BAL GOPAL Imaging Centre

06/05/2026

22/02/2026

Ultrasound Diagnosis of Pr*****ed Endometrial Polyp
A pr*****ed endometrial polyp refers to an endometrial polyp arising from the uterine cavity that extends through the internal os into the cervical ca**l and sometimes protrudes into the va**na. Ultrasound plays a key role in its diagnosis.
📌 Clinical Presentation
Abnormal uterine bleeding (intermenstrual / postmenopausal)
Spotting
Occasionally mass protruding per vaginum
May be asymptomatic
🔎 Ultrasound Evaluation
1️⃣ Modality of Choice
Transva**nal sonography (TVS) – First-line investigation
Transabdominal scan – Helpful for large lesions
Saline infusion sonohysterography (SIS) – For better delineation
2️⃣ Gray-Scale (B-Mode) Findings
Well-defined echogenic mass within endometrial cavity
Mass seen extending through internal os into cervical ca**l
May appear as:
Homogeneous echogenic lesion
Heterogeneous if degeneration present
Identifiable pedicle/stalk connecting lesion to endometrium
Endometrial cavity may appear thickened
If pr*****ed further:
Polyp visualized within cervix or upper va**na
3️⃣ Color Doppler Findings (Key Diagnostic Feature)
Single feeding vessel entering the polyp (pedicle artery sign)
Vascularity confined to central stalk
Helps differentiate from:
Blood clots (avascular)
Submucosal fibroid (multiple peripheral vessels)
4️⃣ Saline Infusion Sonography (SIS)
Clearly outlines intracavitary lesion
Demonstrates:
Smooth margins
Pedunculated attachment
Mobility within cavity
📊 Differential Diagnosis
Condition
Key Differentiating Feature
Submucosal fibroid
Hypoechoic, broad-based, peripheral vascularity
Retained products
Irregular margins, increased vascularity
Blood clot
No internal vascularity
Cervical polyp
Arises from cervical ca**l, not endometrium
🧠 Important Ultrasound Pearls
Always trace the lesion to its site of origin.
Identify the internal os to confirm prolapse.
Use color Doppler to look for the single feeding vessel sign.
In postmenopausal women, any vascular polypoidal lesion warrants further evaluation.

16/02/2026

🌸 Nasal Bone Examination at NT–NB Scan (11–13+6 Weeks)
👩‍⚕️ For Radiologists & FMF Practitioners
The nasal bone (NB) assessment is an essential component of the first trimester NT–NB scan, performed between 11 weeks and 13 weeks + 6 days (CRL 45–84 mm). It is a valuable soft marker for aneuploidy, especially Trisomy 21.
🎯 Why Examine the Nasal Bone?
🔎 Absent or hypoplastic nasal bone is strongly associated with:
Down syndrome
Trisomy 18
Trisomy 13
📊 Seen in:
~60–70% of fetuses with Down syndrome
1–3% of euploid fetuses (ethnicity-dependent)
🖥️ Proper Technique (FMF Recommended)
✔ True midsagittal section
Same plane as NT measurement
Visualize:
Echogenic tip of nose
Rectangular palate
Diencephalon
✔ Image Magnification
Head and upper thorax occupy >75% of screen
✔ Angle of insonation
Ultrasound beam ~45° to nasal bone
Avoid underestimation due to shadowing
✔ Three-line sign
Skin (top echogenic line)
Nasal bone (brighter, thicker middle line)
Nasal tip
👉 Nasal bone should appear more echogenic than overlying skin
📏 Interpretation
Finding
Significance
✅ Present
Low risk (if other markers normal)
❌ Absent
Increased risk for aneuploidy
⚠ Hypoplastic
Soft marker; correlate with risk calculation
🌍 Ethnic Consideration
Higher incidence of absent NB in Afro-Caribbean population
Use population-adjusted risk models
📌 Clinical Integration
Nasal bone assessment should be combined with:
NT measurement
Ductus venosus Doppler
Tricuspid regurgitation assessment
Maternal serum biochemistry
For accurate risk calculation using validated software such as Fetal Medicine Foundation protocol.
📝 Reporting Tip (Sample Line)
Nasal bone is visualized and appears normally ossified in the midsagittal plane.
OR
Nasal bone is not visualized in the appropriate midsagittal plane; correlation with combined screening risk is advised.
✨ Pearl:
If unsure, re-evaluate after optimizing fetal position rather than overcalling absence.

12/02/2026

Female radiographer is required for xray procedure

01/02/2026

Ultrasound Diagnosis of Rectova**nal Fistula (RVF)

👉Definition
A rectova**nal fistula is an abnormal epithelialized communication between the re**um/a**l ca**l and the va**na, resulting in passage of gas or f***l matter through the va**na.

✔️Role of Ultrasound --

Ultrasound is a non-invasive, easily available, first-line imaging tool for suspected RVF, especially using transva**nal (TVS) and transperineal ultrasound (TPUS).

❗Ultrasound Techniques Used-

🗝Transva**nal ultrasound (TVS)
🗝Transperineal ultrasound (TPUS) – preferred for low RVF
🗝Endoa**l ultrasound (EAUS) – best for a**l sphincter involvement
🗝3D ultrasound – improves delineation of fistulous tract
🗝Color Doppler – to assess inflammatory hypervascularity.

🔦Key Ultrasound Findings
1. Direct Signs
*Hypoechoic or anechoic linear tract between re**um and va**na
*Disruption of normal rectova**nal septum
*Visible communication between re**al lumen and va**nal lumen
*Air echoes within va**na (echogenic foci with dirty shadowing)
2. Indirect Signs
*Thickened va**nal or re**al walls
*Periva**nal or perire**al inflammatory changes
*Fluid or gas in va**nal ca**l
*Associated abscess or collection in surrounding tissues.

Dynamic & Functional Assessment--
Valsalva maneuver may demonstrate movement of air or fluid through the tract

Re**al saline / hydrogen peroxide instillation can help outline fistula (bubble flow into va**na)

Compression technique may accentuate the tract

Doppler Findings
Increased vascularity around fistulous tract in active inflammation
Helps differentiate active vs chronic fistula.

✌Advantages of Ultrasound--

Bedside, non-radiating, cost-effective
Real-time and dynamic evaluation
Useful in post-obstetric injury, post-surgical cases, and Crohn’s disease
Helpful in pre-operative planning and follow-up.

👉Limitations--
Small or high fistulas may be missed
Operator-dependent
Limited field of view compared to MRI

➡ MRI pelvis remains the gold standard for complex or high RVF.

👍Conclusion
Ultrasound, particularly TVS and TPUS with 3D and Doppler, plays an important role in the initial diagnosis, localization, and assessment of rectova**nal fistula. It is an excellent screening and follow-up modality, with MRI reserved for complex cases.

27/01/2026

A case of complex cyanotic congenital heart defect detected at term pregnancy!!!

Findings-- Physiological Monoventricle ( right ventricular morphology) , atretic Mitral valve
, small left atrium, Both great vessels arising from physiological right ventricle, branching main pulmonary artery anterior, very narrow Aorta with flow revesrsal.

Complex, cyanotic congenital heart defect, typically representing a form of Single Ventricle Physiology or severe Hypoplastic Left Heart Syndrome (HLHS) variant.

The prognosis for this combination of defects is considered poor without prompt neonatal intervention and a series of palliative surgeries.

1. Understanding the Anatomy
Monoventricle (Single Ventricle): Only one ventricle is capable of acting as a functional pump. The other is severly hypoplastic (underdeveloped).

Atretic Mitral Valve (Mitral Atresia): The valve between the left atrium and left ventricle is closed or did not form. Blood cannot flow from the left atrium into the left ventricle, causing the left ventricle to be small (hypoplastic).

Double Outlet Right Ventricle (DORV): Both the aorta and pulmonary artery arise primarily from the right ventricle.
Combined Anatomy: Blood from the lungs returns to the left atrium, passes through an atrial septal defect (ASD/PFO) to the right atrium, mixes with body blood, enters the right ventricle, and is pumped to both the body (aorta) and lungs (pulmonary artery).

2. Significance of Flow Reversal in Aorta
Flow reversal (retrograde flow) in the aortic arch or isthmus, especially when combined with a single ventricle/mitral atresia, is a significant marker of pathology:
Indication of Coarctation/Obstruction: It strongly suggests critical Coarctation of the Aorta (CoA) or severe arch obstruction, where the left side of the heart is not contributing enough forward flow to the aorta.

Ductal Dependence: The lower body and cerebral circulation may be entirely dependent on flow from the right ventricle through a Patent Ductus Arteriosus (PDA) in a retrograde direction.

Poor Prognostic Sign: It indicates a high-risk state.

3. Management and Treatment
This is a critical, life-threatening situation requiring management in a high-volume pediatric cardiac center, usually involving:
Prostaglandin (PGE) Infusion: Immediately after birth to keep the ductus arteriosus open, allowing oxygenated blood to reach the body, as the left side of the heart is not functional.
Staged Palliation (Fontan Sequence):
Stage 1 (Neonatal Period): Norwood procedure or a variation to ensure unobstructed systemic blood flow (treating the coarctation) and controlled pulmonary blood flow.
Stage 2 (4–6 months): Bidirectional Glenn (superior vena cava connected to pulmonary artery).
Stage 3 (2–4 years): Fontan procedure (inferior vena cava connected to pulmonary artery).
4. Prognosis
Without Surgery: Survival is rare.
With Treatment: While it requires complex, high-risk interventions, many children with single-ventricle physiology can survive to adulthood with long-term, staged palliation, though they often face ongoing complications.

11/01/2026

Basic steps of fetal echocardiography!!!