Sonographic findings in focal fibrocystic changes of the breast

The purpose of this study was to identify the spectrum of sonographic appearances in histologically proven focal fibrocystic changes (FC) of the breast to enhance understanding of imaging findings in this commonly encountered benign condition of the breast. During a 28-month period, the pathology database at two breast centers was searched to identify all patients with a pathologic diagnosis of focal FC resulting from biopsy of a focal mammographic, sonographic, or palpable abnormality and who had undergone sonographic evaluation before biopsy. The authors included lesions with a pathologic diagnosis of FC with or without a specific histologic subtype, such as stromal fibrosis, sclerosing adenosis, and apocrine metaplasia. In 58 patients, there were 60 lesions with a pathologic diagnosis of focal FC. Sonographically, focal FC appeared as solid mass in 28 cases (46.6%) and as cysts in eight (13.3%). In nine cases (15%), heterogeneously echogenic tissue was seen, and in the remaining 15 (25%) cases, there was no sonographically visible focal change. Thirteen of the 28 (46.4%) masses were classified as sonographically indeterminate. One mass was classified as probably malignant, and 14 masses were sonographically benign. A significant number of focal FC appear as solid masses. The sonographic features are not specific enough to differentiate between those that have a dominant component of focal fibrosis, sclerosing adenosis, or apocrine metaplasia from FC without a specific histologic subtype. Many of these solid masses may appear indeterminate, based on published criteria. An understanding of the imaging findings also helps to avoid repeat biopsy for discordant histologic and imaging findings.     

Sonographic features of focal orchitis

High-resolution sonography is a very sensitive imaging modality for detecting intratesticular pathology and is an accurate means of distinguishing intratesticular lesions (usually malignant) from extratesticular ones (usually benign). Unfortunately, there are no reliable sonographic criteria to distinguish testicular neoplasms from focal benign intratesticular lesions such as infarction, hemorrhage, or infection. We describe three cases of focal orchitis in which the sonographic features did allow a confident diagnosis of intratesticular infection. In each case a focal peripheral hypoechoic intratesticular abnormality was seen that was poorly defined or crescent-shaped, adjacent to an enlarged epididymis. The specific sonographic features suggest the diagnosis of focal orchitis and orchiectomy can be prevented. Rapid improvement (2 to 4 weeks) should be seen sonographically and in all cases the intratesticular lesions should be followed to complete resolution.     

Sonographic evaluation of early-stage breast cancers that undergo neoadjuvant chemotherapy.

OBJECTIVE: We prospectively evaluated low-stage breast cancers treated with neoadjuvant chemotherapy using whole-volume sonography and color Doppler imaging. METHODS: Thirty-four women with breast cancer (mean maximum size, 2.4 cm) received neoadjuvant chemotherapy with doxorubicin and docetaxel. Targeted whole-volume sonography of tumor sites was performed before and after chemotherapy to assess mass size, color pixel speed-weighted density, and American College of Radiology Breast Imaging Reporting and Data System sonographic characteristics. After chemotherapy, tumor sites were excised by lumpectomy or mastectomy. RESULTS: Three (11.3%) of 34 patients had a complete histologic response. After chemotherapy, correlation was r = 0.716 between final histologic and sonographic sizes. Compared with histologic residual tumors, sonography had 4 false-negative results, 3 false-positive results, and 27 true-positive results (sensitivity, 87%), with no false-negative results among a subgroup of tumors of 7 mm and larger (sensitivity, 100%). The 3 cases with false-positive results were histologic fibrosis or biopsy changes. Mean speed-weighted density was 0.015 before and 0.0082 after chemotherapy (P = .03). After chemotherapy, vascularity was less common within (P = .06) or adjacent to (P = .009) masses or in tumor sites (P = .05). Prechemotherapy variables of gray scale characteristics and vascularity were compared with final histologic size, and all had P > .20. CONCLUSIONS: Postchemotherapy sensitivity of sonography was high for residual tumors of 7 mm or larger. Correlation was moderate between histologic and sonographic final tumor sizes. False-positive results were caused by fibrosis or biopsy-related changes. False-negative results occurred with residual tumor size of 6 mm or smaller. After chemotherapy, vascularity usually decreased, and this was not specific for complete response. Before chemotherapy, no vascular or gray scale feature at initial imaging predicted complete responders.     

Sonographic appearance of focal fatty infiltration of the pancreas

We report the sonographic, CT, and MRI findings in a case of focal fatty infiltration of the pancreas. Sonography revealed an echogenic mass in pancreas head. On CT, the mass was hypodense. The mass showed same signal intensity to the surrounding normal pancreas on in‐phase T1‐weighted MR images and a loss of signal intensity on opposed‐phase MR images. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010     

Utility of targeted sonography in the evaluation of focal breast pain.

OBJECTIVE: To determine the utility of targeted sonography in the evaluation of patients with focal breast pain. METHODS: From January 1995 through December 1999, 110 targeted sonographic examinations were performed in 99 patients for evaluation of focal breast pain in the absence of an associated palpable mass. The sonographic, mammographic, and clinical findings were reviewed. The hospital pathology database was searched to identify any interval cancers and false-negative interpretations. RESULTS: No cancer was identified in any of the 110 examinations. Eighty-five (77.3%) of the examinations had negative findings. Cysts were identified in 15 cases (13.6%), and 3 solid masses (2.7%) were identified. Two of these 3 solid masses had biopsies and were shown to be benign, whereas the third mass was followed for 29 months without change. Most patients were premenopausal, had no family or personal history of breast cancer, and were not taking exogenous hormones. Eighty-five patients (77%) were referred by primary care physicians. CONCLUSIONS: In patients with focal breast pain without an associated palpable mass, sonography may be more useful for patient reassurance than for cancer detection.     

Sonographic evaluation of the incompetent cervix

Ultrasound can provide objective information in diagnosing incompetency of the internal os of the cervix during pregnancy and in evaluating the need for surgical correction. Attention must be paid to the technical aspects of the examination, and the examiner must be familiar with normal variations in the configuration.     

Sonographic evaluation of the yolk sac

This pictorial essay aims to inform related clinicians by summarizing the normal and abnormal sonographic findings of the yolk sac in the first trimester of pregnancy. An abnormality in the sonographic appearance of a yolk sac can predict subsequent embryonic death or abnormalities. Therefore, the accurate recognition of normal and abnormal sonographic findings concerning the yolk sac can be used to anticipate the course of pregnancy.     

乳腺癌的超声诊断

目的 探讨超声在乳腺癌诊断中的应用价值。方法 对经临床手术及病理证实的29例患者,30个乳腺癌肿块的超声检查资料进行回顾性分析。结果 二维超声可清楚地显示肿块的数目、形态、大小、边界、内部回声,周围组织有无受侵及有无淋巴结转移等;彩色多普勒超声（CDFI）可显示肿块内部及周边的血流情况。结论 超声检查方便,安全、无痛苦,有较高的敏感性,对组织显示十分清晰而在乳腺疾病的诊断中有着不可替代的优势,故能为临床诊断及治疗提供重要的参考价值。     

Dirofilariasis of the breast: Sonographic appearance

Human dirofilarial infections characteristically manifest as pulmonary “coin” lesions or as subcutaneous nodules. A case of subcutaneous Dirofilaria infection of the breast involving a 25‐year‐old woman with a painful breast lump is presented. The patient had not traveled anywhere and did not have any animals, but provided a history of being bitten by mosquitoes. The suspicion of a parasitic infection was raised by the presence of rod‐like structures within a hypoechoic nodule on sonography; movement within the nodule was detected during the examination. Histopathological examination revealed viable, adult female Dirofilaria repens, a nematode that is commonly found in dogs, cats, and wild mammals throughout parts of Europe, Africa, and Asia. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42 :433–435, 2014     

Sonographic features of breast hamartomas

The sonographic features of ten breast hamartomas are reported. Four masses were clinically palpable. The mammographic appearance was characteristic of hamartomas in five cases. In the remaining five lesions, because the radiographic appearance was not pathognomonic, surgical excision was required for pathologic confirmation of the diagnosis. A wide spectrum of sonographic appearances was identified, the most frequent was that of a moderate to well-circumscribed, solid, hypoechoic mass with posterior acoustic shadowing. Two isoechoic hamartomas were very difficult to visualize on sonography. We conclude that ultrasound has a minimal role in the diagnosis of breast hamartomas, in view of their wide sonographic variability.     

Sonographic evaluation of pediatric rhabdomyosarcomas

The ultrasound examinations of ten pediatric patients with retroperitoneal or pelvic embryonal rhabdomyosarcomas were reviewed. A pattern of coarse low-, medium-, or high-level echoes was observed in these tumors. Sonolucent areas, probably secondary to necrosis or hemorrhage, were seen in the tumors of five patients. Serial examinations were performed during the course of chemotherapy and/or radiotherapy in seven patients. These studies were examined retrospectively to determine whether a specific change in the echo characteristics of the tumor occurred during therapy. No such specific change was observed in these patients. Ultrasound was useful in following tumor size and thus, response to therapy, which is important with the advent of newer, more conservative forms of therapy for rhabdomyosarcoma.     

Sonographic evaluation of ectopic pregnancy

To assess sonographic findings in the evaluation for ectopic pregnancy, all women referred over a two-year period were prospectively evaluated. The incidence of intrauterine as well as adnexal findings was assessed in an attempt to optimize sonographic evaluation. Visualization of a double decidual sac sign (DDSS) within the uterus provided an accurate means of confirming an intrauterine pregnancy (IUP) prior to embryo visualization. Forty-two of 130 women with IUP were diagnosable only by the DDSS. As a screening test for ectopic pregnancy, sonographic documentation of an IUP provided the only convincing evidence for the absence of an ectopic gestation. Any woman clinically at risk for ectopic pregnancy whose sonogram did not confirm the presence of an intrauterine pregnancy was at relatively high risk (43 per cent) for having an ectopic gestation. Characterization of adnexal findings increased the level of risk for ectopic pregnancy in these women to 70-100 per cent. However, 20 per cent of women with a surgically confirmed ectopic pregnancy had normal adnexal findings.     

乳腺表皮样囊肿的超声表现

目的：探讨乳腺表皮样囊肿的高频超声图像特征。方法：对18例因乳腺肿块就诊,经术前超声及手术病理证实为表皮样囊肿患者的病例资料进行回顾性分析。在灰阶声像图上观察肿块位置、形状、大小、边界、内部回声及后方回声。应用彩色多普勒成像（CDFI）观察病灶内部及周围血流分布和供应情况。结果：灰阶声像图显示肿块多位于乳腺皮下或皮下脂肪层;16例呈圆形或椭圆形,2例形态不规则;肿块最大长径8～55mm;14例边界清晰,可见薄的包膜回声,4例边界部分不清;15例肿块内部回声不均匀,呈高低回声相间,可伴无回声（2例肿块内见微小钙化）,3例为相对均匀低回声;15例肿块后方回声增强,3例后方回声无明显改变。CDFI检查,16例肿块内部及周边均未探及血流信号,2例肿块边缘可探及血流信号。结论：乳腺表皮样囊肿声像图有一定的特征性,高频超声具有较高的诊断价值。     

Sonographic evaluation of the nonfunctioning kidney.

The results of B-mode ultrasound examinations in 113 consecutive patients with unilateral renal nonfunction or severe azotemia were reviewed. The causes of nonfunction included the following: hydronephrosis; renal parenchymal disease; renal agenesis; atrophy or dysplasia; multicystic, medullary cystic, and polycystic kidneys; renal arterial or venous occlusive disease; extensively infiltrating neoplasm. The sonographic findings were consistent with the final diagnosis in 92 percent of the cases. A coronal view of the kidney for diagnosing hydronephrosis is described. This view demonstrates the dilated calyces in continuity with the renal pelvis and, when combined with transverse views, improves the reliability of the sonographic diagnosis of hydronephrosis. In cases where the renal landmarks appear totally normal, obstruction can be excluded as a cause of nonfunction, and retrograde pyelography may be avoided. The sonographic manifestations of other parenchymal abnormalities associated with nonfunction, such as cystic renal disease, glomerulonephritis, and renal transplant rejection, are also discussed.     

Sonographic findings of necrotizing fasciitis in the breast

Necrotizsing fasciitis is a rapidly developing, fatal bacterial infection of deep subcutaneous tissues. It may occur at any site in the body. We describe a case of necrotizing fasciitis in the breast that was diagnosed on the basis of sonographic findings. Sonographic examination revealed fluid collection in deep tissues with bright echoes likely to represent gas microbubbles. The diagnosis of necrotizing fasciitis was subsequently confirmed on surgical exploration.     

Sonographic features of breast hamartomas.

OBJECTIVE: The purpose of this study was to elucidate the sonographic characteristics of breast hamartomas. METHODS: Data and sonographic images of 14 breast hamartomas were retrospectively reviewed. RESULTS: All patients had clinically palpable lumps. The median patient age was 39.5 years (range, 24-60 years). Eleven (78.6%) tumors occurred in the right breast, and 3 (21.4%) were in the left. The median tumor size measured by sonography was 2.8 cm (range, 1.2-4.9 cm). The median longest transverse dimension-anteroposterior diameter ratio of the tumors was 2.44 (range, 1.52-3.73). All tumors were oval and compressible with transducer pressure. Thirteen (92.9%) tumors were well circumscribed with smooth tumor margins, and 1 (7.1%) had indistinct margins. The internal echo texture was hyperechoic in 6 (42.9%), mixed (heterogeneous) echogenicity in 5 (35.7%), and isoechoic in 3 (21.4%). Four (28.6%) tumors had echogenic halos, and 2 (14.3%) had anechoic halos. Ten (71.4%) tumors had no retrotumor acoustic phenomena. Two (14.3%) had bilateral edge shadowing; 1 (7.1%) had posterior enhancement; and 1 (7.1%) had a mixture of enhancement and shadowing. CONCLUSIONS: Breast hamartomas were well-circumscribed, solid, oval tumors without intratumor microcalcification. The internal echo texture of most hamartomas is either hyperechoic or composed of mixed echogenicity. Retrotumor acoustic phenomena were absent in most hamartomas.