasound demonstrates a small echogenic focus within the fetal cardiac ventricle. The finding is identified during assessment of the four-chamber view. No major structural cardiac abnormality is demonstrated on the provided examination. The finding should be interpreted in conjunction with the complete fetal anatomical survey, gestational age and available aneuploidy screening information.

02 Ultrasound Image

Figure 1. Fetal four-chamber cardiac view demonstrating a small echogenic intracardiac focus within the ventricle.

03 Ultrasound Morphology

Feature	Sonographic Description
Location	Within a fetal cardiac ventricle, commonly visualized in the left ventricle.
Appearance	Small discrete echogenic focus with brightness similar to or greater than surrounding bone.
Size	Usually a small focal echogenic area; document its location and appearance rather than relying solely on size.
Mobility	Typically remains associated with the papillary muscle / chordal region.
Acoustic Shadow	May demonstrate a small or subtle posterior acoustic shadow.
Cardiac Anatomy	The four-chamber view and outflow tracts should be assessed for associated structural abnormalities.
Doppler	Doppler assessment is interpreted according to the clinical indication and complete fetal cardiac examination.

04 Ultrasound Report

A small echogenic intracardiac focus is visualized within the fetal cardiac ventricle. The fetal four-chamber view demonstrates preserved overall cardiac chamber appearance on the provided examination.

No obvious major structural cardiac abnormality is identified on the described views.

The remainder of the fetal anatomical survey should be evaluated for additional sonographic markers or structural abnormalities.

05 Impression

Sonographic Impression Fetal echogenic intracardiac focus identified within the cardiac LV. In the absence of additional structural abnormalities or sonographic markers, the finding should be correlated with available aneuploidy screening and the overall clinical context.

06 Recommendation

Correlate with the complete fetal anatomical survey and available aneuploidy screening results. If the finding is isolated and screening is reassuring, management should follow the applicable local obstetric/fetal medicine guidelines. Further evaluation may be considered when additional abnormalities or risk factors are present.

07 Learning Points

EIF is a focal echogenic finding within the fetal heart and is commonly encountered during routine obstetric ultrasound.

The four-chamber view and fetal cardiac anatomy should be carefully evaluated when an EIF is identified.

An isolated EIF should be interpreted together with the patient's aneuploidy screening status and the remainder of the ultrasound examination.

The presence of additional sonographic markers or structural abnormalities changes the clinical context and may require further evaluation.

07 Learning Points

Key sonographic feature.

Important differential diagnosis.

Important scanning technique.

Common interpretation pitfall.

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