Sonographic Findings of Tuberculous Vasitis

The purpose of this series was to describe the sonographic findings of tuberculous vasitis. We conducted a retrospective analysis of 3 cases of tuberculous vasitis. The following grayscale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, epididymal or testicular involvement, presence of hydrocele, and blood flow within the lesion. All 3 patients had focal (n = 2) or multifocal (n = 1) involvement of the scrotal segment of the vas deferens. The sonographic findings for tuberculous vasitis were heterogeneously hypoechoic in all of the cases. On color Doppler sonography, no blood flow was identified within the lesions of the vas deferens. All 3 patients had tuberculous epididymitis in addition to tuberculous vasitis. Tuberculous vasitis presents with infection along with tuberculous epididymitis, and it appears as a heterogeneously hypoechoic lesion in the scrotal segment of the vas deferens adjacent to the epididymal tail.     

Transvaginal sonographic evaluation of endometrial polyps.

The purpose of this study was to correlate the sonographic and histologic findings of focal lesions of the endometrium as depicted by transvaginal sonography. Sixteen focal endometrial masses were encountered during an 8 month period. The transvaginal sonographic appearance was correlated with findings at surgery or hysteroscopy. All uniformly hyperechoic endometrial masses were benign endometrial polyps. Five heterogeneous lesions were complicated endometrial polyps; one of these showed a focus of endometrial carcinoma. Four small and uniformly hypoechoic lesions were all prolapsed submucosal leiomyomata. Our results showed that a well-defined, uniformly hyperechoic mass within the endometrial cavity is most suggestive of a benign endometrial polyp. Larger masses with a heterogeneous appearance are nonspecific and warrant further evaluation and biopsy.     

Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics

OBJECTIVE: The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. METHODS: We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. RESULTS: The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. CONCLUSIONS: Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.     

Sonographic Findings of Acute Vasitis

Objective. The purpose of this study was to describe the sonographic findings of acute vasitis. Methods. This was a retrospective analysis of 12 cases of acute vasitis. The following gray scale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, presence of hydrocele, epididymal involvement, and blood flow within the lesion. Results. Of the 12 patients, 10 had acute vasitis in the scrotal segment; 1 had acute vasitis in the suprascrotal segment; and 1 had acute vasitis in both the scrotal and suprascrotal segments. The sonographic finding for acute vasitis of the scrotal segment was a heterogeneously hypoechoic appearance of the vas deferens (n = 11). The vas deferens was thickened (6.4 mm in diameter) in the 2 patients with suprascrotal involvement; it was heterogeneously hypoechoic in 1 and had a normal appearance in the other. On color Doppler sonography, the degree of blood flow was increased in all of the cases. Of the 12 patients, 11 had inflammation of the epididymis. Conclusions. Acute vasitis usually presents with infection combined with acute epididymitis, and it usually appears as a heterogeneously hypoechoic lesion in the scrotal segment, suprascrotal segment, or both.     

Hypoechoic normal renal sinus and renal pelvis tumors: sonographic differentiation.

OBJECTIVE: To evaluate the sonographic findings of an unusually hypoechoic renal sinus that mimics a tumor in the renal pelvis or renal sinus. METHODS: Sonographic scans of 7 patients with an unusually hypoechoic portion in the renal sinus were reviewed retrospectively. Computed tomography, excretory urography, or both confirmed all sinuses as normal. Five consecutive cases of renal pelvis tumors, which were detected on sonography initially in same period, were also reviewed to determine the differences between the 2 conditions. All cases were transitional cell carcinomas of the renal calyces. The images were analyzed for location, shape, margin, presence of posterior sonic attenuation, and associated findings such as caliectasis. RESULTS: Sonographic findings noted in patients with hypoechoic normal renal sinuses were irregular and poorly defined margins (n = 7), a central and symmetric location in the renal sinus (n = 6), the presence of posterior sonic attenuation with nonvisualization of the posterior border of the lesion (n = 7), an unaffected peripheral hyperechoic renal sinus (n = 7), and traversing hilar vessels in the lesion on color Doppler sonography (n = 7). In contrast, renal pelvis tumors had a relatively well-defined margin (n = 4), an eccentric location in the renal sinus (n = 2), a partially or completely obliterated hyperechoic renal sinus (n = 2), a visible posterior margin (n = 5), no posterior shadowing (n = 5), vessel displacement by the mass on color Doppler sonography (n = 5), and associated caliectasis (n = 1). CONCLUSIONS: By being familiar with the sonographic characteristics of a hypoechoic renal sinus, it can be differentiated from renal pelvis tumors, and unnecessary diagnostic workups can be avoided.     

Chronic tuberculous epididymitis: color Doppler US findings with histopathologic correlation

BACKGROUND: The aim of this study was to determine the color Doppler features of tuberculous epididymitis and to correlate these findings with histopathologic findings. METHODS: Color Doppler ultrasound (US) findings of 12 histopathologically proven tuberculous epididymitis and tuberculous epididymo-orchitis in 11 consecutive patients were retrospectively analyzed. Color Doppler US findings of tuberculous epididymitis were correlated with histopathologic findings. RESULTS: Color Doppler US findings of tuberculous epididymitis demonstrated no blood flow in the epididymal lesions except for focal linear or spotty flow signals in the peripheral portion. These findings correlated well with pathologic findings; the central portion of the epididymal lesions demonstrated granulomas with caseation necrosis, and the peripheral portion of the epididymal lesions had several medium to small vessels. CONCLUSIONS: Color Doppler US may be helpful for differential diagnosis of tuberculous epididymitis and non-tuberculous epididymitis.     

Soft tissue diffuse neurofibromas: sonographic findings.

OBJECTIVE: The purpose of this study was to describe the sonographic findings of soft tissue diffuse neurofibromas. METHODS: Seven soft tissue diffuse neurofibromas proven pathologically were retrospectively evaluated. Medical records and histologic examinations were reviewed, and sonograms were analyzed for the echogenicity, location, margin, and vascularity. RESULTS: All identified lesions were hyperechoic masses permeated by multiple interconnecting irregular hypoechoic tubular or nodular structures. All lesions were located in the subcutaneous fat zone, and all had poorly defined margins with adjacent normal subcutaneous fat. The margins between the lesions and the adjacent muscles were well defined in 5 and poorly defined in the other 2. The vascularity was extensive in 5 lesions and scarce in the other 2. CONCLUSIONS: Soft tissue diffuse neurofibromas have a characteristic sonographic appearance; therefore, sonography should be considered a useful tool in the initial screening of this disease.     

Abdominal wall endometriomas near cesarean delivery scars: sonographic and color doppler findings in a series of 12 patients.

PURPOSE: To describe the sonographic and color Doppler features of endometriomas of the abdominal wall arising near cesarean delivery scars. METHODS: Twelve women (mean age, 31 years; range, 22-42 years) underwent sonographic and color Doppler examination of the abdominal wall with high-frequency probes for the presence of painful nodules near cesarean delivery scars, cyclic or continuous lower abdominal pain, or both. RESULTS: All patients had undergone at least 1 cesarean delivery before admission (mean, 4.1 years; range, 2-12 years). A typical clinical presentation (ie, mass and cyclic pain and swelling during menses) was recorded in 6 cases. Sonography disclosed all subcutaneous nodules (mean size, 28.1 mm; range, 7-50 mm). Common sonographic features included (1) a hypoechoic inhomogeneous echo texture with internal scattered hyperechoic echoes; (2) irregular margins, often spiculated, infiltrating the adjacent tissues; and (3) a hyperechoic ring of variable width and continuity. At color Doppler examination, a single vascular pedicle entering the mass at the periphery was shown in 7 cases. Abundant intralesional vascularization was shown in 3 cases with diameters of greater than 3 cm, whereas no vascular sign could be detected in 2 lesions smaller than 15 mm. All patients underwent wide surgical excision, and pathologic examination disclosed endometrial tissue in all of them. No relapses were recorded at clinical and sonographic follow-up (4-23 months). CONCLUSIONS: Sonographic and color Doppler findings, when properly combined with clinical data, may substantially contribute to the correct preoperative diagnosis of abdominal wall endometriomas.     

Real-time imaging with the sonographic contrast agent SonoVue: differentiation between benign and malignant hepatic lesions.

OBJECTIVE: We investigated the ability of contrast-enhanced sonography with SonoVue (Altana Pharma, Konstanz, Germany), a sulfur hexafluoride microbubble contrast agent, to reveal differences between benign and malignant focal hepatic lesions. METHODS: One hundred twenty-six lesions in 124 patients with focal hepatic lesions detected by B-mode sonography (hepatocellular carcinoma, n = 36; metastasis, n = 25; cholangiocellular carcinoma, n = 1; lymphoma, n = 2; focal nodular hyperplasia, n = 9; adenoma, n = 4; regenerative cirrhotic nodule, n = 13; hemangioma, n = 29; and focal hyposteatosis, n = 7) were examined in a prospective study. After intravenous injection of 2.4 mL of SonoVue, the liver was examined continuously for 3 minutes by low-mechanical index pulse inversion sonography. RESULTS: For the discrimination of malignant versus benign liver lesions, SonoVue-enhanced sonography improved sensitivity from 78% to 100% and specificity from 23% to 92% compared with baseline sonography. Receiver operating characteristic analysis revealed a significant improvement in this discrimination (area under the receiver operating characteristic curve, 0.510 +/- 0.054 [SD] at baseline sonography, 0.998 +/- 0.003 with SonoVue-enhanced sonography; P < .001). The following flow patterns in the early phase were diagnosis specific: early central starlike pattern for focal nodular hyperplasia, peripheral globular-nodular pattern for hemangioma, and diffuse arterial enhancement for malignant lesions. Homogeneous enhancement in the late phase was predictive for benign lesions (P < .001). Conversely, 93% of patients without contrast enhancement in the late phase had malignant lesions (P < .001). CONCLUSIONS: SonoVue-enhanced sonography has greater specificity and sensitivity than baseline sonography for the differentiation of benign and malignant liver lesions.     

Testicular Epidermoid Cysts

Objective. The purpose of this series was to describe the sonographic features of intratesticular epidermoid cysts with clinicopathologic correlation. Methods. A retrospective review of the sonographic features of all intratesticular epidermoid cysts within the radiologic pathology archive of the Armed Forces Institute of Pathology with correlation with clinical, surgical, and pathologic data was performed. On sonograms, intratesticular epidermoid cysts were evaluated for shape, borders, and the presence of characteristic features, including alternating hypoechoic and hyperechoic rings, mural calcifications, and echogenic central core. Color Doppler imaging was evaluated for the presence of internal flow. Results. Of 21 cysts seen in 20 male patients (mean age, 24 years; range, 11–52 years), the most common finding was mural calcifications, which were seen in 18 lesions (86%). Concentric rings of alternating echogenicity were shown in 13 lesions (62%), and 7 cysts (33%) had an echogenic central core. No cysts showed internal vascularity. Conclusions. Testicular epidermoid cysts are uncommon solid‐appearing testicular masses that usually present as palpable masses and are benign. Knowledge of the sonographic and pathologic features may help differentiate these lesions from malignancy and possibly prevent unnecessary orchiectomy.     

Common and uncommon sonographic features of papillary thyroid carcinoma.

OBJECTIVE: To determine the relative frequency of various sonographic findings in papillary carcinoma of the thyroid. METHODS: We retrospectively analyzed the sonographic features in 55 patients with proven papillary carcinoma of the thyroid. Sonographic features analyzed were echo texture, cystic change, margin, contour, presence of a peripheral halo, vascularity, and calcification pattern. Features were classified as common (> or = 35% of cases) or uncommon (< 10% of cases). Combinations of features were also analyzed. RESULTS: Common sonographic features of papillary carcinoma included hypoechoic texture (86%), microcalcifications (42%) or no calcifications (47%), well-defined margins (47%), and intrinsic hypervascularity (69%). Uncommon features included hyperechoic or mixed echo texture, cystic elements, irregular margins, hypovascularity, and coarse or peripheral calcifications. Of the 29 lesions that had calcifications, 20 (69%) had microcalcifications; 5 (17%) had coarse calcifications; and 1 had peripheral calcifications. In total, 54% of cases had at least 1 uncommon feature, and 11% had 2 or more uncommon features. Cystic carcinomas were rare and accounted for only 6% of lesions; all had hypervascular solid components. No carcinomas in our series were completely avascular. CONCLUSIONS: There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid. Half of the lesions in this series had at least 1 uncommon sonographic feature.     

Correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis.

OBJECTIVE: To record the correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. METHODS: Women with palpable breast masses scheduled for excision biopsy were scanned with two- and three-dimensional color power Doppler sonography before and after the administration of a sonographic contrast agent. Vessel counts were performed on two- and three-dimensional sonographic images before and after contrast agent administration. All tumors were surgically removed and underwent immunohistochemical analysis for microvessel density assessment. The sonographic measure of tumor vascularity was correlated with microvessel density. RESULTS: Pathologic examination showed 43 breast cancers and 14 benign breast masses. Higher microvessel density was noted in malignant than benign breast masses (P < .0005). Color power Doppler sonographic measurement of tumor vessel number showed a significant positive correlation with tumor size (P < .05) and progesterone receptor negativity (P < .05). A significant positive correlation was observed between microvessel density and the number of intratumoral blood vessels assessed by both two- and three-dimensional color power Doppler sonography (P < .05). Regression models showed three-dimensional color power Doppler sonography to have a significantly higher correlation with microvessel density when compared with two-dimensional color power Doppler sonography at baseline (P < .005). The administration of a sonographic contrast agent did not improve correlation with microvessel density. CONCLUSIONS: A significant correlation was shown between color power Doppler sonographic measurement of tumor vascularity and microvessel density by immunohistochemical analysis. Further improvement in Doppler sonographic techniques to map capillary vessel flow should be explored to improve the current association with pathologic findings.     

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.     

Sonographic features of head and neck hemangiomas and vascular malformations: review of 23 patients

The sonographic features of 23 head and neck hemangiomas and vascular malformations are presented. A focal mass lesion was seen in all patients. The predominant sonographic features were a well-defined hypoechoic mass lesion with heterogeneous echotexture and the presence of cystic and sinusoidal spaces within, as well as the occasional presence of phleboliths. Color Doppler imaging demonstrated flow in 12 of 13 lesions. When performing sonography on soft tissue masses in the head and neck, the presence of color Doppler signal in a well-defined hypoechoic mass with heterogeneous echotexture should raise the possibility of an hemangioma.     

Relationship between sonographic and pathologic findings in epidermal inclusion cysts

PURPOSE: We evaluated the sonographic findings in epidermal inclusion cysts and related them to the pathologic findings. METHODS: We retrospectively reviewed the sonograms and pathology specimens of 24 patients with pathologically proven epidermal inclusion cysts. We evaluated the lesions for shape, size, internal echogenicity, posterior sound enhancement, and presence of color Doppler signals. We classified the masses into 5 sonographic types according to their internal echogenicity. The relationship between the sonographic types and the pathologic findings was examined. RESULTS: The masses were ovoid or spherical in 17 cases (71%), lobulated in 5 (21%), and tubular in 2 (8%). The longest diameter ranged from 1 to 6 cm (mean, 3.1 cm). Twenty-three cases (96%) were associated with posterior sound enhancement. Color Doppler signals were absent in 20 cases, but some vascularity was noted in 4 ruptured epidermal cysts, in areas of granulation tissue. The most common sonographic type was a hypoechoic lesion with scattered echogenic reflectors (10 cases). Sonographic findings were related to the lamellation of keratin debris and the granulation tissue secondary to rupture. Most cases with a lobulated configuration (4 of 5) or color Doppler signals (4 of 4) were ruptured cysts. CONCLUSIONS: Epidermal inclusion cysts most often appeared sonographically as a hypoechoic mass containing variable echogenic foci without color Doppler signals. Ruptured epidermal cysts, however, may have lobulated contours and show color Doppler signals, mimicking a solid mass.     

Transvaginal sonographic evaluation of cervix length after cervical conization.

OBJECTIVE: The purpose of this study was to evaluate transvaginal sonographic cervical length before and after cervical conization for squamous intraepithelial lesions. METHODS: Between November 2002 and October 2004, all women undergoing conization by either cold-knife conization or a loop electrosurgical excision procedure for squamous intraepithelial lesions were prospectively enrolled in this study. Cervical length was measured by transvaginal sonography (TVS) before and after conization. RESULTS: A total of 48 women were studied before and after a mean of 7 days after conization. Complete excision was achieved in 41 patients, and endocervical margins were involved in 7 patients. Mean TVS cervical length was significantly shorter after than before conization (mean +/- SD, 22.7 +/- 6.9 versus 26.7 +/- 8.1 mm; P < .001). The correlation coefficient between cone specimen length and postoperative length was r = 0.75 (P < .001). Mean TVS cervical lengths were 24.3 +/- 6.7 mm in the group of women who underwent a loop electrosurgical excision procedure and 20.7 +/- 9.4 mm in the group of women who underwent cold-knife conization (P = .13). CONCLUSIONS: Transvaginal sonographic measurement of cervical length after conization is well correlated with cone specimen length.     

Unusual sonographic appearance of an epidermoid cyst of the testis.

Epidermoid cyst of the testis is a rare benign testicular tumor with varied sonographic appearances. We present a case in which two specific ultrasonographic patterns were seen: (1) an "onion ring" configuration of alternating hyperechoic and hypoechoic regions, described previously as being characteristic of this lesion, and (2) a heterogeneous region with multiple punctate hyperechoic foci.     

Color Doppler sonographic findings of inflamed and perforated Meckel diverticulum.

OBJECTIVE: To describe color Doppler sonographic findings in 2 cases of inflamed and perforated Meckel diverticulum. METHODS: Two patients with inflamed and perforated Meckel diverticulum underwent color Doppler sonographic studies. RESULTS: Gray scale sonographic examination identified a fixed cystlike structure with a gut signature surrounded by a hyperechoic layer. Color Doppler sonography revealed hyperemia in the diverticular wall and hyperechoic layer, which was more intense in 1 patient. CONCLUSIONS: Identification of a fixed cystlike structure with a gut signature and wall hyperemia suggests the diagnosis of inflamed Meckel diverticulum; when a hyperechoic layer surrounds this structure, perforation of the diverticulum should be suspected.     

Secretory carcinoma of the breast: sonographic features.

OBJECTIVE: The purpose of this series was to evaluate the sonographic features of secretory carcinoma of the breast. METHODS: Between 1994 and 2006, 9 patients had histologically confirmed secretory carcinoma of the breast in our institution, and 6 of them underwent breast sonography. We retrospectively evaluated the sonographic findings of the patients in correlation with other available images and reviewed the clinical records. RESULTS: Clinical manifestations were a palpable mass (n=3), a bloody nipple discharge (n=1), and screening-detected abnormalities (n=2). Breast sonograms showed masses with a round or oval (n=5) or tubular (n=1) shape, with relatively well-circumscribed (n=2) or partially microlobulated (n=4) margins, and with a hypoechoic (n=4) or an isoechoic (n=2) internal echo texture. Most lesions were single nodules (n=3) or groups of nodules (n=2) measuring 1 cm or smaller, except 1 mass measuring 3.5 cm with axillary lymph node metastasis. Two cases had associated ductectasia. Sonographic assessments were classified as Breast Imaging Reporting and Data System category 3 in 2 cases, category 4A in 3 cases, and category 4B in 1 case. CONCLUSIONS: Secretory carcinoma of the breast is frequently shown as a small benign-looking nodule or group of nodules or sometimes as an intraductal lesion with a low clinical stage on sonography. Although secretory carcinoma is a rare breast malignancy, awareness of its sonographic features will be helpful for the differential diagnosis.