Imaging and Differential Diagnosis of Suprarenal Masses in the Fetus

Prenatal sonography and magnetic resonance imaging of suprarenal fetal masses is presented, along with clinical information and follow‐up. Imaging pearls and differential considerations for each diagnosis will be discussed. Fetal suprarenal mass diagnoses include neuroblastoma, extralobar pulmonary sequestration, congenital adrenal hyperplasia, partial multicystic dysplastic kidney, renal duplication, urinoma, gastric duplication cyst, and splenic cyst. Recognizing the range of malignant and benign suprarenal fetal masses that can present on prenatal imaging can help guide patient counseling and management.     

Benign and Malignant Epididymal Masses Evaluated With Scrotal Sonography

Objective. The purpose of this study was to determine whether the clinical history and sonographic appearance of solid epididymal masses could aid in distinguishing benign and malignant disease. Methods. We retrospectively reviewed the medical records of all patients who had solid epididymal masses evaluated by scrotal sonography at our institution between 1996 and 2004. We evaluated multiple clinical and sonographic variables, including lesion size, location, echogenicity, color Doppler characteristics, and calcifications. Results. Of the 85 patients included in the study, 25 (29%) underwent surgical intervention, and 5 (6%) had malignant disease. A mass size of greater than 1.5 cm and the presence of color Doppler flow were statistically significant markers for malignancy (P < .05). Combining these 2 variables as a test for malignancy yielded sensitivity of 100%, specificity of 80%, a positive predictive value of 24%, and a negative predictive value of 100%. Conclusions. Most solid epididymal masses (94%) are benign. A size of greater than 1.5 cm and the presence of color Doppler flow may help identify possible malignant masses.     

Sonography of Female Genital Hernias Presenting as Labia Majora Masses

Inguinal herniation of the ovary or uterus presenting as a labia majora mass is a rare congenital condition that may be complicated by strangulation, torsion, and infertility. A labial mass in a prepubertal female patient can represent an inguinal hernia, a hydrocele of the canal of Nuck, a congenital labial cyst, leiomyoma, an abscess, lipoma, or lymphangioma. With a large differential diagnosis and an often limited physical examination, imaging plays an importance diagnostic role. We present 3 cases in which a labial mass contained an ovary alone and both ovaries and the uterus. We demonstrate sonographic findings and discuss the utility of sonography in the diagnosis of genital hernias and in detecting potential complications.     

Grayscale and Color Doppler Features of Testicular Lymphoma

Pooled data from 16 radiology centers were retrospectively analyzed to seek patients with pathologically proven testicular lymphoma and grayscale and color Doppler images available for review. Forty‐three cases were found: 36 (84%) primary and 7 (16%) secondary testicular lymphoma. With unilateral primary lymphoma, involvement was unifocal (n = 10), multifocal (n = 11), or diffuse (n = 11). Synchronous bilateral involvement occurred in 6 patients. Color Doppler sonography showed normal testicular vessels within the tumor in 31 of 43 lymphomas (72%). Testicular lymphoma infiltrates through the tubules, preserving the normal vascular architecture of the testis. Depiction of normal testicular vessels crossing the lesion is a useful adjunctive diagnostic criterion.     

彩色多普勒超声诊断涎腺肿块

目的探讨涎腺肿块高频声像图特点,并评价CDFI对涎腺肿块的应用价值,旨在不断提高诊断符合率。方法用CDFI对48例涎腺肿块患者的声像图进行对比分析。结果显示恶性肿块的血流信号检出率高,良、恶性肿块的血流信号检出率分别为33.3%(11/33)、73.3%(11/15)。两者有显著性差异。结论高频超声能确定腺体内是否有占位性病变,而CDFI对涎腺肿块的囊、实性和良、恶性诊断及鉴别诊断具有重要参考价值。     

Sonographic Findings of Axillary Masses

The diagnosis of axillary masses can be challenging because various tumors can develop in parts of the axilla other than lymph nodes, even though we frequently encounter axillary masses in daily practice. These lesions include soft tissue masses associated with nontumorous conditions (accessory breast tissue and chronic granulomatous inflammation) and benign and malignant tumorous conditions (lipomas, epidermal inclusion cysts, lymphangiomas, fibroadenomas, schwannomas, malignant neuroendocrine tumors, and lymph node–associated diseases). In this pictorial essay, we display commonly encountered sonographic findings of various axillary lesions to assist in the differential diagnosis of axillary masses.     

Multiparametric Sonography of Hematologic Malignancies of the Testis: Grayscale,Color Doppler,and Contrast‐Enhanced Ultrasound and Strain Elastographic Appearances With Histologic Correlation

Primary testicular lymphoma is rare and appears with nonspecific findings on grayscale and color Doppler sonography. We present 8 patients further examined with contrast‐enhanced sonography, strain elastography, and histologic analysis after orchiectomy. Seven of 8 patients had a diagnosis of large B‐cell lymphoma, and 1 of 8 had a diagnosis of granulocytic sarcoma, with solitary lesions (2 of 8), multiple lesions (3 of 8), or entire testicular involvement (3 of 8). Lesions appeared hypoechoic (7 of 8) or isoechoic (1 of 8), all with increased vascularity on color Doppler sonography and a nonbranching linear pattern of intratumoral vessels (7 of 8). Contrast‐enhanced ultrasound (CEUS) confirmed this pattern and showed increased enhancement in all lesions. On strain elastography, all lesions were hard, with an elasticity score of greater than 4. Multiparametric sonography of testicular lymphoma identifies increased vascularity on color Doppler and contrast‐enhanced ultrasound and increased lesion stiffness on strain elastography.     

经阴道彩色多普勒能量显像鉴别卵巢良恶性肿块的价值

目的 探讨经阴道彩色多普勒能量显像（ＴＶ－ＣＤＥ）鉴别卵巢良恶性肿块的价值。方法 对１０５例卵巢肿块患者于术前１～７天进行ＴＶ－ＣＤＥ检查,与术后病理对照。结果 恶性组血管分布及血流动力学特征与良性组比较,存在明显差异。在此基础上提出血管评分系统,并以≥７为界值,回顾性评价了１１９枚卵巢肿块的良、恶性,其敏感性为１００％,特异性９４．２５％,阴性预测值１００％,阳性预测值８６．８４％。结论 此血管     

Three‐Dimensional Endovaginal Sonography of Synthetic Implanted Materials in the Female Pelvic Floor

The objective of this pictorial essay is to emphasize the ability of 3‐dimensional endovaginal sonography to image synthetic implanted materials in the female pelvic floor. Implanted materials discussed in this pictorial essay include polypropylene vaginal mesh, polypropylene suburethral slings, and urethral bulking agents. Three‐dimensional endovaginal sonography allows for more detailed imaging compared to computed tomography and magnetic resonance imaging of the female pelvic floor, in that each plane can be manipulated to show unique images of synthetic implanted materials.