Echogenic Contents Research Articles

Diagnostic utility of ultrasonography for thoracic and abdominal bacterial and parasitic diseases in ruminants: a comprehensive overview.

This review article describes the roles of ultrasound in assessing thoracic and abdominal infectious diseases, mainly bacterial and parasitic ones that affect farm animals, including cattle, camels, sheep, and goats. Ultrasonography is a non-invasive imaging technique used to diagnose infectious diseases affecting the cardiovascular, respiratory, digestive, urinary, and hepatobiliary systems. In cases of thoracic and abdominal infections, ultrasound typically reveals abnormalities in echogenicity and echotexture, the presence of unusual artifacts, and mass formation exerting pressure on surrounding structures. Inflammatory and degenerative changes within the viscera can be identified ultrasonographically by comparing the echogenicity of affected areas with that of the surrounding normal parenchyma, such as in fascioliasis. Bacterial and parasitic infections often result in capsular mass lesions with anechoic contents, as observed in hydatid cysts and cysticercosis, or varying echogenic contents, as observed in liver abscesses. Effusions within the pericardium, pleura, and peritoneum are common ultrasonographic findings in infectious thoracic and abdominal diseases. However, these effusions' echogenicity does not always allow for clear differentiation between transudates and exudates. The routine use of ultrasonography in the evaluation of the chest and abdomen in affected or suspected ruminants is highly beneficial for detection, guiding therapeutic decisions, assessing prognosis, and aiding in the eradication of highly contagious diseases that cause significant economic losses.

Visualizing thyroid health: a pictorial journey through 2017 ACR TI-RADS and common thyroid pathologies.

With the advent of high-resolution ultrasonography (HRUS), more thyroid nodules are being detected than ever before, and they are being identified at an earlier stage. It poses a challenge for radiologists and clinicians in deciding what to do next. Most nodules are benign and require no follow-up and intervention. Even highly suspicious nodules can be followed up, if the size is small. Variations in HRUS interpretation among radiologists are common, with frequent misidentifications between spongiform and solid-cystic lesions, hypoechoic and very hypoechoic nodules, and microcalcification and hyperechoic foci with comet-tail artifacts. Cystic lesions with echogenic contents are often confused with solid nodules, cystic papillary carcinoma thyroid is often confused with colloid cysts. The 2017 ACR TI-RADS (American College of Radiology Thyroid Imaging Reporting and Data System) aims to standardize the interpretation of thyroid nodules and guide further management. Rather than giving specific diagnosis like colloid cyst, adenomatous nodule and papillary carcinoma; ACR TI-RADS classifies nodules from TI-RADS 1 to TI-RADS 5 based on HRUS characteristics and recommends further management. What the authors often read are textual contents that are theoretical, and in practice, the authors get confused while interpreting the characteristics of thyroid nodules. This review offers a detailed visual overview of the 2017 ACR TI-RADS and common thyroid conditions, explaining key features through imaging data and examples for consistent interpretation. Combining textual explanations with visual aids, this article provides practical guidance for interpreting thyroid nodules for radiologists, and clinicians seeking a clear understanding of thyroid imaging and pathology.

Contrast-enhanced guided endoscopic ultrasound procedures

Contrast-enhanced endoscopic ultrasound (CH-EUS) can overcome the limitations of endoscopic ultrasound-guided acquisition by identifying microvessels inside inhomogeneous tumours and improving the characterization of these tumours. Despite the initial enthusiasm that oriented needle sampling under CH-EUS guidance could provide better diagnostic yield in pancreatic solid lesions, further studies did not confirm the supplementary values in cases of tissue acquisition guided by CH-EUS. This review details the knowledge based on the available data on contrast-guided procedures. The indications for CH-EUS tissue acquisition include isoechoic EUS lesions with poor visible delineation where CH-EUS can differentiate the lesion vascularisation from the surrounding parenchyma and also the mural nodules within biliopancreatic cystic lesions, which occur in select cases. Additionally, the roles of CH-EUS-guided therapy in patients whose pancreatic fluid collections or bile ducts that have an echogenic content have indications for drainage, and patients who have nonvisualized vessels that need to be highlighted via Doppler EUS are presented. Another indication is represented if there is a need for an immediate assessment of the post-radiofrequency ablation of pancreatic neuroendocrine tumours, in which case CH-EUS can be used to reveal the incomplete tumour destruction.

Correlation between pathology and quantitative ultrasonographic evaluation of pancreatic fat with ultrasonographic classification.

No studies of the relationship between grayscale sonographic findings and pancreatic fat content have been reported to date. This study aimed to investigate the correlation between echogenicity and fat content of resected specimens using quantitative analysis. Forty-two consecutive patients who underwent pancreatoduodenectomy or distal pancreatectomy for pancreatic tumors were enrolled in this study. Ultrasonographic images were compared with quantitative pathological analysis. Subjective evaluation of echogenicity was classified as hypoechoic, isoechoic, hyperechoic, and super hyperechoic. The total and intralobular fat areas were measured. The mean, median, modal, minimum, and maximum ultrasound gray values correlated with the proportion of total fat area (r = 0.349; 0.357, 0.486, 0.466, and 0.347; p = 0.024, 0.020, 0.014, 0.019, and 0.089, respectively), but did not correlate with the proportion of intralobular fat area. Subjective classification was correlated with median gray value (p < 0.001), intralobular fat area (p = 0.118), and total fat area (p = 0.011). Cases were classified as hypoechoic (n = 3), isoechoic (n = 7), hyperechoic (n = 30), and super hyperechoic (n = 2). The subjective classification was correlated with the median gray value (p < 0.001) and total fat area (p = 0.005), and not correlated with the intralobular fat area (p = 0.118). Hyperechoic or super hyperechoic pancreatic parenchyma contains over 19.7% fat. Computed tomography values correlated with the proportion of intralobular fat area (r = -0.479, p = 0.004) and total fat area (r = -0.541, p < 0.001). Echogenicity classified based on subjective evaluation and image analysis were correlated with the proportion of fat in the pancreas.

A Perforated Meckel's Diverticulum Simulating Appendicular Peritonitis : Case report

Meckel's diverticulum results from the partial persistence of the omphalomesenteric duct and its complications are rare. Diagnosis is often made intraoperatively. We present the case of a 46-year-old patient admitted to the emergency ward with symptoms suggestive of peritonitis. Clinical examination revealed tenderness in the right iliac fossa. Abdominal and pelvic ultrasound revealed a swollen appendix located laterocecally, measuring 9.2 mm in maximum thickness, with an associated oval collection containing finely echogenic contents measuring 32 × 14 mm, without evidence of effusion.During surgery, a perforated Meckel's diverticulum was discovered as the cause of the peritonitis. The patient underwent segmental bowel resection with ileostomy formation. Postoperative recovery was uneventful, and the patient was discharged on the third postoperative day. Anatomopathological examination of the surgical specimen showed inflammatory changes without signs of malignancy. One month after the operation, the patient underwent ileal continuity restoration.

Fetal "gallstones" are still an unsolved mystery. Case series.

Echogenic content in the fetal gallbladder is rather an incidental finding during third-trimester ultrasonography. The etiology, clinical course, and prognosis of this condition are still unclear. We highlight the demographic, clinical and ultrasound characteristics of our patients with echogenic content in the fetal gallbladder. This is a retrospective single-center study conducted at the University of Medicine and Pharmacy Cluj-Napoca, Romania, between March 2022 and April 2023. All pregnant patients who were admitted to the hospital and had echogenic content in the fetal gallbladder detected by ultrasound were identified. The clinical and ultrasonography parameters were obtained from the databases of the ultrasound units and the medical records of the patients. Four patients were found to have echogenic content in the fetal gallbladder. The mean maternal age at diagnosis was 27.5 years (range 25-31). All patients had singleton pregnancies. The mean gestational age at diagnosis was 36.5 weeks (range 35-40). In all cases, the predominant aspect of echogenic content on ultrasound was multiple hyperechogenic foci; additionally, in one case, sludge was also observed. The mean maximal length of the hyperechogenic foci was 3.375 mm (range 1.6-5.4). All fetuses were delivered at full term, either vaginally or by cesarean section. The mean weight at birth was 3082.5 g (range 2800-3450). In all four cases, the EC disappeared spontaneously at birth. Neither of the four newborns displayed digestive symptoms or complications during the follow-up. The EC is still a medical mystery since little is known about its etiology and long-term outcome. Many cases are likely to be undetected until after birth; therefore, fetal gallbladder examination should be included in the US routine. The condition appears to be benign, and usually, it improves naturally after birth. Consecutively, asymptomatic newborns with EC can be managed through a wait-and-see approach.

Ultimobranchial body cyst in an adult horse: clinical, histopathologic, and immunohistochemical features.

A 9-y-old Mangalarga Marchador gelding was referred to a veterinary hospital because of a swelling on the upper right side of the neck. Ultrasound examination revealed a multilocular structure adjacent to the thyroid gland with low echogenic content suggestive of fluid. The mass was removed surgically. Histologically, the cystic cavities in the surgical sample were filled with abundant eosinophilic secreta and lined by cuboidal, segmentally ciliated, columnar epithelium with interspersed goblet cells. Segmental crowding of the multilayered lining of the cyst was noted. Immunohistochemistry suggested the presence of both C cells and follicular cells, given the positivity of the immunomarkers calcitonin and TTF-1, respectively. The histogenesis of ultimobranchial cysts is uncertain. Based on clinical, histopathologic, and immunohistochemical identification, the cystic structure in this case is compatible with an ultimobranchial body cyst.

Papillary Cystadenocarcinoma in a Budgerigar (Melopsittacus undulatus)

Budgerigar (Melopsittacus undulatus) is a tiny colorful parrot and one of the most popular pets worldwide. This study was performed on a 5-year-old male budgerigar with a large and fluid-filled mass in the anterior part of the neck. Fine needle aspiration was accomplished to determine tumor origin, and the tumor content was cultured on blood and MacConkey agars (aerobic and anaerobic conditions). Besides, tumor ultrasonography and whole-body radiographs were done in the lateral and ventrodorsal positions. Finally, the tumor was removed, fixed in 10% neutral buffered formalin, and stained with hematoxylin and eosin (H &amp; E). The radiology and ultrasonography results showed that the tumor (5.2×4×3.7 cm) had a homogenous structure filled with echogenic fluid content. The tumor content culture revealed no bacterial growth. Histopathologically, the mass was composed of cystic spaces with invagination of the lining epithelial cells, forming intraluminal papillae. The tumor was diagnosed as a papillary cystadenocarcinoma.

Echogenic Content in the Fetal Gallbladder: Systematic Review of Ultrasound Features and Clinical Outcome.

It is rare to detect echogenic content in the fetal gallbladder. The etiology, natural course, and prognosis of this condition remain unclear. In addition to providing a systematic review of this topic, we suggest a plan for patient follow-up. From a total of 100 database entries identified in PubMed, EMBASE, and ICTRP reviews, we selected 34 studies in which we investigated the ultrasound features and outcome of this condition. There were 226 fetuses with gallbladder echogenic content identified. Seventy-two fetuses were found to have biliary sludge; thirty cases had a single hyperechogenic focus, and one hundred fetuses had multiple foci in the gallbladder. There were 16 cases of distal shadowing, 37 fetuses with comet tail and twinkling, and 26 cases with no acoustic artifacts. Nine cases of spontaneous resolution before birth have been documented; nine fetuses exhibited no echogenic content at birth, and 138 cases of resolution of echogenic content within the first year of life have been described. Typically, the condition resolves spontaneously during the postnatal period. After adequately reassuring the parents, the patients should be monitored for spontaneous resolution; medical or surgical intervention is not indicated. Asymptomatic patients can be managed with a wait-and-see strategy.

A Comparative Evaluation of Digital Radiography and Ultrasound Imaging to Detect Periapical Lesions in the Oral Cavity.

Purpose This study evaluates the efficacy of digital radiography and ultrasound (USG) for the distinction between periapical cysts and granulomas, determines the nature and extent of the periapical lesion, visualizes the lumen of the lesion, assesses its size, content, and vascularity. Material and Methods Thirty patients, ages 18 to 40, with well-defined periapical radiolucencies on maxillary or mandibular teeth, indicated for the extraction or periapical surgery, underwent digital radiography examination using the paralleling technique, followed by USG examination. A sonologist evaluated the lesions' size, echogenicity, and vascular content. The diagnosis was compared to histopathological examinations of tissues obtained through extraction or periapical surgery. Results The diagnostic value of USG compared to the histopathological diagnosis of the periapical cyst was greater than that of the radiographic diagnosis, with an ultrasonographic diagnostic sensitivity (SN) value of 60% and a radiographic diagnostic SN value of 40%, respectively. The diagnostic value of USG imaging against the histopathological diagnosis of periapical granuloma was slightly lower than that of digital radiography, with an SN value of 72.2% for USG and 83.33% for digital radiography. However, the specificity (SP) value and precision of USG imaging were superior to those of digital radiographic diagnosis. USG imaging and radiographic diagnosis had 58.33% and 50% SP values, respectively. In cases of periapical abscess, the diagnostic values of USG against histopathological diagnosis were lower than those of radiographic diagnosis, which had an SN value of 100%. Conclusion USG with color doppler is a more effective tool than digital radiography for diagnosing periapical lesions. The echo structure of the lesions and the presence of vascularity on USG with color doppler correlated with histopathology better than the radiological diagnosis.

Combined use of non-laboratory methods for the practical diagnosis of endometritis in postpartum dairy cows.

Postpartum endometritis can cause subfertility in cows and reduce the reproductive performance of dairy herds. Thus, there is a critical need to improve the accuracy of the diagnosis of this disease, particularly in dairy cows. This study confirmed the effects of the combined use of two non-laboratory methods: Metricheck device (MT) and ultrasonography (UT) to detect signs of endometritis and therefore predict the likelihood of pregnancy. The reproductive tract of 67 lactating Holstein cows (25 primiparous and 42 multiparous) was observed at 4 and 6 weeks postpartum using the MT and UT. The cows with flecks and more purulent material in the vaginal discharge were defined as MT-positive, and the cows with uterine echogenic contents were defined as UT-positive. The combined definition was also used; both the UT and MT results or either the UT or MT result had to be positive for the final decision to be positive. The true-negative cows were determined as both MT-UT-negative. When comparing the diagnostic results obtained by MT and UT, 37.3% and 32.8% of the total cows showed conflicting results at 4 and 6 weeks postpartum. The proportion of non-pregnant cows until 200 days postpartum was significantly greater in both MT-UT-positive cows than in the true negative cows. The hazard ratios of pregnancy rate were 0.37 for both MT-UT-positives relative to the true negatives at 4 weeks postpartum. Similar significant differences were not detected using the MT or UT alone. These results indicate that a more severe effect on the chance of pregnancy could be detected in cows that are both MT-UT-positive compared with those positive for MT or UT alone. The combined use of MT and UT could support veterinary practitioners in diagnosing endometritis, potentially improving the accuracy of predicting subsequent reproductive performance.

Sonographic patterns of retained products of conception among women attending Murtala Muhammed Specialist Hospital Kano, Nigeria

Retain products of conception (RPOC) remains a major concern because its complications are among the leading cause of morbidity and mortality among women with postpartum uterus. Every locality should have a documented findings of postpartum uterus predicting retained products of conception. This study was aimed at evaluating the sonographic pattern of RPOC among women attending Murtala Muhammad Specialist Hospital, Kano. The study was prospective, conducted from January 2021 to August 2021. A total of 200 patients referred on the suspicion of RPOC on the basis of history or clinical examination were enrolled in the study. Transabdominal ultrasound with 3.5MHtz transducer was performed in all referred cases. The findings obtained were recorded on data capture sheet. Data was analyzed using SPSS Version 23.0. Mean age of the patients was 21.7 ±6.7 years and the mean gestational age was 11.7 ±4.8 weeks. Most of the patients present with per vaginal bleeding, lower back pain or fever as their clinical history. Sonographic findings of RPOC were mix-echogenic content 106(53%), hypoechoic fluid collection 52(26%) and hyperechoic mass 42 (21%). The correlation between clinical history and sonographic pattern of RPOC shows a significant weak positive correlation (r= 0.15 and p= 0.03). The correlation between RPOC size and gestational age also shows a significant weak positive correlation (r= 0.27 and p= 0.00). Sonography is an accurate tool for diagnosis of retained products of conception, with mixed echogenic content as the most common sonographic pattern RPOC.

Clinical, haemato-biochemical, and ultrasonographic findings of abomasal impaction and abomasal ulcers in buffaloes

The current study evaluated the clinical, ruminal, haemato-biochemical, and ultrasonographic findings of abomasal disorders' affected buffaloes grouped as abomasal impaction (n = 18) and abomasal ulcers (n = 15). The abomasal disorders' screening was based on clinical examination and confirmed by ultrasonography. The most common clinical findings of the buffaloes affected with abomasal disorders include depressed demeanour (96.97%), absence of rumination (87.88%), abdominal guarding (87.88%), sunken eye balls (81.82%), tachycardia (78.79%), tachypnea (72.73%), and kyphosis (63.64%). The average rumen motility, respiratory rate, and pulse rate for abomasal impaction and abomasal ulcers were 0.28, 33.37, and 83.44, and 0.33, 35.87, and 92.60, respectively. The faecal occult blood test (benzidine test) revealed the presence of melena in all the buffaloes diagnosed with abomasal ulcers (100%). The ultrasonographic examination of the abomasal impaction group revealed increased abomasal size with no movement of the abomasal contents. The ultrasonographic imaging of abomasal ulcer-affected buffaloes showed irregularity in the abomasal wall-outline with moderately echogenic abomasal contents and a layer of fibrin at the affected area. Nine buffaloes had ultrasonographic evidence of peritonitis. The abomasal contents of buffaloes with positive benzidine test (n = 15) were screened for Clostridium perfringens by a polymerase chain reaction and were found positive for cpa toxin yielding 900-bp length. The rumen protozoal count was higher in healthy buffaloes, while the sedimentation test, (time) methylene blue reduction test, (time) and chloride levels were higher (P < 0.01) in the buffaloes affected with abomasal disorders. Haematological findings revealed a higher haematocrit, total leucocyte count, neutrophils, and eosinophil proportion and lower haemoglobin, total erythrocyte count, and lymphocyte proportion without affecting the fractions of monocytes and basophils. Furthermore, the buffaloes affected with abomasal disorders showed lower albumin, phosphorus, and potassium and higher aspartate transaminase, blood urea nitrogen, creatinine kinase, creatinine, and chloride concentrations. The present study projects clinical signs, ruminal parameters, and haemato-biochemical parameters as better indicators of abomasal disorders; however, ultrasonography is the sole diagnostic aid for the confirmation of abomasal disorders in buffaloes.

Ovarian Serous Surface Papillary Borderline Tumor: Sea Anemone Sign

HomeRadioGraphicsVol. 41, No. 7 PreviousNext Cases from the Cooky JarFree AccessOvarian Serous Surface Papillary Borderline Tumor: Sea Anemone SignC. Austin Wheeler , Ciléin Kearns, Valery L. Turner, Tushar R. GargC. Austin Wheeler , Ciléin Kearns, Valery L. Turner, Tushar R. GargAuthor AffiliationsFrom the Department of Radiology, University of Alabama at Birmingham School of Medicine, 619 19th Street S, JT N338, Birmingham, AL 35249 (C.A.W.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (V.L.T.); and Department of Radiology, Seth GS Medical College and KEM Hospital, Parel Mumbai, Maharashtra, India (T.R.G.).Address correspondence to C.A.W. (e-mail: [email protected]).C. Austin Wheeler Ciléin KearnsValery L. TurnerTushar R. GargPublished Online:Nov 1 2021https://doi.org/10.1148/rg.2021210201MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In On the pathway from benign cystadenoma to malignant cystadenocarcinoma, borderline tumors represent a crucial entity within the spectrum of ovarian epithelial carcinogenesis. Of this class, serous borderline neoplasms represent the common subclass (65%) (1).One distinct sub-subclass is named serous surface papillary borderline tumor (SSPBT) for its unique (although not wholly exclusive) imaging features (2) (Figs 1–3). Macroscopically, its surface stroma frequently branches into exophytic papillary stalks; hence the name. When these cystic lesions form frondlike excrescences, they mimic the likeness of a sea anemone at MRI (1,2). Histopathologic analysis even recapitulates this architectural pattern with micropapillary tumor cell proliferation.Figure 1. Classically described sea anemone appearance of a borderline serous surface papillary tumor in a 52-year-old woman. (A) Axial postcontrast T1-weighted MR image of the pelvis demonstrates heterogeneous soft-tissue enhancement with multiple enhancing fronds (arrow). (B, C) Axial (B) and sagittal (C) T2-weighted MR images of the pelvis demonstrate a complex T2-hyperintense adnexal tumor with multiple papillary excrescences (arrow).Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. (A, B) Gray-scale (A) and color Doppler (B) transvaginal US images in a 52-year-old woman (same patient as in Fig 1) show that this mass has internal echogenic content with a branching appearance (arrow in A) and internal vascularity (arrowhead in B). (C) Low-power photomicrograph (hematoxylin-eosin stain) used for histologic correlation shows that epithelial ovarian tumor cells grow as papillary structures (P) in a hierarchical fashion (large, medium, and small papillae). Tumor cells composing papillae are of serous type with eosinophilic cytoplasm and mild to moderate nuclear atypia. No mitotic activity is seen in this case. (Fig 2C courtesy of Longwen Chen, MD, PhD.)Figure 2.Download as PowerPointOpen in Image Viewer Figure 3. Medical illustration shows the sea anemone sign, which features papillary fingerlike projections with internal branching. Associated findings may include coarse calcifications, ascites, para-aortic lymphadenopathy, and spread to the peritoneum. (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2021.)Figure 3.Download as PowerPointOpen in Image Viewer Preoperative detection at diagnostic imaging can be informative because less aggressive borderline tumors tend to carry a more favorable prognosis, potentially altering management. Early identification and treatment are vital, as these tumors commonly manifest in younger women of childbearing age who may benefit from fertility-sparing surgery (1).All authors have disclosed no relevant relationships.

Abdominal ultrasound and clinicopathologic findings in 22 cats with exocrine pancreatic insufficiency.

BackgroundAwareness of exocrine pancreatic insufficiency (EPI) in cats has increased since the development of an assay for feline trypsin‐like immunoreactivity (fTLI). Ultrasound findings in cats with EPI have only been reported rarely and described as nonspecific.Hypothesis/ObjectivesTo describe the ultrasonographic findings, clinical signs, and concurrent diseases in cats with EPI.AnimalsTwenty‐two client‐owned cats with EPI.MethodsMulticenter retrospective descriptive study including cats with serum fTLI concentration ≤8 μg/L and an abdominal ultrasound examination performed within 6 weeks of fTLI measurement. Sonographic measurements of maximal pancreatic thickness and maximal pancreatic duct diameter as well as ratios of pancreatic duct diameter to pancreatic thickness were obtained. Additional sonographic findings, concurrent conditions, and clinical signs were recorded.ResultsThe most common clinical sign was weight loss (15/22 cats). Chronic enteropathy was the most common concurrent disease (13/22 cats). In 39% of cats, the pancreas had minimal or no sonographic alterations. Pancreatic duct dilatation (>2.5 mm), pancreatic duct tortuosity with variable diameter, or both were seen in 6/13 cats. The pancreatic parenchyma was subjectively thin in 6 cats. A significant relationship was found between subjectively thin pancreatic parenchyma and increased pancreatic duct size : pancreatic thickness ratio (P = .004). Diffuse gastrointestinal dilatation with echogenic content was observed in 8/22 cats.ConclusionExocrine pancreatic insufficiency often causes minimal to no sonographic pancreatic changes. Nonetheless, the findings of thin pancreatic parenchyma, pancreatic duct dilatation, or diffuse small intestinal dilatation with echogenic contents in cats with unexplained weight loss or unformed feces should raise clinical suspicion for EPI.

Bacterial infective stifle arthritis secondary to a migrating grass seed foreign body in an adult dog

AbstractAn adult neutered male cocker spaniel was presented with a 2‐ to 3‐week history of left pelvic limb lameness, stifle effusion, general malaise and pyrexia. Computed tomography imaging revealed an irregular tubular tract, extending from the stifle distally to the level of the mid tibial diaphysis, associated with the long digital extensor muscle. Ultrasonography revealed the tract had echogenic contents; however, no foreign body could be identified. Following surgical exploration, a grass seed was identified in the medial compartment of the left stifle. Culture of the grass seed and joint capsule tissue yielded growth of Pantoea agglomerans. Following the surgery and subsequent antibacterial and non‐steroidal anti‐inflammatory medication, the dog made a full recovery to normal activity.

Ovary: MRI characterisation and O-RADS MRI.

Ultrasound has a high specificity for the diagnosis of a benign lesion in cases of classic appearing simple cyst, hemorrhagic cyst, endometrioma and dermoid. However, ultrasound can sometimes be limited for definitive characterisation and risk stratification of other types of lesions, including those with echogenic content that may appear solid, with or without blood flow. Frequently, MRI can be used to further characterise these types of lesions, due to its ability to distinguish solid tissue from non-tissue solid components such as fat, blood, or debris. Incorporating the MR imaging into the evaluation of adnexal lesions can improve diagnostic certainty and guide clinical management potentially avoiding inappropriate surgery for benign lesions and expediting appropriate treatment for malignant lesions, particularly in the females with sonographically indeterminate adnexal lesions.

Imaging in gynecological disease (21): clinical and ultrasound characteristics of accessory cavitated uterine malformations.

To describe the clinical and ultrasound characteristics of accessory cavitated uterine malformations (ACUMs). This was a single-center observational study of consecutive patients diagnosed with an ACUM, who had undergone an ultrasound examination by an experienced ultrasound examiner between January 2013 and May 2019, identified retrospectively from medical records. ACUM was diagnosed when a cavitated lesion with a myometrial mantle and echogenic contents was seen within the anterolateral wall of the myometrium beneath the insertion of the round ligament. In all women, presenting symptoms and clinical history were recorded along with detailed descriptions of the lesions and any concomitant pelvic abnormalities. Twenty patients diagnosed with an ACUM were identified. Median age was 29.2 (interquartile range, 25.0-35.8) years. None of the women was premenarchal or postmenopausal. All of the women reported painful periods or pelvic pain and none of them reported subfertility. Twelve of the ACUMs were in the right anterolateral myometrium and eight were in the left anterolateral myometrium. Both a myometrial mantle and a fluid-filled cavity were considered to be defining features on ultrasound. The fluid contained within the cavity was either echogenic with a ground-glass appearance or hyperechoic. All of the lesions were spherical in shape. The Doppler flow seen in the outer rim was not markedly different from that of the surrounding myometrium, and the content of the cavity was avascular on Doppler examination. The mean outer cavity diameter of the ACUMs was 22.8 (95% CI, 20.9-24.8) mm and the mean internal cavity diameter was 14.1 (95% CI, 12.2-16.1) mm. Four women opted for transvaginal ultrasound-guided alcohol sclerotherapy. Surgical excision was carried out in eight cases, and the diagnosis was confirmed on histopathological examination in all of them. ACUMs are a uterine abnormality with a distinct ultrasound appearance, which are associated with dysmenorrhea and chronic pelvic pain. Knowledge of their typical appearance on ultrasound could facilitate early detection and treatment. There are several treatment options for ACUM, ranging from simple analgesia to complete excision. Further prospective and longitudinal studies are required to study the prevalence and natural history of this condition. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasonographic Detection of Interstitial Nephritis in a Canine Fetus

Background: A detailed ultrasound examination of the fetal urinary tract as part of prenatal care is important to detect possible abnormalities. Early diagnosis can prevent more serious damage such as loss of kidney function. Interstitial nephritis can compromise renal functionality. Also, acute interstitial nephritis is a frequent cause of acute kidney injury and can become chronic if not treated. Besides, a renal biopsy can help in the diagnosis and at the staging of the disease. Therefore, this report aims to describe the ultrasonographic findings of the renal tissues in a canine fetus affected by interstitial nephritis.Case: Gestational ultrasound evaluations were performed in a female Pug, at the 25th, 45th, and 58th gestational days. Ultrasound examination was performed with a 9.0 MHz linear transducer and a high-resolution digital transducer with a frequency standardized at 17.0 MHz. During the first evaluation, embryonic vesicles were detected and were compatible with the gestational period. At 45 days of gestation, some abnormalities were observed in the kidneys of one of the fetuses, such as increased cortical echogenicity, cortical thickening, loss of corticomedullary ratio (1:1), renal pelvis and ureter dilatation by echogenic content. Biparietal and abdominal diameters were also lower than that from the other fetuses, which did not show abnormalities, being compatible with the estimated gestational age. However, the heart rate was similar among all fetuses. On the 58th day, we observed in the underdeveloped fetus that both kidneys still presented the abnormalities seen previously, in addition to the presence of a cystic structure in the right kidney, in the cranial topography of the cortex. The other fetuses kept showing normal ultrasonographic findings, normal heartbeat, all of these compatible with the ultrasound gestational age. The delivery occurred without complications and only the underdeveloped fetus stillborn. Then, it was submitted to a necropsy where chronic interstitial nephritis was found in the histopathological analysis.Discussion: Adequate prenatal care is important to detect abnormalities in fetuses, in which ultrasound examination allows to access fetal development. The gestation in the bitch seemed to be occurring without complications, but the B mode and High Definition ultrasound techniques were able to identify abnormal development of the fetus' kidneys. Both techniques showed to be secure to the fetuses and the mother, as they are non-invasive and free of radiation. These findings, different from those described as normal for a fetus, reinforce the warning signal for a possible establishment of anomalies consistent with nephropathy. Still, histopathology is important to exclude other diseases and help to define prognosis. Interstitial nephritis can significantly affect perinatal survey, considering that the fetus was stillborn, confirming that the description of such anomalies can help to prevent disease. Since nephritis can be associate with the use of some medicines, the orientation of the owner regarding drug use during bitch pregnancy is essential. Therefore, this is the first report describing renal abnormalities in a canine fetus, which highlights the importance of ultrasound examination for disease identification in prenatal care. Lastly, high-resolution ultrasound (HD) could provide detailed information on abnormalities in the fetal kidney.

"Sein dans le sein": échographie et mammographie de l'hamartome

We report a 20-year-old patient, mother of 2 children and with no personal or family history of breast disease who consulted for a painless right breast mass evolving for 6 months. The mass was firm, painless and mobile at the right inferior-external quadrant. No inflammatory signs, nipple discharge or associated axillary adenopathy. Breast ultrasonography revealed a tissue formation of 4x2x4cm, parallel to the skin plane, well limited, heterogeneous hypoechoic with hyperechoic trabeculae, and containing tubulated structures with echogenic content, without attenuation or reinforcement of the echoes (A). In color Doppler, its vascularization was identical to that of the normal mammary gland. In view of this aspect, a complementary mammography was performed. It allowed the visualization in the right inferior-external quadrant of a well-limited, encapsulated oval mass of mixed fat and glandular density, thus producing the image of "breast within the breast" (B, C). This allowed the diagnosis of mammary hamartoma. The mammary hamartoma is a pseudotumor (benign) consisting of fibrous tissue, adipose tissue and glandular element. It is a rare mammary disorder occurring at any age from puberty. In its typical form as in our patient, mammography is the key examination and is sufficient to establish the diagnosis even without biopsy. Its treatment does not require an excision except in the case of aesthetic discomfort. It should be noted that its differential diagnosis includes other benign mammary tumors of adolescents and young adults such as adenofibroma, phyllode tumor, lipoma and papilloma.