Dr_Hari Ram_radiology.

14/08/2025

🚨 Understanding Hypertrophic Pyloric Stenosis (HPS) in Infants 🚨



HPS is a condition where the pyloric muscle (connecting the stomach and small intestine) thickens, leading to gastric outlet obstruction.

Symptoms: Typically appear between 3 to 6 weeks of age, but can start earlier or later.

Look out for:

Nonbilious projectile vomiting, often after feeding.Constant hunger, despite vomiting.
Wavelike stomach contractions after feeding.
Dehydration and weight loss.

Diagnosis:

A doctor might feel an "olive-sized" mass in the baby's upper abdomen (the thickened pylorus).

Ultrasound is the preferred imaging method, providing a direct view of the pyloric muscle and avoiding radiation exposure.
Classic sonographic signs include the antral ni**le sign, cervix sign, and target sign.

Important: HPS can cause electrolyte imbalances, specifically hypochloremic metabolic alkalosis, due to loss of stomach acid from vomiting. Early diagnosis and treatment are crucial to prevent dehydration and malnourishment.

If you notice these symptoms in your infant, contact the healthcare provider immediately for prompt evaluation and treatment.

05/08/2025

Acute ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. Ovarian torsion should be considered a clinical diagnosis, and a high level of clinical suspicion is needed by the practitioner to ensure that this diagnosis is not missed.

Torsion of the o***y in the third trimester is rare as the compressive effect of the gravid uterus restricts the mobility of the ovarian pedicle. However this case clearly demonstrates that it can occur and needs to be considered as a differential diagnosis when patients present with an acute abdomen.

Additionally this highlights the difficulty in producing good quality radiological imaging of the pelvic organs in advanced pregnancy. Radiologists often have limited experience of pelvic imaging in the third trimester, so in all but the most experienced hand, a definitive diagnosis may not be forthcoming. This case serves to remind us of the importance of clinical acumen alongside diagnostic test as well as ensure that the correct incision is performed to ensure good surgical access. Furthermore, ultrasound scan examinations in early pregnancy should also address the cervix and the adnexa leading to early diagnosis and management of ovarian masses, thus avoiding later emergency situations and the possibility of preterm deliveries.

The patient presented at 30 weeks of gestation, with a 4-hour history of sudden, severe and constant abdominal pain in the left iliac fossa. She found changing position incredibly painful and examination displayed involuntary guarding and rigidity of the left side of her abdomen. The pain was associated with uncontrollable vomiting. There was no history of vaginal bleeding and normal fetal movements had been felt.

Ultrasound assessment demonstrated fetal heart movements, cephalic presentation, and an anterior high lying placenta. Internal os was closed and cervical length was 32 mm. Previous LSCS scar appear healthy for the gestation. On further examination left adnexal region demonstrated approx 6 x 4 cm sized left ovarian dermoid with twisted pedicle.

Fetal monitoring using cardiotocography was reassuring.

On opening the abdominal cavity through a midline laparotomy incision, a large purple but not necrotic left sided mass was noted.

The left o***y was then examined and it was torted thrice and appeared as a purple enlarged structure of 6 × 4 cm. There were some well perfused white parts noted on the o***y on close examination. A cystectomy of the left dermoid and evacuation of blood clots were performed.

01/08/2025

01/08/2025

Q: Assign chorionicity and amnionicity in this pregnancy?

Determining chorionicity (number of placentas) and amnionicity (number of amniotic sacs) in a pregnancy is crucial for proper management and to identify potential risks. This is best done with an ultrasound examination during the first trimester, ideally between 11+2 and 14+1 weeks gestation.

09/07/2025

03/05/2025

In cases of obstructive azoos***mia, dilated vas deferens and ejaculatory ducts can be observed on ultrasound. This finding suggests an obstruction in the reproductive tract preventing s***m from being released. Specifically, ultrasound may reveal dilation of the epididymal tubules, rete te**is, or the proximal vas deferens. In addition, transrectal ultrasound can better visualize dilated seminal vesicles or ejaculatory ducts, indicating an obstruction.

Other Imaging:

In some cases, further imaging like vasography (contrast injection into the vas deferens) or MRI may be used to evaluate the extent and nature of the obstruction.

Treatment:

The treatment for obstructive azoos***mia depends on the cause and location of the obstruction, and may include surgical repair of the vas deferens or ejaculatory ducts, or procedures like vasectomy reversal.

***mia

03/05/2025

An interstitial ectopic pregnancy, a type of tubal ectopic pregnancy, is diagnosed using ultrasound by identifying a gestational sac located within the intramural (uterine) part of the fallopian tube, outside the endometrial cavity, and surrounded by minimal myometrium (less than 5mm). The "interstitial line sign," an echogenic line connecting the gestational sac to the endometrial cavity, is a helpful indicator.

Key Ultrasound Findings for Interstitial Ectopic Pregnancy:

• Empty Uterine Cavity:
The endometrial cavity should be free of a gestational sac.
• Eccentric Gestational Sac:
The gestational sac is located laterally in the interstitial (intramural) part of the tube, outside the endometrial cavity.
• Thin Myometrial Mantle:
The myometrial layer surrounding the gestational sac is less than 5mm thick.
• Interstitial Line Sign:
An echogenic line extending from the endometrial cavity to the gestational sac is a characteristic finding.
• Intense Peri-trophoblastic Blood Flow:
Doppler ultrasound may reveal an increase in blood flow around the gestational sac.

3D Ultrasound can be helpful in visualizing the location of the gestational sac and assessing the thickness of the myometrial mantle, particularly in the fundal region of the uterus.

10/04/2025

Lens dislocation - The lens is seen floating en face in the vitreous chamber associated with vitreous hemorrhage and detachment.

10/04/2025

Transcervical migration of endometrial polyp prolapsing through the introitus.

Polyps can be a common cause of postmenopausal bleeding. In premenopausal women they may cause intermenstrual bleeding, metrorrhagia and infertility.

10/02/2025

Fetal megacystis refers to the presence of an unusually large urinary bladder in a fetus.
It can result from a number of causes but the main underlying mechanism is either distal stenosis or reflux.

Associated anomalies are common and include:
-posterior urethral valves
-chromosomal anomalies
-oligohydramnios
-megacystis microcolon intestinal hypoperistalsis (MMIH) syndrome (Berdon syndrome)
-megacystis megaureter syndrome
-prune belly syndrome

The overall prognosis can be variable from progressive obstruction to spontaneous resolution. A follow-up ultrasound is necessary to correctly interpret the significance of megacystis detected in the first trimester.

Management will depend on the underlying pathology.

10/02/2025

Dancing Sperm😊

Dancing megas***m is the ultrasound finding of continuously oscillating tiny echogenic foci within dilated tubules of the epididymis.

This is seen in post-vasectomy patients and others with obstruction of the s***matic cord and is thought to represent clumps of trapped s***matozoa which oscillate due to the turbulence created during ultrasound interrogation of the sc***um.

The first differential diagnosis to consider in this case was lymphatic scrotal filariasis.

***mia

10/02/2025

Weigert-Meyer law

With duplex kidney and complete ureteral duplication, the upper renal and lower renal moieties are drained by separate ureters, each having its own ureteral or***ce in the bladder.

upper renal moiety ureter has ectopic insertion medial and inferior to the lower renal moiety ureter, and frequently ends in a ureterocele

lower renal moiety ureter has orthotopic insertion lateral and superior to the upper renal moiety ureter, and vesicoureteral reflux can occur.