This document summarizes several ultrasound examinations performed by Dr. Arun Gupta and colleagues. It includes summaries of chorionic-amniotic separation, angulation in the fetal spine, giant cell tumor of the tendon sheath, pelvic floor ultrasound examining the levator sling, ureterocoele, and stenosis of the spermatic artery. Definitions, ultrasound findings, and images are provided for each condition.

1. Dr Arun Gupta
Director imaging
Dr Rakhee gupta
Dr Vinayak Mittal
Dr Niharika Mahajan
Dr Gaurav Sharma
Dr Ritesh Mahajan
ADVANCED USG LOUNGE
•C H O R I O A M N I O N S E P A R A T I O N .
•A N G U L A T I O N I N F E T A L S P I N E .
•G C T O F T E N D O N S H E A T H
•P E L V I C F L O O R ( L E V A T O R S L I N G
A N D C H R O N I C L E V A T O R M U S C L E
I N J U R Y .
•U R E T E R O C E L E
•S M A S T E N O S I S ( A T O S T I A D U E
T O C A L C I F I E D P L A Q U E S ) .

2. AMNION SEPARATION
APPRECIATED
3D RENDERED IMAGE OF THE
CHORIO-AMNION SEPARATION.
Chorio-Amnion Separation

3. DEFINITION COMPLICATIONS
 Chorioamniotic separation
(CAS) is an intra-uterine event which
can occur in pregnancy and is
characterised by separation of
placental (chorion) and fetal
(amnion) membranes.
 Sonographic detection of a small
chorioamniotic membrane
separation especially before 14 weeks
gestation is considered a benign
incidental finding. A careful search
for aneupliodic and other
developmental anomalies is often
recommended if a spontaneous
chorioamniotic separation is detected
after 14 weeks.
 Recognised
complications
following a large
separation include :
1. Miscarriage
2. In utero fetal death umbilical cord
complications
3. Pre-term delivery
4. Amniotic band formation
CAS ( CHORIO-AMNION SEPARATION)

4. NORMAL G SAC WITH
NORMAL YOLK SAC
CHORIO-AMNION SEPARATION

5. NT/ NB SCAN DONE
3D RENDERED IMAGE
OF THE FETAL SPINE.
Angulation in Fetal spine
ANGULATION
IN FETAL SPINE

6. FREE HAND STRAIN ELASTOGRAPHY IMAGE
SHOWS MOSIAC PATTERN OF THE LESION
(S/O BENIGN ETIOLOGY)
HYPOECHOIC LESION WITH
INTERNAL VASCULARITY
GIANT CELL TUMOR
OF THE TENDON SHEATH

7. DEFINITION GCTTS
ULTRASOUND FINDINGS
ARE
 Giant cell tumours of the
tendon sheath (GCTTS), also
known as pigmented
villonodular tumour of the
tendon sheath
(PVNTS) or extra-articular
pigmented villonodular
tumour of the tendon
sheath, are uncommon and
usually benign lesions that arise
from the tendon sheath. It is
unclear whether these lesions
represent neoplasms or merely
reactive masses.
 Ultrasound
 Ultrasound is useful as it allows not only
the characterisation of the lesion but also
is able to demonstrate the relationship
with the adjacent tendon. On dynamic
scan, there is free movement of the
tendon within the lesion. Typically they
appear as:
 associated with the volar surface of the
digits
 does not move with flexion or
extension of adjacent tendons
 usually homogeneously hypoechoic,
although some heterogeneity may be
seen in echotexture in a minority of
cases
 most will have some internal
vascularity
GIANT CELL TUMOR
OF THE TENDON SHEATH

8. LEVATOR SLING
The levator ani, also
known as
the muscular pelvic
diaphragm, is the
musculotendinous sheet
that forms the majority of
the pelvic floor, supports
the pelvic viscera, and aids
in the urinary and faecal
evacuation as well as
maintaining continence.
The levator ani has three main
components, each of which is
paired :
1. pubococcygeal (pubovisceral) muscle
1. subparts: puboperineal, pubovaginal,
puboanal
2. iliococcygeus muscle
3. puborectalis muscle

9. LEVATOR SLING

10. 3D RENDERED IMAGE
OF THE LEVATOR SLING
MULTIPLANAR IMAGE
CORELATION.
PELVIC FLOOR USG ( LEVATOR SLING)

11. Normal levator sling
Focal interruption in the normal contour
of the left side of the levator muscle .
(UNILATERAL LEVATOR ATROPHY LEADING TO
PELVIC FLOOR DYSFUNCTION.)
Focal atrophy of the levator muscle
( left side )

12. URETEROCELE
Ureterocoeles represent congenital
dilatation of the distal-most portion of
the ureter. The dilated portion of the
ureter may herniate into the bladder
secondary to the abnormal structure
of vesicoureteric junction (VUJ).
Epidemiology

13. SIMPLE URETEROCELE TYPES
URETEROCELE
There are two main types of
ureterocoele, both of which are the
result of cystic ectasia of the
subepithelial portion of the ureter
as it inters the bladder.
•Simple: a ureterocoele that
occurs at a VUJ in a normal
position.
•Ectopic: that which occurs at
a VUJ whose site is abnormal.

14. GREY SCALE OF THE LEFT
SMA WITH CALCIFICATION IN
THE OSTIAL REGION.
VIDEO CLIP OF THE
SMA SPECTRA
STENOSIS OF SMA

15. REFERENCE
DIAGNOSTIC
ULTRASOUND
FOURTH EDITION
Carol M. Rumack, MD, FACR
J. William Charboneau, MD, FACR
Deborah Levine, MD, FACR
Ultrasound of Congenital
Fetal AnomaliesDifferential
Diagnosis and Prognostic
Indicators
Dario Paladini MD
Head, Fetal Cardiology Unit
Department of Obstetrics and
GynecologyUniversity Federico II
of NaplesNaplesItaly
Paolo Volpe MD
Head, Fetal Medicine Unit
Department of Obstetrics and
GynecologyHospital Di Venere
Bari