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Bulky
Uterus

Bulky uterus ultrasound case study

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Reporting Panel

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Uterine Pathology

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USG

Bulky Uterus — Ultrasound Case Study

Case Study Record

SN	Case Name	Report Line
1	Bulky Uterus	View Report Line

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CASE–1
Bulky Uterus

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Clinical History

A 42-year-old female presented with lower abdominal heaviness, pelvic discomfort, and increased menstrual flow for the past several months. No history of acute pelvic inflammatory symptoms was reported.

Ultrasound Findings

The myometrium appears mildly heterogeneous without a definite focal myometrial mass or well-defined fibroid. The endometrial cavity is centrally positioned and the endometrial thickness appearing regular. Both ovaries are visualized separately with preserved morphology and vascularity. No definite adnexal mass or significant pelvic free fluid is identified.

Pelvic ultrasound. Bulky uterus measuring approximately 12.7 × 5.9 × 5.0 cm with an estimated uterine volume of 197 mL . The myometrium appears mildly heterogeneous without a definite focal myometrial lesion. Endometrial thickness measures 9.5 mm .

Report Line

Bulky uterus measuring approximately 12.7 × 5.9 × 5.0 cm (estimated uterine volume 197 mL ) with mildly heterogeneous myometrial echotexture. Endometrial thickness measures 9.5 mm . No definite focal myometrial lesion identified.

Impression

Bulky uterus with mildly heterogeneous myometrial echotexture. No definite focal uterine mass identified on the present ultrasound examination.

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Recommendation

Clinical correlation with menstrual history and pelvic symptoms is recommended. Gynecological evaluation may be considered if symptoms persist or progress. Follow-up ultrasound may be performed according to clinical indication.

Key Learning Points

• Bulky uterus is a descriptive sonographic finding and should be interpreted together with uterine contour and myometrial appearance.
• Uterine size should preferably be documented using three orthogonal measurements and uterine volume may be calculated.
• Assessment should include the myometrium, endometrium, cervix, and adnexa .
• Diffuse myometrial heterogeneity may be seen in various benign uterine conditions.
• A bulky uterus without a focal mass should not automatically be labeled as fibroid.
• Clinical correlation with menstrual symptoms and pelvic examination is important.

Prostatomegaly and Benign prostatic hyperplasia

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Benign Prostatic
Hyperplasia (BPH)

Benign Prostatic Hyperplasia ultrasound case study

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Reporting Panel

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Prostate Pathology

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USG

Benign Prostatic Hyperplasia (BPH) — Ultrasound Case Study

Case Study Record

SN	Case Name	Report Line
1	Mild Benign Prostatic Hyperplasia (BPH-Grade-1)	View Report Line
2	Moderate BPH with Median-Lobe Prominence (BPH-Grade-2)	View Report Line
3	Moderate BPH with Median-Lobe Prominence (BPH-Grade-3) with Significant Post-Void Residual Urine	View Report Line

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CASE–1
Mild Benign Prostatic Hyperplasia [BPH-Grade-1]

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Clinical History

A 58-year-old male presented with increased urinary frequency, nocturia, and mild difficulty in initiating urination for the past several months. The patient reported a weak urinary stream with occasional sensation of incomplete bladder emptying. No history of hematuria or acute urinary retention was reported.

Ultrasound Findings

Ultrasound examination demonstrates mild enlargement of the prostate gland with maintained overall contour and relatively homogeneous echotexture. The transitional zone appears mildly prominent, producing mild enlargement of the central gland. The urinary bladder demonstrates mild trabecular prominence without definite intraluminal mass or calculus. Pre-void urinary bladder volume is within the expected range. Post-void assessment demonstrates a small residual urine volume. No definite focal suspicious prostatic lesion or significant pelvic free fluid is identified on the present ultrasound examination.

Ultrasound of the prostate. Sonographic image demonstrates mild prostatomegaly with mild prominence of the transitional/central gland and relatively preserved prostatic contour, favoring mild benign prostatic hyperplasia (BPH).

Report Line

Mild prostatomegaly with prominence of the transitional/central gland, suggestive of benign prostatic hyperplasia. Prostatic volume 30.41 ml Small post-void residual urine.

Impression

Mild prostatomegaly and benign prostatic hyperplasia (BPH-Grade-1) with small post-void residual urine.

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Recommendation

Clinical correlation with lower urinary tract symptoms is advised. Correlation with serum PSA and digital rectal examination may be performed according to clinical indication. Urological evaluation may be considered if symptoms persist or progress.

Key Learning Points

• BPH commonly affects the transitional zone of the prostate.
• Ultrasound may demonstrate enlargement of the central/transitional gland with variable heterogeneity.
• Assessment of the urinary bladder and post-void residual urine is important in patients with lower urinary tract symptoms.
• Prostate volume should preferably be calculated using three orthogonal measurements.
• Clinical correlation is important because prostate size does not always directly correlate with symptom severity.

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CASE–2
Moderate Benign prostatic hyperplasia [BPH-Grade-2] with Median-Lobe Prominence

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Clinical History

A 66-year-old male presented with progressive lower urinary tract symptoms including weak urinary stream, increased frequency, nocturia, hesitancy, and a sensation of incomplete bladder emptying for approximately one year.

Ultrasound Findings

Report Line

Moderate prostatomegaly with prominent transitional-zone enlargement and intravesical protrusion of the median lobe, consistent with benign prostatic hyperplasia. Prostatic volume 45.4 ml Moderate post-void residual urine.

Impression

Moderate prostatomegaly and benign prostatic hyperplasia with median-lobe prominence. and moderate post-void residual urine.

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Recommendation

Clinical and urological correlation is recommended. Correlation with urinary symptoms, PSA level, and other relevant clinical parameters may be considered. Urological assessment is advised in patients with significant obstructive symptoms or increasing residual urine volume.

Key Learning Points

• Median-lobe enlargement may project into the bladder lumen.
• Intravesical prostatic protrusion can be assessed sonographically when clinically relevant.
• Bladder wall trabeculation may develop in association with chronic bladder outlet obstruction.
• Post-void residual urine provides useful information regarding bladder emptying.
• BPH should be interpreted together with clinical symptoms rather than prostate size alone.

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CASE–3
Severe Benign prostatic hyperplasia [BPH-Grade-3] with Significant Post-Void Residual Urine

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Clinical History

A 72-year-old male presented with long-standing urinary frequency, nocturia, weak urinary stream, hesitancy, and marked sensation of incomplete bladder emptying. The patient reported progressively worsening urinary symptoms.

Ultrasound Findings

Ultrasound demonstrates marked prostatomegaly with prominent transitional-zone enlargement and heterogeneous central-gland echotexture. The prostate produces elevation of the bladder base with associated intravesical prostatic protrusion. The urinary bladder is significantly distended with diffuse wall trabeculation. Following voiding, a substantial amount of urine remains within the bladder, consistent with a significant post-void residual volume. No definite intravesical calculus or focal bladder mass is identified on the present examination.

Report Line

Marked prostatomegaly with prominent transitional-zone enlargement and intravesical prostatic protrusion, compatible with benign prostatic hyperplasia. Prostatic volume 30.41 ml Diffuse urinary bladder wall trabeculation with significant post-void residual urine, suggesting impaired bladder emptying.

Impression

Marked benign prostatic hyperplasia with intravesical prostatic protrusion and significant post-void residual urine.

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Recommendation

Urological evaluation is recommended, particularly in view of the significant post-void residual urine and symptoms of bladder outlet obstruction. Clinical correlation with renal function, PSA, and other relevant investigations may be considered according to clinical indication. If there is acute inability to void, severe suprapubic pain, fever, or other acute symptoms, urgent clinical assessment is appropriate.

Key Learning Points

• Significant post-void residual urine may indicate impaired bladder emptying.
• Chronic bladder outlet obstruction may be associated with bladder wall trabeculation.
• Intravesical prostatic protrusion can be an important sonographic finding in patients with obstructive lower urinary tract symptoms.
• Ultrasound assessment should include the prostate, urinary bladder, pre-void volume, and post-void residual volume when clinically indicated.
• Renal tract assessment may also be considered in patients with significant or long-standing bladder outlet obstruction.
• Persistent or severe lower urinary tract symptoms warrant appropriate clinical/urological evaluation.

Axillary lymphadenitis/Lymphadenopathy

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Axillary Lymphadenitis

Axillary Lymphadenitis ultrasound case study

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Reporting Panel

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Axillary Pathology

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USG

Axillary Lymphadenitis ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Right Axillary lymphadenitis	View Report Line
2	Left Axillary lymphadenitis	View Report Line
3	-	View Report Line

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CASE–1
Multiple Right Axillary Lymphadenitis

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Clinical History

A 28-year-old lactating female presented with pain, tenderness, and localized swelling in the right axillary region for the past 3 days. She also reported discomfort in the adjacent right breast with low-grade fever. There was no history of nipple retraction, bloody nipple discharge, previous breast surgery, or known breast malignancy.

Ultrasound Findings

Ultrasound examination of the right axilla demonstrates multiple enlarged lymph nodes of variable size, predominantly oval in morphology, with relatively preserved echogenic fatty hila. The lymph nodes demonstrate mild to moderate cortical thickening with maintained hilar architecture. On Color Doppler imaging, increased hilar vascularity is noted. No definite cystic necrosis, liquefaction, calcification, or matting of the lymph nodes is identified. The surrounding axillary soft tissues show mild inflammatory changes. The visualized right breast parenchyma may demonstrate mild inflammatory changes in the appropriate clinical setting. No definite focal suspicious solid mass or drainable fluid collection is identified within the visualized breast or axillary region.

Ultrasound of the right axilla. Sonographic image demonstrates multiple enlarged oval lymph nodes with relatively preserved echogenic fatty hila and mild cortical thickening, favoring reactive/inflammatory axillary lymphadenopathy.

Report Line

Multiple enlarged right axillary lymph nodes with preserved echogenic fatty hila and mild cortical thickening, demonstrating predominantly hilar vascularity on Color Doppler, favoring reactive/inflammatory lymphadenitis. No definite nodal necrosis, calcification, or collection identified.

Impression

Multiple right axillary lymphadenopathy with sonographic features favoring reactive/inflammatory lymphadenitis.

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Recommendation

Clinical correlation is advised, particularly for an underlying inflammatory or infectious process involving the right breast or adjacent soft tissues. Appropriate medical management and clinical follow-up should be considered according to the patient's symptoms. If the lymph nodes persist, progressively enlarge, develop abnormal morphology, or fail to regress after resolution of the underlying inflammatory process, repeat ultrasound examination may be performed. Further breast and axillary evaluation should be considered for persistent or atypical lymphadenopathy.

Key Learning Points

• Reactive axillary lymphadenitis is commonly associated with inflammatory or infectious conditions of the breast and adjacent tissues.
• Ultrasound typically demonstrates oval lymph nodes with preserved echogenic fatty hila and mild cortical thickening.
• Color Doppler may demonstrate predominantly hilar vascularity in reactive lymph nodes.
• Features such as loss of the fatty hilum, marked eccentric cortical thickening, irregular contour, abnormal peripheral vascularity, necrosis, or calcification should raise concern for an alternative etiology and warrant further evaluation.
• Multiple enlarged lymph nodes can occur as a reactive response to breast inflammation or infection.
• Ultrasound is useful for assessing the morphology, cortical thickness, internal architecture, and vascular pattern of axillary lymph nodes.
• Persistent, progressive, or morphologically suspicious axillary lymphadenopathy requires appropriate clinical and breast-imaging follow-up.

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CASE–2
Single Left Axillary Lymphadenitis

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Clinical History

A 30-year-old female presented with localized pain, tenderness, and swelling in the left axillary region for the past 4 days. She also reported mild discomfort in the adjacent left breast with low-grade fever. There was no history of nipple retraction, bloody nipple discharge, previous breast surgery, or known breast malignancy.

Ultrasound Findings

Ultrasound examination of the left axilla demonstrates a single mildly enlarged oval lymph node with a relatively preserved echogenic fatty hilum. Mild cortical thickening is noted with maintained nodal architecture. Color Doppler examination demonstrates predominantly hilar vascularity. No definite cystic necrosis, liquefaction, calcification, matting, or surrounding collection is identified. The visualized left breast parenchyma does not demonstrate a definite focal suspicious solid mass or drainable fluid collection. The sonographic appearance of the axillary lymph node favors a reactive/inflammatory lymphadenitis in the appropriate clinical setting.

Ultrasound of the left axilla. Sonographic image demonstrates a single enlarged oval lymph node with preserved echogenic fatty hilum and mild cortical thickening, favoring reactive/inflammatory lymphadenitis.

Report Line

Single mildly enlarged oval left axillary lymph node with preserved echogenic fatty hilum and mild cortical thickening, demonstrating predominantly hilar vascularity on Color Doppler, favoring reactive/inflammatory lymphadenitis. No definite nodal necrosis, calcification, matting, or collection identified.

Impression

Single left axillary lymph node with sonographic features favoring reactive/inflammatory lymphadenitis.

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Recommendation

Clinical correlation is advised for an underlying inflammatory or infectious process involving the left breast or adjacent soft tissues. Appropriate medical management and clinical follow-up should be considered according to the patient's symptoms. If the lymph node persists, enlarges, develops abnormal morphology, or fails to regress after resolution of the underlying inflammatory process, repeat ultrasound examination may be performed. Further breast and axillary evaluation should be considered for persistent or atypical lymphadenopathy.

Key Learning Points

• Reactive axillary lymphadenitis may occur secondary to inflammatory or infectious conditions of the breast and adjacent tissues.
• A reactive lymph node is commonly oval in shape with a preserved echogenic fatty hilum.
• Mild cortical thickening may be seen in reactive lymphadenopathy.
• Color Doppler may demonstrate predominantly hilar vascularity.
• Suspicious features include loss of the fatty hilum, marked or eccentric cortical thickening, irregular contour, abnormal peripheral vascularity, necrosis, or calcification.
• Ultrasound is useful for evaluating lymph-node morphology, cortical thickness, internal architecture, and vascular pattern.
• Persistent or progressively enlarging axillary lymphadenopathy requires appropriate clinical and breast-imaging follow-up.

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Breast mastitis

Breast mastitis ultrasound case study

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Reporting Panel

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Breast Pathology

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USG

Breast mastitis ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Right Breast mastitis	View Report Line
2	Left Breast mastitis	View Report Line
3	Bilateral Breast mastitis	View Report Line

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CASE–1
Right Breast Mastitis

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Clinical History

A 28-year-old lactating female presented with pain, tenderness, and localized swelling of the right breast for the past 3 days. She also reported warmth and redness over the affected area, with associated low-grade fever. There was no history of nipple retraction, bloody nipple discharge, or previous breast surgery.

Ultrasound Findings

Ultrasound examination of the right breast demonstrates an area of heterogeneous hypoechoic parenchymal echotexture involving the symptomatic region, with associated interstitial edema and skin thickening. Increased vascularity is noted within the involved breast parenchyma on Color Doppler imaging. The affected area shows ill-defined margins without a discrete well-defined drainable fluid collection. No definite focal abscess, solid mass, or suspicious cystic lesion is identified. The right axillary lymph nodes may show mild reactive enlargement with preserved fatty hila.

Ultrasound of the right breast. Sonographic image demonstrates heterogeneous hypoechoic breast parenchyma with surrounding edema and skin thickening in the symptomatic region, consistent with inflammatory changes of mastitis.

Color Doppler ultrasound of the right breast. Increased vascularity is demonstrated within the inflamed breast parenchyma, supporting the diagnosis of mastitis.

Report Line

Ill-defined heterogeneous hypoechoic area involving the right breast parenchyma with associated skin/interstitial edema and increased vascularity on Color Doppler, consistent with inflammatory changes of mastitis. No definite drainable abscess or focal suspicious solid lesion identified.

Impression

Sonographic features suggestive of right breast mastitis without a drainable abscess.

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Recommendation

Clinical correlation is advised. Appropriate medical management and follow-up should be considered according to clinical findings. If symptoms persist or worsen despite treatment, repeat ultrasound examination may be performed to assess for development of a breast abscess or other focal complication. Persistent or atypical imaging findings should undergo further breast evaluation as clinically indicated.

Key Learning Points

• Mastitis is an inflammatory condition of the breast and is commonly encountered during lactation.
• Ultrasound may demonstrate heterogeneous hypoechoic parenchymal changes, edema, skin thickening, and increased vascularity.
• Color Doppler commonly demonstrates increased vascularity within the inflamed breast tissue.
• A breast abscess should be suspected when a focal complex or fluid-containing collection develops within the inflamed tissue.
• Reactive axillary lymphadenopathy may accompany breast inflammation.
• Ultrasound is useful for distinguishing uncomplicated mastitis from a focal drainable collection.
• Persistent, recurrent, or atypical inflammatory changes require appropriate clinical and breast-imaging follow-up to exclude an underlying lesion.

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Nuchal Cord

Nuchal Cord ultrasound case study

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Reporting Panel

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Cord Pathology

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USG

Nuchal cord ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Single loop	View Report Line
2	Dual loops	View Report Line
3	Triple loop	View Report Line
4	For or more loop	View Report Line

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CASE–1
Single Loop Nuchal Cord

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Clinical History

A 27-year-old pregnant female at 38 weeks of gestation presented for routine third-trimester obstetric ultrasound examination. Fetal movements were perceived normally. There was no history of vaginal bleeding, leaking per vaginum, or decreased fetal movements.

Ultrasound Findings

Obstetric ultrasound demonstrates a single loop of the umbilical cord encircling the fetal neck. Color Doppler imaging confirms the presence of a single nuchal cord loop with the umbilical vessels seen coursing around the neck. No evidence of multiple loops, true knot, or cord prolapse is identified. Fetal cardiac activity is normal, and amniotic fluid volume is within normal limits. Fetal biometry is appropriate for gestational age.

Color Doppler obstetric ultrasound. Sonographic image demonstrates a single loop of umbilical cord encircling the fetal neck, producing the characteristic appearance of a single nuchal cord.

Power Doppler obstetric ultrasound. Sonographic image demonstrates a single loop of umbilical cord encircling the fetal neck, with Power Doppler clearly delineating the vascularized cord loop around the neck, consistent with a single nuchal cord.

Report Line

Single loop of nuchal cord noted around the fetal neck,(3V in dopler and U-shaped depresion on fetal neck in gray scale imaging) without sonographic evidence of significant cord compression or associated fetal hemodynamic compromise.

Impression

Single loop nuchal cord.

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Recommendation

Clinical and obstetric correlation is advised. A single nuchal cord is a common antenatal finding and is usually not associated with adverse fetal outcome. Routine fetal surveillance should be continued as clinically indicated. Further assessment may be considered if there is decreased fetal movement, abnormal fetal heart rate patterns, or suspected cord complications.

Key Learning Points

• A nuchal cord refers to the umbilical cord encircling the fetal neck.
• Single-loop nuchal cord is the most common type and is frequently detected during the third trimester.
• Color Doppler imaging improves diagnostic confidence by demonstrating the cord vessels around the neck.
• Most cases are incidental findings and result in normal perinatal outcomes.
• The likelihood of fetal compromise increases with multiple tight loops rather than a single loose loop.
• Differential considerations include cord adjacent to the neck without complete encirclement and body cord loops.
• Routine obstetric follow-up is generally sufficient in isolated single-loop nuchal cord cases.

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CASE–2
Double Loop Nuchal Cord

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Clinical History

A 27-year-old pregnant female at 38 weeks of gestation presented for routine third-trimester obstetric ultrasound examination. Fetal movements were perceived normally. There was no history of vaginal bleeding, leaking per vaginum, or decreased fetal movements.

Ultrasound Findings

Obstetric ultrasound demonstrates two loops of the umbilical cord encircling the fetal neck. Color Doppler and Power Doppler imaging confirm the presence of a double nuchal cord, with the umbilical vessels seen coursing around the fetal neck in two distinct loops. The two cord loops are clearly delineated on Doppler examination. No evidence of a true knot or cord prolapse is identified. Fetal cardiac activity is normal, and amniotic fluid volume is within normal limits. Fetal biometry is appropriate for gestational age.

Color Doppler obstetric ultrasound. Sonographic image demonstrates two loops of umbilical cord encircling the fetal neck, producing the characteristic appearance of a double nuchal cord.

Power Doppler obstetric ultrasound. Sonographic image demonstrates two loops of umbilical cord encircling the fetal neck, with Power Doppler clearly delineating the vascularized cord loops around the neck, consistent with a double nuchal cord.

Report Line

Two loops of nuchal cord noted around the fetal neck, with two distinct vascularized cord loops demonstrated on Color/Power Doppler and corresponding double U-shaped cord configuration around the fetal neck on gray-scale imaging. No sonographic evidence of significant cord compression or associated fetal hemodynamic compromise.

Impression

Double loop nuchal cord.

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CASE–3
Triple Loop Nuchal Cord

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Clinical History

A 27-year-old pregnant female at 38 weeks of gestation presented for routine third-trimester obstetric ultrasound examination. Fetal movements were perceived normally. There was no history of vaginal bleeding, leaking per vaginum, or decreased fetal movements.

Ultrasound Findings

Obstetric ultrasound demonstrates three loops of the umbilical cord encircling the fetal neck. Color Doppler and Power Doppler imaging confirm the presence of a triple nuchal cord, with the umbilical vessels seen coursing around the fetal neck in three distinct loops. The three cord loops are clearly delineated on Doppler examination. No evidence of a true knot or cord prolapse is identified. Fetal cardiac activity is normal, and amniotic fluid volume is within normal limits. Fetal biometry is appropriate for gestational age.

Color Doppler obstetric ultrasound. Sonographic image demonstrates three loops of umbilical cord encircling the fetal neck, producing the characteristic appearance of a triple nuchal cord.

Power Doppler obstetric ultrasound. Sonographic image demonstrates three loops of umbilical cord encircling the fetal neck, with Power Doppler clearly delineating the vascularized cord loops around the neck, consistent with a triple nuchal cord.

Report Line

Three loops of nuchal cord noted around the fetal neck, with three distinct vascularized cord loops demonstrated on Color/Power Doppler and corresponding multiple U-shaped cord configurations around the fetal neck on gray-scale imaging. No sonographic evidence of significant cord compression or associated fetal hemodynamic compromise.

Impression

Triple loop nuchal cord.

Go To Table

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CASE–4
Four-Loop Nuchal Cord

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Clinical History

A 27-year-old pregnant female at 38 weeks of gestation presented for routine third-trimester obstetric ultrasound examination. Fetal movements were perceived normally. There was no history of vaginal bleeding, leaking per vaginum, or decreased fetal movements.

Ultrasound Findings

Obstetric ultrasound demonstrates four loops of the umbilical cord encircling the fetal neck. Color Doppler and Power Doppler imaging confirm the presence of a four-loop nuchal cord, with the umbilical vessels seen coursing around the fetal neck in four distinct loops. The four cord loops are clearly delineated on Doppler examination. No evidence of a true knot or cord prolapse is identified. Fetal cardiac activity is normal, and amniotic fluid volume is within normal limits. Fetal biometry is appropriate for gestational age.

Color Doppler obstetric ultrasound. Sonographic image demonstrates four loops of umbilical cord encircling the fetal neck, producing the characteristic appearance of a four-loop nuchal cord.

Power Doppler obstetric ultrasound. Sonographic image demonstrates four loops of umbilical cord encircling the fetal neck, with Power Doppler clearly delineating the vascularized cord loops around the neck, consistent with a four-loop nuchal cord.

Report Line

Four loops of nuchal cord noted around the fetal neck, with four distinct vascularized cord loops demonstrated on Color/Power Doppler and corresponding multiple U-shaped cord configurations around the fetal neck on gray-scale imaging. No sonographic evidence of significant cord compression or associated fetal hemodynamic compromise.

Impression

Four-loop nuchal cord.

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