Echogenic Spots Research Articles

A 64 Years Old Man with a Rare and Serious Cardiac Complication of Lung Cancer

A 64 years old man with prior history of lung cancer presented with increased shortness of breath. Echocardiography showed small bright echogenic spots in the pericardial sac. Thoracic CT scan found a pneumopericardium of 24 mm and the patient was successfully managed by an urgent drainage.

Multiple Brain Abscesses In A Child With Infective Endocarditis

Background: Infective endocarditis is a lethal infection affecting the endocardium of the heart and the valves.The causes are varied with staphylococcus aureus and streptococcus as the major causative agents.The triad of fever exceeding 38oc,vegetation in the heart and blood culture of the causative agents are the hallmarks of the diagnosis .The disease is known to be affect all ages with the very young age group, those with congenital heart disease and those on cardiac prosthesis as the most vulnerable. Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections.It therefore has multisystemic manifestations and complications. Though neurological complications are common, brain abcess is known to be rare constituting only 1.0% of neurological complications. Objective: The study aimed at reporting occurrence of both cerebral and cerebellar micro- and macro-abscesses in a 3 year boy with infective endocarditis; a rare occurrence in the literature. Methods: This case report was carried out at University College Hospital Ibadan. Results: The boy presented with fever of 38oc for five weeks, convulsions and altered state of consciousness for ten days..In course of treatment patient however developed irritability and aggressive behaviour, which attracted the use of largactil to which he reacted with extrapyramidal signs and convulsions. Within the week he developed yellowness of the eyes and increase in abdominal girth. Patient had cranial computed tomography (CT) after plain skull X-rays and was referred to University College Hospital Ibadan as a result of the radiologically diagnosed brain abscess seen on CT images. child had grunting respiration with dyspnea, and the respiratory rate was 50/mm. However, the chest was clinically clear. In the cardiovascular system (CVS); the pulse was 140/mm, with moderate volume. The blood pressure (BP) was l60/110 mmHg. The first and second heart sounds were heard with a gallop rhythm. Cranial CT scan showed multiple ring enhancing hypodense lesions with surrounding hypodensity measuring 1cm in diameter and above with only a few measuring less than 1.0cm in both cerebral hemispheres and cerebelli in keeping with multiple cerebral and cerebellar abscesses. An echocardiography showed a brightly echogenic spot attached to the papillary muscle in the left ventricle suggesting vegetation consistent with an infective endocarditis. Retroviral test was negative for both type I and II.Blood culture — was negative, however urine culture yielded klebsiella sp. Serum urea, creatinine, Ca2+ and P04 were all elevated.The abdominal ultrasound scan confirmed the hepatosplenomegaly with decreased echogenicity but both kidneys appeared normal.There was no demonstrable ascitis. The boy was placed on antimicrobials; and had craniotomy for the drainage of the macroabscesses. He improved significantly. His renal and cardiac condition equally improved; he was subsequently discharged to continue treatment in the the paediaric outpatient. The infective endorcarditis still poses enormous challenge in management and the condition calls for multi disciplinary approach. It requires high index of suspicion for early detection; as well deployment of multiple imaging modalities by the cardiologists and radiologists to arrive at a more accurate diagnosis for effective patient management. This may save financial and material resources on part of the patients, care givers, the facility managers and the society at large.

Application of Color Doppler Ultrasound in Microscopic Imaging Diagnosis of Adenomyosis.

In order to explore the value of color Doppler ultrasonography (TVCDS) in the diagnosis and differential diagnosis of adenomyosis. A total of 150 patients with adenomyosis admitted to a hospital from January 2020 to December 2021 were selected, taking transvaginal three-dimensional color Doppler ultrasound and abdominal ultrasound for examination, all results were compared with patient pathology or surgical results, in order to compare the accuracy of the two inspection methods. The positive predictive value of three-dimensional color Doppler ultrasonography was higher than that of abdominal ultrasonography, and the difference was statistically significant (P < 0.05). The coincidence rate, sensitivity, and specificity of three-dimensional color Doppler ultrasonography were higher than those of abdominal ultrasonography, while the misdiagnosis rate was lower than that of abdominal ultrasonography, and the differences were statistically significant (all P < 0.05). The imaging features of vaginal three-dimensional color Doppler ultrasound in patients with adenomyosis are mainly enlarged uterus, slightly stronger echoes in the myometrium with enhanced echogenic spots, and short or short branch blood flow signals in the lesions. After statistical analysis, there was a significant difference in the blood flow changes between benign and malignant endometrial echoes and abnormal echoes in the uterine cavity, P < 0.05. Normal endometrium and benign intrauterine lesions mainly showed no blood flow signal, while malignant lesions in the uterine cavity mostly showed changes in blood flow signal. Compared with abdominal examination, transvaginal color Doppler ultrasonography has obvious advantages in the diagnosis of adenomyosis. According to the characteristics of ultrasound images, blood flow distribution, frequency spectrum, etc., it can provide a more accurate basis for clinical timely, provide the identification points of uterine fibroids, and provide help for clinicians to choose a treatment plan.

Abnormal Ultrasonographic Findings of Acellular Dermal Matrix in Implant-Based Breast Reconstruction: Correlations with Histopathology.

Background: Acellular dermal matrix (ADM) in implant-based breast reconstruction can show various ultrasound (US) findings. However, there are limited reports on the US features of the ADM. The aims of this study were to evaluate US findings of the ADM in implant-based breast reconstruction and correlate them with histopathological findings. Methods: Between January 2015 and August 2020, 250 women who underwent implant-based breast reconstruction with ADM and a breast US examination at 6 months to 1 year after reconstruction were retrospectively analyzed. Abnormal US findings were classified as type 1 (focal thickening with decreased echogenicity), 2 (diffusely hyperechoic), or 3 (bright echogenic spots). ADM biopsy was performed in 33 patients who underwent second stage or revisional surgeries. Results: In total, 176 consecutive women with 207 US findings were analyzed. The US findings were normal in 52.2% of the women. The percentages of type 1, 2, and 3 patients were 13.5%, 11.1%, and 23. 2%, respectively. These patients had microscopic findings that showed patchy areas with chronic inflammatory infiltrates, dense collagen bundles without degenerative or inflammatory changes, and empty spaces or degenerated foci unaccompanied by inflammation. Conclusion: Knowing the various ADM presentations on US can help avoid unnecessary invasive procedures.

Scleredema diabeticorum in a patient: un uncommon etiology of restrictive lung pattern Escleredema diabeticorum en un paciente: una etiología infrecuente de patrón restrictivo pulmonar

Scleredema adultorum of Buschke is a rare skin disease characterized by skin thickening and tightening typically at the neck and the upper part of the body. This thickening results from increased mucin deposition in the reticular dermis. Three variants are recognized. Scleredema diabeticorum is one subtype associated with diabetes mellitus. We report a man with a history of poorly controlled diabetes presenting with extensive scleredema adultorum of the trunk in a "cuirasse" pattern associated with restrictive lung disease. Cutaneous ultrasonography revealed a marked thickening of the dermis as well as various echogenic spots in the dermis. Cutaneous hardness secondary to scleredema may cause limited mobility. Therefore, respiratory manifestations may be associated and assessed, mainly in cases of extensive scleredema involving trunk and shoulders. Moreover, cutaneous ultrasonography may be useful to monitor the evolution of scleredema and confirm the diagnosis.

Sonographic characteristics of pilomatricomas and their association with symptom duration.

This study aimed to investigate the associations between the sonographic findings and duration of symptoms in children with pilomatricoma.This study included 86 children with 95 lesions confirmed to be pilomatricoma after pathological examination. The associations between symptom duration and sonographic observations, including the presence or absence of peritumoral hyperechogenicity, calcification, and vascularity were investigated. The internal echogenicity of each pilomatricoma was scored using a 5-point scale based on echogenic spots and calcification with posterior acoustic shadowing. The Mann–Whitney U and Kruskal–Wallis tests were used for statistical analysis.We found that the absence of peritumoral hyperechogenicity and severity of calcification were associated with increased symptom duration. Calcification, (present, 19.19 ± 18.99 months vs absent, 4.31 ± 3.24 months; P < .01) and peritumoral hyperechogenicity (present, 5.02 ± 5.80 months vs absent, 16.17 ± 18.24 months; P < .01), and grade of internal echogenicity (grade 0/1/2/3/4 = 3 months [1 patient]/4.33 ± 3.26 months [range, 1–12]/4.57 ± 3.46 months [range, 2–12]/10.89 ± 9.17 months [range, 3–28]/35.27 ± 19.16 months [range, 9–60], respectively; P = .01 and <.01) were associated with significant differences in symptom duration. There were no significant between-group differences in vascularity (6.01 ± 7.24 months; range, 1–48 vs 15.50 ± 19.12 months; range, 1–60; P = .08).Pilomatricomas with a relatively short symptom duration were more likely to exhibit peritumoral hyperechogenicity and calcification with less severe posterior acoustic shadowing compared to lesions with a longer symptom duration. These sonographic findings provided useful information that facilitated the correct and rapid diagnosis of pilomatricoma.

Inter- and Intraobserver Agreement in the Assessment of Thyroid Nodule Ultrasound Features and Classification Systems: A Blinded Multicenter Study.

Background: Single-center trials demonstrated moderate-substantial level of interobserver agreement in the evaluation of ultrasound (US) features of thyroid nodules. Multicenter studies on US agreement, however, are scanty, and data on intraobserver agreement are poor. Aim of the study was to assess inter- and intraobserver agreement between different thyroid centers and different specialists. Methods: A blinded analysis of 100 electronically recorded thyroid nodule US images was conducted in three large-volume thyroid centers by seven radiologists and endocrinologists. The evaluation was repeated after randomization 4 months later. The following US characteristics were evaluated: composition, echogenicity, margins, intranodular echogenic spots, vascularity, and shape. Thyroid nodules were also classified according to AACE/ACE/AME, EU-TIRADS, ATA, and ACR-TIRADS US classifications. Intra- and interobserver agreement was calculated using cross-tabulation expressed as mean Cohen's Kappa. Results: Interobserver agreement for US features: K-coefficient was 0.53 for composition, 0.47 for echogenicity, 0.46 for intranodular vascularity, and 0.33 for margins of the nodules. For echogenic foci, the K-coefficient was 0.47 for microcalcifications, 0.38 for macrocalcifications, 0.11 for the subcategory comet-tail artifacts, and 0.42 for shape. Operators resulted uncertain on hyperechoic foci definition in 16% of cases and described them as "hyperechoic foci of uncertain significance." Interobserver Cohen-K for US classification systems was 0.44 for AACE, 0.42 for ACR-TIRADS, 0.39 EU-TIRADS, and 0.34 for ATA. Intraobserver agreement: the K-coefficient for nodule US features was 0.62 for intranodular vascularity, 0.58 for composition, 0.60 for echogenicity, 0.54 for macrocalcifications, 0.55 for microcalcifications, 0.47 for comet tails, 0.39 for margins, and 0.35 for shape. Intraobserver Cohen-K for US classification systems was 0.54 for AACE, 0.49 for ACR-TIRADS, 0.38 for ATA, and 0.33 for EU-TIRADS. Conclusions: Intraobserver reproducibility for thyroid nodule US reporting and US classification systems appears fairly adequate, while the interobserver agreement between different centers is lower than that assessed in single-center trials. Reporting and rating ability of thyroid US examiners still appear not consistent. An unified lexicon of thyroid US features, a simplified method of classification, and a dedicated training in the description of thyroid US findings may increase the observers' agreement and the predictive value of US classification systems in real world practice.

P10.02: Abdominal wall endometriosis: an up‐to‐date perspective

Abdominal wall edometriosis (AWE) is defined by the presence of endometrial tissue in the subcuteneous fatty layer and/ or muscles of the abdominal wall. The purpose of our study was to evaluate imagistic and clinical features and the management options of these cases. A series of 47 patients over a 9-year period was analysed. The risk factors, clinical findings, imagistic (ultrasound, MRI, CT) aspects, treatment and the follow-up were taken into account. A systematic overview for the research articles published up until February 2019 was also performed. 45 patients presented a diagnostic Esquivel triad: history a Caesarean section, various degree of cyclic local pain during ovulation or/and menses and a nodular tumour nearby surgical scar. No previous history of pelvic endometriosis was detected. The ultrasound scans were performed in 46 cases – usually AWE appears as a nonhomogeneous hypoechoic mass with echogenic spots or thick echogenic strands, hypovascular. (figure 1). Surgical removal of the tumour was done in 42 cases and endometriosis was histopathological confirmed. No recurrence till now was reported. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Natural Poisoning by Tephrosia cinerea in Sheep from Western Region of Rio Grande do Norte State, Northeastern Brazil

Background: Tephrosia cinerea is a toxic plant responsible for liver fibrosis, which results in ascites and weight loss in sheep and probably goats. Although T. cinerea is widespread in Brazil, reports of poisoning are described in a few regions, named Eastern “Seridó” region of Rio Grande do Norte state, Central “Sertão” region of Ceará state, and “Sertão” of Paraíba state. Thus, this paper aimed to report the clinical-epidemiological, laboratorial, pathological and ultrasonographic findings of sheep spontaneously poisoned by T. cinerea in the Western region of Rio Grande do Norte state, Northeastern Brazil.Cases: The evaluated cases occurred in sheep raised on properties located in the municipalities of Areia Branca and Tibau, Western region of Rio Grande do Norte state, Northeastern Brazil. In all visited farms, the pasture had a marked predominance of the T. cinerea. Clinical signs included progressive weight loss, dehydration, bilateral abdominal distension, and respiratory dyspnea probably due to diaphragmatic compression. Other less frequent clinical signs were hyporexia, pale mucosae, rough hair coat and polyuria. Hematology revealed leukocytosis by neutrophilia, while serum biochemical analysis revealed increased activities of GGT (mean 96.3 U/L, reference: 20-52 U/L) and ALT (mean 55.0 U/L, reference: 22-38 U/L) and reduced levels of total proteins (mean 5.3 g/dL, reference 6.0-7.9 g/dL), albumin (mean 2.0 g/dL, reference 2.4-3.0 g/dL), and globulins (mean 3.2 g/dL, reference 3.5-7.0 g/dL). Abdominal ultrasonography was performed in one sheep, revealing a large amount of anechoic peritoneal effusion without floating echogenic debris or spots, and distention of hepatic vessels and portal veins. On the other hand, the ultrasonographic examination did not reveal changes in gallbladder, in right kidney and in the size of the liver. Gross pathological findings included severe ascites, moderate hydrothorax and hydropericardium, and liver showing irregular nodular surface, whitish areas and hardened consistency. The ascetic fluid was clear and is volume ranged from 8 to 13.5 liters. Microscopic evaluation of liver revealed hepatocyte necrosis, diffuse deposition of collagen fibers, and ductular proliferation.Discussion: Definitive diagnosis of poisoning by T. cinerea was made by the association of epidemiological, clinical, laboratory and pathological findings. It is known that the plant is part of the botanical composition of the diet of sheep all year long, but the poisoning becomes important mainly during the dry season. Affected sheep showed a typical ascitic condition due to diffuse liver fibrosis. Main ultrasonographic findings corresponded to hyperechoic diffuse diseases patterns, such as lipidoses and toxic liver diseases. The alterations observed in the biochemical panel are consistent with hepatic damage caused by the plant. The hematological findings are suggestive of immune system interference of poisoned sheep, but it is not possible to infer if it were the direct action of some component(s) of the plant or if it would be secondary to the severe nutritional deficiency induced by the poisoning. The toxic principle of T. cinerea remains undetermined, but it is already known that it is not pyrrolizidine alkaloids. The probable pathophysiological mechanism of ascites is the increased blood pressure on the portal vein walls due to the greater resistance of the liver parenchyma, but there should also be some contribution of hypoalbuminemia, which reduces plasmatic colloid osmotic pressure.

Ultrasonographic Findings of Scleredema Adultorum of Buschke Involving the Posterior Neck.

ObjectiveTo describe the clinical and ultrasonographic (US) findings in patients with scleredema adultorum of Buschke, who presented with sclerotic skin on their posterior neck.Materials and MethodsAfter obtaining IRB approval, eight patients with scleredema adultorum of Buschke were enrolled. They underwent US examination of their posterior neck. The diagnoses were confirmed pathologically. The clinical history and US images were evaluated retrospectively. Dermal thickness was compared between the patient group and the age- and sex-matched control group.ResultsThe patients included seven males and one female with a mean age of 51.5 years. All patients presented with thickening of the skin and/or a palpable mass on the posterior neck. Five (62.5%) of the eight patients showed erythematous discoloration. Six patients (75.0%) had a history of diabetes. The Hemoglobin A1c level was found to be increased in all patients. US images did not show any evidence of a soft tissue mass or infection. The mean dermal thickness in patients (7.01 ± 1.95 mm) was significantly greater than that in the control group (3.08 ± 0.87 mm) (p = 0.001). Multiple strong echogenic spots in the dermis were seen in all patients. Seven patients (87.5%) showed posterior shadowing in the lower dermis.ConclusionWhen a patient with a history of diabetes presents with a palpable mass or erythematous discoloration of the posterior neck and US shows the following imaging features: 1) no evidence of a soft tissue mass or infection, 2) thickening of the dermis, 3) multiple strong echogenic spots and/or posterior shadowing in the dermis, scleredema adultorum of Buschke should be considered in the differential diagnosis.

Value of additional von Kossa staining in thyroid nodules with echogenic spots on ultrasound

PurposeTo evaluate the clinical value of additional von Kossa staining on cytology in thyroid nodules with echogenic spots on ultrasound (US). Materials and methods342 thyroid nodules were analyzed for cytology and von Kossa staining was performed to detect microcalcifications. We compared diagnostic performances and accuracies of FNA and FNA with von Kossa staining to detect malignancy. We evaluated associations of aggressive pathologic features and von Kossa positivity in the surgically confirmed papillary thyroid carcinoma (PTC) group. ResultsTwo hundred and thirty two (67.8%) nodules were malignant and 110 (32.2%) were benign on cytopathology. Compared to cytology alone, additional von Kossa staining slightly improved sensitivity from 89.7% to 90.9% (P=0.081). In 207 cases of surgically confirmed PTC, von Kossa positivity was an independent predictor of central lymph node metastasis in PTCs by multivariate analysis (odds ratio, 2.218; P=0.021). ConclusionsAdding von Kossa staining to cytology improved the sensitivity of thyroid nodules with echogenic spots on US. Positive von Kossa stains in PTCs may also be useful in predicting central lymph node metastasis.

Ultrasonographic Study of Testicular Development in Beetal Bucks

Two dimensional (2D) ultrasound imaging of testis was conducted on six prepubertal bucks from 1 month to 9 months of age. Testicular scanning was done through direct contact in longitudinal and vertical positions by using 6.0 MHz frequency with a real time ultrasound scanner. The testicular parenchyma (TP) appeared homogenous with a coarse medium echo-pattern which appeared anechoic at first month of age and then moderately echogenic as development occurred with advancement of age. The mediastinum appeared as a longitudinal structure in the middle of testis having greater echogenicity than TP in longitudinal plane and as an echogenic spot in centre of TP in transverse plane. The scrotal septum was seen as a hyperechoic structure in lateral sonograms from initial scanning onwards. The tunics of the testes appeared as a bright echogenic line. Intertesticular septal depression also appeared between testes as anechoic linear band on transverse scanning. The length, width and circumference of the testes showed significant increase (P<0.05) with the advancement of age. Pixel value of testes showed an incremental pattern with slight deviations at few points. All testicular parameters increased linearly as age advanced, with maximum increase from third to fourth month.

Case of right-neck tumor that appears to be ectopic thymus

A 7-year-old female infant presented with an asymptomatic soft tissue mass in the right neck. The tumor was considered to be a benign one because it had a smooth margin and no change in its size was observed. Ultrasonography showed a 4.5-cm-diameter solid tumor with a smooth, well-defined border. Inside the tumor, flow signals were observed on color Doppler and there were numerous echogenic spots. Magnetic resonance imaging (MRI) examination showed findings consistent with an ectopic thymus, i.e., T1- and T2-weighted images showed thymus-like signals. The course of the case is being continuously followed.

No abomasal curd formation in pre-ruminant calves after ingestion of a clotting milk replacer

The aim of this study was to ultrasonographically evaluate curd formation in 29 pre-ruminant calves that were fed a clotting milk replacer. Abomasal curd was absent in 8/29 calves at 2 h after feeding. In these eight calves, abomasal contents were observed as an anechoic image with small echogenic spots (five calves), or as an echogenic image with an unclear outline (three calves), but there was no echogenic image with a clear outline corresponding to curd that was visualised in the other 21 calves. The curd was not observed until 7 h after feeding in the eight calves. Our analysis also indicated that the absence of curd formation in the pre-ruminant calves did not have a significant impact on the appearance, appetite and vigour of pre-ruminant calves or on their blood parameters, including serum triglyceride, blood urea nitrogen and glucose concentrations. The study provided the first evidence that the abomasum of some calves does not form curd despite ingestion of a clotting milk replacer.

Indeterminate calcification and clustered cystic lesions are strongly predictive of the presence of mucocele-like tumor of the breast: a report of six cases

Mucocele-like tumor (MLT) of the breast is a mucinous disorder that is generally difficult to distinguish from mucinous carcinoma. Moreover, MLT is often accompanied by atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS), and preoperative diagnosis is very confusing. In this paper, we summarize the clinicopathological characteristics of six cases of MLTs, comparing them with mucinous carcinoma. MLTs were characterized by clustered, coarse calcification on mammography and clustered, hypoechoic lesions with or without echogenic spots on ultrasonography. On fine-needle aspiration cytology (FNAC), three cases were correctly diagnosed and three cases were judged to be indeterminate, or insufficient material was present. Ultimately, excisional biopsies were performed to obtain a correct diagnosis in all cases. Immunohistochemical staining of MLTs accompanied by ADH or DCIS (malignant MLTs) revealed the presence of MUC6, while MLTs without ADH or DCIS (benign MLTs) were MUC6-negative. At present, as it is difficult to detect small areas of DCIS adjacent to the MLT by FNAC, excisional biopsy is essential. Immunohistochemical staining for MUC6 may be useful in differentiating between benign MLTs and malignant MLTs, although further investigation is needed.

Ultrasonographic assessment of embryonic, fetal and placental development in Ossimi sheep

The aim of the present study was to determine the pattern of fetal growth in breeds characterized by low litter size and birth weight. Also, accuracy of the fetal kidney length (KIL) in predicting the gestational age (GA) in sheep was investigated. In experiment 1, serial ultrasonographic examinations were performed in 12 Ossimi ewes for a total of 336 times between days 22 and 146 of gestation. Sequential changes of the fetal crown-rump length (CRL), diameter of the amniotic vesicle (AVD), chest depth (CHD), abdominal diameter (ABD), eyeball diameter (EBD), ruminal length (RUL), placentome diameter (PLD), and kidney length (KIL) were recorded. Changes in echogenicity of the placentome and fetal fluids, and beginning of ossification were registered. Regression models for estimation of the gestational age were derived from the biometric indices. In experiment 2, the KIL was estimated in 30 Ossimi ewes and the GA was calculated with the mean squared predicted errors method. The value obtained was compared with the actual GA. The embryo and amniotic vesicle were first observed by days 25.38 ± 1.2 and 28.67 ± 1.0, respectively. Organization of the embryo into head, body and limb buds was detected by day 38 ± 3.2. Ossification was observed on the head, ribs and vertebrae by days 44.86 ± 2.5, 50.25 ± 3.4 and 51.50 ± 2.5, respectively. The amniotic fluid remained clear and echo-free until day 80.67 ± 11.2, then it became slightly turbid. Definite turbidity was observed by day 103.0 ± 8.0. Echogenic spots appeared in the allantoic fluid by day 138.0 ± 9.5. The placentome increased in size until day 82.73 ± 7.7, then it began to collapse. The fetal kidney was first visualized by day 73.2 ± 6.3. Its mean long axis increased linearly from 1.41 ± 0.2 cm on day 76 to 3.61 ± 0.3 cm on day 146 ( Y = 0.0345 X − 1.2052, R 2 = 0.81). Except the PLD, regression and correlation coefficients of the various measurements on gestational age were high significant. Using the KIL—predicting equation, no significant difference was found between the expected and observed fetal ages. In conclusion, sonographic fetometry in Ossimi sheep can be valuable for the evaluation of fetal development, the estimation of gestational age and the prediction of parturition dates. The KIL was easy to make and could therefore be included into the model for dating pregnancies. The times of organization, ossification, turbidity of the fetal fluids and degeneration of placentome might be helpful in judging the fetal age.

Adenomiomatósis vesicular pseudotumoral: Diagnóstico ecográfico. Caso clínico

Adenomyomatosis of the gallbladder wall is a frequent benign degenerative hyperplasia of unknown etiology. In some cases it looks like a malignant tumor. The diagnosis can be suspected during ultrasound examination. We report a 36 year-old male that presented with nonspecific dyspepsia. The ultrasound showed a gallbladder mass with small cyst and echogenic spot inside that suggested the presence of Rokitansky-Ashoff sinuses, seen in adenomyomatosis. The patient was operated and the tumor was excised. The pathological examination of the surgical specimen confirmed the presence of gallbladder adenomyomatosis.

The quality and size of yolk sac in early pregnancy loss

Accurate differentiation between normal pregnancy and pregnancy loss in early gestation remains a clinical challenge. To determine whether ultrasound findings of yolk sac size and morphology are valuable in relation to pregnancy loss at six to ten weeks gestation. Transvaginal ultrasonography was performed in 111 normal singleton pregnancies, 25 anembryonic gestations, and 18 missed abortions. Mean diameters of gestational sac and yolk sac were measured. The relationship between yolk sacs and gestational sacs in normal pregnancies was depicted. The yolk sacs ultrasound findings in cases of pregnancy loss were recorded. In normal pregnancies with embryonic heartbeats, a deformed or an absent yolk sac was never detected. Sequential appearance of yolk sac, embryonic heartbeats and amniotic membrane was essential for normal pregnancy. The largest yolk sac in viable pregnancies was 8.1 mm. Findings in anembryonic gestations included an absent yolk sac, an irregular-shaped yolk sac and a relatively large yolk sac (> 95% upper confidence limits, in 11 cases). In cases of missed abortion with prior existing embryonic heartbeats, abnormal findings included a relatively large, a progressively regressing, a relatively small, and a deformed yolk sac (an irregular-shaped yolk sac, an echogenic spot, or a band). A very large yolk sac may exist in normal pregnancy. When embryonic heartbeats exist, the poor quality and early regression of a yolk sac are more specific than the large size of a yolk sac in predicting pregnancy loss. When an embryo is undetectable, a relatively large yolk sac, even of normal shape, may be an indicator of miscarriage.

The significance of urethral hyperechogenicity in female lower urinary tract symptoms.

To explore the significance of hyperechogenic spots in the urethra on ultrasound cystourethrography. One hundred and five women with lower urinary tract symptoms who had undergone urodynamic study and ultrasound cystourethrography were included. Ultrasound cystourethrography was used to evaluate the morphology of the lower urinary tract, including the bladder neck position, bladder wall thickness at the trigone and dome, and presence or absence of hyperechogenic spots (urethral hyperechogenicity) in the urethra and their location and number. Of the 105 women, 30 (29%) had hyperechogenic spots in the urethra, including 26 (87%) with only one spot; 17 (53%) of the echogenic spots were located in the proximal urethra, including four cases with multiple echogenic spots. No significant differences were found in the demographics, urinary symptoms, ultrasonographic, urodynamic and urethrocystoscopic findings between those women with and without urethral hyperechogenicity, except for parity (P = 0.030). There was no association between urethral hyperechogenicity and urinary symptoms. A weak but negative correlation between the number of echogenic spots in the urethra and maximum urethral pressure was found in the subgroup with urethral hyperechogenicity (r = -0.421; P = 0.023). On ultrasound cystourethrography, a single echogenic spot in the urethra is not associated with specific urinary symptoms and does not affect urethral function.

A case of chondromatous tumor of the breast

This report describes an exceedingly rare case of a benign cartilage-containing breast tumor that developed in the right breast of a 52-year-old woman. She found the mass on self examination. Physical examination revealed a 1.5 x 1.4 cm, firm, smooth and mobile lump in the lower medial quadrant close to the nipple of the right breast. Mammography revealed a slightly indistinct margined, oval-shaped, and high density nodule without microcalcifications. On ultrasonography, the lesion was a hypoechoic, oval-shaped mass with an echogenic spot. The border was slightly rough. Fine needle aspiration cytology revealed some giant cells and necrotic tissue. Excisional biopsy was then performed. Histopathologically, the lesion consisted of islands of mature hyaline cartilage with intervening strands of fibrous stroma. Mammary lobules and ducts were lacking within the mass. Fat and muscular components were not present. Therefore chondromatous tumor of the breast was diagnosed.