Fetal doppler assessment

Gestational Age: 2022242628303234363840 Weeks 0123456 Days

UA PI: MCA PI:

CPR: —

Umbilical Artery

Middle Cerebral Artery

Cerebroplacental Ratio

Massive Hepatocellular Carcinoma (HCC)

Fetal Biometry — Input (Fixed)

LMP date Not known

Or enter Gestational Age weeks 0123456 days

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BPD (mm)

HC (mm)

AC (mm)

FL (mm)

FHR (bpm)

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Fetal position & presentation Cephalic (vertex)BreechTransverseOblique

Placenta location AnteriorPosteriorFundalLateral (left)Lateral (right)Low-lying / Previa

Amniotic fluid AFIMVP

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Umbilical cord vessels 3V2V1V

Nuchal cord NoneSingle loopDouble loopTriple loopFour loops

Calculated summary:

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Interpretation (behind graphs)

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Conclusions & Recommendations

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BPD growth (mm)

HC growth (mm)

AC growth (mm)

FL growth (mm)

Estimated Fetal Weight (g)

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Normal Ovary — Luteal Phase

During the luteal phase (post-ovulation, Day ~14–28), the ovary is dominated by the corpus luteum (CL), a physiologic structure formed from the ruptured follicle. It produces progesterone to support potential implantation. Sonographically, its characteristic appearance allows confident identification of a normal luteal-phase ovary and avoids misinterpretation as pathology.

Key sonographic features — normal luteal-phase ovary:

• Corpus luteum (CL)
• Internal contents may be hypoechoic, mixed echogenicity, or lace-like (hemorrhagic variant)
• Characteristic peripheral ring of the luteal wall
• Doppler showing the “ring of fire”: well-vascularized peripheral flow with low resistance (RI 0.4–0.5)
• Normal ovarian volume (~5–15 mL), possibly mildly enlarged due to CL
• Ovarian stroma mildly echogenic; small background follicles may still be present
• Possible minimal physiologic free fluid in the pouch of Douglas, especially immediately post-ovulation

Physiology review: The luteal phase is characterized by:

• Progesterone peak 6–8 days after ovulation
• Moderate estrogen increase
• Negative feedback on LH and FSH

The sonographic appearance of the CL directly reflects its role as a temporary endocrine gland.

Differentiation from pathology:

• Vs. simple ovarian cyst: CL has a thick vascular wall; cysts are thin-walled and anechoic.
• Vs. ectopic pregnancy: CL is within the ovary; ectopic tubal rings are separate from the ovary.
• Vs. ovarian torsion: normal CL shows preserved low-resistance flow; torsion shows enlarged ovary with reduced/absent venous flow.

Clinical significance: This appearance confirms recent ovulation and is a normal cyclic finding. Radiology reports frequently describe:

• “Normal ovary—luteal phase appearance”
• “Corpus luteum present”
• “No adnexal mass”

If pregnancy occurs, the CL persists as the corpus luteum graviditatis until approximately 10–12 weeks.

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Suggested caption for readers: In the luteal phase, the ovary normally contains a corpus luteum, often thick-walled and vascular (“ring of fire”). This is a physiologic cyclic structure and should not be confused with a pathologic ovarian cyst or adnexal mass when typical features are present.

Normal Ovary — Follicular Phase

During the follicular phase (early-mid menstrual cycle) the ovary normally contains multiple small follicles of varying size. A dominant follicle may be visible as a follicular (anechoic) structure that progressively enlarges. This is a physiologic appearance and should not be mistaken for pathologic cysts when features are typical.

Key sonographic features — normal follicular-phase ovary:

• Multiple small anechoic follicles (typically 2–10 mm) scattered in the ovarian cortex
• Occasionally a dominant follicle (up to ~18–25 mm prior to ovulation)
• Anechoic (fluid-filled) round/ovoid follicles with thin walls and posterior acoustic enhancement
• No internal echoes, no mural nodules, and no internal vascular solid components within follicles
• Tubal/adjacent structures normal; no free fluid unless physiologic minimal amount

Clinical significance: This is a normal cyclic appearance. Dominant follicles grow prior to ovulation; follow-up is only required if a cyst persists >6–8 weeks, is symptomatic, or demonstrates suspicious features such as solid vascular nodules, papillary projections, or thick irregularized walls.

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Suggested caption for readers: Normal ovarian morphology in the follicular phase often shows multiple small follicles; one may become dominant. Typical follicles are simple, anechoic, mobile with probe pressure, and avascular internally on Doppler.

Hemorrhagic Ovarian Cyst (Fishnet Weave / Reticular Pattern)

Fishnet Weave / Reticular Pattern

A Hemorrhagic Ovarian Cyst (HOC) is a functional ovarian cyst that forms when a normal follicle or corpus luteum bleeds internally. It is not a tumor, not cancer, and usually resolves on its own within 6–12 weeks.

Cyst wall

The cyst wall is the outer boundary of the ovarian cyst, formed by stretched ovarian tissue or the capsule of a functional follicle/corpus luteum.

Sonographic characteristics:

• Thin or mildly thickened
• Smooth inner margins
• May show mild wall hyperemia
• No mural nodules (important — nodules = suspicious)

Clinical significance:A smooth thin wall supports a benign functional cyst. A thickened irregular wall may indicate infection, endometrioma, or neoplasm.

FIBRIN STRANDS (Fishnet / Reticular Pattern)

Fibrin strands are thin, web-like internal echoes created by the formation of fibrin as blood clots inside the cyst.

Sonographic characteristics:

• Thin, linear, curvilinear internal echoes
• Intersecting pattern (“fishnet”, “lace”, “reticular”)
• Avascular on Color Doppler
• May show subtle movement with probe pressure

Clinical significance: The presence of fine fibrin strands with a reticular or fishnet appearance is highly suggestive of a hemorrhagic ovarian cyst (HOC). This characteristic pattern helps differentiate HOC from:
Ovarian tumors — which typically contain vascular solid areas
Endometriomas — which show homogeneous “ground-glass” internal echoes

CLOT FRAGMENTS (Echogenic Debris)

Clot fragments are irregular echogenic masses formed from organizing blood inside the cyst.

Sonographic characteristics:

• Non-shadowing echogenic foci or masses
• May be mobile or layered
• No internal vascularity (key diagnostic point)
• Often settle in the dependent portion of the cyst

Clinical significance: These echogenic clot fragments strongly support the diagnosis of a hemorrhagic ovarian cyst. Their avascular nature helps differentiate them from vascular solid tumors. Typically, these clots resolve spontaneously within 6–12 weeks on follow-up sonography.

Why This Pattern Is Important

The fishnet pattern helps diagnose HOC confidently without mistaking it for:
1. Endometrioma ("ground glass" homogeneous pattern)
2. Tumors (vascular nodules)
3. Tubo-ovarian abscess (complex echogenicity)

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Hemorrhagic Ovarian Cyst — Bilingual MCQ Panel

Fishnet weave / Reticular pattern • Toggle language • Immediate feedback • 10 questions

Both / दोनों English हिन्दी

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