Characteristic Sonographic Appearance Research Articles

Ultrasound of palpable lesions: a pictorial review.

Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.

Does automated breast ultrasound (ABUS) add to breast tomosynthesis (DBT) in assessment of lesions in dense breasts?

BackgroundAs mammography has its known limitations in dense breast, additional imaging is usually needed. We aimed to evaluate the role of automated breast ultrasound in addition to tomosynthesis in detection and diagnosis of breast lesions in dense breasts. Seventy patients with dense breasts subjected to full-field digital mammography (FFDM) including digital breast tomosynthesis (DBT) and automated breast ultrasound (ABUS). Both studies were evaluated by two experienced radiologists to assess breast composition, mass characterization, asymmetry, calcification, axillary lymphadenopathy, extent of disease (EOD), skin thickening, retraction, architectural distortion, and BIRADS classification. All breast masses were interpreted as above described and then correlated with final pathological diagnosis.ResultsStudy included 70 females presenting with different types of breast lesions. Eighty-two masses were detected: 53 benign (n = 53/82), 29 malignant (n = 29/82). Histopathology of the masses was reached by core biopsy (n = 30), FNAC (n = 14), and excisional biopsy (n = 11). The rest of the masses (n = 27/82) were confirmed by their characteristic sonographic appearances; 20 cases of multiple bilateral anechoic simple cysts, 7 typical fibroadenomas showed stationary course on follow-up. As regards the final BIRADS score given for both modalities, tomosynthesis showed accuracy of 93.1% in characterization of malignant masses with accuracy of 94.3% in benign masses, on the other hand automated ultrasound showed 100% accuracy in characterization of malignant masses with 98.1% accuracy in benign masses.ConclusionAdding ABUS to tomosynthesis has proven a valuable imaging tool for characterization of breast lesions in dense breasts both as screening and diagnostic tool. They proved to be more sensitive and specific than digital mammography alone in showing tissue overlap, tumor characterization, lesion margins, extent, and multiplicity of malignant lesions.

Prenatal Diagnosis of Fetal Oral Masses by Ultrasound Combined With Magnetic Resonance Imaging.

To analyze the imaging manifestations of common fetal oral masses by ultrasound combined with magnetic resonance imaging (MRI) and to discuss their differential diagnoses. A retrospective study of 6 fetuses with oral masses was performed at a tertiary referral center. The imaging features of prenatal ultrasonography and MRI in the diagnosis of fetal oral masses were analyzed. Histopathological examination and/or postpartum ultrasound revealed lymphangioma malformation in 2 fetuses, and mucosal retention cyst, mature teratoma, immature teratoma, and cranial meningocele in 1 fetus, respectively. The teratoma had a characteristic sonographic appearance. In our study, the 4 cases of cystic masses did not have an abnormal vessel architecture. Supplemental MRI revealed a mass effect at the level of the hypopharynx, and in 2 cases with polyhydramnios, the mass obstructed the fetuses' upper airway. Thus, ex-utero intrapartum therapy surgery was performed to secure the newborn's airway. Oral fetal tumors represent rare congenital malformations. This study shows that a prenatal diagnosis of oral masses is feasible by ultrasound examination. MRI can further confirm the results of ultrasonography and clearly show the relationship between the mass and the hypopharynx. Ultrasonography combined with MRI could, to a large extent, facilitate early detection and appropriate treatment and improve outcome.

Ultrasound for the Diagnosis of Carotidynia.

The purpose of this work is to draw attention to the characteristic sonographic features of carotidynia, which, in the context of a typical clinical picture support its diagnosis. Six patients presented with primary symptoms of neck pain and focal tenderness. In all patients, focal wall thickening of the distal end of the common carotid artery was found exactly in the region of tenderness, leading to mild lumen narrowing. Treatment with nonsteroidal anti-inflammatory drugs or glucocorticoids led to full symptom resolution. Carotidynia will often be encountered first on sonography performed for evaluation of neck pain and has a characteristic sonographic appearance.

Prenatal Sonographic Detection of Ebstein’s Anomaly

Ebstein’s anomaly is a rare type of congenital heart defect characterized by a malformation of the tricuspid valve and the right side of the heart. This case study presents a well-documented case of Ebstein’s anomaly that was diagnosed prenatally using sonography. The ability of prenatal sonography to detect and accurately diagnosis this case allowed for a change in the management of the pregnancy to properly evaluate the condition and prepare for treatment. In addition, information regarding Ebstein’s anomaly is reviewed and specifically addresses etiology, symptoms, diagnosis, treatment, characteristic sonographic appearance, and common differential diagnoses.

Lymphoid Hyperplasia of the Appendix: A Potential Pitfall in the Sonographic Diagnosis of Appendicitis.

The objective of this study was to test the hypothesis that thickening of the lamina propria, a finding produced by lymphoid hyperplasia, is significantly associated with false-positive sonographic diagnoses of appendicitis in 6- to 8-mm noncompressible appendixes. Sonograms of 119 consecutive patients with suspected appendicitis and 6- to 8-mm noncompressible appendixes were retrospectively blindly evaluated for thickening of the lamina propria (short axis thickness ≥ 1 mm). The reference standard for appendicitis was pathologic analysis of resected specimens. Results were compared with the two-tailed Fisher exact test. Thirty-one patients (26.1%) had a thickened lamina propria and 88 (73.9%) did not. Of the 27 pediatric patients with a thickened lamina propria, five (18.5%) had true-positive and 22 (81.5%) had false-positive sonograms for appendicitis; among the 55 pediatric patients without a thickened lamina propria, 27 (49.1%) had true-positive and 28 (50.9%) had false-positive sonograms for appendicitis (p = 0.009). Similar differences in adult patients were not statistically significant. All five pediatric patients with appendicitis and thickened lamina propria also showed two or more findings of periappendiceal fluid, hyperechoic periappendiceal fat, or mural hyperemia on color Doppler examination, compared with two of 22 similar pediatric patients without appendicitis (p < 0.001). Lymphoid hyperplasia may result in a noncompressible appendix 6-8 mm in diameter and may be misdiagnosed as appendicitis in pediatric patients. True-positive diagnoses of appendicitis can be accurately identified by the presence of at least two additional findings from the group of periappendiceal fluid, hyperechoic periappendiceal fat, and mural hyperemia. Identifying the characteristic sonographic appearance of lymphoid hyperplasia may help prevent false-positive misdiagnoses of appendicitis.

Sonography of musculoskeletal soft-tissue masses: techniques, pearls, and pitfalls.

The purpose of this article is to review the appropriate use of ultrasound in the workup of soft-tissue masses of the extremities. The normal sonographic appearance of superficial soft tissues, the importance of proper technique in image acquisition, and the characteristic sonographic appearance of certain masses and potential pitfalls are discussed. Ultrasound is increasingly being used for the initial evaluation of soft-tissue masses of the extremities. Certain clinical and imaging findings allow diagnosis of selected soft-tissue masses; however, most imaging findings are nonspecific, and further evaluation is necessary. The many potential pitfalls can lead to adverse patient outcomes.

Sonographic Features of Common Soft Tissue Masses in the Extremities

A wide variety of superficial soft tissue masses may be seen in clinical practice and imaging modalities can be helpful in achievement of a definitive diagnosis or limit a differential diagnosis. Among them, ultrasonography is well suited for screening soft tissue masses because of its safety, low cost, and real-time dynamic imaging. The purpose of this article is to review the characteristic sonographic appearance of soft tissue masses in the extremities.

Medial Ankle and Heel: Ultrasound Evaluation and Sonographic Appearances of Conditions Causing Symptoms

The complex anatomy of the medial ankle and hindfoot can make clinical assessment of medial ankle and heel pain challenging. Ultrasound is an accessible, relatively inexpensive modality, and modern high-resolution probes allow eloquent demonstration of the main structures that are implicated as potential causes of medial ankle pain. In this work we review highlights the clinically relevant anatomy and normal sonographic appearances of structures around the medial ankle and heel and discuss key techniques to allow optimal ultrasound assessment. The conditions that cause medial-sided ankle and heel symptoms are discussed with their characteristic sonographic appearances.

Focal Liver Lesions

A high proportion of focal liver lesions are detected using ultrasonography. Many of them have characteristic sonographic appearances and can be diagnosed confidently in association with an accurate clinical history. Others require confirmation with computed tomography or magnetic resonance imaging. Contrast-enhanced ultrasonography has an increasing role in assessing these lesions. Typical and atypical features are described in this article, and correlative imaging is discussed.

Multimodality Imaging of Common and Uncommon Cystic Focal Liver Lesions

Cystic lesions of the liver are frequently encountered in clinical practice. In general, they can be classified as developmental, neoplastic, infectious, inflammatory, or miscellaneous lesions. Most cystic focal liver lesions have specific sonographic, computed tomographic, and magnetic resonance imaging features. These features help narrow, in combination with critical clinical information, the differential diagnosis and negate the need for biopsy or further diagnostic investigations in many patients. The purposes of this essay are to illustrate the characteristic sonographic, computed tomographic, and magnetic resonance imaging appearances of a gamut of both common and uncommon cystic focal liver lesions, to correlate these imaging findings with gross and microscopic pathology features, and to emphasize the essential information that allows differentiating among cystic hepatic lesions. Among others, imaging features that are important to recognize include the size and shape of the cyst; the presence and thickness of a cyst wall; the presence of calcifications, mural nodularity, debris, and septations; the density and signal intensity spectrum along with the enhancement pattern; the presence of communication with the biliary tree; and the presence of pericystic changes in the hepatic parenchyma. Familiarity with the complete spectrum of cystic focal liver lesions and a thorough understanding of their classic imaging appearances will undoubtedly allow a more definitive diagnosis and shorten the diagnostic workup.

Feasibility of Emergency Physician Diagnosis of Hypertrophic Pyloric Stenosis Using Point-of-Care Ultrasound: A Multi-Center Case Series

Hypertrophic pyloric stenosis (HPS) is an acute abdominal emergency in infants that often presents to Emergency Departments. The clinical diagnosis of HPS relies on palpation of an olive-sized mass in the right upper quadrant of an infant with a history of projectile vomiting. However, studies have shown that clinicians cannot detect the olive in 11% to 51% of cases. Ultrasonography is the imaging modality of choice to diagnose HPS. HPS has a highly characteristic sonographic appearance that makes it readily identifiable on ultrasound. To our knowledge, there have been no reports documenting the ability of Emergency Physicians to diagnose HPS using point-of-care ultrasound. We present a multi-center case series (n = 8) of HPS diagnosed by Emergency Physician-performed ultrasound. We review the technique of incorporating point-of-care ultrasound into the physical examination of infants with suspected HPS and discuss the possible role of point-of-care ultrasound in the management of these patients.

Der sonographische Nachweis von Gas im Gefäßsystem der Leber: Ein Bildessay

Gas within the vascular system of the liver was demonstrated sonographically in 5 patients. In contrast, plain films of the abdomen in these patients failed to demonstrate this serious finding. 3 patients presented with gas within the hepatic portal venous system, 1 patient with gas in the liver veins. In these patients, gas formation was probably caused by sepsis with gas-producing bacteria. In the last patient, air within the hepatic arterial system was caused by insufflation of air thru a port-a-cath catheter located in the main hepatic artery. The characteristic sonographic appearance of intravascular gas are highly echogenic particles flowing within the vessels. Different pathophysiologic mechanisms of gas formation in the hepatic portal venous system include sepsis with gas forming organisms, gastrointestinal necrosis of various origin in combination with elevation of intramural pressure and alteration of gas solubility of blood. The significance of sonography as a very sensitive and specific modality is outlined.

Sonography of adrenal gland diseases in the newborn infant

Diseases and morphological changes of the adrenal gland play an important role especially in the newborn, because malformations, congenital errors of metabolism, connatal tumours and birth injuries become symptomatic in this period of life. In this paper, the possibilities of neonatal adrenal ultrasonography for diagnosis and in the aspect of differential diagnosis are discussed. The characteristic sonographic appearance is the thin echogenic core surrounded by a thick transonic zone. Adrenal haemorrhage as well as the neuroblastoma disturb these structures and show their own characteristic pattern. In congenital adrenal hyperplasia the organ is enlarged in a fold-like manner. In agenesis or displacement of the kidney the adrenal gland presents as an elongated mass in the renal fossa and on the psoas muscle.

Sonographic evaluation of enteric duplication cysts

Sir, Dr. Hur and colleagues have provided an excellent pictorial essay on imaging features of gastrointestinal (GIT) duplications in infants and children [1]. We would like to elaborate upon the following sonographic features of GIT duplications. The authors describe the characteristic sonographic appearance of small-bowel duplication cysts as consisting of an inner hyperechoic rim and an outer surrounding hypoechoic layer. They also mention the potential pitfalls. Cheng et al. [2] have recently suggested that a Y-shaped configuration of the hypoechoic outer layer (representing the muscularis propria) may be more reliable in the diagnosis of duplication cysts. Although demonstrated in vitro by the authors, this sign has not yet been demonstrated in vivo. Another sonographic sign that may be noted in patients with duplication cysts is peristaltic contractions in the cyst wall [3]. We recommend that sonographers actively search for these signs to arrive at a confident preoperative diagnosis of duplication cyst.

Soft Tissue Diffuse Neurofibromas

The purpose of this study was to describe the sonographic findings of soft tissue diffuse neurofibromas. 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. 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. Soft tissue diffuse neurofibromas have a characteristic sonographic appearance; therefore, sonography should be considered a useful tool in the initial screening of this disease.

Sonographic Evaluation of the Endometrium in Patients With a History or an Appearance of Polycystic Ovarian Syndrome

The purpose of this study was to assess the incidence and significance of a thick, cystic-appearing endometrium in association with a history or an ovarian appearance of polycystic ovarian syndrome. An Institutional Review Board-approved, retrospective medical record review of sonographic studies from January 1, 1998, to December 31, 2005, found 245 patients with clinical features, a characteristic sonographic appearance of the ovaries, hormonal abnormalities, or a history of polycystic ovarian syndrome. The sonographic thickness and appearance of the endometrium (homogeneous or heterogeneous) and histologic findings on biopsy were obtained. Two hundred twenty-seven patients had a homogeneous endometrium in the range of 1 to 17 mm (mean +/- SD, 6.4 +/- 3.1 mm); 18 patients had a heterogeneous endometrium in the range of 4 to 23 mm (mean, 13.2 +/- 5.6 mm). Of the 18 patients with a heterogeneous endometrium, 9 also had a sonographic finding of tiny cystic foci within the endometrium. Of these, 5 had endometrial biopsy, resulting in 2 cases of a proliferative endometrium and 1 case each of simple hyperplasia, hyperplasia with atypia, and scant tissue. No cases of hyperplasia were present in the patients with a homogeneous endometrium. A heterogeneous cystic endometrium is associated with the prolonged proliferative phase from chronic anovulation as well as endometrial hyperplasia.

Sonography of the thoracic and abdominal walls

Pathologic processes that may involve the thoracic or abdominal wall occasionally raise diagnostic challenges because of the low specificity of physical findings. Congenital and developmental anomalies may mimic soft-tissue or bone tumors; tumors may mimic inflammatory and infectious diseases, and vice versa. Furthermore, these disorders may produce remote manifestations that are frequently misdiagnosed as visceral pain. Many of these parietal processes have typical sonographic appearances that allow definitive diagnosis. This article reviews characteristic sonographic appearances of thoracic and abdominal wall disorders. Familiarity with these sonographic features facilitates accurate diagnosis and optimal patient treatment.

Characteristic Sonographic Appearance of Normal Appendix in Children: Inner Hypoechoic Band without Folding

Purpose: To identify the characteristic ultrasonographic findings of the normal appendix in children in order to detect it more easily and so to exclude acute appendicitis from a diagnosis with more confidence. Materials and Methods: Among 64 patients presenting with right lower quadrant pain, 44 patients, excluding 15 patients diagnosed as acute appendicitis and 5 patients with non-visualization of the appendix due to severe ileus and obesity, were evaluated for the point of incidence, the thickness and the presence of folding of the inner hypoechoic band of the normal appendix. The age of the patients ranged from 3 to 15 years with a mean age of 6.5 years. Two patients were operated on and we correlated the preoperative ultrasonographic findings with the histologic findings. Results: In all the cases of the 44 patients with normal appendix, the inner hypoechoic band was discovered, which was seen as a linear structure without folding along the whole length of appendix. This measured as 0.75 mm (0.3-1.5 mm) for the mean thickness. The inner hypoechoic band corresponded to the mucosal layer that had abundant lymphoid tissue on the histologic examination. Conclusion: For the pediatric normal appendix, the inner hypoechoic band without folding is present, and this corresponds to the mucosal layer with abundant lymphoid tissue.

Characteristic Sonographic Appearance of Normal Appendix in Children: Inner Hypoechoic Band without Folding

Characteristic Sonographic Appearance of Normal Appendix in Children: Inner Hypoechoic Band without Folding