Common Sonographic Finding Research Articles

Clinical Manifestations Laboratory Tests Abdominal Ultrasonic Findings and In-hospital Prognosis of COVID-19 in 185 Pediatric Cases in a Tertiary Center.

Despite the COVID-19 pandemic, there is little information about the different clinical aspects of COVID-19 in children. In this study, we assessed the clinical manifestations, outcome, ultrasound, and laboratory findings of pediatric COVID-19. This retrospective study was conducted on 185 children with definitive diagnosis of COVID-19 between 2021 and 2022. The patients' information was retrieved from hospital records. The average age of the patients was 5.18 ± 4.55 years, and 61.1% were male. The most frequent clinical manifestation was fever (81.1%) followed by cough (31.9%), vomiting (20.0%), and diarrhea (20.0%). Mesenteric lymphadenitis was common on ultrasound and found in 60% of cases. In-hospital death was identified in 3.8% of cases. The mean length of hospital stay was 8.5 days. Mandating intensive care unit (ICU) stay was found in 19.5% and 5.9% of cases were intubated. Acute respiratory distress syndrome (ARDS), lower arterial oxygen saturation, higher white blood cell (WBC) count, and higher C-reactive protein (CRP) were the main determinants of death. Lower age, respiratory distress, early onset of clinical manifestations, lower arterial oxygen saturation, lower serum hemoglobin (Hb) level, and higher CRP level could predict requiring ICU admission. We recommend close monitoring on CRP, serum Hb level, WBC count, and arterial level of oxygenation as clinical indicators for potential progression to critical illness and severe disease. Mesenteric lymphadenitis is a common sonographic finding in pediatric COVID-19 which can cause abdominal pain. Ultrasound is helpful to avoid unnecessary surgical interventions in COVID-19.

Genetic abnormalities in fetal congenital heart disease with aberrant right subclavian artery

Fetal aberrant right subclavian artery (ARSA) is a relatively common sonographic finding. Congenital heart disease (CHD) is the most common structural abnormality in patients with ARSA. We aimed to assess the prevalence of genetic abnormalities, particularly sequence variants, in fetuses with CHD and ARSA. By clinical phenotyping and genomic sequencing, we retrospectively reviewed all fetuses with a prenatal diagnosis of CHD combined with ARSA at a single center. As a result, we identified 30 fetuses with ARSA combined with CHD, with conotruncal anomalies being the most common (n = 12, 40%), followed by left ventricular outflow tract obstruction (n = 6, 20%) and atrioventricular septal defects (n = 6, 20%). Overall, 18 (60%) cases had a genetic diagnosis. Copy number variation sequencing analysis identified six (20%) fetuses with aneuploidy and seven (23%) with pathogenic copy-number variants. Whole-exome sequencing (WES) analysis of the remaining 17 cases revealed diagnostic genetic variants in five (29%) cases, indicating that the diagnostic yield of WES for the entire cohort was 17% (5/30). Our findings reveal the high burden of genetic abnormalities in fetal CHD with ARSA. Single-gene disorders contribute substantially to the genetic etiology of fetal CHD with ARSA.

Prenatal diagnosis of Coffin-Siris syndrome: What are the fetal features?

To present both our center's and previously reported experience of prenatal diagnosis of Coffin-Siris syndrome (CSS) with regard to the laboratory testing and fetal features of this syndrome. This was a retrospective study of eight pregnancies with fetal CSS identified by prenatal or postnatal genetic testing. Clinical and laboratory data were collected and reviewed for these cases, including maternal demographics, prenatal sonographic findings, chromosomal microarray and exome sequencing (ES) results, and pregnancy outcomes. A total of eight cases of fetal CSS based on molecular testing were detected. Two cases presented with an increased nuchal translucency (NT) in the first trimester. The remaining six were identified at the second trimester scan. Agenesis of the corpus callosum (ACC) was the most common sonographic finding, accounting for 5/7 (71.4%) cases in which a second trimester sonogram was performed: four had ACC as an isolated finding, and one had additional features of cerebellar hypoplasia and left congenital diaphragmatic hernia. CSS should be included in the differential diagnosis when ACC is found by prenatal ultrasound. Both chromosomal microarray and ES should be options when counseling patients with a structurally anomalous fetus.

Idiopathic Granulomatous Mastitis: Diagnosis and Histopathologic Features, A Review

Background: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast condition, mostly affecting women of reproductive age within a few years of pregnancy. Due to diverse clinical and radiologic features, IGM can mimic a vast spectrum of breast conditions. Therefore, histological findings are one of the most essential bases of diagnosis. Methods: A literature search was performed to review the characteristics of IGM with an emphasis on histopathological features in English sources from 2010 to 2022. The key words used for PubMed database search were “breast”, “granulomatous mastitis”, “histopathology”, and “pathology.” Results: In total, 192 articles were retrieved, from which 38 most relevant manuscripts were selected for this review article. Conclusion: The diagnosis of IGM depends on clinical, radiologic, and pathologic findings. Palpable mass is the most frequent complaint. An irregular hypoechoic mass with varying degrees of posterior phenomena is the most common sonographic finding. Histologically, IGM is characterized by a non-caseating lobulocentric granulomatous inflammation; composed of tight aggregates of epithelioid histiocytes with or without multinucleated giant cells. At times, the presence of cystic empty vacuoles lined by neutrophils is noted that is commonly associated with cystic neutrophilic granulomatous mastitis (CNGM), a variant of IGM. Atypical findings for IGM includes: The presence of atypia and/or malignancy, caseous necrosis, marked eosinophilic infiltration, absence of granulomatous inflammation, etc.

Prenatal imaging features and perinatal outcomes of foetal volvulus-A literature review.

To conduct a review of the literature on foetal volvulus with emphasis on prenatal imaging, pregnancy characteristics and clinical outcomes. A review of all published cases of foetal volvulus diagnosed prenatally and indexed in Medline, EBSCOhost, CINAHL, SOCIndex and Healthy Policy Reference Centre. Studies without antenatal sonographic signs of foetal volvulus and without a postpartum surgical diagnosis were excluded. Data were analysed for frequencies and distributions and tested for statistical significance. Eighty-eight cases of foetal volvulus were identified from 58 published case reports/series. The most common ultrasound findings were dilated bowel/stomach (77.3%), polyhydramnios (30.7%) and whirlpool/snail sign (28.4%). Median gestation at diagnosis was 31.9weeks (IQR 27-34) and mean gestation at delivery was 34.5weeks (SD 2.8). Underlying aetiology included intestinal malrotation (15.9%), cystic fibrosis (14.8% of all cases, 32.5% of tested cases) and abnormal mesenteric fixation (12.5%). Complications included intestinal atresia (36.4%) and foetal anaemia (9.1%). The overall perinatal mortality rate was 14.5%. Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. Intestinal malrotation and cystic fibrosis are common predisposing causes, although the majority are idiopathic. Bowel and/or gastric dilatation is by far the most common sonographic finding.

1203 Sialendoscopy In Non-Stone Sialadenitis Is an Effective Therapeutic Approach

Abstract Introduction The aim of this retrospective case series was to investigate the therapeutic effectiveness of salivary endoscopy for non-stone related sialadenitis and obstructive symptoms. Method The records of 46 patients who underwent salivary endoscopy between September 2018 and December 2019 were reviewed. Included cases presented with at least one symptomatic major salivary gland, with no history or evidence of stone disease on clinical or radiologic examinations. Results A total of 22 patients (48%) and 26 glands were identified. These patients had a mean age of 50.8 years (range 27–74) and 73% were female. Most cases (19/26) involved the parotid gland. The primary imaging modality used was ultrasound, with sialography reserved for suspected strictures. The most common sonographic finding was ductal dilation (50%). Dexamethasone was instilled at completion of sialendoscopy in 23/26 cases. Outcomes included symptomatic improvement in 15/18 patients (4 patients have follow-up pending) with 5/15 experiencing complete symptom resolution. 2/18 patients did not have any symptomatic improvement, and 1/18 experienced acute infection that was treated with antibiotics. No patients required gland excision. Conclusions Salivary endoscopy is a minimally invasive and effective treatment for patients with non-stone sialadenitis that is refractory to conservative measures. Our review demonstrated 83% therapeutic benefit with gland preservation in all patients.

Concomitant Adenomyosis among Patients with Asherman Syndrome

To characterize obstetric outcomes for concomitant Asherman syndrome and adenomyosis. A retrospective cohort study. A community teaching hospital affiliated with a large academic medical center. A total of 227 patients with Asherman syndrome with available hysteroscopy and pelvic ultrasound reports. Telephone survey to assess and compare the obstetric outcomes of patients with Asherman syndrome with concomitant adenomyosis (Group A) vs patients with Asherman syndrome without concomitant adenomyosis (Group B). A telephone survey and confirmatory chart review were conducted to obtain information on patients' demographics, gynecologic and obstetric history, past medical and surgical history, and Asherman syndrome management. Adenomyosis was a common sonographic finding, detected in 39 patients with Asherman syndrome (17.2%). In this cohort, 77 patients attempted pregnancy and produced 87 pregnancies. Age (odds ratio [OR] 0.67; 95% confidence intervals [CI], 0.52-0.86) was negatively associated with a pregnancy outcome. Age (OR 0.83; 95% CI, 0.73-0.95) and severe Asherman disease (OR 0.06; 95% CI, <0.01-0.99) were negatively associated with a live birth outcome. Adenomyosis was not an independent predictor of pregnancy rate, miscarriage rate, or live birth rate among patients with Asherman syndrome. Adenomyosis is relatively common in patients with Asherman syndrome. Adenomyosis does not seem to add any distinct detriment to fertility among patients with Asherman syndrome.

The value of ultrasound in diagnosis of neonatal upper and lower gastrointestinal perforation

Objective To explore the value of ultrasound in the differential diagnosis of neonatal upper and lower gastrointestinal tract(GIT)perforation. Methods We retrospectively reviewed the ultrasound findings of 42 neonates of surgery-confirmed neonatal GIT perforation in our hospital from January 1, 2015 to December 31, 2018.The accuracy of ultrasound for detecting GIT perforation and the ultrasound features of upper and lower GIT perforation were evaluated. Results (1)Of the 42 neonates with GIT perforation, 1 case didn′t undergo ultrasound, 2 cases were missed, and 1 case was misdiagnosed.Thirty-eight neonates were diagnosed of GIT perforation by ultrasound preoperatively, with a detection rate of 92.7%(38/41). The locations of GIT perforation were identified by ultrasound in 30 cases(78.9%, 30/38), including 11 cases of upper GIT perforation and 19 cases of lower GIT perforation.(2)A common sonographic finding of GIT perforation in 38 cases was pneumoperitoneum, which appeared as an echogenic line with posterior reverberation artifact under diaphragm or anterior to hepatic/splenic surface and a stratosphere sign in M-mode sonography.Free gas changed position when the patient′s position was changed, and didn′t change due to respiratory change.Besides, free gas dispersed with compression on abdomen, and gathered without compression.(3)Upper GIT perforation was showed that poor filling of the stomach cavity, and the abdominal free gas sharply increased.Lower GIT perforation was characterized by collapsed bowel, blurred and interrupted intestinal wall structure, and more accompanied with intestinal obstruction.(4)There was no significant difference of detection rate between ultrasound and X-ray in diagnosing GIT perforation[92.7%(38/41)vs.83.3%(35/42)](P>0.05), whereas ultrasound more sensitive for a very small amount of free gas in the early stage of perforation.(5)Helicobacter pylori infection was found in two cases of GIT perforation. Conclusion Ultrasound can be used for differential diagnosis of upper and lower GIT perforation, and could be recommended as the first choice for detecting GIT perforation in neonatal patients. Key words: Ultrasound; Upper gastrointestinal tract perforation; Lower gastrointestinal tract perforation; Intestinal obstruction

Microarray analysis has no additional value in fetal aberrant right subclavian artery: description of 268 pregnancies and systematic literature review.

Fetal aberrant right subclavian artery (ARSA) is a relatively common sonographic finding. Several studies have reported a significant association between ARSA and Down syndrome, as well as 22q11.2 microdeletion. The objective of this study was to assess the risk of abnormal chromosomal microarray analysis (CMA) findings in a large cohort of pregnancies with fetal ARSA as an isolated, as well as a non-isolated, sonographic anomaly. A secondary objective was to review the literature, examining the frequency of chromosomal microarray aberrations in fetuses with isolated ARSA. Data from all pregnancies referred for invasive testing and CMA due to sonographic diagnosis of fetal ARSA, between 2013 and 2017, were obtained retrospectively from the computerized database of the Israeli Ministry of Health. The rate of clinically significant CMA findings in these fetuses was compared to that in a local control population of 2752 low-risk pregnancies with normal ultrasound and serum screening results. In addition, a literature search was conducted in PubMed, from inception to February 2018, of original studies in the English language describing the frequency and nature of microscopic and submicroscopic aberrations in fetuses with isolated ARSA. Of 246 pregnancies with isolated ARSA that underwent CMA analysis, a clinically significant finding was detected in one (0.4%) pregnancy (trisomy 21). This rate did not differ significantly from that in the control population (P = 0.1574). Of 22 fetuses with non-isolated ARSA, one (4.5%) additional case of trisomy 21 was noted. The frequency of trisomy 21 in this cohort also did not differ from that in the control population (relative risk, 5.5 (95% CI, 0.8-37.6)). The literature search yielded 13 additional relevant papers, encompassing 333 cases of isolated ARSA. Of 579 cases overall (including those of the present study), 13 (2.2%) cases of trisomy 21 were detected, with no cases of 22q11.2 microdeletion. While an association may exist between non-isolated ARSA and Down syndrome, isolated ARSA might better serve as a soft marker for Down syndrome, rather than a routine indication for invasive prenatal testing. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Imaging Findings of Metaplastic Carcinoma of the Breast with Pathologic Correlation.

Objectives:To review the imaging findings of a series of cases of metaplastic carcinoma of the breast, a rare and aggressive form of breast cancer with variable imaging features.Materials and methods:Retrospective review of multimodality imaging features of eleven cases of metaplastic carcinoma of the breast retrieved from a single hospital institution database. Clinical and pathologic data were also documented.Results:The median age of presentation was 65 years. Four cases had axillary lymphadenopathies, and two had distant metastases. An oval mass was the most common sonographic finding (7/11; 64%). Lesions displayed circumscribed/partially circumscribed margins (6/11; 55%) or non-circumscribed margins (5/11; 45%). Most lesions had a heterogeneous echo structure (9/11; 82%) and posterior acoustic enhancement (6/11; 55%). In nine patients, mammographies were available. An oval dense mass was the most common mammographic finding (5/9; 56%). The majority of cases had non-circumscribed margins (6/9; 67%), and nearly half displayed calcifications (4/9; 44%).Conclusions:Mammographic findings were not different from the usual features of more prevalent types of breast cancer, though the majority of metaplastic carcinoma of the breast showed possible distinctive sonographic features, such as circumscribed margins or complex echogenicity, reflecting the histologic background.

First-Trimester Crown-Rump Length and Risk of Chromosomal Aberrations-A Systematic Review and Meta-analysis.

Lower than expected first-trimester crown-rump length (CRL) is a common sonographic finding, usually leading to reassessment of gestational age. The aim of this study was to perform a meta-analysis defining the risk of chromosomal aberrations in pregnancies with decreased first-trimester CRL. A search was conducted by a research librarian in 5 databases, with no time or language restrictions. Original researches examining the risk of chromosomal aberrations in pregnancies with low CRL were selected. The effect estimates were presented as odds ratios with 95% confidence intervals). Following screening of 3894 references, 12 articles were selected. Only 2 articles directly fulfilled the review goals, comparing the rates of chromosomal aberrations in small-CRL versus normal-CRL fetuses. Combined analysis of these 2 studies, encompassing a total of 403 fetuses with small CRL and 4047 control pregnancies, yielded an odds ratio of 5.54 (95% confidence interval, 1.2-26.1) for abnormal karyotype in small-CRL fetuses. Ten studies compared CRL in fetuses with specific chromosomal aberrations to pregnancies with normal karyotype, yielding a significant growth delay in fetuses with trisomy 18 (6 of 7 articles) and triploidy, but not in fetuses with trisomy 21. Overall quality of evidence was rated as "very low" using Grading of Recommendations Assessment, Development and Evaluation criteria. Our review results indicate that low first-trimester CRL might be associated with a significantly increased risk of chromosomal anomalies. Thus, invasive prenatal testing or cell-free DNA screening might be offered in such pregnancies, particularly if dating is certain.

Complex malformations involving the fetal body wall – definition and classification issues

The objective of the study is to analyse the sonographic features, cytogenetic results and pregnancy outcomes in complex malformations involving the body wall in a large cohort of fetuses with regard to different definitions proposed in the literature. A retrospective study on 96 fetuses with complex malformations comprising ventral wall, craniofacial structures, limbs and umbilical cord that were evaluated between 1997 and 2015. The most common sonographic finding was an extensive ventral wall defect (95.8%; 92/96) comprising liver (94.6%; 87/92), intestine (82.6%; 76/92), heart (17.4%; 16/92) and bladder (8.7%; 8/92). Acrania and encephalocoele were observed in 24 and 9 fetuses (25.0%, 24/96; 9.4%, 9/96), respectively. Limb anomalies were present in 54 fetuses (56.3%; 54/96). Rudimentary or absent umbilical cord was observed in 62 fetuses (64.6%; 62/96). In 79 fetuses, there were additional multiple structural anomalies detected prenatally. None of the currently used definitions encompasses all possible phenotypes of body wall defects present in our cohort. Chromosomal aberrations were seen in 8 out of 60 cases with conclusive cytogenetic result (13.3%, 8/60). Chromosomal anomalies are common, and karyotyping should be offered. There is a need for a more rigorous classification of complex malformations in order to better understand the underlying pathophysiology. © 2017 John Wiley & Sons, Ltd.

Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study

BackgroundThe aims of this study were to: (a) Identify tendon sheaths most commonly treated with steroid injections in a pediatric patient population with Juvenile Idiopathic Arthritis (JIA); (b) Describe technical aspects of the procedure; (c) Characterize sonographic appearance of tenosynovitis in JIA; (d) Assess agreement between clinical request and sites injected.MethodsThis was a 10 year single-center retrospective study (May 2006-April 2016) of patients with JIA referred by Rheumatology for ultrasound-guided tendon sheath injections. Patient demographics, clinical referral information, sonographic appearance of the tendon sheaths and technical aspects of the procedure were analyzed.ResultsThere were 308 procedures of 244 patients (75% female, mean age 9.6 years) who underwent a total of 926 tendon sheath injections. Ankle tendons were most commonly injected (84.9%), specifically the tendon sheaths of tibialis posterior (22.3%), peroneus longus (20%) and brevis (19.7%). The majority of treated sites (91.9%) showed peritendinous fluid and sheath thickening on ultrasound. There were 2 minor intra-procedure complications without sequelae. A good agreement between clinical request and sites injected was observed.ConclusionsUltrasound-guided tendon sheath injections with steroids are used frequently to treat patients with JIA. It is a safe intervention with a high technical success rate. The ankle region, specifically the medial compartment, is the site most commonly injected in this group of patients. The most common sonographic finding is peritendinous fluid and sheath thickening. These findings might assist clinicians and radiologists to characterize and more effectively manage tenosynovitis in patients with JIA.

Asymptomatic Bile Duct Dilatation in Children: Is It a Disease?

PurposeBile duct dilatation is a relatively common sonographic finding; nevertheless, its clinical significance in children is controversial because little research has been done in the area. Therefore, we investigated the natural course and clinical significance of biliary duct dilatation in children.MethodsWe performed a retrospective study of 181 children (range, 1-day-old to 17-year-old) in whom dilatation of the intrahepatic duct and/or common hepatic duct and/or common bile duct was detected by abdominal ultrasonography at the Severance Children's Hospital between November 2005 and March 2014. We reviewed and analyzed laboratory test results, clinical manifestations, and clinical course in these patients.ResultsPediatric patients (n=181) were enrolled in the study and divided into two groups. The first group included 59 subjects, without definitive cause of bile duct dilatation, who did not require treatment; the second group included 122 subjects, with definitive cause of bile duct dilatation or underlying biliary disease, who did require treatment. In the first group, 24 patients (40.7%) showed spontaneous resolution of bile duct dilatation, 20 patients (33.9%) showed no change, and 15 patients (25.4%) were lost to follow-up. In the second group, 31 patients were diagnosed with choledochal cysts, and 91 patients presented with biliary tract dilatations due to secondary causes, such as gallbladder or liver disease, post-operative complications, or malignancy.ConclusionBiliary dilatation in pediatric patients without symptoms, and without laboratory and other sonographic abnormalities, showed a benign clinical course. No pathologic conditions were noted on follow-up ultrasonography.

Sonographic signs of snakebite

Background. Crotaline snakebites are routinely assessed with serial external examinations. We sought to correlate external findings with changes observed on ultrasound imaging. Methods. This was a prospective, observational study of consecutive rattlesnake envenomation in patients treated at a single hospital in central California. Information recorded for each case included clinical data, gross external examination, and ultrasound images of tissue edema, localized fluid collections, and video footage of muscle fasciculations. Results. Thirteen patients were enrolled. Ultrasound imaging of the bitten extremity was consistent with external examination of the bitten limb. The most common sonographic finding was subcutaneous tissue edema. Edema and necrosis in 3 patients with rapidly progressive leg swelling spared the deeper muscle layers and fascial planes. In 2 patients with bites on the fingers, edema and tendon involvement were readily visualized using a water-bath technique (placement of the hand in a pool of water, allowing more detailed examination of the tissue planes). Conclusion. Ultrasound imaging may allow for a more complete understanding of the local effects of snakebite. We were also able to document normal deeper muscle integrity in cases with diffuse leg edema. More studies are needed to fully elaborate the strengths and limitations of bedside ultrasound as a diagnostic adjunct in envenomation assessment.

First trimester tricuspid regurgitation and fetal abnormalities.

Tricuspid regurgitation (TR) is a common sonographic finding during the fetal life. It has been reported in 7% of normal fetuses. It may be associated with aneuploidy and with both cardiac and extracardiac defects. In this study, we have looked at the characteristics of fetuses with and without TR at 11+0 to 13+6 weeks' gestation. Groups were compared with respect to the following variables: prevalence of chromosomal defects; other markers of aneuploidy; fetal cardiac; and extracardiac anomalies. The study group included women, who underwent an ultrasound examination at 11-13+6 weeks' gestation between 2009 and 2012. The inclusion criteria were singleton pregnancies with crown-rump length measurements of 45-84 mm where the pregnancy outcome was known. Some 1075 patients met our inclusion criteria including 979 fetuses without TR and 96 with TR. There were 72 cases of aneuploidy diagnosed (6.7%). Isolated TR was found in 53 euploid fetuses (5.2%). All of the TR(+) aneuploid fetuses (n=40) had additional ultrasound markers present. Extracardiac anatomy showed a higher prevalence of abnormalities in the group of TR positives (12.5%) vs. TR negatives (1.6%). Abnormal cardiac findings were more frequent in the TR-positive group independently of chromosomal status and were found in 18.8% of fetuses with TR and in 1.9% with a normal tricuspid flow. TR in combination with other markers is the strongest predictor for aneuploidy. TR, as an isolated parameter, is a poor screening tool both for all and for each individual chromosomal abnormality and congenital cardiac defects.

Stromal fibrosis of the breast: outcome analysis

Stromal fibrosis in the breast is a non-specific benign pathologic entity with wide spectrum of imaging finding. The false-negative rates (number of cancers missed) previously reported have limited value because short follow-up period and small number of populations. To describe the mammographic and sonographic findings of stromal fibrosis of the breast diagnosed by imaging-guided biopsy and to determine the false-negative rate at percutaneous biopsy. Between January 2007 and December 2008, 3097 consecutive imaging-guided breast core biopsies were performed. Patients were included in our study if stromal fibrosis was the predominant pathologic finding. Patients who had received <2 years of follow-up were excluded. Mammographic and sonographic findings were reviewed. Follow-up imaging for >2 years and histologic data were reviewed to evaluate lesion stability. Stromal fibrosis was diagnosed in 187 (6.0%) of 3097 imaging-guided biopsies among patients with >2 years of follow-up (mean, 41.9 months). Among them, 91 (49%) of 187 lesions were not visible on mammography and calcifications were the most common findings, being identified in 33 lesions (17.6%). The most common sonographic finding was an oval hypoechoic mass with a circumscribed margin. Forty-two lesions (22.5%) were excised. Four false-negative lesions (2.1%, 4/187) were identified; all false-negative lesions were diagnosed within 6 months because of imaging-pathology discordance (75%, 3/4) or disease progression (25%, 1/4). Stromal fibrosis diagnosed by imaging-guided biopsy has a wide spectrum of imaging finding and can be managed safely with radiologic-pathologic correlation and subsequent short-term imaging follow-up.

Pure Lobular Carcinoma of the Breast Presenting as a Hyperechoic Mass: Incidence and Imaging Characteristics

The purpose of this study was to determine the proportion of invasive lobular carcinomas with increased sonographic echogenicity. A retrospective review of mammographic and sonographic findings included cases of pure invasive lobular carcinoma with available images from January 1998 to June 2010. We assessed ultrasound images for the presence of a mass, internal echogenicity, margin characteristics, and attenuation effects. In hyperechoic tumors, more than 90% of the mass had increased echogenicity compared with surrounding fat. In heterogeneously echogenic tumors, the echogenic component constituted 20-90% of the tumor. Findings at mammography, MRI, and surgery were correlated with sonographic findings. A breast pathologist reviewed histologic findings and confirmed the diagnosis of pure invasive lobular carcinoma. Of 509 invasive lobular carcinomas, 27 (5%) were hyperechoic, of which 13 (48%) were associated with posterior acoustic shadowing. Heterogeneously echogenic cancer was seen in 57 (11%) cases. The most common sonographic finding was a hypoechoic, irregular mass with or without posterior shadowing (n = 323; 63%). In 66 (13%) lesions, focal shadowing was seen without a discrete mass. Fourteen (3%) lesions were isoechoic with respect to surrounding normal adipose tissue without acoustic shadowing. Twenty-two (4%) of the malignant tumors were not identified sonographically. Of these, 15 (68%) had mammographic abnormalities, one (5%) was seen at MRI, and six (27%) presented as palpable masses that were surgically excised. Pure invasive lobular carcinomas can present as a hyperechoic mass or with substantial hyperechoic component. All sonographic lesion characteristics should be evaluated and biopsy recommended when there are suspicious features, even in a lesion that is predominantly hyperechoic.

Subscapularis tendon tears: A common sonographic finding in symptomatic postarthroplasty shoulders

Subscapularis tendon tears can complicate shoulder arthroplasty because the subscapularis tendon is typically divided surgically to gain access to the joint. The purpose of this study is to document the prevalence of subscapularis tears on sonography of symptomatic postarthroplasty shoulders. We retrospectively reviewed official reports of shoulder sonograms performed over an 11-year period by one experienced radiologist. Sonographic findings in 112 (mean age, 61.7 years; age range, 38-87 years; 40% female) symptomatic patients who had undergone either total shoulder arthroplasty or hemiarthroplasty were compared with findings in both a symptomatic control group consisting of 209 patients (mean age, 55.2 years; age range, 32-79 years; 37% female) who had undergone surgery for rotator cuff repair but no arthroplasty, and an asymptomatic control group consisting of 11 (mean age, 66 years; age range, 61-77 years; 45% female) volunteers who had shoulder arthroplasty but were without complaints. The prevalence of subscapularis tears in arthroplasty patients (51%, 57/112) was higher (p < 0.0001) than that of rotator cuff repair patients (16%, 33/209). In the asymptomatic volunteers, subscapularis tears (9%, 1/11) were less common (p < 0.01) than in the symptomatic patients. Subscapularis tendon tears are a common sonographic finding in symptomatic postarthroplasty shoulders.

Sonographic evaluation of peripheral nerve injuries following the Wenchuan earthquake

To analyze retrospectively the sonographic characteristics of the peripheral nerve injuries (PNIs) resulted from Wunchuan earthquake. The sonographic images of 38 patients with surgically proved PNIs were reviewed and compared with the surgical findings. A total of 78 nerves in 38 patients were found injured in surgery, which included 16 median nerves in the forearm (20.5%), 6 ulnar nerves in the forearm or arm (7.7%), 8 radial nerves in upper limb (10.0%), 8 sciatic nerves (10.3%) in gluteal region, 17 tibial nerves in the leg (21.8%), and 23 peroneal nerves (29.5%). The most common injured nerve in the lower extremity was the peroneal nerve (29.5%) and in upper extremity was the median nerve (20.5%). Sonography correctly diagnosed 72 earthquake-related nerve injuries (92.3%), which included 5 complete disruption (6.4%), 4 partial disruption (5.1%), 63 nerve entrapment (88.5%, included 1 entrapment by bone calus, 38 entrapments by the scar tissue, 13 entrapments by the thickened muscle or tendinous arch, and 11 entrapment in the narrowed osteofibrous tunnels). Nerve entrapment injury was the common sonographic finding in earthquake-related PNI.