Sonographic pitfalls in the diagnosis of enteric duplication cysts

OBJECTIVE: The sonographic double wall sign has been well described in the literature and is often the cornerstone in suggesting the diagnosis of an enteric duplication cyst. We report two cases with this sign that were erroneously diagnosed as enteric cysts and a third case without this sonographic feature that proved to be a duplication cyst. Histologic analysis of the specimens helps explain the cause of the sonographic pitfalls. CONCLUSION: The potential sonographic visualization of the split hypoechoic muscularis propria layer or identification of all five layers will increase the specificity in making the sonographic diagnosis of duplication cyst.     

Spectrum of sonographic findings in 125 renal masses other than benign simple cyst

The sonographic findings of 125 renal masses that did not meet the sonographic criteria of benign simple cyst were retrospectively reviewed and correlated with the pathologic diagnosis. Of the 125 masses, 102 were renal cell carcinoma. These carcinomas, two of nine angiomyolipomas, and the 14 other renal masses of various histologic types exhibited a broad spectrum of sonographic findings. Seven of nine angiomyolipomas and the one multiloculated cystic nephroma had a rather characteristic sonographic appearance. With the knowledge of this spectrum of sonographic findings and strict attention to scanning techniques and sonographic criteria, the radiologist should be able to define the characteristics of a variety of renal masses and suggest the correct diagnosis. It should be possible to make the diagnosis of angiomyolipoma confidently if the characteristic sonographic and computed tomographic appearance of these tumors can be demonstrated. In some cases, the correct histologic diagnosis of a renal mass can be made only with biopsy or surgery.     

Ultrasound evaluation of renal parenchymal disease and hydronephrosis

The ultrasonic findings in renal disease are reviewed and a differential diagnosis is formulated for each sonographic abnormality. Lesions can be characterized by their location and sonographic texture. The sonographic findings combined with the clinical history may lead to a specific diagnosis or be useful in determining the next imaging study that should be obtained.     

An assessment of sonography in the diagnosis and management of neonatal renal candidiasis

The renal sonographic findings in six cases of neonatal candidiasis and 13 cases previously reported in the literature are reviewed. Focal and diffuse parenchymal changes and obstruction due to mycetoma formation were frequent features. In the current series the sonographic changes were found to bear an inconstant relationship to the probable time of onset of the infection. In addition, apparent sonographic deterioration occurred in neonates well after adequate antifungal treatment was initiated. In view of the potential toxicity of systemic antifungal therapy, sonographic renal parenchymal changes are not considered an adequate indication for either its initiation or its continuation.     

Changes in the epididymis after vasectomy: sonographic findings

Scrotal sonograms were obtained in 31 men before vasectomy and at 2 and 12 months after vasectomy to determine the effect of the surgery on the sonographic appearance of the testis and epididymis. The sonographic appearance of the testis was unchanged after vasectomy. However, in 14 men (45%), there were persistent changes in the epididymis. These consisted of enlargement (14 patients), development of cysts (11 patients), and an inhomogeneous echo pattern (five patients). The presence of these sonographic changes was unrelated to symptoms. The history of vasectomy in men referred for scrotal sonography should be noted so that the altered sonographic appearance of the epididymis may be interpreted properly.     

Differential diagnosis of pelvic masses by gray scale sonography.

An approach to the sonographic differential diagnosis of pelvic masses based on their size, location, internal consistency, and definition of borders is presented. Diagnostic schemes were derived from correlating the sonographic features with histomorphology in 170 surgically proven pelvic masses. Besides separating pelvic masses into the conventional categories of cystic, complex, and solid, gray scale sonographic features of a pelvic mass can be used to subcategorize these masses into a more useful differential diagnoses. Although the features seen on a sonographic image were specific in only two types of pelvic masses (pattern specificity greater than 85%), the sonographic information can be effectively utilized for establishing differential diagnoses of pelvic masses. Among the various sonographic patterns observed, homogenously cystic adnexal masses were the least specific pattern, whereas a predominantly cystic, extrauterine mass with internal septation was highly specific for a pseudomucinous cystadenoma. Several pelvic masses such as dermoid cysts demonstrated more than one sonographic appearance and, therefore, had to be considered in more than one diagnostic category.     

Sparing of fatty infiltration around focal hepatic lesions in patients with hepatic steatosis: sonographic appearance with CT and MRI correlation

OBJECTIVE: The purposes of this study were to illustrate the sonographic features of focal hepatic lesions with peritumoral sparing of fatty infiltration in patients with hepatic steatosis, to correlate the sonographic findings with CT and MRI findings, and to discuss the possible mechanisms. CONCLUSION: Various focal hepatic lesions can accompany peritumoral sparing of fatty infiltration in patients with hepatic steatosis, and they can manifest with an atypical sonographic appearance.     

Saline microbubbles monitoring sonography-assisted abscess drainage

The objective of this study was to assess the use of saline microbubbles as a sonographic contrast medium in monitoring abscess drainage. Seven abscesses were localized and drained with sonographic guidance. Four were in the brain and three were small abscesses in the liver, the subhepatic region, and the pancreas. After aspiration of the purulent material, irrigation with saline produced a highly echogenic sonographic pattern that was free of artifacts and distinctly different from the abscess contents and capsule, and the surrounding parenchyma. In one case, previously unsuspected loculation was detected, requiring repositioning of the needle for complete drainage. All abscesses were resolved and no untoward effects, such as sepsis, were encountered. In one additional patient, microbubble sonographic evaluation was used to monitor the progress of an abscess in which a percutaneous catheter was placed. Saline microbubbles may be used as a sonographic contrast medium to monitor sonography-assisted abscess drainage.     

Type 1 primary hyperoxaluria in pediatric patients: renal sonographic patterns

OBJECTIVE: Our aim was to review the sonographic features of type I primary hyperoxaluria in children and to correlate the sonographic patterns with the clinical development of end-stage renal disease (ESRD). MATERIALS AND METHODS: We performed a retrospective analysis of the clinical and imaging files of 13 patients with type I primary hyperoxaluria who were treated in one institution and of the sonographic patterns and the clinical follow-up reports. RESULTS: We encountered the following two sonographic patterns: medullary nephrocalcinosis in eight patients and cortical nephrocalcinosis in five patients. The sonographic appearance of cortical nephrocalcinosis is quite specific: a hyperechoic peripheral renal cortex with acoustic shadowing behind it. Medullary nephrocalcinosis is less specific because there are many other causes of hyperechoic pyramids. All patients with medullary nephrocalcinosis developed lithiasis during the course of the disease. All patients with cortical nephrocalcinosis but only two of eight with medullary nephrocalcinosis developed ESRD. CONCLUSION: Sonography can be used differentiate the two patterns of type 1 primary hyperoxaluria. The cortical nephrocalcinosis type carries a higher risk of developing ESRD.     

Sonographic criteria for differentiation of benign and malignant solid breast lesions: size is of value

PURPOSE: The purpose of this study was to evaluate whether lesion size may influence the value of sonographic findings in the differential diagnosis between benign or malignant breast lesions. MATERIALS AND METHODS: Sonographic features of 256 histologically confirmed (148 benign, 108 malignant) breast lesions were retrospectively and independently reviewed by three radiologists unaware of mammographic findings and pathology results. Each lesion was assessed for several sonographic features and assigned a level of suspicion. Logistic modelling defined the predictive value of each sonographic feature per se and in relation to lesion size. The k statistic (k) evaluated interobserver agreement in lesion classification. The accuracy of breast sonography in characterising solid lesions was also evaluated. RESULTS: Analysis of the sonographic features predictive of malignant disease, taken as a whole, showed that only irregular margins and marked hypoechogenicity maintain their predictive value independent of lesion size. When lesion size is considered, the other features remain significant only for lesions larger than 7 mm. Interobserver agreement for sonographic suspicion, when calculated not taking into account lesion size, was good or excellent whereas it was reduced for lesions smaller than 7 mm. Accuracy of breast sonography improved when evaluating lesions larger than 7 mm. CONCLUSIONS: Lesion size influences the value of sonographic findings in distinguishing benign from malignant lesions. The usually adopted criteria in sonography have a significantly lower accuracy in characterisation of small lesions.     

Sonography of inguinal region hernias

OBJECTIVE: The purpose of this article is to describe the anatomy of the inguinal region in a way that is useful for sonographic diagnosis of inguinal region hernias, and to illustrate the sonographic appearance of this anatomy. We show sonographic techniques for evaluating inguinal, femoral, and spigelian hernias and include surgically proven examples. CONCLUSION: Understanding healthy inguinal anatomy is essential for diagnosing inguinal region hernias. Sonography can diagnose and differentiate between various inguinal region hernias.     

Sonographic findings in ischemic colitis in 58 patients

OBJECTIVE: The purpose of this study was to describe the sonographic findings of 58 patients with proven ischemic colitis and to evaluate whether any of the findings are related to the presence or development of transmural necrosis. MATERIALS AND METHODS: We reviewed the histories of patients diagnosed with ischemic colitis over a period of 5.5 years. Sixty-two patients had undergone sonographic examinations. The spectrum of sonographic findings in ischemic colitis was based on the original imaging report, with an analysis of the presence of colonic abnormalities and their associated alterations. In the second part of the study, we divided the patients into two groups according to the presence or absence of transmural necrosis, and the sonographic findings of each group were compared. Ten patients had sonographic follow-up studies during their hospital stay. RESULTS: The prospective sensitivity of sonography for the characterization of colonic abnormalities was 93.5% (58/62 patients). Segmental involvement was detected in 57 of the 58 patients, with left-sided colitis in 47 (81%). The mean length of bowel involved was 19 cm, with a mean wall thickness of 7.6 mm. Colon wall stratification was preserved in 38 patients (66%). Altered pericolic fat was observed in 16 patients (28%). Absence of or barely visible color Doppler flow in the thickened bowel wall was recorded in 80% of patients. Altered pericolic fat was the only sonographic variable significantly associated with the presence of transmural necrosis (p = 0.004). Improvement as assessed on sonography was observed in all patients with a good clinical course. In patients with transmural necrosis, sonography did not show improvement. CONCLUSION: Sonography is a valuable technique for the detection of colonic abnormalities resulting from ischemic colitis. In this study, altered pericolic fat or the absence of improvement in sonographic follow-up studies were factors associated with transmural necrosis.     

超声对中晚孕分娩后胎物残留的诊断价值

目的 探讨超声对中晚孕分娩后胎物残留的诊断价值。方法 对中晚孕分娩后疑有胎物残留的186例患者进行盆腔或经阴道超声检查，分析超声表现，并与病理及临床随访对照。结果 186例患者中，为判定有无胎物残留诊刮37例，其中，30例经病理证实有胎物残留，7例无胎物残留；149例未诊刮，采用临床随访或保守治疗。子宫内膜团块是胎物残留最敏感、最特异的超声表现，其敏感性为83％，特异性为92％。宫腔积液和宫内膜增厚的敏感性较低，分别为17％和10％。胎物残留患者无1例具有正常的超声表现。结论 子宫内膜团块是诊断和排除胎物残留最敏感、最特异的超声表现；超声检查正常可以排除胎物残留。     

Palpable prostatic nodules: comparison of US and digital guidance for fine-needle aspiration biopsy

This study was undertaken to evaluate the use of transrectal sonographically guided fine-needle aspiration biopsy and to compare sonographic with digital guidance for biopsy. In 62 patients in whom prostatic carcinoma was suspected at digital rectal examination, fine-needle aspiration biopsies were performed transperineally under sonographic guidance and transrectally under digital guidance. These patients had 89 nodules, 73 of which were sampled with both techniques. Malignant cells were obtained under digital guidance in 17 of 73 nodules (23%) and under sonographic guidance in 16 (22%). An additional seven nodules, which were not seen sonographically, were sampled under digital guidance and proved to be negative. In nine other nodules that were nonpalpable and evident only with sonography, malignant cells were obtained under sonographic guidance in three. These findings indicate that sonographic guidance for fine-needle aspiration biopsy is as good as digital guidance for palpable lesions.     

Sonographic determination of the irradiated pulmonary volume in case of irradiation of the thoracic wall

In order to determine the irradiated pulmonary volume, comparative examinations by sonography and computed tomography were made in ten patients submitted to postoperative radiotherapy for mammary carcinoma. The physical and anatomical conditions of sonographic volumetry are discussed. In all cases irradiated with tangential contralateral fields, the irradiated pulmonary volume was less than 200 ccm (118 ccm on an average). The sonographic results did not differ essentially from those of computed tomography, so that the sonographic examination can be offered as a simple and sufficiently precise method of documentation within the frame of an individual therapy planning.     

Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis

BACKGROUND AND PURPOSE: Sonographic criteria of the lymph node have been found to be good indicators for metastatic lymph nodes. We determined which sonographic features are most predictive of metastasis in cervical lymph nodes among patients with head and neck cancer. METHODS: Gray-scale and power Doppler sonograms were retrospectively analyzed in 133 cervical lymph nodes (57 metastatic and 76 reactive nodes) from 52 patients with head and neck cancer. The gray-scale sonographic features of the presence or absence of hilar echoes, parenchymal echogenicity, and short and long axis lengths as well as the power Doppler features of normal hilar flow and abnormal parenchymal flow were evaluated. Univariate and multivariate logistic regression analyses were conducted to determine the relative value of each sonographic feature. RESULTS: At univariate analysis, all sonographic features assessed were found to be important. Multivariate analysis, however, suggested that the presence or absence of hilar echoes, increases in short axis length, and the presence of normal hilar flow were the only sonographic features that were predictive of reactive (presence of hilar echoes and hilar flow) and metastatic (increases in short axis length) lymph nodes. Although multivariate analysis did not indicate any significant contribution of the color-flow criteria for predicting metastatic nodes, the color-flow criteria appeared to improve the overall diagnostic accuracy for the less experienced observer. CONCLUSION: The sonographic criteria most predictive of metastatic cervical lymph nodes were absent hilar echoes and increases in short axis length, as assessed by logistic regression analysis. Compared with these gray-scale criteria, color-flow criteria had fewer predictive advantages.     

Virtual endoscopy using perspective volume-rendered three-dimensional sonographic data: technique and clinical applications

OBJECTIVE: We present a technique for obtaining three-dimensional external and virtual endoscopy views of organs using perspective volume-rendered gray-scale and Doppler sonographic data, and we explore potential clinical applications in the carotid artery, the female pelvis, and the bladder. CONCLUSION: Using the proposed methods, radiologists will find it possible to create virtual endoscopy and external perspective views using sonographic data. The technique works well for revealing the interior of fluid-filled structures and cavities. However, expected improvements in computer performance and integration with existing sonographic equipment will be necessary for the technique to become practical in the clinical environment.     

Sonography of the normal female urethra

This report of the sonographic appearance of the normal adult female urethra includes discussion of the anatomy and four representative cases. Six sonograms are shown that demonstrate normal urethras in both sagittal and transverse sections of pregnant and nonpregnant women. This anatomy is easily demonstrated with a sonographic B scanner. Insufficient knowledge of the sonographic appearance of the normal female urethra may lead to the erroneous diagnosis of a urinary bladder tumor.