The sonographic appearance of acute pyelonephritis.

Acute pyelonephritis and acute ureteral obstruction often present with similar clinical and urographic findings. Ultrasound, however, can easily detect the presence of obstruction as well as demonstrate characteristic findings suggestive of acute pyelonephritis, and thus allows differentiation. In two patients with acute pyelonephritis, the ultrasonic findings consisted of a large swollen kidney with an increased anechoic corticomedullary area, with multiple scattered low-level echoes. Each of the two cases is discussed in detail.     

Cerebrospinal fluid leakage after lumbar puncture in neonates: incidence and sonographic appearance

OBJECTIVE: The purpose of this article is to review the incidence and sonographic appearance of cerebrospinal fluid leakage after lumbar puncture in the neonatal period. Thirty-three neonates underwent spinal sonography after diagnostic lumbar puncture. A total of 21 of these patients showed cerebrospinal fluid leakage into the epidural space extending from the level of the cauda equina to the lumbar (n = 9), the thoracic (n = 8), or the cervical (n = 4) region. In eight patients, the subarachnoid space was markedly compressed by the epidural fluid collection. CONCLUSION: Cerebrospinal fluid leakage into the epidural space is a frequent complication of lumbar puncture in neonates and has a characteristic appearance on sonograms. Leakage after lumbar puncture must be differentiated from cerebrospinal fluid leakage due to perinatal meningeal injury. If cerebrospinal fluid leakage at the puncture site compresses the subarachnoid space, sonography assists in the performance of subsequent lumbar puncture.     

Fibroadenoma of the breast: sonographic appearance

The sonographic patterns of 100 fibroadenomas, including two giant fibroadenomas and two cystosarcoma phyllodes, were reviewed. The lesions were mostly hypoechoic (92%) and homogeneous in echotexture (72%). Twenty-seven percent of fibroadenomas showed irregular margins. Intratumoral calcifications were noted in 10% of lesions. A marked acoustic shadow without associated calcification was seen in six cases. The mean ratio of the length to the anteroposterior diameter of the tumors was 1.84 +/- 0.52 (standard deviation), indicating an elongation along the general orientation of the breast tissue planes. The ratios of length to anteroposterior diameter calculated in two matching groups of small (less than 1 cm3) fibroadenomas and carcinomas differed significantly. State-of-the-art high-frequency transducers, geometric analysis of tumors, and real-time ultrasound-guided fine-needle aspiration biopsy should help to distinguish between benign and malignant solid breast masses.     

The inferior accessory hepatic fissure: sonographic appearance

The inferior accessory hepatic fissure, a coronal or parasagittal fissure through the parenchyma of the posterior segment of the right hepatic lobe, was observed sonographically in 15 of 2000 patients. The fissure was seen as a thin, echogenic membrane stretching downward from the right branch of the portal vein to the inferior surface of the right hepatic lobe. On cadaveric sections, the fissure was an invagination of peritoneum directed laterally and slightly posteriorly from the medial inferior surface of the right hepatic lobe below the porta hepatis.     

The gray scale sonographic appearance of intra-abdominal mesenchymal sarcomas

Twenty-eight patients with intra-abdominal mesenchymal sarcomas were examined with gray scale ultrasonography. Masses were present in the mesentery, abdominal hollow viscera, liver, and retroperitoneal areas. Four different ultrasonic patterns were observed in the extra hepatic abdominal masses: (a) hyperechoic masses intermixed with anechoic zones; (b) hyperechoic masses with central fluid-filled zones; (c) homogeneous hyperechoic masses; and (d) homogeneous hypoechoic masses. Three of 6 patients with hepatic masses were totally anechoic alongside other more typical metastatic patterns. The presence of a large mass with sonographic signs of necrosis should strongly suggest the possibility of sarcoma. The differential diagnosis is discussed.     

A sonographic appearance of testicular lymphoma

The sonographic findings in two cases of testicular lymphoma are presented. Both show hypoechoic striations radiating out from a hypoechoic mediastinum testis. This appearance has not previously been described and may represent infiltration along the lymphatics within the testis.     

Juvenile papillomatosis of the breast: sonographic appearance

Three patients with juvenile papillomatosis of the breast are described. The lesions were apparent clinically as a palpable mass. At mammography, juvenile papillomatosis was not depicted in two patients and was seen as a poorly defined mass in one case. In all patients, high-frequency ultrasound examination showed an ill-defined, inhomogeneous mass with one or several small (up to 0.4 cm), rounded, relatively echo-free areas, which were seen mainly or exclusively near the borders of the lesion.     

Cohen ureteral reimplantation: sonographic appearance

The sonographic records of 27 children who underwent a Cohen ureteroneocystostomy were reviewed. In 13 children (48%) sonograms demonstrated an echogenic, nonacoustically shadowing structure at or just above the trigone that was fixed in position within the bladder wall and covered by intact mucosa. This constellation of sonographic findings, which represent the submucosal segment of the reimplanted ureter, produces a "tunnel sign." Awareness of this appearance will enable the sonographer to better evaluate children who have undergone surgical procedures on the bladder.     

Lingual thyroid gland: sonographic appearance

Thyroid dysgenesis is often manifested by a lingual or sublingual location of the thyroid gland. If radionuclide studies are not readily available or are contraindicated, ultrasound (US) may be used to locate the gland. The US appearance of a lingual thyroid gland and the role of US in the evaluation of suspected thyroid dysgenesis are described.     

The sonographic appearance of acute focal pyelonephritis 8 years experience

AIM: Acute focal pyelonephritis (AFP) is a variant of pyelonephritis in which single or multiple discrete areas show changes of inflammation. The reported sonographic appearances of AFP are varied but are typically described as being echopoor. The purpose of this study was to review the sonographic appearances of AFP and attempt to explain the range of findings by correlation with clinical details. MATERIALS AND METHODS: We reviewed retrospectively the sonographic findings and medical records of 17 cases of AFP. The study group consisted of 13 women and four men (mean age 20 years). Lesions were designated as echogenic, echopoor or of mixed echogenicity as compared to the adjacent renal cortex, and to the liver or spleen. RESULTS: The abnormal areas were echogenic in 12 patients, echopoor in three and of mixed echogenicity in two. An attempt was made to explain the variation in appearances by correlation with clinical details including the patient's age, the duration of symptoms, the length of antibiotic treatment and the presence of haematuria. CONCLUSION: Areas of acute focal pyelonephritis may be echogenic, echopoor or of mixed echogenicity. Our data would suggest that areas of increased echogenicity are more common. There is no discernible correlation with clinical findings.     

Klatskin tumors of the bile ducts: sonographic appearance

The authors present 3 cases of surgically proved Klatskin tumor diagnosed by ultrasound alone. Sonographic features of these tumors include (a) dilatation of the intrahepatic biliary ducts but not the extrahepatic duct, (b) non-union of the right and left hepatic ducts, and (c) small, solid masses at the hepatic hilus. Local spread to the liver may also be seen. If the pancreas appears normal and no primary tumor can be found, Klatskin tumor can be diagnosed with a high degree of accuracy.     

Prenatal testicular torsion: sonographic appearance in the newborn infant

The prenatal diagnosis of spermatic cord torsion is often really difficult and the diagnosis is usually retrospective. Herein, we report a case of a male newborn baby who presented at delivery with an enlarged, swollen and tender scrotum. US showed an enlarged right testis, with dishomogeneous texture, fluid collection between the testis and the tunica vaginalis and large hydrocele. Differential diagnosis included hydrocele complicated by infection or hemorrhage, testicular tumor or postnatal testicular torsion. Color and power Doppler did not reveal any flow signal, and the diagnosis of antenatal torsion with initial necrosis was made. The role of color Doppler US is emphasized in directing the patient to emergency surgical exploration, when testicular salvage may be possible. Delayed surgical treatment can be proposed, when the diagnosis of antenatal torsion has a high degree of certainty. However, the Doppler examination of a newborn baby's testis is a very difficult challenge even for an experienced radiologist. Electronic Publication     

神经母细胞瘤酷似畸胎瘤声像图表现一例

患儿男,一岁四个月。入院前两周发现右腹部局限性隆起。入院查体:右上腹部可触及13cm×10cm的肿物,质硬、无囊性感、光滑、活动度差,压之无哭闹。超声检查示:右上腹部可探及105×81mm的混合性包块,边界尚清,形态不规则,内部回声以中低回声为主,并可见强回声光团,后方伴声影,与肝脏分界清楚,右肾受压并可见中度积水。超声提示:腹部混合性包块,考虑为畸胎瘤。CT示:右侧腹腔肝门处可见不规则软组织影,密度不均匀,其内可见高密度灶,CT值173.4Hu,中心亦有低密度区,右肾盏呈球形扩张,腹膜后淋巴结肿大,肿块与周围组织及大血管分界不清。CT诊断:…