Category: Interesting Cases

A patient presented with symptoms of vascular compromise in the left lower extremity—pain, coolness, discoloration, and cramping—prompting a referral for diagnostic imaging. An initial lower extremity arterial ultrasound revealed an occlusion of the distal left femoral artery, with reconstitution of blood flow at the level of the popliteal artery. These findings indicated a significant arterial blockage contributing to reduced circulation in the leg.

An endovascular procedure was promptly performed to place a stent and restore blood flow. The patient experienced temporary relief, but symptoms gradually returned. A follow-up CT angiogram confirmed that the stent had become occluded, signaling the need for surgical intervention. The patient subsequently underwent an autogenous bypass using the left great saphenous vein (GSV), connected from the common femoral artery to the distal popliteal artery to re-establish sustained blood flow to the limb.

BB Imaging played a key role in providing detailed vascular imaging that continues to guide timely surgical decision-making. Moving forward, the patient will undergo annual imaging, including lower extremity arterial ultrasound, ankle-brachial indices (ABIs), and CT angiography (CTA), to monitor graft function and screen for new vascular disease. Ongoing care will include medication management and lifestyle modifications, coordinated through a multidisciplinary care team.

This case highlights the power of precision imaging in both acute diagnosis and long-term care. Through expert sonography and close clinical collaboration, BB Imaging helped support the patient on their path to surgical resolution, reinforcing the critical importance of advocating for proactive, informed care that can create better outcomes and preserve quality of life.

A 36-year-old patient was referred to maternal-fetal medicine for advanced imaging following confirmation of a quintuplet pregnancy—an occurrence so rare it affects roughly 1 in 55 million births. Her clinical profile included advanced maternal age, hypothyroidism, and a history of miscarriage.

The pregnancy followed a single round of intrauterine insemination (IUI). However, the patient reported taking emergency contraception after experiencing complications and being told she could not get pregnant at the time. She also disclosed a personal and family history of hyper-ovulation syndrome.

The fetuses, labeled 1 through 5, presented as triamniotic, with one monochorionic-diamniotic pair (3 and 4). The pregnancy included three female and two male fetuses. Routine imaging identified growth restrictions in 3, 4, and 5. Notably, 2 exhibited dolichocephaly, with a cephalic index of 64%, and 3 presented with severe intrauterine growth restriction (IUGR) and abnormal umbilical artery Doppler findings—including absent end-diastolic flow, an indicator of compromised placental blood flow.

Initially planned for delivery at 32 weeks, the pregnancy was expedited due to deteriorating conditions. At 28 weeks and two days, all five babies were delivered via Cesarean section. Despite low expectations for 3, who weighed just 500 grams, each baby survived, with none requiring intubation.

This case demanded extensive collaboration between BB Imaging and our physician partners. While our team supported the pregnancy with a series of critical scans, including fetal echocardiography, biophysical profiles, and growth monitoring, additional anatomical and growth assessments were conducted by our partner’s sonography team. It was a coordinated effort built on clinical trust, diagnostic precision, and a shared commitment to maternal-fetal health.

As one of the few documented successful quintuplet deliveries in El Paso, Texas, this case is a powerful reminder of what’s possible when physicians and sonographers work side by side to guide even the most complex pregnancies with precision and compassion.

A 28-week pregnant patient (Gravida 8, Para 2) was receiving high-risk prenatal care due to several factors: advanced maternal age, chronic hypertension, obesity, and a history of two prior Cesarean deliveries (2020, 2022). During a routine visit, she reported localized pain in the lower uterine segment, right of midline, particularly when transitioning between sitting and standing.

Through a high degree of clinical coordination and further targeted ultrasound, the BB Imaging team supported the discovery of a uterine window defect—an area of thinning in the lower uterine segment. This structural vulnerability directly corresponded with the patient’s symptoms and raised concern for potential uterine rupture, especially given her obstetric history.

Following the findings, the patient was promptly sent to labor and delivery for administration of antenatal corticosteroids to accelerate fetal lung maturity, with a repeat Cesarean delivery planned within 24–48 hours. Thanks to early detection, the care team was able to proactively plan a carefully managed delivery, reducing the risk of future maternal and fetal complications. The critical findings were later confirmed at delivery via Cesarean section, reinforcing the importance of timely and informed obstetric intervention.

With highly detailed imaging and thoughtful clinical intuition, the BB Imaging team identified a subtle yet significant concern, reinforcing the value of timely, informed intervention in advancing care outcomes.

A 48-year-old male was referred for ultrasound evaluation after experiencing shortness of breath and atrial flutter—common symptoms with an uncommon cause. Imaging revealed heart failure secondary to biventricular non-compaction cardiomyopathy, a rare and often underdiagnosed condition affecting the heart’s muscle structure.

Management includes medications such as ACE inhibitors or ARBs, beta-blockers, diuretics, and devices like pacemakers, implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization therapy (CRT). In severe cases, while a patient is awaiting a heart transplant, a ventricular assist device (R/L-VAD) may be required. Ongoing care emphasizes adopting a heart-healthy lifestyle and maintaining regular follow-ups with a dedicated care team.

This case underscores the value of high-quality ultrasound as a diagnostic tool and a clinical compass, guiding immediate and long-term care. By detecting a rare and potentially life-threatening condition, the BB Imaging team played a crucial role in enabling immediate case management, thereby reducing the risk of further complications and setting the stage for sustainable symptom and medication management.

A patient was referred for a detailed anatomy survey due to Advanced Maternal Age. Upon ultrasound examination, ascites was initially suspected, but Doppler imaging revealed unexpected blood flow. Further evaluation confirmed an absent ductus venosus with the umbilical vein draining directly into the right atrium.

Additional findings included a single umbilical artery, persistent left superior vena cava, an apically offset mitral valve relative to the tricuspid valve, a duplicated right renal artery, and velamentous cord insertion. Due to the umbilical vein’s direct drainage into the right atrium, the perinatologist noted an increased risk for congestive heart failure. These findings were also associated with Noonan Syndrome.

An amniocentesis was performed and returned normal. A follow-up ultrasound later detected pericardial effusion and ventriculomegaly, both of which have since resolved. The patient remains under close monitoring until delivery.

Patient was referred to MFM office for intrauterine growth restriction and incomplete anatomy views from her primary OB office. Upon ultrasound examination, an absent left kidney was quickly suspected, then later located superior to the stomach. Two weeks later, the patient returned for an amniocentesis and Dopplers.

Patient was sent for an MRI due to a possible ectopic kidney or congenital diaphragmatic hernia based on ultrasound exam. The MRI confirmed a posterior congenital diaphragmatic hernia containing the left kidney, adrenal, and bowel.

A placenta previa paired with suspected accreta was identified and tracked throughout this pregnancy. With a previous history of two cesarean sections along with a suspected accreta and previa, a third cesarean was scheduled for 34 weeks. The delivery plan would also involve an immediate hysterectomy given these indications.

When the patient delivered, everyone was surprised to discover no accreta, although placenta previa was still present. The patient and baby were both healthy, and the hysterectomy was not performed.