Septated pleural effusion

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Right
Septated pleural effusion

Septated pleural effusion ultrasound case study

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Pleural Pathology

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Septated pleural effusion ultrasound case study

CASE–1

Clinical History

A 65-year-old male was referred for thoracic ultrasound due to fever, cough, pleuritic chest pain, dyspnea, or persistent right-sided pleural effusion. There may be a history of pneumonia, tuberculosis, trauma, or previous thoracic surgery.

Ultrasound Findings

Ultrasound examination demonstrates a moderate to large right pleural fluid collection with multiple internal septations and fine fibrin strands. The pleural fluid shows complex echogenicity with loculations. Mild pleural thickening is noted. Adjacent right lung compression with partial atelectatic changes is present. No definite pleural mass is identified. Color Doppler demonstrates no internal vascularity within the pleural collection.

Report Line

A complex septated pleural fluid collection is seen in the right pleural cavity, measuring approximately ____ × ____ mm. Multiple internal septations and fibrin strands are noted within the pleural fluid with associated mild pleural thickening. Adjacent compressive atelectatic changes are present in the right lung. No internal vascularity is demonstrated on color Doppler imaging. Findings are suggestive of a complex right-sided septated pleural effusion.

Impression

Features are consistent with a complex right-sided septated pleural effusion with associated adjacent compressive atelectatic changes. Clinical correlation is recommended to exclude a complicated parapneumonic effusion or empyema.

Key Learning Points

• Septated pleural effusion represents a complex pleural fluid collection with fibrin deposition and loculation.
• Ultrasound is superior to chest radiography for demonstrating septations and internal echoes.
• Complex septated effusions commonly occur in complicated parapneumonic effusion, empyema, tuberculosis, hemothorax, or malignant pleural effusion.
• Color Doppler usually demonstrates no internal vascularity within the pleural fluid.
• Adjacent lung compression and partial atelectasis are common findings.
• Ultrasound is valuable for guiding diagnostic thoracentesis and chest tube placement.
• Clinical findings and pleural fluid analysis are essential for determining the underlying etiology.

Recommendation

Clinical and laboratory correlation is recommended. Correlation with pleural fluid analysis should be considered when clinically indicated. Ultrasound-guided thoracentesis or chest tube drainage may be required depending on the clinical condition. Contrast-enhanced CT of the thorax may be performed for further evaluation if clinically indicated.

X-ray Correlation

Chest radiograph (PA/AP and lateral views) typically demonstrates a right pleural opacity with blunting of the right costophrenic angle. In loculated septated pleural effusion, the opacity may appear lenticular or non-dependent rather than freely layering. Adjacent right lower lobe compressive atelectasis or consolidation may be present. Internal septations are not visualized on plain radiography.

X-ray Findings

Chest radiograph demonstrates a homogeneous pleural-based opacity occupying the lower to mid right hemithorax with obliteration of the right costophrenic angle. The opacity has a loculated appearance with adjacent compressive atelectatic changes of the right lower lung. No pneumothorax is identified. Cardiomediastinal silhouette is within normal limits or mildly displaced depending on the size of the pleural collection.

X-ray Report Line

Homogeneous pleural-based opacity is seen in the right lower hemithorax with blunting of the right costophrenic angle. The opacity demonstrates a loculated appearance with adjacent compressive atelectatic changes of the right lower lobe. Findings are suggestive of a complex right-sided pleural effusion. Ultrasound correlation demonstrates internal septations, consistent with a septated pleural effusion.

Pleural Empyema

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Right
Pleural Empyema

Pleural Empyema ultrasound case study

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Pleural Pathology

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Pleural Empyema ultrasound case study

CASE–1

Clinical History

7y old Patient was referred for thoracic ultrasound due to fever, pleuritic chest pain, cough, dyspnea, or persistent right-sided pleural effusion. There may be a history of pneumonia, thoracic surgery, trauma, or tuberculosis.

Ultrasound Findings

Ultrasound examination demonstrates a moderate to large right pleural collection with complex internal echogenicity. Multiple internal septations and fibrin strands are noted within the pleural fluid. The collection appears loculated with associated pleural thickening. The adjacent right lung is compressed with partial atelectatic changes. No obvious solid pleural mass is identified. Color Doppler demonstrates no internal vascularity within the pleural collection.

Report Line

A complex loculated pleural fluid collection is seen in the right pleural cavity, measuring approximately ____ × ____ mm. Internal echoes, fibrin strands, and multiple septations are present with associated pleural thickening. Adjacent compressive atelectatic changes are noted in the right lung. No internal vascularity is demonstrated on color Doppler imaging. Findings are suggestive of right-sided empyema.

Impression

Features are consistent with right pleural empyema with complex septated pleural collection and adjacent compressive atelectatic changes.

Key Learning Points

• Empyema is an infected pleural fluid collection and represents a complicated parapneumonic effusion.
• Ultrasound typically demonstrates complex pleural fluid with internal echoes, fibrin strands, and septations.
• Pleural thickening and loculations strongly favor empyema over simple pleural effusion.
• Color Doppler usually shows no internal vascularity within the pleural collection.
• Adjacent lung compression or atelectatic changes are commonly present.
• Ultrasound is valuable for detecting septations and guiding diagnostic aspiration or chest tube placement.
• Differential diagnoses include complicated parapneumonic effusion, hemothorax, malignant pleural effusion, and chronic organized pleural collection.

Recommendation

Urgent clinical correlation is recommended. Correlate with inflammatory markers and pleural fluid analysis. Image-guided thoracentesis or chest tube drainage should be considered when clinically indicated. Contrast-enhanced CT of the thorax may be performed to assess the extent of empyema and evaluate associated pulmonary pathology.

X-ray Correlation

Chest radiograph (PA/AP and lateral views) typically demonstrates a moderate to large right pleural opacity with a meniscus or lenticular configuration. In loculated empyema, the opacity may appear lentiform or biconvex rather than freely layering. Blunting of the right costophrenic angle is present with adjacent right lower lobe compressive atelectatic changes or consolidation. Pleural thickening may be evident in chronic cases. Air-fluid level may be seen if a bronchopleural fistula or gas-forming organism is present.

X-ray Findings

Chest radiograph demonstrates a homogeneous pleural-based opacity occupying the lower to mid right hemithorax with obliteration of the right costophrenic angle. The collection has a lenticular configuration suggestive of loculated pleural fluid. Adjacent right lower lung compressive atelectatic changes are noted. No evidence of pneumothorax is seen. Cardiomediastinal silhouette is within normal limits or mildly shifted depending on the volume of the pleural collection.

X-ray Report Line

Homogeneous pleural-based opacity is seen involving the right lower hemithorax with blunting of the right costophrenic angle. The opacity demonstrates a lenticular/loculated appearance with adjacent compressive atelectatic changes of the right lower lobe. Findings are highly suggestive of a loculated right pleural empyema. Correlation with thoracic ultrasound and contrast-enhanced CT chest is recommended for further evaluation.

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Vaginal cyst

Vaginal cyst ultrasound case study

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Vaginal Pathology

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Vaginal cyst

Vaginal cyst ultrasound case study

CASE–1

Clinical History

Patient presents with a painless or mildly painful vaginal swelling, sensation of a vaginal lump, discomfort during walking or sitting, dyspareunia, or incidental detection during gynecological examination. The patient was referred for pelvic/perineal ultrasound to characterize the vaginal cystic lesion.

Ultrasound Findings

Ultrasound examination demonstrates a well-defined, thin-walled, anechoic cystic lesion arising from the vaginal wall. The lesion shows posterior acoustic enhancement without internal septations, solid components, or mural nodules. No internal vascularity is demonstrated on color Doppler imaging. The surrounding soft tissues appear normal with no evidence of inflammatory changes or abscess formation. The uterus, cervix, and bilateral ovaries are unremarkable.

Report Line

A well-defined thin-walled anechoic cystic lesion is seen arising from the vaginal wall, measuring 2.8 × 2.1 × 2.4 cm. The lesion demonstrates posterior acoustic enhancement without internal septations, solid components, or internal vascularity. No surrounding inflammatory changes are identified. The findings are consistent with a simple vaginal cyst.

Impression

Features are consistent with a simple vaginal cyst. No suspicious solid component or evidence of infection is identified.

Key Learning Points

• Vaginal cysts are uncommon benign lesions and are often discovered incidentally.
• Common types include Gartner duct cysts, Müllerian cysts, epidermal inclusion cysts, and Bartholin gland cysts (located at the vaginal introitus).
• Ultrasound typically demonstrates a well-defined anechoic cyst with posterior acoustic enhancement.
• Absence of internal vascularity, mural nodules, or solid components favors a benign cyst.
• Large cysts may cause dyspareunia, pelvic discomfort, urinary symptoms, or vaginal fullness.
• Differential diagnoses include urethral diverticulum, Bartholin gland cyst, vaginal abscess, cystocele, rectocele, and cystic vaginal neoplasms.
• MRI may be useful when the site of origin or relationship to adjacent pelvic structures is uncertain.

Recommendation

Clinical gynecological correlation is recommended. Asymptomatic simple vaginal cysts generally require observation only. Symptomatic, enlarging, infected, or atypical cysts should undergo further evaluation with gynecological consultation, and surgical excision may be considered when clinically indicated.

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Right ovarian Live Ectopic pregnancy

Right ovarian Live Ectopic pregnancy ultrasound case study

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Ovaries Pathology

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Right ovarian Live Ectopic pregnancy ultrasound case study

CASE–1

Clinical History

Patient presents with amenorrhea, positive urine/serum pregnancy test, lower abdominal pain, and/or vaginal bleeding. The patient was referred for pelvic ultrasound to evaluate the location and viability of the pregnancy.

Ultrasound Findings

Ultrasound examination demonstrates an extrauterine right adnexal gestational sac containing a live embryo with demonstrable cardiac activity. The gestational sac is separate from the right ovary and corresponds to a right tubal ectopic pregnancy. The uterus is empty with no evidence of an intrauterine gestational sac. A corpus luteum is noted within the right ovary. Mild to moderate free fluid may be present in the pouch of Douglas. No sonographic evidence of adnexal rupture is identified.

Report Line

A right ovarian gestational sac containing a live embryo is identified within the right ovary. The crown–rump length (CRL) measures 10.02 mm, corresponding to a calculated ultrasound age (CUA) of 7 weeks 1 day. Fetal cardiac activity is present with a fetal heart rate (FHR) of 147 bpm. No intrauterine gestational sac is identified. Mild free pelvic fluid is present without definite sonographic evidence of rupture. The findings are consistent with a live right ovarian ectopic pregnancy.

Impression

Features are consistent with a live right ovarian ectopic pregnancy. No intrauterine pregnancy is identified. Mild free pelvic fluid is noted without definite sonographic evidence of rupture. Urgent gynecological consultation is recommended.

Key Learning Points

• Ovarian ectopic pregnancy is a rare form of ectopic gestation accounting for less than 3% of all ectopic pregnancies.
• Ultrasound demonstrates a gestational sac located within the ovarian parenchyma, separate from the fallopian tube.
• Visualization of a live embryo with cardiac activity confirms a live ovarian ectopic pregnancy.
• An empty uterine cavity in the presence of a positive pregnancy test strongly supports the diagnosis.
• Careful assessment for ovarian rupture and hemoperitoneum is essential.
• Differential diagnoses include corpus luteum cyst, hemorrhagic ovarian cyst, ruptured ovarian cyst, and tubal ectopic pregnancy.
• Prompt diagnosis is important because ovarian ectopic pregnancy is a gynecological emergency.

Recommendation

Immediate gynecological consultation is recommended. Correlation with quantitative serum β-hCG levels and clinical findings is advised. Appropriate medical or surgical management should be instituted promptly based on the patient's hemodynamic status and sonographic findings.

Polycystic Ovary Syndrome (PCOS/PCOD)

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Beaver Tail Liver

PCOS/PCOD ultrasound case study

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Ovarys Pathology

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Polycystic Ovary Syndrome (PCOS/PCOD) ultrasound case study

CASE–1

Clinical History

Patient was referred for pelvic ultrasound due to irregular menstrual cycles, infertility, hirsutism, acne, or suspected polycystic ovarian syndrome. Clinical and biochemical correlation is advised.

Ultrasound Findings

Ultrasound examination demonstrates bilateral enlarged ovaries containing multiple small peripheral follicles measuring approximately 2–9 mm in diameter, arranged in a characteristic "string of pearls" appearance. The ovarian stroma appears mildly increased in echogenicity with increased stromal volume. No dominant follicle, adnexal mass, or free fluid is identified. The uterus demonstrates normal size and echotexture.

Report Line

Both ovaries are enlarged and demonstrate multiple (≥10) small peripheral follicles measuring approximately 2–9 mm with increased central stromal echogenicity, producing a characteristic "string of pearls" appearance. The findings are suggestive of bilateral polycystic ovaries (PCOD/PCOS morphology). Clinical and biochemical correlation is recommended.

Impression

Features are consistent with bilateral polycystic ovarian morphology (PCOM), suggestive of PCOD/PCOS in the appropriate clinical setting. Correlation with clinical findings and hormonal profile is recommended for the diagnosis of polycystic ovary syndrome.

Key Learning Points

• PCOS is diagnosed using a combination of clinical, biochemical, and imaging findings.
• Ultrasound typically demonstrates bilateral enlarged ovaries with multiple peripheral follicles measuring 2–9 mm.
• Increased ovarian stromal volume and echogenicity are common sonographic features.
• The characteristic "string of pearls" appearance supports the diagnosis of polycystic ovarian morphology.
• Ultrasound findings alone do not establish the diagnosis of PCOS.
• Differential diagnoses include multifollicular ovaries, ovarian hyperstimulation, and normal physiological follicular development.
• Clinical correlation using the Rotterdam criteria is essential for definitive diagnosis.

Recommendation

Correlation with clinical symptoms, serum hormonal profile, and the Rotterdam diagnostic criteria is recommended. Gynecological or endocrinological consultation may be considered for comprehensive evaluation and management.

Post-injection Gluteal hematoma (intramuscular )

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Post-injection
Gluteal Hematoma

Intramuscular gluteal hematoma ultrasound case study

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Reporting Panel

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Buttock Pathology

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Case Study

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Post-injection Gluteal Hematoma (Intramuscular)

CASE–1

Clinical History

Patient presents with painful swelling in the gluteal region following recent intramuscular injection.

Ultrasound Findings

Ultrasound examination of the gluteal region demonstrates a heterogeneous intramuscular collection within the gluteal musculature at the injection site. Internal echogenic clot/debris is seen. No significant internal vascularity is demonstrated on color Doppler imaging. Mild surrounding soft tissue edema may be present. No definite abscess formation is identified.

Report Line

A well-defined heterogeneous intramuscular collection is seen within the gluteal musculature at the site of recent intramuscular injection, measuring approximately ____ × ____ × ____ mm. Internal echogenic debris/clot is present without significant internal vascularity on color Doppler imaging. Mild surrounding soft tissue edema may be noted. The ultrasound features are consistent with a post-injection intramuscular gluteal hematoma. No sonographic evidence of abscess formation is identified.

Impression

Ultrasound features are suggestive of post-injection intramuscular gluteal hematoma.

Key Learning Points

• Recent intramuscular injection history is an important clue.
• Hematoma appears as a heterogeneous intramuscular collection.
• Internal echoes/debris may represent clot material.
• Color Doppler usually shows no internal vascularity.
• Peripheral hyperemia may suggest inflammation or secondary infection.
• Abscess, injection granuloma, seroma, and soft tissue tumor are important differentials.

Recommendation

Clinical correlation is advised. Follow-up ultrasound may be considered if swelling increases, pain persists, fever develops, or secondary infection is suspected.

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Normal Chest X-Ray PA view

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NORMAL
CXR-PA VIEW

Understanding a Healthy Chest X-Ray Appearance

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Chest Pathology

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Case Study

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Normal Chest X-Ray (PA View)

CASE–1

Clinical History

Routine chest radiograph performed for baseline evaluation.

Findings

PA chest radiograph demonstrates normal cardiac size and mediastinal contours. Both lungs are adequately expanded and clear. No focal consolidation, collapse, pleural effusion, or pneumothorax is identified. Hilar structures appear normal. Costophrenic angles are preserved. No acute osseous abnormality is evident on the visualized thorax.

Impression

Normal PA chest radiograph. No active cardiopulmonary abnormality.

Key Learning Points

• Normal cardiomediastinal silhouette.
• Clear lung fields.
• Sharp costophrenic angles.
• No pleural effusion.
• No pneumothorax.