Monday, 6 July 2026

Glitter sign

2D Echo
πŸ“„ SonoAcademy

Glitter sign
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Glitter sign

PLVLA,2D usg

Glitter in ultrasound refers to the dynamic shimmering or sparkling appearance of numerous tiny echogenic (bright) particles within a fluid-filled lesion during real-time sonography. This phenomenon occurs when the particles move in response to gentle transducer pressure or changes in the patient's position.

These particles may consist of:

  • Red blood cells
  • Fibrin strands
  • Clot fragments
  • Proteinaceous or cellular debris

The shimmering appearance results from the changing reflection of ultrasound waves as these suspended particles move within the fluid.

Ultrasound Features: Glitter is the real-time sonographic appearance of mobile, highly reflective intracystic particulate matter that produces a transient sparkling or shimmering effect during ultrasound examination. This dynamic phenomenon is best appreciated when gentle transducer pressure or changes in patient position cause the intracystic particles to move, creating a characteristic glittering appearance.

Sites of Glitter sign

SN Organ Name View detailed
1 Breast
a-Hemorrhagic cyst
b-Complicated cyst with mobile debris
c-Resolving hematoma
View
2 Ovary
a-Hemorrhagic ovarian cyst
b-Retracting clot producing mobile echogenic particles
View
3 Thyroid
a-Colloid cysts
View
4 Kidney
a-Hemorrhagic renal cyst with mobile internal echoes
b-Infected renal cyst
View
5 Liver
a-Hemorrhagic or infected hepatic cyst with mobile debris
View
6 Scrotum
a-Hematocele
b-Complex hydrocele containing blood or fibrin
View


BREAS
a-Hemorrhagic cyst

US Report line
A round/oval, well-defined cystic lesion with low-level mobile internal echoes demonstrates a dynamic glitter sign (shimmering echogenic particulate matter) on real-time ultrasound. Posterior acoustic enhancement is present. No mural nodule or internal vascularity is seen on color Doppler. Findings are consistent with a benign hemorrhagic breast cyst (BI-RADS 2).

Targeted Imaging for Fetal Anomalies (TIFA) Scan/Level 2

2D Echo
πŸ“„ SonoAcademy

TIFA /
Level-2

Targeted Imaging for Fetal Anomalies (TIFA) Scan/Level-2

TIFA TIFA
TIFA Scan / Level 2 Ultrasound

The Targeted Imaging for Fetal Anomalies (TIFA) Scan, also known as the Level 2 Ultrasound or Anomaly Scan, is a comprehensive prenatal ultrasound performed between 18 and 22 weeks of pregnancy. This detailed examination assesses the baby's growth and development by carefully evaluating major organs, including the brain, heart, spine, face, kidneys, stomach, bladder, and limbs. It also examines the placenta, amniotic fluid, umbilical cord, and cervix to help monitor the overall health of the pregnancy.

The TIFA scan plays a vital role in detecting many structural abnormalities before birth, allowing healthcare providers to plan appropriate care and management when needed. It is a safe, non-invasive, and painless procedure that uses ultrasound waves and does not expose the mother or baby to radiation. As a routine part of second-trimester prenatal care, the TIFA scan provides reassurance about your baby's development and supports informed decision-making throughout pregnancy.

SN Takes Image for TIFA View Detail
1 Fetal Head and Brain View Detail
2 Face (Including Lips and Profile) View Detail
3 Neck View Detail
4 Spine View Detail
5 Heart (Four-Chamber View and Outflow Tracts) View Detail
6 Chest and Lungs View Detail
7 Abdomen View Detail
8 Stomach View Detail
9 Kidneys View Detail
10 Bladder View Detail
11 Limbs (Arms, Hands, Legs, Feet) View Detail
12 Placenta View Detail
13 Umbilical Cord View Detail
14 Amniotic Fluid View Detail
15 Cervix View Detail
16 Fetal Biometry (BPD, HC, AC, FL, etc.) View Detail

Objectives of the TIFA Scan

The Targeted Imaging for Fetal Anomalies (TIFA) Scan, also known as the Level II Obstetric Ultrasound, is performed during the second trimester to conduct a comprehensive evaluation of fetal anatomy, growth, and overall well-being. The primary objectives are as follows:

  1. To Detect Congenital Fetal Anomalies
    • Identify structural abnormalities affecting the fetal brain, face, spine, heart, lungs, diaphragm, gastrointestinal tract, kidneys, urinary bladder, abdominal wall, and limbs.
    • Facilitate early diagnosis of major and minor congenital malformations.
  2. To Evaluate Fetal Anatomy Systematically
    • Perform a detailed examination of all major fetal organ systems using standardized imaging planes and protocols.
    • Confirm normal anatomical development appropriate for the gestational age.
  3. To Assess Fetal Growth and Biometry
    • Measure Biparietal Diameter (BPD).
    • Measure Head Circumference (HC).
    • Measure Abdominal Circumference (AC).
    • Measure Femur Length (FL).
    • Measure Humerus Length (HL), when indicated.
    • Estimate Fetal Weight (EFW) and compare measurements with gestational age.
  4. To Assess Fetal Cardiac Anatomy
    • Evaluate the fetal heart using standard cardiac views, including the four-chamber view and outflow tracts.
    • Detect congenital heart defects and abnormalities in cardiac position, size, rhythm, and function.
  5. To Determine Placental Location and Morphology
    • Identify the position of the placenta (anterior, posterior, fundal, or low-lying).
    • Assess placental appearance and detect abnormalities such as placenta previa or abnormal placental morphology.
  6. To Evaluate the Amniotic Fluid Volume
    • Assess whether the amniotic fluid volume is within the normal range.
    • Detect oligohydramnios or polyhydramnios, which may indicate fetal or maternal complications.
  7. To Examine the Umbilical Cord
    • Confirm the presence of a three-vessel umbilical cord.
    • Evaluate cord insertion into the placenta and fetal abdomen when feasible.
  8. To Assess the Cervix and Uterus
    • Measure cervical length, when clinically indicated, to estimate the risk of preterm birth.
    • Identify uterine abnormalities or masses that may affect pregnancy.
  9. To Confirm Fetal Viability and Presentation
    • Verify fetal cardiac activity and movement.
    • Determine fetal presentation (cephalic, breech, transverse, or oblique), recognizing that presentation may change before delivery.
  10. To Identify Soft Markers for Chromosomal Abnormalities
    • Detect ultrasound markers associated with increased risk of chromosomal disorders, including increased nuchal fold thickness, echogenic bowel, echogenic intracardiac focus, mild ventriculomegaly, shortened long bones, and renal pelvic dilatation.
    • Recommend further evaluation or genetic testing when appropriate.
  11. To Guide Further Prenatal Management
    • Facilitate referral to fetal medicine specialists when abnormalities are detected.
    • Assist in planning additional investigations, fetal surveillance, intrauterine therapy (when available), delivery planning, and postnatal care.
  12. To Provide Parental Counseling
    • Provide accurate diagnostic information regarding fetal development.
    • Support informed decision-making by explaining findings, prognosis, available treatment options, and expected neonatal outcomes.

Thursday, 2 July 2026

Parasternal Aorta Short-Axis View At the Aortic Valve Level

2D Echo
πŸ“„ SonoAcademy

Parasternal Aorta Short-Axis View
At the Aortic Valve Level

Parasternal Aorta Short-Axis View At the Aortic Valve Level

PLVLA,2D 2D Echo

Parasternal Aorta Short-Axis View at the Aortic Valve Level (PSAX-AV) is one of the standard two-dimensional (2D) transthoracic echocardiographic views obtained by rotating the transducer approximately 90° clockwise from the parasternal long-axis view. It provides an en-face cross-sectional image of the aortic valve, displaying its characteristic three cusps (right coronary, left coronary, and non-coronary cusps) in the classic "Mercedes-Benz" configuration. This view also visualizes the aortic root, sinuses of Valsalva, right ventricular outflow tract (RVOT), pulmonary valve, main pulmonary artery, tricuspid valve, right atrium, left atrium, and interatrial septum. The PSAX-AV view is routinely used to evaluate aortic valve morphology and function, congenital heart disease, pulmonary valve abnormalities, proximal great vessel anatomy, and atrial septal defects. It is an essential imaging plane for comprehensive assessment of valvular heart disease and Doppler evaluation during transthoracic echocardiography.

Image 1 Image 2 Image 3 Image 4 Image 5 Image 6
1. Introduction
The Parasternal Aorta Short-Axis View at the Aortic Valve Level (PSAX-AV) is a fundamental transthoracic echocardiographic imaging plane obtained by rotating the transducer approximately 90° clockwise from the parasternal long-axis position. This view provides an en-face cross-sectional image of the aortic valve and surrounding cardiac structures. It is widely used for assessment of the aortic valve, pulmonary valve, right ventricular outflow tract (RVOT), proximal pulmonary artery, atrial septum, and congenital heart disease.

Commonly Used PSAX-AV View Abbreviations

Abbreviation Full View Name
PSAX-AV Parasternal Short-Axis View at Aortic Valve Level
PSAX Parasternal Short-Axis View
PLAX Parasternal Long-Axis View
A4C Apical Four-Chamber View
A2C Apical Two-Chamber View
A5C Apical Five-Chamber View
SC4C Subcostal Four-Chamber View
SSN Suprasternal Notch View

2. Scanning Method
Patient Position
  • Supine or left lateral decubitus position.
  • Left lateral decubitus usually provides better acoustic windows.
Transducer
  • Phased-array cardiac transducer.
  • Frequency: 2–5 MHz.
Probe Position
  • Left parasternal border.
  • 3rd or 4th intercostal space.
Probe Marker

Rotate approximately 90° clockwise from PLAX so the probe marker points toward the patient's left shoulder (1–2 o'clock).

Technique
  1. Begin from the parasternal long-axis view.
  2. Rotate the transducer clockwise approximately 90°.
  3. Adjust depth and gain.
  4. Tilt slightly superiorly until the aortic valve appears centrally.
  5. Optimize visualization of the RVOT, pulmonary valve, pulmonary artery, tricuspid valve and atrial septum.

3. Section Structure
Structures Visualized
  • Aortic Valve (Right, Left and Non-coronary Cusps)
  • Aortic Root
  • Sinuses of Valsalva
  • Ascending Aorta
  • Right Ventricular Outflow Tract (RVOT)
  • Pulmonary Valve
  • Main Pulmonary Artery
  • Right Pulmonary Artery
  • Left Atrium
  • Right Atrium
  • Interatrial Septum
  • Tricuspid Valve

4. Measuring Method and Normal Values

Measurements obtained from this view include the aortic annulus, sinus of Valsalva, sinotubular junction, proximal ascending aorta, pulmonary artery diameter and RVOT dimensions. Valve morphology and opening motion are carefully assessed in systole and diastole. Color Doppler is routinely used to evaluate valvular stenosis, regurgitation and intracardiac shunts.

Measurement Normal Value
Aortic Annulus 18–26 mm
Sinus of Valsalva 29–45 mm (adult)
Sinotubular Junction 22–36 mm
Ascending Aorta 22–36 mm
Main Pulmonary Artery 20–30 mm
RVOT Diameter 21–35 mm

5. Clinical Application
  • Assessment of aortic valve morphology.
  • Evaluation of bicuspid aortic valve.
  • Assessment of aortic stenosis.
  • Assessment of aortic regurgitation.
  • Pulmonary valve evaluation.
  • RVOT assessment.
  • Detection of atrial septal defects.
  • Assessment of proximal pulmonary artery.
  • Evaluation of congenital heart disease.
  • Guidance for Doppler examination.

6. Diagnosable Pathology
  • Bicuspid Aortic Valve
  • Aortic Stenosis
  • Aortic Regurgitation
  • Aortic Valve Endocarditis
  • Aortic Root Dilatation
  • Ascending Aortic Aneurysm
  • Pulmonary Valve Stenosis
  • Pulmonary Regurgitation
  • Atrial Septal Defect (ASD)
  • Tetralogy of Fallot
  • Double Outlet Right Ventricle (DORV)
  • Pulmonary Hypertension
  • Congenital Aortic Valve Abnormalities
  • RVOT Obstruction
  • Great Vessel Anomalies

SonoAcademy Digital MCQ Examination

Topic: Parasternal Aorta Short-Axis View at the Aortic Valve Level (PSAX-AV) – 2D Echocardiography

Total Questions: 10 | Total Marks: 10 | Time: 30 Minutes

Instruction: Enter your details, start the examination, answer all questions, submit the examination, and download your PDF marksheet after completion.

Exam Result

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Topic: Parasternal Aorta Short-Axis View at the Aortic Valve Level (PSAX-AV) – 2D Echocardiography

Total Marks: 10

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Ultrasound Probe Handling

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