Mucocele of the appendix. Sonographic, computed tomographic and radiologic characteristics

The knowledge of the diagnostic imaging methods features of the mucocele of the appendix is important for a correct preoperative diagnosis, especially to avoid the formation of pseudomyxoma peritonei. A case of a mucocele of the appendix with a special sonographic appearance by a patient with an additional carcinoma of the left kidney is reported. The computer-tomographic and radiological features of the mucocele (plain abdominal film, i.v. urography, barium enema) are presented and discussed with a review of the literature. A sonographically-guided fine-needle puncture of the mucocele was performed. Its importance for the diagnosis is discussed.     

Sonographic characteristics of recurrent hepatocellular carcinoma

Our purpose was to determine the characteristics findings of recurrent hepatocellular carcinomas (HCCs) on sonography. We reviewed sonographic findings of 85 recurrent tumors in 57 patients with prior partial hepatectomy for HCCs. Of 57 patients, 47 (82.5%) had localized recurrence; one or two tumors in a segment (44 patients) and a recurrent tumor near the resected hepatic stump (3 patients). Of 85 tumors, 58 (68.2%) were less than 2 cm, and 82 of 85 tumors (96.5%) were less than 4 cm. A total of 49 tumors (57.6%) were seen as hypoechoic, and 20 tumors (23.5%) as hyperechoic. Posterior echo enhancement was seen in 36 tumors (42.4%), hypoechoic halo in 24 tumors (28.2%), lateral shadow in 21 tumors (24.7%), and mosaic pattern in 6 tumors (7.1%). Recurrent HCC can be detected at an early stage by sonography. Hypoechoic pattern and posterior echo enhancement are commonly seen. These findings suggest recurrent HCCs. Correspondence to: T. Shibata     

Sonographic characteristics of peripheral nerve sheath tumors

OBJECTIVE: We have found variability in the sonographic appearance of peripheral nerve sheath tumors. The purpose of this study was to characterize the sonographic appearances of pathologically proven peripheral nerve sheath tumors. CONCLUSION: Peripheral nerve sheath tumors are often hypoechoic with posterior acoustic enhancement and so may simulate a ganglion cyst. The presence of intrinsic blood flow on color Doppler sonography and peripheral nerve continuity suggests the diagnosis of peripheral nerve sheath tumor. Sonography cannot reliably distinguish neurofibromas from schwannomas.     

Sonographic appearance of plasmacytoma of the testis.

A case of solitary extramedullary plasmacytoma of the testis is presented demonstrating the appearances on ultrasound. The clinical implications of this diagnosis are discussed.     

Sonographic morphology of the normal menstrual cycle.

Sequential gray-scale sonograms were obtained during 20 menstrual cycles in 16 normal female volunteers. Hormonal and physical parameters of an ovulatory cycle were correlated with morphological changes in the ovaries, uterus, and cul-de-sac as seen on the sonogram. Ovarian cysts of two sizes were observed, corresponding chronologically and morphologically to Graafian follicles and corpora lutea. Small amounts of free pelvic fluid were demonstrated in many women at ovulation. A characteristic uterine appearance is seen prior to menstruation and is related to hormonal influences on the uterus. These findings emphasize the importance of recognizing normal physiological changes when interpreting gynecologic sonograms.     

Sonographic diagnosis of fetal hydrops.

Sonograms obtained during the 32nd and 34th weeks of a pregnancy complicated by severe Rh isoimmunization demonstrated features diagnostic of fetal-hydrops-scalp and body wall edema, ascites, hepatosplenomegaly and placental enlargement. The earliest sign that can be detected sonographically is placental enlargement.     

Sonographic detection of the normal and abnormal appendix.

A prospective study of 170 patients with suspected appendicitis was performed to assess the value of sonography in detecting the normal and abnormal appendix. The wall thickness (normal, less than or equal to 3 mm), compressibility of the appendix, and echogenicity of surrounding fat were the primary criteria used to determine the status of the appendix. Of 60 patients who underwent surgery, appendicitis was proved in 45. The remaining 110 patients who did not have surgery, contacted by telephone at the end of the study, had no clinical follow-up evidence of acute appendicitis. A normal appendix was clearly identified in 102 (82%) of 125 patients without acute appendicitis. The sensitivity of sonographic examination in detecting appendicitis was 93%, the specificity was 94%, and the accuracy was 94%. The predictive value of a positive test was 86%; that of a negative test was 98%. Ruptured appendicitis was predicted in all cases (11/11). Sonography is useful in detecting acute appendicitis and can clearly show the normal appendix more frequently than previously reported.     

Sonographic findings after surgical ablation of the endometrium.

OBJECTIVE. Endometrial ablation is a new surgical technique that is an alternative to hysterectomy in women with dysfunctional uterine bleeding. The endometrium is either coagulated or resected in an attempt to render the patient amenorrheic. Because of the newness of the procedure, no report of radiologic findings after endometrial ablation has been published. Accordingly, the sonographic appearance of the uterus after endometrial ablation is described. MATERIALS AND METHODS. Using transvaginal sonography, we examined a select group of 16 women, seven of whom were symptomatic after endometrial ablation. All patients had a preoperative diagnosis of menorrhagia not responsive to conventional hormonal therapy and no evidence of cancer. RESULTS. In the seven symptomatic patients, sonography showed that postoperatively two had hematometra, one had a nonviable intrauterine pregnancy, and four had residual islands of functioning endometrial tissue alone or in combination with hematometra. In nine asymptomatic patients, postoperative sonography showed seven had normal findings except for leiomyomata and two had residual islands of functioning endometrial tissue. CONCLUSION. Sonographic examination of the uterus after endometrial ablation provides a method for evaluating symptomatic patients and for identifying any remaining endometrium that could later become symptomatic.     

Spontaneous regression of a cyst of the cavum septi pellucidi

A 20-year-old woman with secondary amenorrhoea and an empty sella turcica was found to have a cyst of the cavum septi pellucidi (CSP) on MRI. The cyst had regressed spontaneously on follow-up MRI. Received: 21 June 1999/Accepted: 5 October 1999     

Sonographic patterns in trophoblastic diseases.

A range of sonographic patterns in patients with hydatidiform moles can be appreciated with gray scale ultrasonography, which more readily reveals areas of internal hemorrhagic degeneration and fetal growth within a molar mass. Sonography may be used to evaluate patients suspected of having recurrent or invasive trophoblastic disease; a focus of invasive trophoblastic tumor can be identified as a cluster of high-amplitude echoes within the myometrium, which is frequently associated with echo-free areas of hemorrhage. The enlargement or regression of theca lutein cysts associated with these disease processes can also be monitored.