Echogenic Rim Research Articles

Micronodulation: ultrasonographic sign of Hashimoto thyroiditis.

The purpose of this work is to assess the validity of an ultrasonographic sign, micronodulation, in the diagnosis of Hashimoto thyroiditis. Among 101 patients found to have ultrasonographic features of micronodulation, 57 patients had autoantibody test results available. Fifty-four patients were positive and three were negative for the autoantibodies. Therefore, the positive predictive value for micronodulation in diagnosing Hashimoto thyroitis is 94.7%. The micronodules were 0.1 to 0.65 cm in size, hypoechoic, and surrounded by an echogenic rim. This corresponds to accentuated lobulation on the pathologic specimen. Although micronodulation is highly diagnostic of Hashimoto thyroiditis, the ultrasonographic features of eight biopsy-proved masses caused by Hashimoto thyroiditis varied and were not specific for the disease.

The chorionic rim and low-impedance intrauterine arterial flow in the diagnosis of early intrauterine pregnancy: evaluation of efficacy.

We undertook this study to evaluate whether sonographic imaging of an intrauterine chorionic rim or arterial flow can help diagnose an early intrauterine pregnancy. One hundred sixty-nine women with early intrauterine pregnancies and 69 women with ectopic pregnancies underwent pelvic sonography. All sonograms were examined for a chorionic rim (an echogenic rim bordering an intrauterine fluid collection) or a double decidual sac. Of these 238 patients, 126 also underwent Doppler examination for endometrial arterial flow. The chorionic rim and double decidual sac had sensitivities for intrauterine pregnancy of 80% and 64%, respectively, and specificities of 97% and 100%, respectively. Intrauterine arterial flow with either peak systolic velocity greater than or equal to 15 cm/sec or resistive index less than or equal to 0.55 had a sensitivity of 70% and a specificity of 95%, Combining these two signs led to sensitivities and specificities of approximately 90%. Similar test performance was observed in patients having intrauterine pregnancies that lacked an embryo, yolk sac, or amniotic remnant. The chorionic rim and low-impedance endometrial arterial flow can indicate an intrauterine pregnancy even when the double decidual sac is not seen. These two signs are particularly useful for patients with intrauterine pregnancies that show no other sonographic findings.

The Significance of Echogenic Rim of Atypical Hepatic Hemangioma on Ultrasonogram

The Significance of Echogenic Rim of Atypical Hepatic Hemangioma on Ultrasonogram

Ultrasonography and CT Findings of Epigastric Hernia: 3 Case Report

This article presents a description of the ultrasonographic and computed tomographic findings with adiscussion of the imaging features in three patients with epigastric hernias, simulating abdominal wall lipomas.Ultrasonogram showed a heterogeneous hypoechoic mass encircled by echogenic rim within subcutaneous space of theab dominal wall. Computed tomographic findings were a localized fatty mass surrounded by a thin capsule in association with a focal discontinuity of the linea alba. Ultrasonogram was not diagnostic, but computed tomogramwas suggestive because of the well demonstration focal defect in linea alba.

The analysis of ultrasonographic findings in breast carcinoma

Authers retrospectively analyzed ultrasonographic findings of 12 cases of breast carcinomas which were proven pathologocally at Yeungnam University Hospital from March 1992 to August 1992. Classically, breast carcinomas were described as irregular and lobulated hypoechoic solid masses with inhomogenous internal echoes and frequent attenuation of the sound beam. And other additional ultrasonographic findings were echogenic rim, disruptions of superficial layer, microcalcification, skin thickening and so on. In our studies, not all of these findings of breast carcinomas were found in each case, but most of these findings were noted. However, several studies have demonstrated considerable overlap in the ultrasonographic appearance of benign lesions and carcinoma. Thus, accurate sonographic determination of the type of solid mass is not possible with current ultrasonographic imaging techniques and criteria. For more accurate diganosis of breast lesions, sonographic and other imaging techniqes are interpreted together.

Imaging of infantile polycystic kidney disease with some rare association.

Seventeen patients, age 1 day to 6 years with infantile polycystic kidney disease were evaluated with ultrasound and other imaging techniques. Most patients showed bilaterally enlarged kidneys with hyperechoic renal parenchyma, which had poor differentiation in outlines as well as between renal sinus, cortex and medulla. Cysts of various sizes were also identified in the kidneys. However, a third of these cases showed well-defined renal outlines, normal echogenic cortical rim, whilst dilated renal collecting systems were seen in another third of the cases. Twelve cases showed hepatomegaly. Few rare findings such as liver cysts, associated Meckel syndrome, renal stone, bilateral vesicoureteric reflux and renal calcification were also noted. This study confirms the diagnostic value of sonography and intravenous pyelography examination. However, the noninvasiveness and the opportunity for repeat examination in antenatal and postnatal life makes sonography the ideal investigative modality.

Intrauterine spermatic cord torsion in the newborn: sonographic and pathologic correlation.

In five newborn patients with spermatic cord torsion, sonography demonstrated an enlarged and globular testis, hydrocele, and skin thickening. In four of these patients the testicular parenchyma was heterogeneous. Peripheral hypoechoic areas were seen in two of the four patients; the other two had a central hypoechoic region and a peripheral echogenic rim. The testis in the fifth patient was diffusely hyperechoic. Duplex Doppler sonography performed in two patients failed to demonstrate any signal in the spermatic cord in either the abnormal or contralateral hemiscrotum. Scintigraphic findings were positive for testicular torsion in two patients and equivocal in three patients. Surgery was performed 2-12 days after sonography and established the diagnosis of spermatic cord torsion. Pathologic examination demonstrated hemorrhagic infarction of the entire testis as well as scattered calcifications. The authors conclude that a solid globular testicular mass seen during the neonatal period is suggestive of intrauterine spermatic cord torsion.

Sonographic appearance and ultrasound-guided fine-needle aspiration biopsy of breast carcinomas smaller than 1 cm3.

The purpose of this study was to review the sonographic appearance and the results of ultrasound-guided fine-needle aspiration biopsies of a series of 49 breast carcinomas smaller than 1 cm3. No tumor was found to be hyperechoic. Contours were irregular in 69% of cases. In 53%, an echogenic rim was present, and the echotexture was nonhomogeneous in 41%. Sound beam attenuation was present in 39%. The ratio of longitudinal diameter to anteroposterior diameter ranged from 0.67 to 2.25 (mean, 1.08 +/- 0.28). Fine-needle aspiration biopsy under continuous real-time sonographic guidance was performed on 36 patients and yielded 30 positive and four suspicious results (sensitivity, 94%), one inadequate specimen, and one false-negative result. With high-resolution hand-held transducers, breast sonography can depict small carcinomas and provides accurate, cost-effective guidance for fine-needle aspiration biopsy.

Cerebral mass lesions in patients with AIDS.

Sir,?We would like to comment on the case report presented by Dr H Montgomery1 and the subsequent letter from Mr I R Whittle concerning the safety of stereotactic biopsy guided by com? puted tomography.2 Brain biopsy guided by ultrasonography and carried out through a burr hole with the Berger neurobiopsy device is a simpler and cheaper alternative to the use of a stereotactic frame.3 It does not require the patient to be moved from the theatre to the scanning suite and back again under general anaesthesia. The Berger device is screwed into the burr hole in theatre and ultrasonography is performed to identify the lesion for biopsy. After alignment of the probe holder and needle guide the biopsy needle can be advanced to the appropriate depth. Assessment of the ultrasound image enables biopsy specimens to be taken from the echogenic rim of a lesion, where living cells are more likely to be found, rather than from the necrotic centre. Biopsy specimens can be taken from multiple sites through the one burr hole. Also, the lesion may be rescanned after each pass of the needle and any haemorrhage identified, enabling prompt treatment without necessitating return to a com? puted tomographic scanner. We have just reported our initial experience with the device in 49 patients4 and consider it to be a valuable alternative to stereotaxis guided by computed tomography in many cases. In our small series there was no appreciable morbidity associated with the procedure and no deaths occurred. WILLIAM HATELY RUDI L BORGSTEIN PETER J HAMLYN

US-guided percutaneous laser ablation of liver tissue in a chronic pig model.

The authors evaluated the safety of ultrasound (US)-guided percutaneous ablation of liver tissue using a neodymium-yttrium-aluminum-garnet (Nd:YAG) laser fiber placed through a skinny needle. The US appearance of the lesion was correlated with the pathologic findings in 19 pigs killed at 1-7 weeks. A 20-gauge needle was percutaneously placed in the liver, and a fiber with a 0.5-cm cladding-stripped tip was inserted. The Nd:YAG laser was fired for 6 minutes at 1-4 W. The early sonographic appearance was recorded, and the US appearance before the pigs were killed was correlated with the gross and histopathologic findings. There were no cases of abdominal bleeding or infection. Mild transient changes in liver function were seen. An initial strong echogenic focus decreased slightly in echogenicity for 10 minutes and then stabilized. Over 1-7 weeks, the 1-cm-diameter lesion decreased in size and developed an echogenic rim that correlated with a peripheral zone of inflammatory repair around a small central cavity and zone of necrosis. US-guided laser ablation of liver tissue is safe in this pig model, and the US appearance corresponds to a process of repair and removal of necrotic liver tissue.

Testicular infarction in the newborn: Ultrasound findings

Three patients with neonatal testicular torsion and infarction (two bilateral, one unilateral) are presented with a distinctive sonographic appearance. All five testes appeared inhomogeneously hypoechoic and each was surrounded by a brightly echogenic rim. Whereas surgical exploration was required in the past to establish the diagnosis of testicular infarction in the neonate, sonographic demonstration of the abnormality in the appearance of the testicular parenchyma permits nonoperative diagnosis. Because surgical salvage of the testis in the setting of neonatal extravaginal torsion is thought to be quite rare, the necessity of removing the testis is less clear when the diagnosis is established preoperatively.

Ectopic pregnancy: features at transvaginal sonography.

A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. A tubal ring (a 1-3-cm mass consisting of a 2-4-mm concentric, echogenic rim of tissue surrounding a hypoechoic center) was seen in 23 of 34 (68%) ectopic pregnancies in which the fallopian tube had not ruptured, and the tubal ring could be distinguished from a corpus luteum cyst in most cases. Transvaginal sonography also depicted simple (n = 22) or particulate (bloody) (n = 13) peritoneal fluid associated with ectopic pregnancy. In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.

Leiomyomas in Pregnancy

LEV-TOAFF, ANNA S.; COLEMAN, BEVERLY G.; ARGER, PETER H.; MINTZ, MARSHALL C.; ARENSON, RONALD L.; TOAFF, MICHAEL E. Author Information

Leiomyomas in pregnancy: sonographic study.

With ultrasound monitoring, analysis of the behavior of uterine leiomyomas (fibroids) and their impact on the course of pregnancy was undertaken in a group of 113 patients. Fibroid size changes were analyzed on the basis of trimesters. In the second trimester, smaller fibroids increased in size, whereas larger fibroids decreased in size. In the third trimester, a decrease in size was documented regardless of initial size. The most common patterns of echotexture were hypoechoic, heterogeneous, and echogenic rim. The development of a heterogeneous pattern or anechoic/cystic spaces on a follow-up study was accompanied in seven of ten patients by severe abdominal pain, compared with 12 cases of abdominal pain in 103 patients without such echotexture changes. Although the number of patients was small, the development of these patterns apparently indicates significant degeneration of the fibroid. Fibroids located in the lower uterine segment were accompanied by a higher frequency of cesarean section and retained placenta. Fibroids located in the uterine corpus were more frequently associated with early abortions. Multiple fibroids were accompanied by a higher frequency of malpresentation and premature contractions compared with cases with one or two fibroids.

Primary adrenocortical carcinoma: sonographic evaluation with clinical and pathologic correlation in 26 patients.

The sonograms of 26 patients (19 adults and seven children) with pathologically proven diagnoses of primary adrenocortical carcinoma were evaluated. Clinical corroboration was obtained in all cases. The size of the lesions ranged from 3 to 22 cm. The five smaller lesions (3-6 cm) showed a homogeneous echo pattern, similar to renal cortical echogenicity. The 21 larger lesions varied in echo texture, having a heterogeneous appearance with focal or scattered echopenic or echogenic zones representing areas of tumor necrosis, hemorrhage, and/or, rarely (19%), calcification. Even the largest lesions were fairly well delineated, often with a lobulated border. Few (7/26 or 27%) showed a surrounding echogenic thin capsulelike rim. All five small lesions showed clinical evidence of endocrine activity. Larger lesions were hormonally active less often (9/21 or 43%). Twelve patients (46%) showed no sign of endocrine activity and presented with symptoms such as fever, weight loss, abdominal discomfort, abdominal mass, hematuria, and hypertension. In the pediatric and adolescent age group (0-16 years), all tumors were hormonally active, while only seven (37%) of tumors in the adult population (17-69 years) were hormonally active. Unfortunately no echo pattern was characteristic enough to allow differentiation of adrenal adenoma from carcinoma. Smaller lesions are more likely to be benign, and larger lesions with areas of necrosis, hemorrhage, and calcification are more likely to be malignant.

Diagnostic criteria of hydatid disease on hepatic sonography.

Ultrasound findings in 31 patients proven to have hydatid disease of the liver are presented. Four distinct patterns are described: a single spherical cystic area; a flattened, spherical, cystic area; the appearance of a cyst within a cyst; and a complex cystic mass. In 21 cases (68 per cent), previously described pathognomonic appearances are encountered. The presence of an echogenic rim usually suggests hydatid infestation; however, it may also be seen in an amebic liver abscess. Delineation of daughter cysts within the complex internal echoes is diagnostic of an infected hydatid cyst.

Sonographic evaluation of hypertrophy of septum of Bertin

Sonography was utilized to evaluate 12 patients with hypertrophy of the septum of Bertin. To confirm the diagnosis, angiography was used in 7 patients and radionuclide imaging in 2. Three sonographic characteristics were found: (1) an isoechogenic, ellipsoid mass with an echogenic linear rim of renal sinus fat; (2) contiguity of the mass with a normal-placed septum of Bertin; and (3) the occurrence of the mass effect always at the level of the emergence of the renal vein. The sonographic findings could be divided into two definite types. Type I showed moderate hypertrophy with a mass effect ranging from 1.1 by 2.3 cm to 2.0 by 3.2 cm in diameter, usually presenting with a smooth contour and discrete mass effect on the intravenous pyelogram (IVP). Type II showed severe hypertrophy with a mass effect ranging from 3.2 by 4. 0 cm to 3.5 by 4.5 cm in diameter, usually presenting with a lobulated contour and irregular stretching of the calyceal system on IVP. The differential diagnosis is discussed. In conclusion, we found that sonography associated with excretory urography is an accurate method for the diagnosis of hypertrophy of the septum of Bertin.

Sonographic appearances of the partial hydatidiform mole.

A partial hydatidiform mole differs morphologically and cytologically from the complete mole. Correct preoperative diagnosis of the partial mole by ultrasonography is often difficult. Some partial moles have sonographic appearances indistinguishable from those of the common complete moles or missed abortions. The predominant feature in the remainder is the presence of a well-defined gestational sac, either empty or containing inappropriately small fetal echoes, surrounded by a relatively thick rim of placental echoes with intermingling cystic spaces. An echogenic rim around the sac, as is found in missed abortion or blighted ovum, is notably absent. There appeared to be no correlation between these sonographic patterns and the clinical profiles of patients.

Perfluoroctylbromide: a liver/spleen-specific and tumor-imaging ultrasound contrast material.

The effect of perfluoroctylbromide (PFOB) on liver and tumor echogenicity was evaluated in rabbits. The echogenicity of the kidney, which is not affected by PFOB, was used as the basis for comparison in the liver studies. For the liver echogenicity study, sonography was performed on four rabbits, two with PFOB and two without PFOB, and four rabbits prior to and following the intravenous administration of 5 ml/kg PFOB. All livers were equal to or less echogenic than kidney in the control animals. All livers became more echogenic than kidney two days after administration of PFOB. The effect of PFOB on tumor echogenicity was evaluated in 18 rabbits with VX2 tumor implanted in the liver. Ultrasound studies of all rabbits were performed by the same physician before and two days after half the rabbits had received PFOB (5 ml/kg intravenously). The reviewers correctly identified all rabbits that received PFOB by visualization of an echogenic rim around the hepatic tumors.

Ultrasonic Evaluation of Abdominal Gastrointestinal Tract Duplication in Children

Ultrasonographic evaluation of a suspected abdominal mass in children is becoming routine. Recognition of a rare congenital anomaly known as duplication of the gastrointestinal tract might aid in diagnosis and obviate the need for an extensive workup. Two cases are presented that clearly demonstrate the ultrasonographic spectrum of findings in this condition, ranging from a sonolucent cyst to an echogenic mass. An echogenic inner rim seen ultrasonographically is highly suggestive of the diagnosis.