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Follicular cyst

Follicular cyst ultrasound case study

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Reporting Panel

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Ovarian Pathology

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USG

Follicular cyst ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Lt. Ovarian Follicular cyst	View Report Line
2	-	-
3	-	-
4	-	-
5	-	-

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CASE–1
Left Ovarian Follicular Cyst

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Clinical History

A 26-year-old female presented with intermittent lower abdominal pain and menstrual irregularity. Pelvic ultrasound was performed for evaluation of the adnexa.

Ultrasound Findings

Ultrasound examination demonstrates a well-defined thin-walled unilocular anechoic cyst within the left ovary. The cyst demonstrates posterior acoustic enhancement without internal septations, mural nodules, papillary projections, or solid components. Color Doppler demonstrates no internal vascularity. The surrounding ovarian stroma is normal with preserved vascularity. The right ovary appears normal. No adnexal mass or free fluid is identified in the pelvis.

Pelvic ultrasound. Transverse sonographic image demonstrates a 19 × 20 mm simple follicular cyst within the left ovary, appearing as a thin-walled anechoic lesion with posterior acoustic enhancement and no internal solid component or vascularity.

Report Line

A 36 × 32 mm thin-walled unilocular anechoic cyst is identified within the left ovary, demonstrating posterior acoustic enhancement without internal septations, mural nodules, papillary projections, or internal vascularity. The appearance is consistent with a simple left ovarian follicular cyst.

Impression

Simple left ovarian follicular cyst.

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Recommendation

Correlate with the patient's menstrual history and clinical symptoms. In premenopausal women, a simple follicular cyst measuring less than 5 cm is typically physiological and usually resolves spontaneously. Follow-up pelvic ultrasound in 6–12 weeks may be considered if the cyst persists, enlarges, or symptoms continue. Gynecological consultation is recommended if complications such as torsion, rupture, or persistent enlargement are suspected.

Key Learning Points

• Follicular cysts are the most common physiological ovarian cysts in women of reproductive age.
• They appear as a thin-walled, unilocular, anechoic cyst with posterior acoustic enhancement.
• There should be no internal septations, mural nodules, papillary projections, or solid components.
• No internal vascularity is seen on Color Doppler, although normal peripheral ovarian stromal vascularity may be present.
• Most simple follicular cysts measuring <5 cm resolve spontaneously over one or two menstrual cycles.
• Large, persistent, or symptomatic cysts warrant follow-up imaging and possible gynecological evaluation.
• Differential diagnoses include corpus luteum cyst, hemorrhagic cyst, paraovarian cyst, and benign ovarian neoplasm.

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Vernix Caseosa

Vernix Caseosa ultrasound case study

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Reporting Panel

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Amniotic fluid Pathology

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USG

Vernix Caseosa ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Vernix Caseosa	View Report Line
2	Vernix Caseosa with meconium	-
3	-	-
4	-	-
5	-	-

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CASE–1
Vernix Caseosa in Amniotic Fluid

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Clinical History

A 29-year-old primigravida in the third trimester presented for a routine obstetric ultrasound examination. She reported normal fetal movements. There was no history of leaking per vaginum, fever, vaginal bleeding, or decreased fetal movements.

Ultrasound Findings

Obstetric ultrasound demonstrates a single live intrauterine fetus with biometric parameters corresponding to the gestational age. The amniotic fluid volume is within normal limits. Multiple fine mobile echogenic particulate echoes are seen suspended within the amniotic fluid, producing a mildly echogenic appearance. These particles demonstrate free movement with fetal activity and are most consistent with vernix caseosa. No focal amniotic fluid collection, cord abnormality, or sonographic evidence of fetal distress is identified.

Obstetric ultrasound. Echogenic particulate matter is seen freely floating within the amniotic fluid, consistent with vernix caseosa, a normal physiological finding in late pregnancy.

Report Line

Multiple fine mobile echogenic particles are visualized floating within the amniotic fluid. The sonographic appearance is most consistent with vernix caseosa. Amniotic fluid volume is adequate, and no sonographic evidence of fetal distress is identified. Ultrasound cannot reliably differentiate vernix from meconium.

Impression

Echogenic particulate matter within the amniotic fluid, most consistent with vernix caseosa. This is a normal physiological finding in the third trimester. No sonographic evidence of fetal compromise.

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Recommendation

Continue routine antenatal follow-up. No specific intervention is required for isolated sonographic evidence of vernix caseosa. If there are clinical concerns regarding fetal well-being, including decreased fetal movements or abnormal fetal heart rate, appropriate obstetric evaluation should be performed, as ultrasound alone cannot reliably distinguish vernix caseosa from meconium-stained amniotic fluid.

Key Learning Points

• Vernix caseosa is the most common cause of echogenic particles within the amniotic fluid during the third trimester.
• It appears as fine, freely mobile echogenic particulate matter suspended in the amniotic fluid.
• Vernix caseosa is a normal physiological finding and does not indicate fetal distress.
• Ultrasound cannot reliably differentiate vernix from meconium.
• Clinical findings and fetal surveillance remain essential when meconium-stained amniotic fluid is suspected.
• Normal amniotic fluid volume and reassuring fetal assessment support a benign interpretation.
• No treatment or additional imaging is required for isolated vernix caseosa.

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Corpus luteum cyst

Corpus luteum cyst ultrasound case study

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Reporting Panel

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Ovarian Pathology

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USG

corpus luteum cyst ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Left corpus luteum cyst with GS	View Report Line
2	Lt. ovarian Corpus luteum cyst ("ring of fire" sign).	View Report Line
3		-
4	-	-
5	-	-

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CASE–1
Early Intrauterine Pregnancy with Left Ovarian Corpus Luteum Cyst

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Clinical History

A 28-year-old female presented with a positive urine pregnancy test and amenorrhea. Pelvic ultrasound was performed for confirmation and dating of pregnancy.

Ultrasound Findings

Ultrasound examination demonstrates an intrauterine gestational sac (GS) corresponding to an estimated gestational age of approximately 4 weeks 6 days. A well-defined, thin-walled unilocular cyst is noted within the left ovary. The cyst demonstrates posterior acoustic enhancement without internal septations, mural nodules, papillary projections, or solid components. No internal vascularity is identified on Color Doppler examination. The right ovary appears normal. No adnexal mass or free fluid is seen in the pelvis.

Pelvic ultrasound. Transverse sonographic image demonstrates an early intrauterine gestational sac (GS) and a 35 × 42 mm left ovarian corpus luteum cyst with a thin wall, posterior acoustic enhancement, and no suspicious internal features.

Report Line

An intrauterine gestational sac (GS) corresponding to approximately 4 weeks 6 days is identified. A 35 × 42 mm thin-walled unilocular cyst is present within the left ovary, demonstrating posterior acoustic enhancement without septations, mural nodules, papillary projections, or internal vascularity. Findings are consistent with a physiological left ovarian corpus luteum cyst of pregnancy.

Impression

Early intrauterine pregnancy with gestational sac (approximately 4 weeks 6 days).
Physiological left ovarian corpus luteum cyst

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Recommendation

Routine obstetric follow-up is recommended. A follow-up ultrasound in 1–2 weeks may be performed to confirm yolk sac, fetal pole, and cardiac activity as appropriate. The corpus luteum cyst is a normal physiological finding in early pregnancy and typically regresses spontaneously by the second trimester.

Key Learning Points

• The corpus luteum cyst is a normal physiological finding during early pregnancy and supports progesterone production until placental function is established.
• It typically appears as a thin- or mildly thick-walled cyst with posterior acoustic enhancement and may measure up to 5 cm.
• Most corpus luteum cysts resolve spontaneously by the second trimester (14–16 weeks).
• Simple cystic morphology without solid components, papillary projections, or vascular nodules favors a benign diagnosis.
• Routine follow-up is generally sufficient unless the cyst enlarges, becomes symptomatic, or develops complex features.

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CASE–2
Left ovarian Corpus Luteum Cyst

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Clinical History

A 28-year-old female presented with a positive urine pregnancy test and amenorrhea. Pelvic ultrasound was performed for confirmation and dating of pregnancy.

Pelvic ultrasound. Transverse sonographic image demonstrates an a 35 × 42 mm left ovarian corpus luteum cyst with a thin wall and posterior acoustic enhancement. Color Doppler demonstrates the characteristic peripheral hypervascular "ring of fire" appearance, consistent with a physiological corpus luteum cyst.

Report Line

A 35 × 32 mm thin-walled unilocular cyst is present within the left ovary, demonstrating posterior acoustic enhancement and peripheral circumferential vascularity ("ring of fire" sign) on Color Doppler, without internal vascularity, septations, mural nodules, or papillary projections. Findings are consistent with a physiological left ovarian corpus luteum cyst.

Impression

Physiological left ovarian corpus luteum cyst.Characteristic peripheral "ring of fire" vascularity on Color Doppler.

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Ovarian Simple cyst

Ovarian Simple cyst ultrasound case study

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Reporting Panel

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Ovarian Pathology

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USG

Ovarian Simple cyst ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Left Ovarian Simple cyst	View Report Line
2	-	-
3		-
4	-	-
5	-	-

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CASE–1
Left Ovarian Simple Cyst

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Clinical History

A 34-year-old female presented with intermittent lower abdominal pain and pelvic discomfort. There was no history of fever, abnormal uterine bleeding, weight loss, or known ovarian malignancy. Pelvic ultrasound was performed for further evaluation.

Ultrasound Findings

Ultrasound examination demonstrates a well-defined, thin-walled, unilocular anechoic cyst measuring approximately 3.8 × 3.2 cm arising from the left ovary. The cyst shows posterior acoustic enhancement without internal septations, mural nodules, papillary projections, or internal echoes. Color Doppler demonstrates no internal vascularity. The remaining left ovarian parenchyma appears normal. The right ovary is unremarkable. No adnexal mass or free fluid is identified in the pelvis.

Pelvic ultrasound. Transvers sonographic image demonstrates a well-circumscribed unilocular anechoic cyst within the left ovary showing posterior acoustic enhancement without septations or solid components, consistent with a simple ovarian cyst.

Report Line

A 55 x 43 mm thin-walled unilocular anechoic cyst is identified within the left ovary. The lesion demonstrates posterior acoustic enhancement without internal septations, mural nodules, papillary projections, or internal vascularity on Color Doppler examination. Findings are consistent with a simple left ovarian cyst.

Impression

Simple left ovarian cyst. No suspicious sonographic features.

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Recommendation

Clinical correlation is advised. In premenopausal women, simple ovarian cysts measuring less than 5 cm are usually physiological and generally do not require follow-up. Follow-up ultrasound may be considered if the cyst enlarges, becomes symptomatic, or develops complex sonographic features. In postmenopausal women, management should follow O-RADS and society guidelines.

Key Learning Points

• A simple ovarian cyst is a thin-walled, unilocular anechoic lesion with posterior acoustic enhancement.
• There should be no septations, mural nodules, papillary projections, or solid components.
• Absence of internal vascularity on Color Doppler supports a benign diagnosis.
• Simple cysts in premenopausal women are commonly physiological (dominant follicle or functional cyst).
• O-RADS US 2 lesions have an estimated malignancy risk of less than 1%.
• Most simple ovarian cysts measuring <5 cm in premenopausal women do not require imaging follow-up.
• Complex internal echoes, papillary projections, mural nodules, thick septations, or vascular solid components warrant further evaluation.

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Pleural effusion

Pleural effusion ultrasound case study

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Reporting Panel

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Pleural Pathology

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USG

Pleural effusion ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Mild Pleural effusion	View Report Line
2	Moderate Pleural effusion	-
3	Massive (Gross) Pleural effusion	-
4	-	-
5	-	-

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CASE–1
Right Mild Pleural Effusion

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Clinical History

A 52-year-old male presented with mild right-sided chest discomfort and progressive shortness of breath for several days. There was no history of chest trauma, fever, hemoptysis, or known pleural malignancy. Ultrasound examination of the thorax was performed for further evaluation.

Ultrasound Findings

Ultrasound examination demonstrates a small anechoic fluid collection within the right pleural cavity, consistent with a mild right pleural effusion. The underlying right lung shows minimal passive compressive atelectatic changes adjacent to the effusion. No internal septations, echogenic debris, pleural nodularity, loculations, or fibrin strands are identified. The visceral and parietal pleura appear smooth, and Color Doppler demonstrates no abnormal vascularity. No left pleural effusion is seen.

Abd- ultrasound. Longitudinal subcostal sonographic image demonstrates a small anechoic collection in the right pleural space with minimal adjacent passive lung atelectasis, consistent with a mild right pleural effusion.

Report Line

A small anechoic fluid collection is identified within the right pleural cavity, consistent with a mild right pleural effusion. Minimal adjacent passive compressive atelectatic change is noted. No septations, internal echoes, loculations, pleural thickening, or pleural nodules are identified.

Impression

Mild right pleural effusion with minimal adjacent passive compressive atelectatic change.

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Recommendation

Correlate with the patient's clinical presentation, chest radiograph, and laboratory investigations to determine the underlying etiology. If clinically indicated, follow-up ultrasound may be performed to assess interval change. Diagnostic thoracentesis should be considered if the effusion enlarges, becomes symptomatic, or if infection or malignancy is suspected.

Key Learning Points

• Ultrasound is more sensitive than chest radiography for detecting small pleural effusions.
• A simple pleural effusion appears as an anechoic fluid collection between the visceral and parietal pleura.
• Minimal passive compressive atelectasis is commonly associated with even small pleural effusions.
• Internal septations, echogenic debris, or loculations suggest a complicated parapneumonic effusion or empyema.
• Pleural nodularity or irregular pleural thickening raises suspicion for malignant pleural disease.
• Ultrasound is the preferred modality for guiding diagnostic and therapeutic thoracentesis.
• Clinical correlation is essential to determine the underlying cause, including cardiac, hepatic, renal, infectious, inflammatory, or malignant conditions.

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Splenomegaly

Splenomegaly ultrasound case study

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Reporting Panel

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Spleen Pathology

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USG

Splenomegaly ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Mild Splenomegaly	View Report Line
2	Moderate splrnomegaly	-
3	Massive (Gross) splenomegaly	-
4	-	-
5	-	-

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CASE–1
Mild Splenomegaly

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Clinical History

A 35-year-old male presented with mild left upper abdominal discomfort and early satiety for several weeks. There was no history of fever, weight loss, jaundice, abdominal trauma, hematological disorder, chronic liver disease, or malignancy. Ultrasound examination of the abdomen was performed for further evaluation.

Ultrasound Findings

Ultrasound examination demonstrates a mildly enlarged spleen measuring approximately 13.4 cm in maximum craniocaudal length. The splenic parenchyma is homogeneous with normal echogenicity and preserved architecture. No focal splenic lesion, calcification, or cyst is identified. The splenic capsule is smooth and intact. Color Doppler demonstrates normal vascularity of the splenic parenchyma with a patent splenic vein. No perisplenic fluid collection is seen. The liver demonstrates normal size and echotexture without evidence of cirrhosis, and there is no sonographic evidence of portal hypertension or ascites.

Abdominal ultrasound. Longitudinal sonographic image demonstrates a mildly enlarged spleen measuring approximately 13.4 cm with homogeneous echotexture, smooth capsule, preserved splenic architecture, and no focal lesion, consistent with mild splenomegaly.

Report Line

The spleen is mildly enlarged, measuring approximately 13.4 cm in longitudinal length. Splenic echotexture is homogeneous with preserved architecture. No focal splenic lesion, calcification, infarction, or perisplenic collection is identified. Splenic vascularity is normal on Color Doppler examination. Findings are consistent with mild splenomegaly.

Impression

Mild splenomegaly (splenic length approximately 13.4 cm). Homogeneous splenic echotexture without focal lesion or sonographic evidence of portal hypertension.

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Recommendation

Correlate with clinical findings and laboratory investigations including complete blood count, liver function tests, and peripheral blood smear where appropriate. Further evaluation for infectious, hematologic, hepatic, or systemic causes should be guided by the clinical presentation. Follow-up ultrasound may be considered if symptoms persist or progressive splenic enlargement is suspected.

Key Learning Points

• Mild splenomegaly is generally defined as a splenic longitudinal length of approximately 12–14 cm in adults.
• Ultrasound is the preferred first-line imaging modality for assessing splenic size and parenchymal morphology.
• Homogeneous splenic echotexture with preserved architecture suggests uncomplicated splenic enlargement.
• Carefully evaluate the liver, portal vein, and splenic vein to identify evidence of portal hypertension.
• Common causes include viral infections, hematological disorders, portal hypertension, inflammatory diseases, and systemic infections.
• Color Doppler helps assess splenic perfusion and the patency of the splenic and portal venous systems.
• Clinical correlation and laboratory evaluation are essential to determine the underlying etiology of splenomegaly.

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Hemorrhagic breast cyst (BI-RADS 2) Glitter sign

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Hemorrhagic breast cyst

Hemorrhagic breast cyst ultrasound case study

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Reporting Panel

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Breast Pathology

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USG

Hemorrhagic breast cyst ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Single Hemorrhagic breast cyst	View Report Line
2	Multiple Hemorrhagic breast cyst	-
3	-	-
4	-	-
5	-	-

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CASE–1
Single Hemorrhagic Breast Cyst (BI-RADS 2) – Glitter Sign

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Clinical History

A 42-year-old female presented with a palpable lump in the upper outer quadrant of the right breast associated with mild intermittent pain. There was no history of breast trauma, nipple discharge, fever, previous breast surgery, or family history of breast malignancy. Breast ultrasound was performed for further evaluation.

Ultrasound Findings

Ultrasound examination demonstrates a well-circumscribed, thin-walled, oval cystic lesion measuring approximately 12 × 9 mm within the right breast. The lesion contains multiple fine mobile echogenic internal echoes producing a characteristic glitter sign (dynamic shimmering intracystic particulate matter) on real-time sonography. Posterior acoustic enhancement is present. No mural nodule, thick septation, irregular wall thickening, or internal vascularity is demonstrated on Color Doppler examination. The surrounding breast parenchyma is unremarkable, and no axillary lymphadenopathy is identified.

Breast ultrasound. A well-defined cystic lesion demonstrates multiple mobile echogenic particles producing the characteristic glitter sign on real-time sonography with posterior acoustic enhancement and no internal vascularity, consistent with a benign hemorrhagic breast cyst.

Report Line

A well-circumscribed oval cyst measuring approximately 12 × 9 mm is identified within the breast parenchyma. The lesion contains mobile echogenic intracystic particulate matter demonstrating a characteristic glitter sign on real-time sonography with posterior acoustic enhancement. No mural nodule, solid component, or internal vascularity is identified on Color Doppler examination. Findings are consistent with a benign hemorrhagic breast cyst (BI-RADS 2).

Impression

Benign hemorrhagic breast cyst demonstrating the characteristic glitter sign. No suspicious sonographic features or internal vascularity. BI-RADS Category 2 (Benign Finding).

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Recommendation

No additional imaging or biopsy is required for this typical benign hemorrhagic cyst demonstrating the glitter sign and lacking suspicious features. Routine age-appropriate breast screening is recommended. Clinical follow-up is advised if the lesion enlarges, becomes persistently painful, develops suspicious imaging features, or if new symptoms arise.

Key Learning Points

• The glitter sign represents mobile shimmering echogenic blood products within a hemorrhagic cyst on real-time ultrasound.
• Posterior acoustic enhancement and absence of internal Doppler vascularity support a benign diagnosis.
• Mobile echogenic debris helps differentiate a hemorrhagic cyst from a solid intracystic mass.
• Lack of mural nodules, irregular wall thickening, or vascular solid components favors a benign lesion.
• Typical hemorrhagic cysts with classic sonographic features are classified as BI-RADS 2 (Benign).
• Color Doppler should always be used to exclude vascular mural nodules or papillary lesions.
• Biopsy is indicated only if suspicious features such as a vascular solid component, irregular wall, or persistent mural nodule are present.

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