Hypoechoic Areas Research Articles

Atypical Shoulder Pain In A Swimmer/rower

HISTORY: A 16 year-old right hand dominant male who is a competitive rower and swimmer presents with 10 months of left shoulder pain that was first noticed after returning to competitive swimming after a 6-month hiatus. He describes the pain as atraumatic, intermittent, progressively worsening and a 3-9/10 anterior “ache”. His pain is noted in the pull phase in rowing, pushups, and pulling aspect of the freestyle stroke. Pain is associated with weakness and crepitus but no paresthesias. He has not been able to continue competitive rowing. Prior workup includes an unremarkable MRI. Previous treatments have included ice, heat, acupuncture, oral and topical NSAIDs, one month of rest and PT without resolution. PHYSICAL EXAMINATION: Muscular build with protracted shoulder position. Full AROM with pain at end range abduction and flexion. Tenderness to palpation over AC joint, subacromial space and bicep tendon area. Strength is 5/ 5 throughout, except trace weakness secondary to pain with external rotation. Positive Speeds, Hawkins, Obriens and Neers tests with palpable popping anteriorly with passive abduction and external rotation. Belly press, lift off and bear hug cause anterior pain. DIFFERENTIAL DIAGNOSIS: Labral pathology AC joint pathology Long head of the bicep tendonopathy RTC tendonopathy Subacromial bursitis/impingement Subcoracoid impingement Bony pathology such as stress fracture or tumor TEST AND RESULTS: MR Arthrogram: normal US: hypoechoic area of distal long head of the bicep tendon and cortical irregularity of the lesser tuberosity with tender sonopalpation. US guided biceps tendon sheath corticosteroid injection for diagnostic and therapeutic purposes resulted in temporary improvement. High resolution CT: 1.1 cm osteochondroma abutting the biceps tendon. TREATMENT AND OUTCOMES: Diagnostic arthroscopy and arthoscopic middle glenohumeral ligament repair with initial improvement. At 6 weeks he returned to completing 75% of his swim workouts and competed in a district rowing championship. However at the 9-month mark, his pain gradually returned to pre-surgical character, quality and intensity level. Orthopedic referral for tumor excision is pending. WORKING DIAGNOSIS: Symptomatic osteochondroma causing mechanical irritation of the bicep tendon and surrounding tissues.

Prevalence of ectopic intrathyroidal thymus in Japan: the Fukushima health management survey.

Ectopic intrathyroidal thymus is thought to be a rare entity, often discovered incidentally, and is due to aberrant thymic migration during embryogenesis. The aim of this study was to determine the prevalence of ectopic intrathyroidal thymus in children using ultrasound screening. This study was cross-sectional and was conducted with the initial preliminary survey of the Fukushima Health Management Survey between October 9, 2011, and March 31, 2012, after the Fukushima Daiichi Nuclear Power Plant accident. A total of 37,816 children were examined in the survey. Diagnostic criteria are based on the ultrasonographic appearance of ectopic intrathyroidal thymus, which were round, oval, or polygonal hypoechoic or hyperechoic areas, with multiple granular and punctate echogenic foci. A total of 375 (0.99%) cases (164 girls) with ectopic intrathyroidal thymus were observed. The mean age was 7.0 years (range 0-18 years). Ectopic intrathyroidal thymus was located in the right (n=180), left (n=178), or bilateral (n=17) thyroid lobes. The incidence of ectopic intrathyroidal thymus was inversely correlated with age and body mass index. The results reflect the prevalence of ectopic intrathyroidal thymus using ultrasonography in the general population. Further examination will be needed by way of longitudinal follow-up.

Fasciolosis.

Fasciolosis is a zoonosis affecting ruminants, caused by the liver flukes Fasciola (F.) hepatica, and F. gigantica, which infect at least 2.4 million people worldwide. This disease may occur in cluster or family infections or after travel in high-risk areas such as the Nile Delta in Egypt, Iran, Turkey, South-East Asia, Mexico, the Caribbean and the Andean Altiplano. In Europe, fasciolosis occurs more frequently in Portugal, Spain and France, although autochthonous infections have also been reported from Ireland and Germany. Infectious metacercariae are ingested with contaminated water or raw or undercooked vegetables. During their larval stage immature flukes migrate through the liver producing an acute febrile syndrome some weeks after infection, followed by a chronic-latent stage which may last for years or decades. Acute fasciolosis is characterized by fever, high eosinophilia and hepatosplenomegaly. At this stage ova are usually not yet produced. Diagnosis relies on the detection of specific antibodies and/or antigens in serum. Typical imaging features include multiple, ill-defined, fleeting hypodense or hypoechoic areas in the liver. Intraabdominal bleeding due to fluke's penetration of the bowel wall or liver capsule, may occur. In chronic latent fasciolosis the diagnosis is achieved by specific serology tests, detection of eggs in bile and parasitological examinations of multiple enriched stools samples. Ultrasonography may sometimes reveal a dilated and thickened common bile duct or crescent-like parasites in the gallbladder or bile ducts. Some patients exhibit sludge which typically does not sediment. Triclabendazole at a single dose of 10 mg/kg body weight is the treatment of choice.

Primary Sjogrens Syndrome in a Child.

Primary Sjogrens Syndrome in a Child.

Sonography of cat scratch disease.

To characterize the sonographic features of cat scratch disease and to identify features that allow differentiation from other causes of medial epitrochlear masses. After Institutional Review Board approval was obtained, patients who underwent sonography for a medial epitrochlear mass or lymph node were identified via the radiology information system. Patients were divided into 2 groups: cat scratch disease and non-cat scratch disease, based on pathologic results and clinical information. Sonograms were retrospectively reviewed and characterized with respect to dimension, shape (round, oval, or lobular), symmetry, location (subcutaneous or intramuscular), multiplicity, echogenicity (anechoic, hypoechoic, isoechoic, hyperechoic, or mixed), hyperechoic hilum (present or absent), adjacent anechoic or hypoechoic area, hyperemia (present or absent), pattern of hyperemia if present (central, peripheral, or mixed), increased posterior through-transmission (present or absent), and shadowing (present or absent). Sonographic findings were compared between the patients with and without cat scratch disease. The final patient group consisted of 5 cases of cat scratch disease and 16 cases of other causes of medial epitrochlear masses. The 2 sonographic findings that were significantly different between the cat scratch disease and non-cat scratch disease cases included mass asymmetry (P = .0062) and the presence of a hyperechoic hilum (P = .0075). The other sonographic findings showed no significant differences between the groups. The sonographic finding of an epitrochlear mass due to cat scratch disease most commonly is that of a hypoechoic lobular or oval mass with central hyperemia and a possible adjacent fluid collection; however, the presence of asymmetry and a hyperechoic hilum differentiate cat scratch disease from other etiologies.

The utility of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation evolution following professional teeth cleaning.

The AIM of this study was to evaluate the usefulness of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation, following professional teeth cleaning. The study was performed on 18 teeth without restorations having subgingival calculus (upper and lower premolars and frontal teeth). After the clinical exam the Gingival Index and the Sulcus Bleeding Index were calculated. Then a 40MHz transducer (ULTRASONIX SonoTouch device) was used to obtain longitudinal sections in the frontal plane. Three measurements were performed: alveolar crest - cementum-enamel junction distance (ACJ), gingival height (GH), and gingival width (GW). Professional cleaning was performed by ultrasound scaling (SatelecP5 booster, France) and airflow (NSK, Japan). Two and seven days after the first evaluation, ultrasonographic and clinical examinations were repeated. Two days after the treatment the median value of the ACJ, was 2.70 (2.38; 2.95) mm, whereas 7 days after treatment it was 2.55 (2.45; 3.01) mm. The intraclass correlation coefficient for ACJ measurement was 98.8 (p<0.001).The values obtained measuring GH [3.84(3.44; 4.27) mm vs. 3.52 (3.00; 3.76) mm] and GW [(1.81 (1.65; 1.95) mm vs.1.62 (1.40; 1.95) mm) had statistically significant differences between the 2nd and 7th day. Periodontal ultrasonography is a highly precise and reproducible imagistic method, with which bone resorption, gingival inflammation as well as the presence or absence of subgingival calculus can be assessed.

Efficacy of transabdominal sonoelastography in the diagnosis of caesarean section scar endometrioma: A pilot study

Transabdominal sonoelastography (TASE) is a new imaging technique that maps the elastic properties of soft tissue. We evaluated 34, consecutive women with suspected scar endometrioma using standard B-mode ultrasound and elastography. Twenty-three women (23/34) underwent surgical excision and had the diagnosis confirmed by histopathology. All endometriomas (23 patients) in B-mode imaging appeared as hypoechoic masses along the line of a previous caesarean section incision and the outer borders were difficult to define precisely. By TASE, the endometrioma presented a typical blue-green-red appearance and the outer borders were clearly defined. (red and green area corresponds with the central hypoechoic soft areas). Strain ratios varied from 0.02 to 0.75. Real-time TASE is a simple, useful technique in confirming a clinical diagnosis of endometrioma in a caesarean section scar. Compared with B-mode ultrasound, it provides additional, preoperative information about the extent of the lesion that may be helpful to the surgeon.

Effect of Cortical Bone Thickness on Detection of Intraosseous Lesions by Ultrasonography.

Background. Usefulness of ultrasound (US) in detection of intrabony lesions has been showed. A cortical bone perforation or a very thin and intact cortical bone is prerequisite for this purpose. Objective. The current in vitro study was aimed at measuring the cut-off thickness of the overlying cortical bone which allows ultrasonic assessment of bony defects. Materials and Methods. 20 bovine scapula blocks were obtained. Samples were numbered from 1 to 20. In each sample, 5 artificial lesions were made. The lesions were made in order to increase the overlying bone thickness, from 0.1 mm in the first sample to 2 mm in the last one (with 0.1 mm interval). After that, the samples underwent ultrasound examinations by two practicing radiologists. Results. All five lesions in samples numbered 1 to 11 were detected as hypoechoic area. Cortical bone thickness more than 1.1 mm resulted in a failure in the detection of central lesions. Conclusion. We can conclude that neither bony perforation nor very thin cortical bones are needed to consider US to be an effective imaging technique in the evaluation of bony lesion.

Tears of the fascia cruris demonstrate characteristic sonographic features: a case series analysis.

fascia cruris (FC) tears have recently been recognised in the literature, although little is known about their characteristic ultrasound findings. The aim was to describe the echo-graphic features of FC tears in order to improve recognition and diagnosis. the ultrasound reports and images of >600 patients attending a specialist musculoskeletal clinic for Achilles tendon ultrasound scans between October 2010-May 2014 were reviewed. Any patient diagnosed with a FC tear had a structured data set extracted. All ultrasound images were performed by one consultant radiologist. Bilateral Achilles images were available for analysis. sixteen patients from >600 subjects were diagnosed with a FC tear. Fourteen subjects were male and two female (mean age 37.8; range 23-61), with seven elite level sports men. Nine tears were right sided and seven left, with eight situated laterally and seven medially. Seven of the tears were situated in the musculotendinous junction. Symptomatic Achilles tendinopathy co-existed in ten of sixteen subjects (average transverse diameter of Achilles tendon = 7.1±2.0 mm). FC tears should be considered in the differential diagnoses for Achillodynia, diagnosed using their characteristic ultrasound findings, with a hypoechoic area at the medial or lateral attachment to the Achilles tendon in the transverse plane.

Ultrasonographic hyperechoic lesions of the breast: are they always benign?

Most of the breast lesions show hypoechogenicity relative to fat on ultrasonography. The frequency and malignancy rate of hyperechoic lesions are not investigated in a large series. To evaluate the frequency and malignancy rate of hyperechoic lesions on breast sonography and to investigate sonographic characteristics that may predict malignancy in hyperechoic breast lesions. Radiologic reports of 16,416 patients who underwent breast sonography between 2007 and 2008 were searched using "hyperechoic", "echogenic" or "heterogeneous echoic" to describe lesions. Sonographic findings were evaluated according to the Breast Imaging Reporting and Data System lexicon. Clinical records including follow-up and pathologic findings were also reviewed. We calculated the frequency of hyperechoic lesions and their malignancy rate. Differences in sonographic appearances between benign and malignant lesions were also investigated. Among the 16,416 patients, 103 (0.6%) hyperechoic lesions were identified (mean size, 1.79 cm). Of these 103 lesions, 27 (26.2%) were pathologically evaluated and five (4.9%, 4 invasive ductal carcinoma and 1 mucinous carcinoma) were confirmed as malignant. Among the 819 malignant lesions diagnosed using sonography-guided core needle biopsy, five (0.6%) were hyperechoic. In benign lesions, fat necrosis and fibroadenoma were common pathologic diagnoses. Malignant lesions were more likely to have irregular shape (P = 0.003), non-parallel orientation (P = 0.002), non-circumscribed margin (P = 0.007), and a hypoechoic area (P = 0.027) than benign lesions. All hyperechoic carcinomas were seen as suspicious masses on mammograms. Hyperechoic masses are very rare and mostly benign. As an adjunct to mammography, the imaging findings reported here could help to avoid misdiagnosis for malignant hyperechoic lesion.

Distribution of serum immunoglobulin G4 levels in Hashimoto's thyroiditis and clinical features of Hashimoto's thyroiditis with elevated serum immunoglobulin G4 levels.

Immunoglobulin G4-related disease (IgG4-RD) is characterized by elevated serum IgG4 levels, IgG4-positive plasmacytes, and lymphocyte infiltration into multiple organs. IgG4 thyroiditis is a subset of patients with Hashimoto's thyroiditis (HT) who exhibited histopathological features of IgG4-RD; its source of serum IgG4 is suggested to be the thyroid gland. Although a relationship between IgG4-RD and IgG4 thyroiditis has been reported, the meaning of serum IgG4 in HT is uncertain. In this report, we prospectively evaluated serum IgG4 levels and clinical features of patients with HT. A total of 149 patients with HT were prospectively recruited into this study. According to the comprehensive diagnostic criteria of IgG4-RD, patients were divided into two groups: elevated IgG4 (>135 mg/dL) and non-elevated IgG4 (≤135 mg/dL). Median serum IgG4 levels of HT patients were 32.0 mg/dL (interquartile range, 20.0-65.0), with a unimodal non-normal distribution. Six patients (4.0%) had elevated serum IgG4 levels above 135 mg/dL. The elevated IgG4 group was older and exhibited enlarged hypoechoic areas in the thyroid gland, as revealed by ultrasonography, relative to the non-elevated IgG4 group. Levothyroxine (L-T4) replacement doses and titers of anti-thyroid antibodies did not differ significantly between the two groups. Two out of six HT patients with elevated serum IgG4 levels had extra-thyroid organ involvement as seen in IgG4-RD. In conclusion, HT patients with elevated serum IgG4 levels shared clinical features with both IgG4-RD and IgG4 thyroiditis. Longer follow-up periods and histopathological assessments are needed to further understand the meaning of elevated serum IgG4 levels in HT.

In Response to the Article "CT of Hepatic Sarcoidosis: Small Nodular Lesions Simulating Metastatic Disease". Pol J Radiol, 2015; 80: 178-180.

Dear Editor, The article by Ufuk F. et al. [1] on CT features of hepatic sarcoidosis was quite informative and made an interesting reading. Sarcoidosis is a systemic disorder of unknown etiology, characterized by non-caseating epitheloid granulomas. It has been suggested that sarcoidosis results from exposure to antigens like aerosols and infectious agents in genetically predisposed individuals [2]. Virtually any organ system may be involved. Although the involvement of the abdominal viscera is less frequent as compared to pulmonary and mediastinal diseases, when it occurs, it may mimic more common infectious or neoplastic conditions and pose a perplexing diagnostic problem. Hepatic involvement is very common in patients with sarcoidosis; liver granulomas were seen in as many as 70% of cases with sarcoidosis in an autopsy series [3]. Most patients with hepatic sarcoidosis are asymptomatic and have normal liver enzyme tests. Hepatosplenomegaly (15–40%) and abdominal pain (5–15%) are the most common clinical findings [3]. Herein we discuss a case of hepatic sarcoidosis in an asymptomatic female patient in whom routine ultrasound abdomen revealed multiple hypoechoic nodules in the liver. A 42-year-old woman who had been asthmatic was referred to our department for ultrasound of the abdomen. She was a follow-up case of appendecetomy which was carried out six months earlier. The ultrasound revealed multiple hypoechoic areas in both lobes of the liver (Figure 1). Those did not show any vascularity on color Doppler flow imaging and did not exert any mass effect on the surrounding liver parenchyma. Hepatic vessels and portal vein were normal. To better characterise the lesions, three-phase CECT of the abdomen was planned. However, the patient did not give consent for contrast administration (As she had a history of atopy and reaction to exogenous drugs and injections). Plain CT of the abdomen was performed which showed presence of multiple round hypodense areas in both lobes of the liver, the largest one measuring 13×9 mm in the right lobe, with their average CT value ranging from 20 to 35 HU (Figure 2A, 2B). The liver measured 15.5 cm in cranio-caudal span indicating borderline hepatomegaly. Also noted were small lesions of similar density in the spleen which was also mildly enlarged in size (Figure 2C). HRCT of the chest showed that lungs were bilaterally grossly normal (Figure 3). No significant abdominal or mediastinal lymphadenopathy was seen. Based on those sonographic and CT findings a differential diagnosis of sarcoidosis, lymphoma, and tuberculosis was made, with less likely possibility of metastasis (from an unknown primary tumour). Ultrasound-guided biopsy of one of the lesions in the liver revealed non-caseating granulomas. No acid-fast bacilli were seen. Similar histologic appearance was obtained from the lesion in the spleen which was subjected to CT-guided biopsy. Her biochemical and laboratory tests including liver enzymes were normal. She had no history of jaundice, fever or any other complaint except for generalised weakness. Her past history was insignificant except for appendectomy. There was no history of fever, decreased appetite or weight loss. As the patient did not have any clinical or laboratory evidence of liver dysfunction, a final impression of asymptomatic hepato-splenic sarcoidosis was made. No treatment was instituted and the patient was discharged with the advice of follow-up check-ups. Figure 1 Trans-abdominal ultrasound showing multiple hypoechoic areas in the liver. Figure 2 Plain CT of the abdomen showing presence of (A, B): multiple round hypodense areas in both lobes of the liver, the largest one was seen in the right lobe; (C) similar-density small lesions were also seen in the spleen. Figure 3 Coronal view of HRCT of the chest showing grossly normal bilateral lung fields.

Integrative analysis of cutaneous skin tumours using ultrasonogaphic criteria. Preliminary results.

of this study is to identify the US features of skin tumors, especially morphological and vascular, in order to develop an integrative and differentiating imaging model for benign and malignant skin tumors. Twenty three patients with solid skin tumors were included in the study. The diagnostic procedures were clinical examination, dermoscopy, multimodal ultrasonography (US), using high frequency and conventional US, contact elastography, and i.v. contrast enhanced ultrasound (CEUS). The US characteristics of the basal cell carcinomas were: hypoechoic, inhomogeneous masses, with hyperechoic or anechoic areas, depending on the histological differentiation, increased rigidity, uneven vascularization at Doppler examination, central or mixed type circulatory model, with 1-2 supply vessels, velocity >2 cm/s, intensely inhomogeneous load of the contrast agent (CA) and quick wash out time. The benign tumors were hypoechoic or echoic masses, with inhomogeneous structure, Doppler signal present only in dermofibromas, peripheral circulation model, velocities < 2.00 cm/s, a weak and uneven loading of the CA in the vascular bed, and a slow wash out time. Analysis of the CA dynamics evidenced a significantly higher value for the wash out time in the malignant tumors (38.2s+/- 15.15) as compared to the benign ones (54.2s +/- 8.5). Particularly the tumor thickness examination by HFUS evidences an ultrasound index that may be considered as a statistically significant predictive factor (p<0.05), highly sensitive (r =0.97) for the non-invasive assessment of the histological Breslow index. Elastography did not represent a differentiation examination in the cases studied. Ultrasound allows a complex, multimodal approach of skin tumors, which completes clinical and histological examinations, orients the therapeutic management and may assess the therapeutic efficacy and the tumoral prognosis.

Morphological changes of the peripheral nerves evaluated by high-resolution ultrasonography are associated with the severity of diabetic neuropathy, but not corneal nerve fiber pathology in patients with type2 diabetes.

Aims/IntroductionTo evaluate the morphological changes of the median and posterior tibial nerve using high-resolution ultrasonography, and the corneal C fiber pathology by corneal confocal microscopy in type 2 diabetic patients.Materials and MethodsThe cross-sectional area, hypoechoic area and maximum thickness of the nerve fascicle of both nerves were measured by high-resolution ultrasonography in 200 type 2 diabetic patients, stratified by the severity of diabetic neuropathy, and in 40 age- and sex-matched controls. These parameters were associated with corneal C fiber pathology visualized by corneal confocal microscopy, neurophysiological tests and severity of diabetic neuropathy.ResultsThe cross-sectional area, hypoechoic area and maximum thickness of the nerve fascicle of both nerves in patients without diabetic neuropathy were larger than those in control subjects (P < 0.05 to P < 0.001), and further increased relative to the severity of neuropathy (P < 0.0001). All morphological changes of both nerves were negatively associated with motor and sensory nerve conduction velocity (P = 0.01 to P < 0.0001), and directly associated with 2,000-Hz current perception threshold (P = 0.009 to P < 0.001). The significant corneal C fiber pathology occurred before developing the neuropathy, and deteriorated only in patients with the most severe neuropathy. The association between the morphological changes of both nerves and corneal C fiber pathology was poor.ConclusionsThe morphological changes in peripheral nerves of type 2 diabetic patients were found before the onset of neuropathy, and were closely correlated with the severity of diabetic neuropathy, but not with corneal C fiber pathology.

Visceral larva migrans syndrome: analysis of serum cytokine levels in children with hepatic lesions confirmed in radiological findings.

Human toxocariasis is a helminth zoonosis resulting from accidental infection of humans by the roundworms Toxocara canis (T. canis) and cati (T. cati). The infection occurs in five forms: systemic (VLM), ocular, neurological, covert and asymptomatic. The aim of this study was to characterize the radiological and immunological findings in hepatic inflammation during the course of systemic infection by Toxocara sp. in children. Fifteen children, 2 to 17 years of age, with serological diagnosis of T. canis infection underwent abdominal ultrasonography and computer tomography (CT). Eosinophil counts, immunoglobulin E titres, interleukins IL-1α, IL-4, Il-6, IL-10 and interferon gamma were measured for all patients. Abdominal ultrasound revealed multiple hypoechoic areas in the livers of all patients. On the CT images, the hepatic lesions were seen as multiple, ill-defined, oval low-attenuating nodules that measured 6 to 9 millimetres in diameter. The nodules were usually best seen in the portal venous phase and were not seen on arterial-phase images. Significant intergroup differences were observed in the concentrations of IL-1α, IL-4, IL-6 and IL-10. The level of IFN-γ was not significantly elevated in patient sera relative to controls. The analysis shows that the production of anti-inflammatory cytokines is insufficient for granuloma formation in children presenting liver lesions in the course of VLM.

An ultrasound biomicroscopy study after deep sclerectomy with supraciliary implant

ObjectiveTo evaluate patients 24 months after deep sclerectomy (DE) with supraciliary implant, and identify any predictive success factors by examination with ultrasound biomicroscopy (UBM). Materials and methodsThis study included 26 eyes of 23 patients evaluated by UBM 24 months after a deep sclerectomy with a supraciliary hema implant. ResultsThere was a significant reduction in intraocular pressure (IOP), changing from a preoperative mean of 25.6±6.4mmHg to a postoperative mean of 16.2±3.4mmHg (p<0.001). The number of preoperative glaucoma medications also decreased from 2.5±0.6 drugs per patient to 0.5±0.5 (p<0.001). No change was observed in the best-corrected visual acuity. The anatomical characteristics of the surgical area and its relationship with IOP were examined using UBM. There was no correlation between the level of IOP at the time of UBM and the horizontal (r=−0.05: p=0.71) and vertical diameter (r=−0.1; p=0.63), the height (r=0.28; p=0.25) and the volume of intrascleral space (r=−0.08; p=0.79), the thickness (r=−0.07; p=0.73) and the length (r=0.39; p=0.13) of trabeculo-Descemet's membrane (TDM), the presence of filtering bleb (p=0.30) and the hypoechoic area in the supraciliary space (p=0.24). ConclusionsThe insertion of a hema implant in the supraciliary space is an effective and safe surgery for patients with open angle glaucoma (OAG). No predictive success factors for supraciliary implant were found using the UBM study.

TEARS OF THE FASCIA CRURIS AT THE ATTACHMENT TO THE ACHILLES TENDON

AimTo describe the clinical presentation, ultrasound imaging characteristics, and the time to recovery of tears of the fascia cruris. The fascia cruris encloses the posterior structures of the calf and...

Bacillus Calmette-Guérin therapy-associated granulomatous prostatitis mimicking prostate cancer on MRI: A case report and literature review.

Granulomatous prostatitis following bacillus Calmette-Guérin (BCG) immunotherapy is a well-known pathological entity, developing following initiation of BCG therapy as a prophylactic measure against the recurrence of non-muscle invasive bladder cancer. In addition, there are certain imaging similarities between granulomatous prostatitis and prostate cancer, including hypoechoic area on transrectal ultrasonography and low T2 signal intensity in some prostate areas on magnetic resonance imaging (MRI). This is the report of a case exhibiting a perfect imaging cross-match between granulomatous prostatitis and potential prostate cancer on repeated MRI exams, adding two supplementary aspects to the already known similarities, namely progressive restricted diffusion and increased contrast enhancement, which are specific to prostate cancer.

Acute tear of the fascia cruris at the attachment to the Achilles tendon: a new diagnosis

BackgroundThe fascia cruris encloses the posterior structures of the calf and connects to the paratenon and the Achilles tendon. We describe the clinical presentation, ultrasound imaging characteristics and the time...

P25.01: Sonographic evaluation of uterine scar 4 and 12 weeks after Caesarean section

The aim of the study was to evaluate uterine scar 4 and 12 weeks after delivery using transvaginal ultrasound. The study group consisted of 108 women who underwent Caesarean section (CS) from September 2011 until September 2012 and reported for the transvaginal ultrasound examination. There were 108 women evaluated 4 weeks and 58 of them 12 weeks after delivery. The lower uterine segment was assessed and the presence of the Caesarean scar, scar defect and defect's dimensions were noted and analyzed. The scar defect was defined as hypoechoic area within the myometrium at the site of CS. 12 weeks after CS there was also external defect evaluated. External defect was defined as the loss of myometrium in the anterior wall under the bladder. Defect was measured in three dimensions: width and depth (sagital plane), and length (transverse plane). The external defect and residual myometrial thickness (RMT) were measured on sagital plane. The uterine scar was visible in all patients. The uterine scar defect was found in 58(49%) and 15(26%) of women 4 and 12 weeks after delivery respectively. External defect was found in 6(10%) cases. The mean width of the defect 4 weeks after CS was 8,7±3,7 mm; depth 7,6±4,1 mm; length 11,9±5,2 mm. The same measurements 12 weeks after CS were: 4,6±2,3 mm; 4,0±1,9 mm; 5,8±2,3 mm. The external defect width was 3,9±11,3 mm and depth 4,7±1,5 mm. RMT 4 weeks after Caesarean section was 8,1±4,4 mm in the defect group versus 13,1±3,8 mm in non-defect group. 12 weeks after Caesarean section the same values were: 5,3±3,0 mm and 8,1±2,7 mm respectively. The ultrasound's sign of successful recovery of the uterus defined as non-defect visualisation can be observed as early as 4 weeks after CS in half of women. As the postpartum evolution of uterus is ending the prevalence of uterine scar defect decreases 12 weeks after CS. There is significant difference in RMT between women with and without uterine scar defect. In women with uterine scar defect myometrium at the site of Caesarean scar is 35-37% thinner compared to those without defect.