BAL GOPAL Imaging Centre

28/07/2025

High Resolution Ultrasound is a valuable tool for diagnosing and assessing injuries to small tendons, particularly in the evaluation of tendonitis, tenosynovitis, and tears.
With advancements tiniest of tendons such as those in the hand, foot, and ankle can be evaluated.
Advantages of Ultrasound:
Non-invasive:
Ultrasound is a non-invasive imaging technique, meaning it doesn't involve needles or injections.
Real-time Imaging:
Ultrasound provides real-time images, allowing for dynamic assessment of tendon movement and function.
Relatively Inexpensive:
Compared to other imaging modalities like MRI, ultrasound is generally more affordable.
Dynamic Assessment:
Ultrasound can be used to assess the tendon during movement, which is crucial for evaluating tendon injuries and function.

Present case __ of young male with inability to flex left index finger after knife cut injury,on high resolution ultrasound complete tear of flexor digitorum superficialis tendon proximal to MCP joint with intact flexor digitorum profundus noted.

19/07/2025

LEFT SIDED CONGENITAL DIAPHRAGMATIC HERNIA picked up at first trimester anomaly scan (NT NB scan)!!!

Congenital diaphragmatic hernia (CDH), a birth defect where abdominal organs migrate into the chest cavity through a hole in the diaphragm,While typically diagnosed in the second or third trimester scan but high resolution advanced ultrasound techniques allow for the possibility of diagnosing CDH as early as in first trimester scan.
Present case- Gravida 2 with previous miscarriage came for NT NB scan, on Scan 72 mm CRL, low risk for Trisomies, growth restriction and Preeclampsia noted.
On careful scan abnormal dextroposition of heart in right hemithorax ( indicating right mediastinal shift) a herrogenous lesion in left hemithorax ( likely bowel loops) and fluid filled stomach in left abdominal position noted, diaphragmatic line on coronal plane show discontinuity on left side. High possibility of left CDH given ( dd- left thoracic mass) and suggested for CMA and WES and follow up for early TIFFA scan .
NT NB beyond NT and NB!!!!!!

07/07/2025

Asherman syndrome--
also known as uterine synechiae, is a condition characterized by the formation of intrauterine adhesions, which are usually sequela from injury to the endometrium and is often associated with infertility.

Pathology---

Intrauterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring . This may be from a previous pregnancy, dilation and curettage, surgery, or infection (e.g. TB endometritis).

The adhesions are composed of fibromuscular-connective tissue bands with or without surrounding superficial epithelial cells or glandular tissue.

Clinical presentation---

Patients may present with infertility, pregnancy loss, menstrual abnormalities or abdominal pain.

Present case ---- nullipara with Secondary Ammenorhea following D&E for incomplete abortion.
On 3D. TVS subseptate (partial septate) Uterus with thinner right horn Endometrium and interrupted right endometrial line in sagittal plane noted , S/O uterine synechiae/Asherman syndrome

28/06/2025

Happy to be part of the voluson club...

Brand new advanced high end 5D ultrasound machine ""GE voluson E6 BT 21 "" installed in our BAL GOPAL Imaging Centre Darbhanga, with 5 probes , Radiant flow and IOTA software.

1) C2-9 XD clear probe
(Specialised probe for fetal imaging work)
2) RAB 6 VOLUME 4 D Probe
3) RIC 5-9 Broadband TV 4D probe
4) C1-6 Regular Convex probe
5) 9L-Regular linear probe ( high pe*******on and wider field of vision)

With additional Features of
A) Realtime 4D
B) SonoVCAD Heart
C) Omniview
D) STIC
E) SONOCNS
F) HDLIVE (5D) (enhances 3D and 4D ultrasound imaging by providing a "see-through" view that improves visualization and understanding of fetal anatomy, aiding in diagnosis and assessment of various conditions. )
G) SONOAVC ANTRAL
H) IOTA software.( For ovarian tumor risk calculation).

Radiant flow is specialised technology which is 4D colour flow
( Colour flow which does not spill over i. e. wall to wall 4D colour flow).

IMAGE THAT AMAZE!!!

08/06/2025

Ruptured Ovarian ectopic pregnancy:---

Ovarian ectopic pregnancies are rare when compared to other types of ectopic pregnancy such as tubal ectopic.

The o***y is the anatomic site of less than 3% of ectopic pregnancies.

Present case-- young female with acute pelvic pain, denied of amenorrhea, on transabdominal scan complex pod collection noted, on TVS Ruptured ectopic pregnancy is located in the right o***y. The ovarian follicles are displaced towards the periphery, with accumulation of abundant fluid in the pelvic cavity.

14/05/2025

From nuchal translucency to intracranial translucency: towards the early detection of spina bifida.

Vast majority congenital anomalies can be detected on ultrasound and the most of these abnormalities can be detected on first trimester dedicated anomaly ultrasound.
A major remaining challenge in first-trimester ultrasonography has been the diagnosis of open spina bifida. This challenge, however, may now have been resolved by the realization that open spina bifida can be suspected by an easily detectable marker within the brain in the same mid-sagittal plane of the fetal face as for measurement of NT and assessment of the nasal bone. In normal fetuses the fourth cerebral ventricle presents as an intracranial translucency (IT) parallel to the NT, while in fetuses with open spina bifida there may be absence of the IT.

NT NB beyond NT and NB!!!!

Present case -- 58 mm CRL , came for NT NB scan , calculated trisomies risks low.
On careful mid sagittal view absence of intracranial translucency ,diagnosis of spina bifida was suspected, on careful examination open neural tube defect ( spina bifida) involving lumbar spine was noted.
Proper counselling done.

07/05/2025

03/05/2025

TRANSPERINEAL ULTRASOUND !!!

Transperineal ultrasound is a non-invasive imaging technique that uses sound waves to visualize the pelvic floor, including the a**l sphincter, urethra, and bladder.

This approach is particularly helpful in cases where transrectal or transvaginal ultrasound is not suitable, or when a more dynamic assessment is needed.

Cost-effective and readily available:
Compared to other imaging modalities like MRI, TPUS is generally less expensive and easier to perform.
Versatile:
TPUS can be used to assess various conditions, including:

Obstetric a**l sphincter injury: Assessing the integrity of the a**l sphincter after childbirth.

Pelvic floor prolapse: Visualizing the descent of pelvic organs during straining.

Fistulas and abscesses: Identifying and evaluating the course of fistulous tracts and abscesses in the peria**l region.

Pelvic floor dyssynergy: Assessing the coordination of pelvic floor muscles.

Assessment of mesh and slings: Evaluating the position and integrity of previously implanted mesh or slings.

Urethral conditions: Assessing the urethra and bladder, including bladder neck mobility and residual urine.

Present case of elderly female with unexplained hematuria, multiple ultrasound and x ray KUB normal report.
After careful transabdpminal and transvaginal ultrasound with no abnormalities , transperineal approach was attempted and an urethral mass detected which was confirmed clinically.

26/04/2025

Intracranial Hemorrhage of Prematurity:

Intraventricular hemorrhages aka Germinal Matrix/Subependymal bleeds are believed to happen due to poor autoregulation of premature infants, sudden changes in pressure or oxygen saturation can cause sudden reperfusion which ruptures of the tiny delicate vessels within the germinal matrix.

Prevalence:

Most of the Bleeds occur early
Day 1 50%
Day 2 25%
Day 3 15%
Day 4 10%
95% of all bleeds occur by day 9.

Categorized into 4 grades.

Sequlae of ICH
Cysts (porencephalic cysts and periventicular leukomalacia)
Encephalomalacia (necrosis of white matter with liquefaction and cavitation) ventricular dilatation.

70% infants with IVH are mild and resolve

15% will be severe

15% or less require shunts

Present case is of premature infant , Right sided Grade 4 and left sided Grade 3 Intraventricular hemorrhage.

27/03/2025

ROCKER BOTTOM FOOT!!

Rocker bottom foot or congenital vertical talus, is a rare fetal foot deformity characterized by a prominent heel and a rounded convex sole, prominent calcaneus and rigid forefoot dorsiflexion.

Associations--

aneuploidic syndromic
trisomy 13
trisomy 18
18q deletion syndrome

non-syndromic
spina bifida
arthrogryposis .

25/02/2025

Common arterial trunk (CAT)!!

Common arterial trunk is a rare congenital heart defect characterized by a single great artery connecting both ventricles, responsible for the pulmonary, systemic, and coronary circulation.

Occurs due to the failure of conotruncal septation during development of the fetus.

Associations

right-sided aortic arch

interrupted aortic arch

persistence of primitive aortic arches

DiGeorge syndrome

CHARGE syndrome

Treatment and prognosis

Due to the parallel nature of fetal circulation, truncus arteriosus does not result in significant hemodynamic disturbances in utero. However, after birth, when separate pulmonary and systemic circulations are required, this congenital heart defect becomes a critical issue. Without prompt surgical correction, approximately 70-85% of affected infants die within the first year , primarily due to complications such as congestive heart failure and pulmonary vascular disease.

Present case-- Gravida 2 , Para1 with previous healthy baby reffered for TGA ( given at some other center) .
On ultrasound left axis deviation ( levocardia) , malaligned VSD with overriding of a large vessel . Aorta and branches of pulmonary arteries arise from common trunk.
Common trunk having thick dysplastic valve, showing color aliasing and regurgitation.
Severely hypoplastic thymus noted.

14/02/2025

Fetal echocardiography is an integral part of TIFFA SCAN!!!

FETAL HETEROTAXY SYNDROME WITH COMPLEX CONGENITAL CARDIAC DEFECT ( AVSD WITH DORV)

Findings --- fetal stomach, liver, gallbladder to right, cardiac apex to left .
Common AV VALVE, both great vessels from right ventricle, narrow RVOT .
Hypoplastic nasal bone.