BAL GOPAL Imaging Centre

23/11/2025

19/11/2025

𝐀𝐠𝐠𝐫𝐞𝐬𝐬𝐢𝐯𝐞 𝐝𝐞𝐞𝐩 𝐞𝐧𝐝𝐨𝐦𝐞𝐭𝐫𝐢𝐨𝐬𝐢𝐬 (𝐃𝐈𝐄) !!!

Aggressive deep endometriosis (DIE) is the most severe form of endometriosis, where lesions pe*****te more than 5 mm deep into tissues and organs like the bowel and bladder.

This can significantly impact quality of life and disrupt the anatomy and function of the pelvic organs, leading to symptoms like chronic pelvic pain, painful bowel movements, and infertility.

𝐖𝐡𝐚𝐭 𝐢𝐬 𝐝𝐞𝐞𝐩 𝐢𝐧𝐯𝐚𝐬𝐢𝐨𝐧 ??

DIE is defined by endometriotic lesions that grow deep into organs, beyond the normal peritoneal lining over (5 mm).

𝑨𝒈𝒈𝒓𝒆𝒔𝒔𝒊𝒗𝒆 𝒏𝒂𝒕𝒖𝒓𝒆
It is considered the most aggressive form because it can significantly alter the anatomy and function of vital organs.

𝑶𝒓𝒈𝒂𝒏 𝒊𝒏𝒗𝒐𝒍𝒗𝒆𝒎𝒆𝒏𝒕
It often affects organs in the pelvic region, most commonly the bowel and urinary bladder.

𝟯𝗗 𝘂𝗹𝘁𝗿𝗮𝘀𝗼𝘂𝗻𝗱 𝗶𝗺𝗮𝗴𝗶𝗻𝗴 is
now preferred and first-line imaging technique for assessment of endometriosis, including deep infiltrating endometriosis.

3D transvaginal ultrasound is much more readily accessible, less expensive and less time-consuming than MRI.

Real-time endometriosis ultrasound imaging allows for the evaluation of areas of tenderness and the use of the sliding sign for a more thorough assessment of the pelvis. Bowel peristalsis does not affect ultrasound imaging as it does MRI.

Present case-- case of primary infertility , severe dysmenorrhoea, dyspareunia . Multiple trans abdominal USG done with inconclusive reports, HSG report of bilateral tubal block. Came for transabdominal USG , keeping in view of above symptoms tvs was attempted.
On 3D tvs USG case of aggressive deep endometriosis with frozen pelvis seen.

13/11/2025

Herlyn-Werner-Wunderlich (HWW) syndrome ,
also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome!!!

is a rare anomaly characterized by Müllerian duct anomalies (MDA) associated with mesonephric duct anomalies .

Clinical presentation
Presentation is typically after menarche with pelvic pain due to the obstructed hemivagina. There may be a palpable pelvic mass.

Pathology--
characterized by a triad of type III Müllerian duct anomaly (uterus didelphys), obstructed hemivagina and mesonephric duct anomalies. Most often renal agenesis, but duplicated kidneys, dysplastic kidneys, rectovesical bands or crossed fused ectopia may also be seen.

Treatment is surgical--with resection of the septum dividing the two hemivaginas in order to relieve the obstruction.

11/10/2025

A high-resolution ultrasound machine is crucial for first-trimester fetal heart screening because its advanced technology enables the visualization of detailed cardiac structures that might otherwise be missed. It allows for the assessment of the heart's position, the four-chamber view, and the great vessels (aorta and pulmonary artery) in the first trimester, which can lead to early detection of potential congenital heart defects (CHDs). This early diagnosis facilitates better planning for postnatal care and can significantly improve outcomes for the infant.

Role in early screening--

Detailed visualization: High-resolution technology provides clearer and more detailed images, making it easier to identify small or subtle abnormalities that may not be visible on standard equipment.

Early detection of anomalies: It allows for the detection of significant CHDs during the first trimester, enabling early intervention and care planning.

Assessing basic cardiac structure: A detailed diagnostic scan can assess the heart's position and axis, and the four-chamber view with and without color Doppler to see blood flow. The three-vessel and trachea view can also be evaluated.

Improving accuracy: While not all CHDs can be detected in the first trimester, a high-resolution scan, particularly in high-risk pregnancies, has been shown to have high sensitivity and specificity for detecting a significant portion of major cardiac abnormalities.

Benefits of early detection
Improved planning: Knowing about a potential defect early allows healthcare providers to plan for delivery in a specialized center and prepare the necessary medical and surgical care.

Informing prognosis: Identifying the type of defect and potential associated genetic abnormalities helps in providing a more accurate prognosis to the parents.

Potential for fetal treatment: In some cases, early identification may open up the possibility of in-utero treatment options.

✔️present case-- primi came for second opinion after raised NT and low risk in NIPT, 86 mm CRL.
On careful examination abnormal 4 chamber heart (small right cardiac chambers) , no flow across TV, abnormal 3 VT -- which suggests a complex cardiac diffect ( ?hypoplastic right heart syndrome) , warrants an early detailed fetal echocardiography.

NT NB beyond NT and NB!!

05/10/2025

An intrathoracic kidney❗

-- is a rare congenital anomaly where one or both kidneys are displaced upward into the chest cavity, above the diaphragm and into the mediastinum. This condition is a form of renal ectopia and is often found incidentally on chest imaging due to its typically asymptomatic nature. It is more common on the left side, more prevalent in males, and can be associated with other birth defects like congenital diaphragmatic hernias.

🔑Key Characteristics

Congenital Anomaly:Intrathoracic kidneys are present from birth.

‼️Rarity:It is a very rare form of an ectopic kidney, accounting for only about 5% of all ectopic kidneys.

✔️Location:The kidney is located above the hemidiaphragm and within the mediastinal compartment of the thorax.

🔸Asymptomatic:Many people with an intrathoracic kidney have no symptoms and are diagnosed by chance during an evaluation for another reason.

🔸Incidental Discovery:It is often discovered incidentally on a chest X-ray or other imaging studies, appearing as a "mass" in the chest.

🔸Association with Other Anomalies:It can be associated with congenital diaphragmatic hernias (like a Bochdalek hernia), where abdominal organs herniate into the chest, and can also be linked with other rare conditions like pulmonary sequestration.

✔️Causes and Associations

The exact cause is related to the developmental anomaly that allows the kidney to fail to descend into its usual position in the abdomen.

The majority of intrathoracic kidneys are found on the left side.

There is a higher incidence in males.

👉Diagnosis

Chest X-ray:Often reveals a soft tissue opacity in the lower thorax, resembling a mass or hernia.

CT Scan:Provides detailed images to confirm the kidney's position and assess for any associated abnormalities.

👉Present case - 6 years old female baby with features of jaundice came for ultrasound, on scan right renal fossa was empty , right sided normal sized kidney seen in right hemithorax above diaphragm.
on x ray correlation an opacity at the right lung base with a smooth outline and visible lung vascularity through it noted. The right hemidiaphragm silhouette remains visible as does the right heart border, indicating that this is not within the right lung itself.

27/09/2025

Leiomyoma of the seminal vesicle!!!

seminal vesicle leiomyoma is an extremely rare benign smooth muscle tumor that arises from the smooth muscle cells of the seminal vesicle, a part of the male reproductive system. While usually benign, these tumors can grow to a large size, leading to symptoms of lower urinary tract obstruction such as difficulty urinating, straining, and increased frequency of urination.

🔑Characteristics

Benign Nature:

Seminal vesicle leiomyomas are typically benign, meaning they are not cancerous and have a low risk of malignant transformation.

🔦Rarity:

These are very uncommon tumors, with few cases reported in medical literature.

🗝Origin:
They originate from the smooth muscle cells intrinsically found within the seminal vesicle.

👉Symptoms

Large leiomyomas can press on surrounding structures, causing symptoms that may include:
Urinary Symptoms:
Hesitancy, straining, dribbling, and increased urinary frequency (polyuria).
Pain:
Lumbar pain or perineal pain.
Gastrointestinal Symptoms:
Constipation or re**al urgency.

🤔Prognosis
While benign, untreated large tumors can lead to serious urinary system disease.
Prompt diagnosis and removal usually result in a full recovery.

21/09/2025

Morel-Lavallée lesion!!!

Morel-Lavallée lesions are closed degloving injuries associated with severe trauma which then present as hemolymphatic collections or masses occurring deep to subcutaneous plane due to disruption of capillaries.
The lesions classically occur over the greater trochanter of the femur.

Morel-Lavallée lesions typically occur when the skin and subcutaneous fatty tissue traumatically and abruptly separate from the underlying fascia.

The initial injury represents a shearing of subcutaneous tissues away from underlying fascia/muscles along interfascial planes.

The initial potential space created superficial to the fascia is filled with various types of fluid, ranging from serous fluid to frank blood.

On Ultrasound--
Typically these lesions are anechoic or hypoechoic. As with a standard hematoma, it can be predominantly echogenic in the acute phase, becoming more hypoechoic as blood products liquefy over time . Internal debris, including fat globules, can give rise to echogenic foci or even fluid-fluid levels . A capsule of variable thickness may be seen. The shape may range from flat to mass-like.

31/08/2025

3D TVS (Three-Dimensional Transvaginal Ultrasound) in infertility...

3D TVS is a valuable, advanced diagnostic tool that provides detailed, three-dimensional views of the uterus, ovaries, and surrounding structures, superior to traditional 2D ultrasound. It aids in identifying congenital uterine anomalies, intrauterine pathologies like polyps and fibroids, assessing ovarian function, and monitoring follicle growth. 3D TVS offers enhanced diagnostic accuracy and helps in personalized treatment planning for infertility.

3D TVS is especially valuable in diagnosing Mullerian Anomalies, especially cases of unicornuate uterus, which can not be diagnosed by 2D TVS or TAS scans.

3D TVS provides multiple orthogonal planes, including a surface-rendered image in the coronal view, which clearly shows the unique elongated and curved shape of the single uterine horn and the absence of the second horn.
Studies have shown that 3D ultrasound is a highly sensitive and specific method for detecting unicornuate uteri, with high agreement rates when compared to hysteroscopy and MRI.

Benefits of 3D TVS

Non-invasive: It is a non-invasive imaging technique.

Comprehensive Anatomy: It provides detailed, comprehensive anatomical information.

Treatment Planning: It aids in planning and executing appropriate surgical interventions.