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.     

Color Doppler sonographic mapping of pulmonary lesions: evidence of dual arterial supply by spectral analysis.

OBJECTIVE: Within pulmonary lesions, flow signals of pulmonary arteries can be discriminated from flow signals of central bronchial and peripheral bronchial arteries on color Doppler sonography. Our aim was to evaluate the evidence and frequency of different arterial supplies of pleural-based pulmonary lesions using qualitative and quantitative color Doppler sonography. METHODS: Forty-one patients with roentgenologically confirmed pleural-based pulmonary lesions were investigated by color Doppler sonography. The following parameters were investigated: (1) qualitative color Doppler sonographic evidence of vascularization, (2) quantitative color Doppler sonographic evidence of arterial flow signals (resistive index and pulsatility index), and (3) number of different arterial flow signals in 1 lesion by color Doppler sonographic mapping. RESULTS: We found no vascularization in 5 patients, sparse vascularization in 21, and pronounced vascularization in 15. Quantitative color Doppler sonographic parameters were as follows: mean pulmonary artery resistive index, 1.2; mean central bronchial artery resistive index, 0.5; mean peripheral bronchial artery resistive index, 0.7; mean pulmonary artery pulsatility index, 7.8; mean central bronchial artery pulsatility index, 0.7; and mean peripheral bronchial artery pulsatility index, 1.6. There was a significant difference between all types of flow signals for resistive and pulsatility index values but not between pulmonary and peripheral bronchial arteries (P = .068). In 41 patients, 57 different arterial flow signals were determined; 19 (46%) of these patients had 2 or more different arterial flow signals in a lesion. There was no significant difference between benign and malignant lesions regarding the number of flow signals. CONCLUSIONS: Evidence of at least a dual arterial supply can be found on quantitative color Doppler sonography in almost 50% of pulmonary lesions. A single spectral analysis is not suitable for characterization of the arterial supply of pulmonary lesions.     

睾丸附件扭转的彩色多普勒超声诊断价值

目的：探讨彩色多普勒超声对睾丸附件扭转的诊断价值。方法对58例急性阴囊肿瘤的患儿进行灰阶及彩色多普勒超声检查，诊断睾丸附件扭转48例（49侧）；并对手术和保守治疗证实的48例患者的声像图进行回顾分析。结果：49例睾丸附件扭转中，超声显示睾丸附睾头间，睾丸上极和附睾头旁结节（扭转的睾丸附件）45例，结节多呈不均质高回声；42例结节内未显示血流信号，睾丸，附睾肿大及其血流信号增多41例；阴囊壁增厚39例，睾丸鞘膜积液31例，48例中，超声诊断正确45例，误诊3例，诊断符合为93．5％，结论：睾丸附睾头间及睾丸附睾旁高回声结节是睾丸附件扭转的特征性声像表现，彩色多普勒超声对本病诊断准确性高，可作为诊断睾丸附件扭转的最佳检查方法。     

Sonographic assessment of blunt abdominal trauma: a 4-year prospective study

PURPOSE: Emergency abdominal sonography has become a common modality worldwide in the evaluation of injuries caused by blunt trauma. The sensitivity of sonography in the detection of hemoperitoneum varies, and little is known about the accuracy of sonography in the detection of injuries to specific organs. The purpose of this study was to determine the overall accuracy of sonography in the detection of hemoperitoneum and solid-organ injury caused by blunt trauma. METHODS: From January 1995 to October 1998, 3,264 patients underwent emergency sonography at our institution to evaluate for free fluid and parenchymal abnormalities of specific organs caused by blunt trauma. All patients with intra-abdominal injuries (IAIs) were identified, and their sonographic findings were compared with their CT and operative findings, as well as their clinical outcomes. RESULTS: Three hundred ninety-six (12%) of the 3,264 patients had IAIs. Sonography detected free fluid presumed to represent hemoperitoneum in 288 patients (9%). The sonographic detection of free fluid alone had a 60% sensitivity, 98% specificity, 82% positive predictive value, and 95% negative predictive value for diagnosing IAI. The accuracy was 94%. Seventy patients (2%) had parenchymal abnormalities identified with sonography that corresponded to actual organ injuries. The sensitivity of the sonographic detection of free fluid and/or parenchymal abnormalities in diagnosing IAI was 67%. CONCLUSIONS: Emergency sonography to evaluate patients for injury caused by blunt trauma is highly accurate and specific. The sonographic detection of free fluid is only moderately sensitive for diagnosing IAI, but the combination of free fluid and/or a parenchymal abnormality is more sensitive.     

Role of Doppler sonography in the evaluation of accessory spleens after splenectomy.

OBJECTIVE: Splenectomy influences the Doppler blood flow pattern in the splenic artery. Blood flow in this vessel might return to normal if an accessory spleen increases in size after splenectomy. Our objective was to evaluate the resistive index of the splenic artery depending on the presence or absence of a hypertrophic accessory spleen in splenectomized patients. METHODS: The resistive index of the splenic artery was evaluated by duplex Doppler sonography in 19 splenectomized patients (8 with a hypertrophic accessory spleen) and in 8 healthy volunteers. The resistive index was measured within 3 cm of the origin of the splenic artery, and 3 different measurements were averaged. The presence or absence of a hypertrophic accessory spleen was diagnosed on the basis of sonography, computed tomography, magnetic resonance imaging, or scintigraphy, as well as by the presence or absence of Howell-Jolly bodies on a peripheral blood smear. RESULTS: The resistive index of the splenic artery in the splenectomized patients without a hypertrophic accessory spleen (mean +/- SD, 0.82 +/- 0.06; n = 11) was significantly (P < or = .0001) higher than in splenectomized patients with a hypertrophic accessory spleen (0.63 +/- 0.06; n = 8) and in control subjects (0.63 +/- 0.05; n = 8). CONCLUSIONS: In the splenectomized patient, a hypertrophic accessory spleen is associated with a normal resistive index in the splenic artery.     

Wandering spleen--the challenge of ultrasound diagnosis: report of 7 cases

PURPOSE: To summarize our experience with sonographic diagnosis of wandering spleen in children and assess for the typical sonographic findings of wandering spleen, complications, and possible diagnostic pitfalls. METHODS: We identified all pediatric patients from 1998-2003 with a surgically confirmed diagnosis of wandering spleen. All sonographic examinations were reviewed for splenic position, size, echotexture, and parenchymal blood flow. RESULTS: Seven children were identified with a mean age of 9.7 years (range 4.2-15.3 years). All presented with abdominal pain. Abdominal sonography, performed in all children demonstrated a low position of the spleen (n = 6), splenomegaly (n = 4), and absence of parenchymal flow in the three patients with splenic torsion and infarction. The diagnosis was made preoperatively via sonography in five children; three required repeated hospital admissions before the correct diagnosis was established. Complications occurred in five patients (gastric obstruction [n = 1], splenic infarction [n = 3], and recurrent pancreatitis [n = 1]). CONCLUSION: The most specific sonographic finding for wandering spleen is low position of the spleen. However, if the spleen regains its normal or near-normal position, the diagnosis may be missed and the condition may recur, and result in complications.     

Power Doppler ultrasonographic assistance in percutaneous ethanol injection of autonomously functioning thyroid nodules.

The purpose of this study was to explore the potential role of power Doppler sonography in guiding percutaneous ethanol injection of autonomously functioning thyroid nodules. Thirty-two patients with pretoxic adenoma and 15 with toxic adenoma underwent percutaneous ethanol injection under power Doppler sonographic guidance. All patients with pretoxic adenoma and 13 of 15 patients with toxic adenoma were treated successfully (normalization of circulating thyroid hormones and thyroid stimulating hormone levels and disappearance of nodular hyperactivity with complete recovery of extranodular tracer uptake at scintigraphy). Power Doppler sonography showed the progressive reduction of the intranodular blood flow until its extinction after 6 to 12 months. Nodular shrinkage was obtained in all patients (from 10.85 +/-1.04 to 2.9 +/- 0.3 ml in pretoxic adenoma and from 15.4 +/- 1.8 to 4.2 +/- 0.7 ml in toxic adenoma. Power Doppler sonographic guidance seems to improve the outcome of percutaneous ethanol injection, allowing detection of blood flow even in very small vessels, permitting the ethanol to be guided toward the main afferent vessels of the nodules, and making it possible to monitor the diffusion and the effects of ethanol on nodular vascularization.     

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.     

结节性甲状腺肿和甲状腺腺瘤的超声诊断及鉴别诊断

目的 分析结节性甲状腺肿和甲状腺腺瘤的声像图表现,探讨超声对二者的鉴别诊断价值.方法 分析32例甲状腺腺瘤和49例甲状腺结节患者的声像图特点,并与术后病理对照.结果 二维声像图示:结节性甲状腺肿表现为多结节分布,占68.7%(22/32),且周边少见晕环,腺体实质同声增粗;甲状腺腺瘤表现为单结节分布,占31.2%(10/32),且周边多见晕环,实质回声均匀.CDFI示:两者结节周边及内部血流信号有显著性差异(P＜0.05).结论 彩色多普勒超声可提高结节性甲状腺肿和甲状腺腺瘤的鉴别诊断水平,具有重要的临床意义.     

Prenatal color Doppler sonographic evaluation of nuchal encirclement by the umbilical cord

PURPOSE: The aim of this study was to assess whether Doppler flow velocimetry of the fetal middle cerebral and umbilical arteries is affected by nuchal encirclement by the umbilical cord (nuchal cord) in the prenatal period. PATIENTS AND METHODS: The position of the fetal umbilical cord was assessed on color Doppler sonography in pregnant women who were referred to our radiology department between September 14, 1998, and January 14, 2000. Pulsatility and resistance indices and the ratio of peak systolic blood flow velocity to diastolic velocity of the umbilical arteries and middle cerebral arteries of all fetuses were prospectively obtained with Doppler flow velocimetry. The fetuses were categorized into 2 groups: group 1 consisted of fetuses without sonographic evidence of nuchal cord and group 2 of fetuses with sonographic evidence of nuchal cord. The results were statistically analyzed with independent-groups t test. A p value of less than 0.05 was considered significant. RESULTS: During the study period, 230 pregnant women underwent sonographic examination of the fetus, and 68 fetuses were delivered. The sonographic examinations were performed at 24-41 weeks' menstrual age. Of the 46 fetuses in group 1, 1 fetus had nuchal cord at delivery; of the 22 fetuses in group 2, 4 did not have nuchal cord at delivery. The sensitivity of color Doppler sonography in detecting nuchal cord was 95% (18 of 19 fetuses), the specificity was 92% (45 of 49), the negative predictive value was 98% (45 of 46), and the positive predictive value was 82% (18 of 22). No statistically significant differences in middle cerebral artery or umbilical artery Doppler flow velocimetry values were detected between the 2 groups. CONCLUSIONS: Color Doppler sonography is a sensitive and specific method of diagnosing nuchal cord, but fetal middle cerebral artery and umbilical artery Doppler flow velocimetry values are not affected by the presence of nuchal cord in the prenatal period.     

Doppler sonographic diagnosis of respiration-dependent reversed flow in the hilar splenic vein.

We describe respiration-dependent reversed flow in the splenic vein detected by color Doppler sonography in 2 patients. In case 1, gray-scale sonography in a patient with liver cirrhosis and abdominal pain showed a hyperechoic, thickened colonic segment and diverticula, with increased echogenicity around the diseased colon. The liver was small, with a nodular surface and coarse echotexture. Doppler sonography of the portal and splenic veins showed a constant hepatopetal flow while the patient held her breath in midinspiration and a brief, transient color change restricted to the hilar splenic veins when the patient took a deep breath. In case 2, abdominal sonography in a patient with pneumonia and right-sided abdominal pain showed mural thickening of the appendix and left-sided pneumonic infiltration. The liver size and texture were normal. Color Doppler sonography of the portal and splenic veins showed a constant hepatopetal flow while the patient held his breath in midinspiration and a transient reversal of flow restricted to the splenic veins when the patient took a deep breath. Although the cause of this flow pattern is unclear, increased intra-abdominal pressure is a possible explanation.     

Evaluation of hepatic focal nodular hyperplasia with contrast-enhanced gray scale harmonic sonography: initial experience.

OBJECTIVE: To assess the potential of contrast-enhanced gray scale harmonic sonography in the evaluation of the typical vascular and enhancement patterns of hepatic focal nodular hyperplasia. METHODS: Thirteen patients with 13 lesions of hepatic focal nodular hyperplasia underwent contrast-enhanced gray scale harmonic sonography. After the injection of a microbubble contrast agent (SH U 508A), gray scale harmonic sonographic studies using a Coded Harmonic Angio technique were performed with a combination of a period of continuous scanning to assess the vascular pattern (vascular imaging) and interval delay scanning to determine the sequential enhancement pattern (acoustic emission imaging). Each imaging pattern was categorized and analyzed by consensus of 2 experienced radiologists. RESULTS: In 12 (92%) of 13 lesions, vascular imaging during the arterial phase showed central arteries of a spoked wheel pattern, whereas the remaining lesion had stippled vascularity. On acoustic emission imaging, 11 (85%) of 13 lesions were hyperechoic during the early phase, and the remaining 2 (15%) were isoechoic compared with surrounding parenchyma. Ten (77%) of 13 lesions remained either hyperechoic (5 of 13) or isoechoic (5 of 13) during the delay phase, whereas the remaining 3 lesions (23%) were hypoechoic. CONCLUSIONS: Contrast-enhanced gray scale harmonic sonography showed the typical vascularity of a spoked wheel pattern during the vascular phase and persistent enhancement on serial acoustic emission imaging in most cases of hepatic focal nodular hyperplasia, and thereby it can be a promising technique in noninvasive diagnosis of this entity.     

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.     

Acute,complete splenic infarction in cancer patient is associated with a fatal outcome

Splenic infarction frequently occurs in patients with myeloproliferative diseases, endocarditis, and sickle cell anemia. Various sonographic patterns of splenic infarction do exist, but little is known about tumor associated splenic infarction in cancer patients. Between January 1992 and December 2002, 66 patients were diagnosed with splenic infarction by color Doppler sonography (CDS). Ten patients had an underlying solid cancer. Clinical and sonographic data of cancer patients were evaluated retrospectively with regard to age, sex, frequency of thrombotic episodes, splenic size, echomorphology and vascularity of splenic lesions, and follow-up examination. The median age was 53 years (range, 16–73 years). Nine of 10 patients had abdominal metastases, four had evidence of a hypercoagulable state, five had a small spleen (< 7 × 3 cm), and seven had acute complete infarction of the spleen without hilar and parenchymal vessels on CDS. Survival of six patients with acute complete infarction ranged from 1 to 30 days. In cancer patients with splenic infarction, an acute complete infarction is the most common pattern. It is caused predominantly by a hypercoagulable state and is associated with an extremely short survival.     

Vascular and nonvascular complications of renal transplants: sonographic evaluation and correlation with other imaging modalities, surgery, and pathology

Cadaveric or living donor renal transplantation is commonly performed in individuals with end-stage renal disease. In recent years, gray-scale sonography, coupled with color Doppler sonography (CDUS), power Doppler sonography (PDUS), or spectral Doppler sonography, has become the primary imaging modality for these patients. Postoperative serial sonography is performed to detect complications and aid in posttransplant management. In addition, sonography is used to guide percutaneous aspiration of fluid or biopsy to diagnose rejection or renal and perirenal masses.In this article we discuss the spectrum of sonographic findings, both vascular and nonvascular, of renal transplant complications, including but not limited to renal arterial and venous stenosis and thrombosis, peritransplant collections (lymphoceles, hematomas, urinomas, and seromas), posttransplant lymphoproliferative disorder, and postbiopsy complications (hematomas, pseudoaneurysms, and arteriovenous fistulas). We correlate sonographic findings with those from other imaging modalities (such as angiography, CT, and MRI) and findings at surgery and pathology when possible.     

Sonographic findings in type I glycogen storage disease.

PURPOSE: The aim of this study was to document the sonographic appearance and dimensions of the liver and spleen in patients affected by type I glycogen storage disease and to correlate those findings with laboratory data to evaluate the potential role of sonography in diagnosing that disease. METHODS: Fourteen patients (age range, 3-26 years; 10 patients younger than 18 years) with type I glycogen storage disease proved by liver biopsy were studied prospectively with gray-scale sonography, color Doppler sonography, and spectral analysis. The liver, kidneys, spleen, portal system, hepatic veins, and hepatic arteries were evaluated. Laboratory data were correlated with sonographic findings. RESULTS: In 13 (93%), of 14 patients, the liver was enlarged, and in 11 patients (79%), hepatic echogenicity was increased. In 9 patients (64%), both kidneys were enlarged, and in 6 cases (43%), the spleen was enlarged. In all patients, flow in the portal, splenic, and superior mesenteric veins was hepatopetal, and flow in the hepatic veins was triphasic. In 5 patients (36%), both triglyceride and total cholesterol levels were higher than normal. No focal hepatic lesions were identified. Analysis found no significant association between sonographic findings and laboratory data. CONCLUSIONS: The most frequent sonographic findings in patients with type I glycogen storage disease were hepatomegaly, increased hepatic echogenicity, and enlarged kidneys. Sonography may help in the diagnosis of type I glycogen storage disease, but a liver biopsy is required for a definitive diagnosis.     

Three-dimensional quantification of tumor vascularity as a tertiary test after B-mode and power Doppler evaluation for detection of ovarian cancer.

OBJECTIVE: The purpose of this study was to investigate the role of 3-dimensional (3D) quantification of tumor vascularity in the differential diagnosis of pelvic indeterminate masses with a solid appearance or unilocular or multilocular cysts with a solid component showing central vascularization on 2-dimensional power Doppler sonography. METHODS: One hundred fifty-seven consecutive pelvic masses in 153 patients were included in this study and underwent sonography before surgery. Masses that showed a typical benign pattern on B-mode sonography (n = 112) and indeterminate masses with peripheral or absent flow on power Doppler sonography (n = 10) were not evaluated by 3D sonography. Only masses with central vascularization were submitted to 3D power Doppler imaging (n = 35). The following 3D vascular parameters were calculated: relative color and flow measure (similar to the vascularization flow index obtained with other systems). RESULTS: With receiver operating characteristic curve analysis, the best cutoff values for relative color and flow measure were 4.4 and 2.7, respectively. Flow measure had sensitivity of 68% and specificity of 40% in the overall population submitted to 3D power Doppler sonography. Accuracy slightly increased when masses with small papillary projections (<10 mL) were excluded. In this group (n = 22), sensitivity was 83%, and specificity was 50%. CONCLUSIONS: In masses with central vascularization on 2-dimensional power Doppler sonography, the use of 3D quantification of tumor vascularity had low diagnostic accuracy in the detection of adnexal malignancies, although an increase in accuracy in masses with a solid portion of greater than 10 mL was reported.     

桥本氏甲状腺炎的超声诊断与鉴别诊断

目的探讨桥本氏甲状腺炎(HT)的二维及彩色多普勒超声表现及鉴别要点。方法60例HT患者及82例甲状腺其他疾病患者应用常规超声检查,分析其声像图表现及超声鉴别要点。结果按回声分类,HT可分为四型:局灶性回声减低型、弥漫性回声减低型、单发结节型及多发结节型。与甲状腺其他疾病比较,各型HT特征性的变化有峡部增厚,双侧叶对称性肿,不规则强回声带,结节呈实性、斑点状钙化,结节外血流信号丰富及双侧甲状腺上动脉PSV值对称性升高。结论二维及彩色多普勒超声对HT的诊断及鉴别诊断有重要价值。     

Sonographic features of xanthogranulomatous pyelonephritis

PURPOSE: The purpose of this study was to describe the various sonographic features of xanthogranulomatous pyelonephritis (XGP). METHODS: We retrospectively reviewed the CT, sonographic, and medical records of patients diagnosed with XGP from January 1981 to December 1998. Twenty-seven patients for whom XGP was histopathologically confirmed were included in the study. There were 12 men and 15 women, with an age range of 21-86 years (mean, 57 years). All patients had undergone sonography of the kidneys. The renal size, shape, and outline were recorded. The presence of perinephric fluid accumulation, of obstructive uropathy, or of internal echoes in the dilated collecting system and the echotexture of the renal parenchyma were documented. RESULTS: We categorized the XGP into 4 groups on the basis of the sonographic features: (1) diffuse hydronephrotic, 12 patients (44%); (2) diffuse parenchymal, 9 patients (33%); (3) diffuse contracted, 4 patients (15%); and (4) segmental or focal, 2 patients (7%). A localized perinephric fluid collection was present in 4 patients (15%). The preoperative sonographic diagnoses were pyonephrosis (n = 14, 52%), renal pelvic tumor with possible associated infection (n = 5, 19%), renal parenchymal mass (n = 2, 7%), hydronephrosis (n = 2, 7%), and chronic pyelonephritis with renal atrophy (n = 4, 15%). XGP was considered a possible diagnosis in only 11 patients (41%). CONCLUSIONS: XGP has no specific sonographic features but is suggested by parenchymal thinning and hydronephrosis, sonographic signs of chronic obstructive uropathy caused by stones; echoes in the dilated collecting system; and a perinephric fluid collection. CT, needle biopsy, or both are recommended to further evaluate and confirm sonographically suspected XGP.     

Granulomatous mastitis: gray-scale and color Doppler sonographic findings

PURPOSE: We examined the roles of gray-scale and color Doppler sonography in the diagnosis of granulomatous mastitis. METHODS: We retrospectively studied the clinical, mammographic, and sonographic findings in 10 women 24-57 years old (mean age, 35.9+/-13.9 years) who had a histopathologic diagnosis of granulomatous mastitis. All patients underwent gray-scale sonographic examination, and 8 patients were further examined with color Doppler imaging. Seven patients had previously undergone mammography. RESULTS: Mammographic findings were nonspecific in all 7 patients. Gray-scale sonographic findings were compatible with mastitis in 6 (60%) of 10 patients. Doppler examination showed increased arterial and venous vascularization within and around the lesion in 5 of 8 patients, but the spectral analysis findings were not specific for granulomatous mastitis. CONCLUSIONS: Neither mammography nor Doppler sonography plays a significant role in the differential diagnosis of granulomatous mastitis versus fibroadenoma or carcinoma. Gray-scale sonography shows findings specific for granulomatous mastitis in some cases, but all cases require histopathologic confirmation for final diagnosis.