Diagnostic sonography SCRS

Lipoma Back lump ultrasound – dorsal wall lesions

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Lipoma Back lump ultrasound – dorsal wall lesions

Case Study No: R-5

Dorsal Wall Ultrasound

Technique: Real-time ultrasound examination of the dorsal wall was performed using a high-frequency linear transducer (7–12 MHz). Systematic evaluation of the posterior thoraco-lumbar region was carried out in longitudinal and transverse planes. Skin, subcutaneous tissue, muscle layers, and underlying soft tissue structures were assessed.
Clinical indication: Back Palpable lump.

Location: Right lateral dorsal wall, within the subcutaneous plane. Skin & Subcutaneous Tissue: A well-defined, oval hyperechoic lesion is seen in the subcutaneous plane, measuring approximately 3.2 × 1.4 cm. The lesion is oriented parallel to the skin surface. No surrounding edema, infiltration, or skin thickening is noted. Muscle Layers: Underlying muscle planes appear normal in bulk and echotexture. No intramuscular extension is identified. Fascial Planes: Fascial layers are intact with no disruption or deep extension. Vascularity: No internal vascularity is noted on Doppler evaluation.

Impression: Features are suggestive of a subcutaneous lipoma in the right lateral dorsal wall.

Recommendation: Clinical correlation is advised. Follow-up ultrasound may be considered if there is increase in size or symptoms. Surgical consultation can be considered if clinically indicated.

Kindly Note:

Limitations / Technical Factors:
Ultrasound evaluation is limited for deep-seated lesions and bony structures.
Clinical correlation and further imaging (MRI / CT) may be required depending on clinical suspicion.
• This report is not valid for medico-legal purposes.

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You have reached the end of this Lipoma – Back Lump (Dorsal Wall Ultrasound Case Study).

This evaluation was performed using Ultrasonography (USG), allowing real-time assessment of superficial soft tissue structures.

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled “Subcutaneous Lipoma – Dorsal Wall (Back Lump) on Ultrasonography (USG)” has been prepared solely for educational and academic purposes. The findings demonstrate a well-defined, hyperechoic lesion located in the subcutaneous plane of the dorsal wall, consistent with a lipoma. The lesion typically shows parallel orientation to the skin surface, absence of internal vascularity, and no surrounding soft tissue infiltration. Ultrasonography is a reliable, non-invasive modality for evaluating superficial soft tissue masses, helping differentiate benign lesions like lipoma from other pathological conditions. These findings are intended for learning and demonstration only. Definitive diagnosis and management require clinical correlation and appropriate medical consultation.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Soft Tissue Imaging
Modality: Ultrasonography (USG)
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology

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Hepatomegaly, Bilateral renal calculus (Nephrolithiasis)

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Hepatomegaly, Bilateral renal calculus (Nephrolithiasis)

TAS Case Study No: R-4

Whole Abdomen & Pelvis Sonography

Technique: Examination performed using a convex 3.5–5 MHz transducer. Longitudinal and transverse planes of the abdomen were evaluated. Color Doppler assessment of hepatic and portal vessels was performed. Pelvic and post-void images were obtained. Patient was fasting for 6–8 hours.
Prior studies: No prior imaging available.
Clinical history: Abdominal pain.

Liver: Liver is enlarged in size, shape, and echotexture. Intrahepatic biliary radicles are not dilated. No focal lesion such as mass, cyst, or abscess is seen. PV: Portal vein is normal in caliber with normal hepatopetal flow.

Gall Bladder: Gall bladder is normal in size, shape, and echotexture. No calculus, mass, or sludge is seen. Wall thickness is normal. Common Bile Duct (CBD): CBD is normal in course and caliber throughout its visualized length. Pancreas: Pancreas is normal in size, shape, and echotexture. Main pancreatic duct is not dilated. No focal mass or calcification is seen.

Spleen: Spleen is normal in size, shape, and echotexture. Splenic vein appears normal. No focal lesion or calcification is seen.

Right Kidney: Right kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is well preserved. A well-defined echogenic focus measuring 4.0 mm calculus is noted, showing posterior acoustic shadowing. Pelvicalyceal system is not dilated. No evidence of hydronephrosis or focal mass lesion is seen.

Left Kidney: Left kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is well preserved. A well-defined echogenic focus measuring 6.6 mm calculus is noted, showing posterior acoustic shadowing. Pelvicalyceal system is not dilated. No evidence of hydronephrosis or focal mass lesion is seen.

Rt. Ureter: Right ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen. Lt. Ureter: Left ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen.
Urinary Bladder: Urinary bladder is adequately distended. Wall thickness appears normal. No intraluminal mass or debris is seen. Post-void residual urine is insignificant. Prostate: Prostate volume is within normal limits. Echotexture appears homogeneous.

Free Fluid: No free fluid is seen in the abdomen or pelvis.

Other Observations: High-frequency linear (7.5–10 MHz) probe evaluation was performed in longitudinal and transverse planes.
Lymph node: No evidence of abdominal lymphadenopathy is seen. Aorta: Abdominal aorta appears normal in course and caliber. No aneurysmal dilatation noted. Bowel: Bowel loops are unremarkable. No bowel wall thickening, dilatation, or abnormal peristalsis observed. Abdominal wall: Appears intact with no evidence of hernia or focal defect. Appendix: Not visualized; no sonographic features suggestive of acute appendicitis Inguinal region: Bilateral inguinal regions appear normal. No evidence of inguinal hernia or lymphadenopathy.

Measurement Summary:

Liver :	XXX mm (Midclavicular length)
Spleen :	XX mm (Bipolar length)
Right Kidney :	XXX mm (Length)
Left Kidney :	XXX mm (Length)
Prostate Volume :	XX mL

Impression: Hepatomegaly noted.
Bilateral renal calculi (nephrolithiasis) seen with echogenic foci showing posterior acoustic shadowing.
No obvious hydronephrosis / obstructive uropathy detected (if applicable).

Recommendation: Clinical correlation advised.
Correlate with renal function tests and consider urological consultation.
Follow-up ultrasound / further imaging (if symptomatic) may be considered.

Kindly Note:

• Kindly intimate us regarding any typographical errors and submit the report for correction within 7 days.
Limitations / Technical Factors: Ultrasound has limitations in detecting small ureteric calculi and subtle bowel lesions.
Visualization of pancreas may be limited due to overlying bowel gas.
Detection of early obstruction or non-shadowing calculi may be limited.
• This report and accompanying images are not valid for medico-legal purposes.

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You have reached the end of this Hepatomegaly with Bilateral Renal Calculi – Ultrasound Case Study.

This evaluation was performed using Ultrasonography (USG), providing real-time assessment of abdominal organs.

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled “Hepatomegaly with Bilateral Renal Calculi on Ultrasonography (USG)” has been prepared solely for educational and academic purposes. The findings demonstrate an enlarged liver consistent with hepatomegaly, along with the presence of calculi in both kidneys (bilateral renal calculi). The renal stones may vary in size and location, with possible posterior acoustic shadowing. Ultrasonography provides a non-invasive and effective modality for evaluating liver size and renal stone disease. These findings are intended for learning and demonstration only. Definitive diagnosis and management require clinical correlation and appropriate medical consultation.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Abdominal Imaging
Modality: Ultrasonography (USG)
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology

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Cervical fibroid TVS

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Bulky uterus and Cervical fibroid

TVS Case Study No: R-3

Transvaginal Sonography (TVS) – Pelvis (Female)

Technique: Transvaginal ultrasound examination performed using a high-frequency endovaginal probe (5–9 MHz). Images obtained in sagittal and transverse planes. Color Doppler applied where indicated.
Prior studies: No prior imaging available.
Clinical history: 37-year-old female presenting with pelvic pain and infertility.

Uterus: Uterus appears bulky in size and normal in position. Myometrium appears homogeneous.

A well-defined hypoechoic mass lesion is seen arising from the anterior cervical wall, measuring 39.5 × 47.7 mm, suggestive of a cervical fibroid. The lesion shows smooth margins with no obvious cystic degeneration or calcification.

Endometrium: Endometrial echo complex appears within normal limits for age and menstrual phase.
Right Ovary: Right ovary is normal in size and echotexture. Follicles are seen. No adnexal mass lesion noted. Left Ovary: Left ovary is normal in size and echotexture. Follicles are seen. No cyst or solid lesion noted. Pouch of Douglas (POD): No free fluid is seen.

Measurement Summary:

Uterus :	99 × 47 × 45 mm
Cervical Fibroid :	39.5 × 47.7 mm

Impression: Bulky uterus with a well-defined hypoechoic lesion arising from the anterior cervical wall, consistent with a cervical fibroid.

Recommendation: Gynecological consultation and clinical correlation advised.

Kindly Note:

• Kindly intimate us regarding any typographical errors within 7 days.
• Ultrasound has limitations in detecting small pelvic lesions.
• TVS provides better resolution for pelvic structures.
• This report is not valid for medico-legal purposes.

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You have reached the end of this Bulky Uterus with Cervical Fibroid – TVS Case Study.

This evaluation was performed using Transvaginal Sonography (TVS), providing high-resolution assessment of pelvic structures.

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled “Bulky Uterus with Anterior Cervical Fibroid on Transvaginal Sonography (TVS)” has been prepared solely for educational and academic purposes. The findings demonstrate a bulky uterus with a well-defined fibroid arising from the anterior cervical wall, measuring approximately 45.5 × 47.7 mm. TVS provides superior resolution for evaluation of uterine and cervical pathology. These findings are intended for learning and demonstration only. Definitive diagnosis and management require clinical correlation and gynecological consultation.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Gynecological Imaging
Modality: Transvaginal Sonography (TVS)
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology

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Bulky uterus Cervical fibroid

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Bulky uterus and Cervical fibroid

L/A / Pelvis ultrasound Case Study No: R-2

Lower Abdomen or Pelvis Sonography (Female)

Technique: Examination performed using a convex 3.5–5 MHz transducer. Transabdominal pelvic scan performed with adequately filled urinary bladder. Longitudinal and transverse sections obtained. Color Doppler used where required.
Prior studies: No prior imaging available.
Clinical history: 37y old patient present with pelvic pain and infertility

Urinary Bladder: Urinary bladder is adequately distended. Wall thickness appears normal. No intraluminal mass or debris is seen. No post-void residual urine. Uterus: Uterus is bulky in size, shape, and position. Myometrium appears homogeneous.

Endometrium: Endometrial echo complex appears normal for age and menstrual phase. Endometrial thickness is within normal limits.

The cervix shows a well-defined hypoechoic mass lesion arising from the anterior cervical wall, measuring 45.5 × 47.7 mm. The lesion appears solid with smooth margins. No obvious cystic degeneration or calcification is noted.
Right Ovary: Right ovary is normal in size and echotexture. Follicles are seen. No cyst or solid lesion noted. Left Ovary: Left ovary is normal in size and echotexture. Follicles are seen. No cyst or solid lesion noted. Adnexa: No adnexal mass or lesion is seen bilaterally. Pouch of Douglas (POD): No free fluid is seen.

Measurement Summary:

Uterus :	110 × 47 × 55 mm
Cevical fibroid :	47.7 × 45.5 mm

Impression: Bulky uterus noted. A well-defined mass is seen arising from the anterior cervical wall,considered to cervical fibroid.

Recommendation: Gynecological consultation and clinical correlation advised.

Kindly Note:

• Kindly intimate us regarding any typographical errors within 7 days.
• Ultrasound has limitations in detecting small pelvic lesions.
• Transvaginal scan may provide better evaluation if clinically indicated.
• This report is not valid for medico-legal purposes.

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You have reached the end of this Bulky Uterus with Cervical Fibroid – Ultrasound Case Study.

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled “Bulky Uterus with Anterior Cervical Fibroid on Ultrasound” has been prepared solely for educational and academic purposes. The sonographic findings demonstrate a bulky uterus with a well-defined fibroid arising from the anterior cervical wall measuring approximately 45.5 × 47.7 mm. These findings are intended for learning and demonstration purposes only. Definitive diagnosis and management require clinical correlation and gynecological consultation.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Gynecological Imaging
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology

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Right renal cortical cyst, Bulky uterus, RPOC, and Left ovarian follicular cyst.

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Right renal cortical cyst, Bulky uterus, RPOC, and Left ovarian follicular cyst

W/A Female ultrasound Case Study No: R-1

Whole Abdomen & Pelvis Sonography

Liver: Liver is normal in size, shape, and echotexture. Intrahepatic biliary radicles are not dilated. No focal lesion such as mass, cyst, or abscess is seen. PV: Portal vein is normal in caliber with normal hepatopetal flow.

Gall Bladder: Gallbladder is not visualized, consistent with post-cholecystectomy status. Gallbladder fossa appears clear with no evidence of fluid collection, mass, or residual tissue. Common Bile Duct (CBD): CBD is normal in course and caliber throughout its visualized length. Pancreas: Pancreas is normal in size, shape, and echotexture. Main pancreatic duct is not dilated. No focal mass or calcification is seen.

Spleen: Spleen is normal in size, shape, and echotexture. Splenic vein appears normal. No focal lesion or calcification is seen.

Right Kidney: Right kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. A well-defined anechoic cortical cyst measuring 15.0 × 15.6 mm is noted in the lower cortex. No internal septation or solid component is seen. No calculus, hydronephrosis, or mass lesion is noted.

Left Kidney: Left kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen.

Rt. Ureter: No evidence of dilatation. Lt. Ureter: No evidence of dilatation.
Urinary Bladder: Urinary bladder is adequately distended. Wall thickness appears normal. No intraluminal mass or debris is seen. Post-void residual urine is insignificant. Uterus: Uterus is anteverted and appears bulky in size with normal myometrial echotexture.
Endometrial cavity shows heterogeneous echogenic contents suggestive of retained products of conception (RPOC). Endometrial thickness is increased.
No focal myometrial lesion is seen. Overall echotexture appears mildly heterogeneous. Rt. Ovary: Normal in size and priserved echotexture. No cyst or mass lesion. Lt. Ovary: Left ovary is normal in size with preserved echotexture. A well-defined thin-walled anechoic cyst (follicular cyst) measuring 21 × 19 mm is seen. No internal septation or solid component is noted. No adnexal mass lesion is seen.
Free Fluid: No free fluid is seen in the abdomen or pelvis.

Other Observations: High-frequency linear (7.5–10 MHz) probe evaluation was performed in longitudinal and transverse planes.
Lymph node: No evidence of abdominal lymphadenopathy is seen. Aorta: Abdominal aorta appears normal in course and caliber. No aneurysmal dilatation noted. Bowel: Bowel loops are unremarkable. No bowel wall thickening, dilatation, or abnormal peristalsis observed. Abdominal wall: Appears intact with no evidence of hernia or focal defect. Appendix: Not visualized. Inguinal region: Bilateral inguinal regions appear normal. No evidence of inguinal hernia or lymphadenopathy.

Measurement Summary:

Liver :	129.6 mm (Midclavicular length)
Spleen :	95.6 mm (Bipolar length)
Right Kidney :	98.2 mm (Length)
Left Kidney :	102.3 mm (Length)
Uterus Volume :	98.2 mL

Impression: Status post cholecystectomy with no obvious complication.
Right renal cortical cyst noted.
Bulky uterus with retained products of conception (RPOC).
Left ovarian simple follicular cyst.

Recommendation: Clinical correlation advised. Gynecological consultation is recommended for further evaluation and management of RPOC. Follow-up ultrasound may be considered if clinically indicated.

Kindly Note:

• Kindly intimate us regarding any typographical errors and submit the report for correction within 7 days.

Limitations / Technical Factors:
Ultrasound is not the modality of choice to rule out subtle bowel lesions.
Examination of the pancreas was partially limited due to overlying bowel gas.
Evaluation of uterus and adnexa may be limited in cases of inadequate bladder filling, bowel gas, or obesity; transvaginal ultrasound provides better resolution when clinically indicated.

• This report and accompanying images are not valid for medico-legal purposes.

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You have reached the end of this Combined Abdomino-Pelvic Ultrasound Case Study.

Findings include Right Renal Cortical Cyst, Bulky Uterus, Retained Products of Conception (RPOC), and Left Ovarian Follicular Cyst.

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled “Right Renal Cortical Cyst with Bulky Uterus, RPOC, and Left Ovarian Follicular Cyst on Ultrasound” has been prepared solely for educational and academic purposes. The sonographic findings demonstrate a simple cortical cyst in the right kidney, bulky uterus with intrauterine echogenic contents suggestive of RPOC, and a left ovarian follicular cyst. These observations are intended for learning and demonstration only. Final diagnosis and management require clinical correlation, laboratory evaluation, and specialist consultation.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography (Abdominal & Gynecological Imaging)
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology

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Renal calculus(Nephrolithiasis)

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Renal Calculus (Nephrolithiasis)

Diagnostic Sonography Case Study No: CS-003

Step-i

Clinical history

Clinical History: A 42-year-old male presented with acute onset right flank pain radiating to the groin, associated with nausea and hematuria. Clinical suspicion of renal/ureteric calculus was raised. Ultrasound examination was advised for evaluation of urinary tract obstruction.

Fig-1. Ultrasound image of the right kidney demonstrates a hyperechoic focus with posterior acoustic shadowing, measurese of 14.7 mm in maximum diameter withinthe renal pelvis consistent with a renal calculus. No dilatation of the pelvicalyceal system may is seen,

Fig-1.1 Ultrasound image of the right kidney demonstrates a hyperechoic focus with posterior acoustic shadowing on color Doppler showing "Twinkling artifact" measurese of 14.7 mm in maximum diameter withinthe renal pelvis consistent with a renal calculus. No dilatation of the pelvicalyceal system may is seen,

Key diagnostic ultrasound signs:

a- Hyperechoic focus within kidney/ureter
b- Posterior acoustic shadowing
c- Twinkling artifact on Doppler
d- Hydronephrosis (if obstructive)
e- Dilated ureter (in ureteric calculus)

Hyperechoic Focus: Renal stones appear as bright echogenic foci due to high acoustic impedance.

Posterior Shadowing: A clean acoustic shadow behind the stone confirms calcification.

Twinkling Artifact: Color Doppler may show twinkling artifact, improving detection.

Clinical Correlation: Patients typically present with flank pain, hematuria, nausea.

Renal Calculus ✔ Echogenic focus
✔ Posterior acoustic shadow
✔ Twinkling artifact
✔ Possible hydronephrosis Renal Mass ✖ No posterior shadow
✖ Solid vascular lesion Blood Clot ✖ Mobile, no shadow
✖ No twinkling artifact Papillary Calcification ✖ Small non-obstructive foci
✖ Usually no hydronephrosis

Findings:
A well-defined echogenic focus is noted within the kidney showing posterior acoustic shadowing. Findings are consistent with renal calculus.

Conclusion:
Ultrasound findings are suggestive of Renal calculus.

Recommendation:
Clinical correlation advised. Further evaluation with NCCT KUB may be considered for confirmation and stone characterization.

You have reached the end of this Renal Calculus – Ultrasound Case Study. Largest calculus size: 8 mm
Location: Right renal pelvis

Intussusception (Target Sign)

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Intussusception (Target Sign)

Diagnostic Sonography Case Study No: CS-002

Step-i

Clinical history

Clinical History: A 2-year-old child presented with intermittent abdominal pain, vomiting, and episodes of crying with drawing up of the legs. Parents reported possible passage of blood-stained stool (currant jelly stool). Ultrasound examination was requested to evaluate for suspected intestinal obstruction or intussusception.

Step-ii

Imaging

Fig-1. Transverse ultrasound image of the abdomen demonstrates the classic "target sign" (also known as the doughnut sign), characterized by multiple concentric echogenic and hypoechoic rings. This appearance represents telescoping of one bowel segment into another, consistent with intestinal intussusception.

Step-iii

Diagnosis

Key diagnostic ultrasound signs:

a- Target sign / doughnut sign in transverse section
b- Pseudokidney sign in longitudinal section
c- Concentric bowel wall layers
d- Mesenteric fat and vessels dragged inside bowel lumen

Why Intussusception?

Target Sign Appearance: The most characteristic ultrasound feature is the target or doughnut sign, formed by concentric rings of invaginated bowel segments.

Telescoping of Bowel: One segment of intestine (intussusceptum) slides into the adjacent segment (intussuscipiens), producing layered bowel wall appearance.

Pseudokidney Sign: On longitudinal imaging, the intussuscepted bowel resembles a kidney-shaped mass due to bowel wall edema and mesenteric fat.

Mesenteric Fat Within Lesion: Mesenteric fat and vessels may be seen within the intussusception, confirming telescoping bowel loops.

Clinical Correlation: Children often present with intermittent abdominal pain, vomiting, and occasionally currant jelly stool.

Condition	Key Ultrasound Features
Intussusception	✔ Target / doughnut sign ✔ Pseudokidney appearance ✔ Concentric bowel layers ✔ Mesenteric fat within lesion
Bowel mass	✖ Solid mass without concentric rings ✖ No telescoping pattern
Appendicitis	✖ Non-compressible tubular structure ✖ Blind ending bowel loop
Enteritis	✖ Diffuse bowel wall thickening ✖ No concentric telescoping bowel loops

Step-iv

Differential Diagnosis

Possible conditions that may mimic intussusception on imaging include:

• Small bowel mass
• Enlarged lymph nodes
• Bowel wall edema from enteritis
• Meckel's diverticulum acting as lead point

Step-v

Documentation

Findings:
A well-defined bowel-within-bowel configuration is visualized in the right abdomen demonstrating the classic target sign on transverse scan and pseudokidney sign on longitudinal scan. Mesenteric fat and vessels are noted within the lesion. These findings are consistent with intestinal intussusception.

Conclusion:
Ultrasound findings are highly suggestive of ileocolic intussusception.

Recommendation:
Urgent pediatric surgical consultation is advised. Air or contrast enema reduction under fluoroscopic guidance may be considered as the first-line treatment.

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You have reached the end of this Intussusception – Ultrasound Case Study (Target Sign).

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled “Intussusception – Target Sign on Ultrasound” has been prepared solely for educational and academic purposes. The imaging findings, measurements, and interpretations are intended for learning and demonstration only. Definitive diagnosis requires clinical correlation, surgical evaluation, and appropriate specialist consultation.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Pediatric Radiology
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology

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Bladder tumor (Papillary Urothelial Carcinoma or TCC )

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Papillary Urothelial Carcinoma or Tumor

Diagnostic Sonography Case Study No: CS-001

Step-i

Clinical hystory

Clinical History: A 55-year-old male referred for ultrasound examination of the urinary bladder for diagnostic evaluation symptoms to include (hematuria, dysuria, frequency, pain).

Step-ii

Imaging

Fig-1. Ultrasound image of the urinary bladder shows an irregular echogenic intraluminal mass arising from the bladder wall, demonstrating internal vascularity on color Doppler. Findings are suggestive of a papillary urothelial carcinoma (bladder tumour).

Step-iii

Diagnos

Fig-2. Key point-
a-Exophytic / papillary mass
b-Vascular flow within lesion (rules out clot)
c-Projects into lumen
d-Arises from bladder wall

Why Papillary Urothelial Carcinoma?

This lesion is suspected to be papillary urothelial carcinoma because it shows the classic ultrasound characteristics of this tumor type:

Papillary / Polypoid Appearance- The mass projects into the bladder lumen rather than thickening the wall diffusely. Papillary tumors grow as finger-like or frond-like projections, which appear as an intraluminal echogenic mass on ultrasound.

Attachment to Bladder Wall- The lesion arises from the bladder wall, a typical origin of urothelial tumors.

Internal Vascularity on Color Doppler- Presence of internal blood flow confirms that this is a solid, viable tumor, not a clot or debris. Papillary urothelial carcinomas are usually vascular, unlike blood clots (which show no flow).

Irregular Surface but Preserved Bladder Lumen- Early or papillary tumors often show irregular margins without complete wall destruction. This appearance fits papillary carcinoma rather than infiltrative muscle-invasive disease.

Typical Clinical Correlation- Most patients present with painless hematuria, which is the hallmark symptom of papillary urothelial carcinoma.

Why NOT ?

• Bladder polyp –
• Blood clots –
• Sludge / debris –
• Inflammatory pseudotumor –

Condition	Key Ultrasound Features
Papillary urothelial carcinoma	✔ Fixed intraluminal bladder mass ✔ Arises from the bladder wall ✔ Irregular papillary surface ✔ Internal vascularity on Color Doppler
Bladder polyp	✖ Usually small and smooth ✖ Minimal or absent Doppler vascularity ✖ Typically benign
Blood clot	✖ No internal vascularity ✖ Often mobile or changes position ✖ Not attached to the bladder wall
Sludge / debris	✖ Non-vascular ✖ Gravity dependent and mobile ✖ Settles in the dependent portion of the bladder
Inflammatory pseudotumor	✖ Ill-defined mass or focal wall thickening ✖ Lacks typical papillary architecture ✖ Variable or minimal vascularity

Step-iv

Differential Diagnosis

Bladder polyp

Fig-3. A bladder polyp is a benign mucosal growth arising from the bladder wall. It is usually small, smooth, and well-defined. Doppler study typically shows little or no internal vascularity. Polyps are fixed to the bladder wall but lack aggressive features.

Blood clot

Fig-4. A blood clot or hematoma represents intravesical hemorrhage rather than a true mass. It has no internal vascularity on color Doppler and often changes position with patient movement or bladder filling. Blood clots are not attached to the bladder wall.

Sludge / debris

Fig-5. Sludge or debris consists of cellular material, pus, or blood products within the urine. It is non-vascular, gravity dependent, and mobile, settling in the dependent portion of the bladder. It does not form a true mass and lacks wall attachment.

Inflammatory pseudotumor

Fig-6. An inflammatory pseudotumor is a benign inflammatory lesion that can mimic a neoplasm. It usually presents as focal bladder wall thickening or an ill-defined mass. Vascularity may be variable, but papillary architecture is typically absent.

Step-v

Documentation

Findings:
An exophytic papillary mass is visualized arising from the urinary bladder wall, measuring approximately 45 × 34 mm. The lesion projects into the bladder lumen and appears fixed at its point of attachment. Internal vascular flow is demonstrated on color Doppler imaging, confirming the solid nature of the lesion and excluding an intravesical blood clot. The surrounding bladder wall at the site of origin shows focal involvement.

Conclusion:
Exophytic papillary intraluminal bladder mass arising from the bladder wall with internal vascularity, favoring a papillary urothelial tumor [? papillary urothelial carcinoma (TCC)].

Recommendation:
Urology consultation is advised. Cystoscopic evaluation with biopsy or transurethral resection is recommended for histopathological confirmation. Further staging workup may be considered based on histology.

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You have reached the end of this Urinary Bladder Tumor – Ultrasound Case Study.

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled “Exophytic Papillary Bladder Mass on Ultrasound” has been prepared solely for educational and academic purposes. The imaging findings, measurements, and interpretations are intended for learning and demonstration only. Definitive diagnosis requires clinical correlation, cystoscopic evaluation, histopathological confirmation, and appropriate specialist consultation.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Uro-Radiology
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology

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Dorsal Wall Ultrasound

End of Case Study

Whole Abdomen & Pelvis Sonography

End of Case Study

Transvaginal Sonography (TVS) – Pelvis (Female)

End of Case Study

Lower Abdomen or Pelvis Sonography (Female)

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Whole Abdomen & Pelvis Sonography

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