Low-level Internal Echoes Research Articles

Radio-Histopathological Spectrum of Ovarian Specimens Following Cystectomy

Ovarian cysts can be benign or malignant and requires accurate diagnosis for efficient treatment. Objective: To characterize the radiological and histopathological spectrum of ovarian specimens following cystectomy. Methods: This retrospective study was conducted at Pakistan Atomic Energy Commission General Hospital, Islamabad from 1st April 2022 to 31st December 2022.Eighty patient’s samples from cystectomy patients who were suffering from ovarian cysts were included. Each patient underwent radiological examination before ovarian cystectomy through laparoscopic surgery except two cases of urgent laparotomy. Gross histopathological specimen examination was conducted. The data were analysed using SPSS version 26.0, wherein p value <. 0.05 was considered as significant. Results: The mean age of the patients enrolled in this study was 35.5±5.9 years. Hemorrhagic cysts were having a reticular pattern of internal echoes with soli appearing area with concave margins and no internal flow, while endometrioma cysts were having homogenous low level internal echoes with non-solid component and tiny echogenic foci in the walls. While within the neoplastic cysts 4/8 werehaving cystic external surface and 1/8 presented with ovarian mass.The surface epithelial tumor presented of 2 cases with carcinoma detection on histopathology slides while in the germ cell tumor 1 cases each of strumaovarii, dysgerminoma and mixed germ cell tumor was observed. Conclusions: Surface epithelial tumors were the most common category of ovarian tumors and majority of the cysts were benign cystadenomas. Radiological imaging provides a precise non-invasive tool for categorizing various ovarian cysts and histopathological findings further confirms the exact category of tumors.

Ultrasonography in the Differentiation of Endometriomas from Hemorrhagic Ovarian Cysts: The Role of Texture Analysis.

The ultrasonographic (US) features of endometriomas and hemorrhagic ovarian cysts (HOCs) are often overlapping. With the emergence of new computer-aided diagnosis techniques, this is the first study to investigate whether texture analysis (TA) could improve the discrimination between the two lesions in comparison with classic US evaluation. Fifty-six ovarian cysts (endometriomas, 30; HOCs, 26) were retrospectively included. Four classic US features of endometriomas (low-level internal echoes, perceptible walls, no solid components, and less than five locules) and 275 texture parameters were assessed for every lesion, and the ability to identify endometriomas was evaluated through univariate, multivariate, and receiver operating characteristics analyses. The sensitivity (Se) and specificity (Sp) were calculated with 95% confidence intervals (CIs). The texture model, consisting of seven independent predictors (five variations of difference of variance, image contrast, and the 10th percentile; 100% Se and 100% Sp), was able to outperform the ultrasound model composed of three independent features (low-level internal echoes, perceptible walls, and less than five locules; 74.19% Se and 84.62% Sp) in the diagnosis of endometriomas. The TA showed statistically significant differences between the groups and high diagnostic value, but it remains unclear if the textures reflect the intrinsic histological characteristics of the two lesions.

A Rare Case Report of Venous Malformation of the Submandibular Gland- Masson’s Haemangioma

Masson’s haemangioma was first described by Masson in 1923 as “haemangioendothelioma vegetant intravasculaire”. It is common in skin and subcutis which appears as red blue nodule. It also occurs in fingers, trunk, head and neck, heart, larynx and hypopharynx. Masson’s haemangioma is a rare venous malformation. Treatment is complete surgical excision. It is rarely known to recur. It is a locally occuring lesion with no reports of metastasis. Venous malformation can be distinguished by their characteristic imaging findings at doppler ultrasound vs Magnetic Resonance Imaging (MRI) and direct phlebography. A 30-year-old male presented with swelling in the left submandibular region for one month. On examination a cystic swelling was present in left submandibular region. Ultrasound Sonography test (USG) neck with doppler revealed multilocular cystic swelling with low level internal echoes in left submandibular region suggestive of low flow venolymphatic malformation. The mass was surgically excised and sent for histopathological examination and reported as masson’s haemangioma. Masson’s haemangioma is a rare venous malformation. Appropriate history, clinical examination and investigation leads to the correct diagnosis and treatment. Incomplete removal of the mass leads to recurrence. The patient was still on follow-up and no recurrence was noted.

Herlyn-Werner-Wunderlich syndrome presented with amenorrhea: A rare urogenital anomaly in females

A 13-year-old prepubertal girl had with primary amenorrhea and severe lower abdominal pain. Pelvic ultrasound showed double uterine cavity and a fluid collection in left uterine cavity with diffuse low level internal echoes, which appeared contiguous with the endocervix. Hymen could not be evaluated because the patient could not be taken to the gynecological table the patient was initially diagnosed as imperforate hymen, gynecologic examination was performed with sedation, and hymen has a normal patency. Magnetic resonance imaging (MRI) revealed two uterus and two cervix, normal right endometrial cavity and 17 mm fluid in the left endometrial cavity and compatible with hematometra. Hematocolpos was observed in the left half of the vagina. There was no left kidney and the right kidney was normal. Based on these findings, the patient was diagnosed as Herlyn-Werner-Wunderlich syndrome and vaginal septum resection was performed as treatment. Evaluation of the genital tract by means of MRI scanning or ultrasonography should be recommended in all girls with known renal abnormalities before the onset of menstruation.

Endoscopic diagnosis of primary anorectal melanoma.

ObjectiveThe present study retrospectively analyzed case data from 12 patients diagnosed with anorectal melanoma, with the purpose of identifying key diagnostic features at endoscopy.Materials and MethodsImages from colonoscopy were reviewed for all patients in order to establish the endoscopic features of primary anorectal melanoma. For the patients whose colonoscopic examinations included endoscopic ultrasound, images were examined to characterize lesions and the depth of infiltration, the results of which were compared with pathological findings after operative resection.ResultsAt colonoscopy, superficial melanin pigmentation was identified in 10 patients with anorectal melanoma, with morphology including spots, patches, or sheets of pigmentation. In patients who underwent endoscopic ultrasound, lesions appeared as masses on the mucosal side with inhomogeneous or low-level internal echoes or ulcer-type lesions invading the muscularis propria. Lesions diagnosed as anorectal melanoma also demonstrated irregular margins and varying degrees of submucosal infiltration. Infiltration depth of melanoma via endoscopic ultrasound (EUS) was concordant with surgical pathology results in 100% of patients.ConclusionColonoscopy combined with biopsy and subsequent pathological examination can accurately diagnose primary anorectal melanoma. Moreover, EUS is a reliable tool for assessing the depth of infiltration of this disease.

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.

Tubular Ectasia of Rete Testis with Spermatocele.

A 55-year-old male patient presented with a slowly enlarging, painless, large soft mass lesion in left scrotal sac for 6 month. On clinical examination the mass lesion could not be separated from testis, hence provisional diagnosis of testicular tumour was made. For further evaluation scrotal ultrasound was performed. In the region of the clinically palpable lump, ultrasound revealed a unilocular, well-circumscribed cystic lesion with moderately thick wall and fine internal echoes [Table/Fig-1]. The size of lesion was approximately 4.5 x 5 cm. It was located cranial to testis, partially replacing left epididymis. No internal or peripheral flow was detected on colour Doppler study. Mild fluid was also noted in scrotal sac, which was consistent with hydrocele. Right testis and epididymis were normal. [Table/Fig-1]: Gray scale ultrasound image of left scrotal sac shows a well circumscribed, rounded, unilocular cystic lesion with low level internal echoes located superior to left testis consistent with the diagnosis of spermatocele Ultrasound examination also revealed a cluster of multiple, small, anechoic cysts located in the region of testicular mediastinum [Table/Fig-2]. No solid component or calcification was seen. No evidence of any obvious arterial or venous flow was noted in the cysts on colour Doppler study [Table/Fig-3]. [Table/Fig-2]: Transverse (A), longitudinal (B) gray scale ultrasound images of left testis shows a cluster of multiple small anechoic cystic structures noted in the region of testicular mediastinum with hydrocele [Table/Fig-3]: Transverse colour Doppler ultrasound image of left testis shows numerous small cysts with no colour flow On the basis of characteristic ultrasound and Doppler findings final diagnosis was made of tubular ectasia of rete testis and spermatocele. Because of benign nature of this condition patient was reassured and ask for 6 monthly follow up. Tubular ectasia of the rete testis is a benign clinical entity in which cystic dilation of rete testis results from partial or complete obliteration of the efferent ducts [1]. The obstruction may occur at different levels and may be classified into intra- or extra-testicular. In testicular lesions, the obstruction generally resulting from previous inflammatory episodes like orchitis, while in extra-testicular lesions, traumatic tearing of epididymis, obstruction from epididymitis, spermatoceles and tunica albuginea cyst and post-vasectomy or other scrotal surgeries are the common causes [2]. Typically this condition affects patients older than 50 year of age. Bilateral lesions have been reported in 29 to 69% of cases [3]. Spermatocele and epididymis cysts are commonly associated with this condition. Ultrasonography is usually the first and only modality needed to diagnose this condition. Sonographic findings of tubular ectasia of rete testis consists of a cluster of several anechoic rounded and serpiginous tubular structures located in the mediastinum testis without any solid areas or calcific foci. They do not cause mass effect on the adjacent testicular parenchyma. Colour Doppler shows no arterial or venous flow within cystic lesions [4]. Spermatoceles are common extra-testicular lesions caused by cystic dilation of efferent ductules in the region of head of epididymis. On ultrasonography, it appears as a unilocular or multilocular hypoechoic cystic lesion located superior to and separate from testis. It is usually small in size ranging from 1-2cm in size. However large lesions upto 8 cm in size have been reported in the literature [5]. Spermatocele may show low-level echogenic internal echoes due to proteinaceous fluid containing dead sperms. MRI is usually not indicated because of typical appearance on ultrasound. However, if done in doubtful cases, reveals a cluster of round or serpiginous lesions in the hilum of testis, which appear hypointense TI-weighted and hyperintense on T2- weighted images. The main differential diagnosis includes intra-testicular varicocele and cystic dysplasia of testis. Intra-testicular varicocele is a rare entity, which can give similar appearance on B-mode ultrasonography, however colour Doppler and pulsed Doppler evaluation shows colour flow with characteristic venous spectral waveform that augments during Valsalva maneuver [6]. Cystic dysplasia of testis is thought to be a congenital condition unlike tubular ectasia of rete testis which is an acquired condition. It is seen in children and has similar appearance to tubular ectasia of rete testis [7]. Other differential diagnosis includes epididymal cystadenoma, teratoma, non-Hodgkin’s lymphoma and seminiferous tubules dilatation secondary to testicular neoplasms [1]. Tubular ectasia of rete testis and spermatocele are benign entities With characteristics features on gray scale and colour Doppler examination. This condition should be recognized in older individuals and its awareness can prevent unnecessary investigations and surgical intervention.

Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy

Endometriosis is a common multifocal gynecologic disease that manifests during the reproductive years, often causing chronic pelvic pain and infertility. It may occur as invasive peritoneal fibrotic nodules and adhesions or as ovarian cysts with hemorrhagic content. Although findings at physical examination may be suggestive, imaging is necessary for definitive diagnosis, patient counseling, and treatment planning. The imaging techniques that are most useful for preoperative disease mapping are transvaginal ultrasonography (US) after bowel preparation, and magnetic resonance (MR) imaging. Initial transvaginal US is a reliable technique for detecting rectosigmoid endometriotic lesions. MR imaging is indicated as a complementary examination in complex cases of endometriosis with extensive adhesions and ureteral involvement. Peritoneal endometriotic implants are typically hypoechoic on transvaginal US images and demonstrate low signal intensity on T2-weighted MR images. Endometriotic implants most commonly are found in retrocervical and rectosigmoid sites, followed by the vagina, bladder, and ureters. Cysts with low-level internal echoes and echogenic peripheral foci at transvaginal US are suggestive of endometriomas. MR imaging has high specificity for identifying endometriomas, which are characterized by high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Correlation of the radiologic imaging features of endometriotic lesions with their laparoscopic appearances may help improve individual proficiency in the radiologic diagnosis of endometriosis.

Sonographic diagnosis of a large and deep endometrioma of the uterine cervix

We present a rare case of endometriosis of the cervix. Transvaginal sonography showed a 35-mm cyst in the cervix with diffuse, low-level internal echoes. Transvaginal sonography-guided aspiration with a 17-gauge needle was performed, yielding a very thick chocolate-colored fluid. Cytological examination of the fluid revealed the presence of endometrial cells. Symptoms resolved after aspiration and no recurrence has developed.

Prenatal Ultrasonographic Diagnosis of Hydrometrocolpos

Prenatal diagnosis of an imperforate hymen remains a clinical challenge. We present a case of a 28-year-old female who was sent to our hospital for an anomaly scan at 32 weeks of gestation. The lower abdomen of the fetus showed a cystic mass, which was funnelling towards the vulva and measured approximately 5.8 × 3.9 cm. The mass showed low level internal echoes and was initially diagnosed as a distended urinary bladder with fluid debris level. The patient was made to wait for 30 to 45 minutes for emptying of the urinary bladder. After 45 minutes, the patient was rescanned and this time another cystic mass appeared adjacent to the existing mass, which was actually the filling of the urinary bladder. Since the sex of the fetus was female and the mass was separate from the urinary bladder funneling towards the vulva, we diagnosed it as a case of hydrometrocolpos.

Subcutaneous endometrial deposit: an unusual cause of right iliac fossa pain

This case illustrates the use of ultrasound in identifying endometrioma and the capability of ultrasound-guided biopsy in providing definitive histological diagnosis of this rare condition.

Variations in Appearance of Endometriomas

Because of the range of patient ages with endometriosis, the persistence of endometriomas, and the degradation of internal blood products over time, the appearance of endometriomas is variable. The purpose of this study was to identify the prospective diagnoses in cases of surgically proven endometriomas and to illustrate the variety of appearances of endometriomas. Sonographic images from 325 women with histologic confirmation of an adnexal mass during a 16-month period were reviewed. Eighty-seven endometriomas in 71 women were found. Prospective diagnoses were scored as follows: 1, the diagnosis was endometrioma only; 2, the differential diagnosis listed endometrioma first; 3, the differential diagnosis listed endometrioma but not first; 4, the diagnosis did not include endometrioma but included a complex or hemorrhagic cyst; and 5, the diagnosis did not include endometrioma. Lesions with the classic appearance of an endometrioma (hypoechoic mass with diffuse low-level internal echoes) or an atypical appearance were chosen for illustration. Thirty-five (60.3%) of 58 endometriomas measuring at least 2 cm in greatest dimension included endometrioma in the differential diagnosis at sonography. In 6 (10.3%) of 58, the lesions were described as complex or hemorrhagic cysts. Atypical endometriomas included cases with retracted clots that appeared solid but without blood flow, endometriomas in pregnant patients, and endometriomas in postmenopausal women with heterogeneous internal echoes and central calcification. A ruptured endometrioma was interpreted as pelvic inflammatory disease. Five endometriomas were suspected to be malignancies because of a solid appearance, blood flow, surrounding adhesions, and, in 1 pregnant patient, extensive decidualization. Recognition of the varied appearance of endometriomas should aid the interpreting physician in giving an appropriate prospective diagnosis of endometriomas.

Endometrioma With Calcification Simulating a Dermoid on Sonography

Journal of Ultrasound in MedicineVolume 25, Issue 9 p. 1237-1241 Case Report Endometrioma With Calcification Simulating a Dermoid on Sonography Kiran A. Jain MD, Corresponding Author Kiran A. Jain MD [email protected] Department of Radiology, University of California Davis Medical Center, Sacramento, California USA.Address correspondence to Kiran A. Jain, MD, Department of Radiology, University of California Davis Medical Center, 4860 Y St, Suite 3100, Sacramento, CA 95817 USA.Search for more papers by this author Kiran A. Jain MD, Corresponding Author Kiran A. Jain MD [email protected] Department of Radiology, University of California Davis Medical Center, Sacramento, California USA.Address correspondence to Kiran A. Jain, MD, Department of Radiology, University of California Davis Medical Center, 4860 Y St, Suite 3100, Sacramento, CA 95817 USA.Search for more papers by this author First published: 01 September 2006 https://doi.org/10.7863/jum.2006.25.9.1237Citations: 7Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume25, Issue9September 2006Pages 1237-1241 RelatedInformation

1172: Assessment of cystic adnexal masses

The sonographic assessment includes a transabdominal and an endovaginal exam or endorectal in virginal patients. The endocavitary probe allows identification of tender organs and can assess the fallopian tubes, ovaries and sigmoid colon. Simple cysts are the most common ovarian masses. It is anechoic, smoothly marginated, unilocular with posterior enhancement. Usually functional and disappear within two cycles. If it does not resolve after three cycles, it is not functional. Theca lutein cysts are small, bilateral cysts associated with PCOD, mole or ovarian stimulation and resolve after treatment. Para-ovarian and para-tubal cysts are remnants of the Wolffian duct. They are mistaken for ovarian cysts. They are small, thin walled, nontender, unchanging in size and separate from the ovary. Complex ovarian masses can be benign or malignant. The primary criteria for a malignant ovarian mass usually are a diameter >4 cm, thick wall or septum >3 mm, large solid or mostly solid mass or nodularity. Ascites, large nodes or a mass fixed or nonmovable on EV exam, are signs of extension locally from the primary mass. A serous cystadenoma or cystadenocarcinoma is the most common ovarian neoplasm. Masses are thin walled, unilocular and may have thin septa or papilla. The malignant ones are thick walled, multilocular with multiple papilla and ascites. Mucinous cystadenoma or carcinoma comprises 20% of all benign and 10% of malignant ovarian masses. They are usually very large, often exceeding 15 cm. They have multiple septa with low-level internal echoes due to the mucin. Hemorrhagic cyst is echogenic and as clot forms, fibrin bands appear as fine septations giving a fishnet appearance. Retracting clot is triangular. An endometrioma may have a varied appearance on US often with a ground glass appearance and low level echoes. There may be layering of echogenic material and the mass may look solid or cystic. The mass is usually tender to palpation with the EV probe. Ectopic pregnancy may have a wide variety of presentations. Echogenic free fluid does not always mean a ruptured ectopic. Dermoid cyst is the most common germ cell tumor. About 30% are malignant if present is a preadolescent. There may be fat-fluid levels, calcification, and an echogenic mass with shadowing and/or bright linear bands that may represent hair. Abscess. There is usually fever and increased white count with a multilocular mass with thick walls that is tender to the touch. The mass is nonmobile. Treatment is antibiotics and/or drainage. Hematosalpinx and hydrosalpinx may be called a septated ovarian cyst but in the correct scan plane the tubular nature of the mass is evident. It is separate from, but adjacent to the ovary with layering of echogenic debris, pus or blood. May be previous PID or tubal ligation. Ovarian torsion. The ovary is enlarged with small peripheral cysts. A larger cyst may also be present. No vascularity seen. If a small amount of flow is present then the ovary can be salvaged if it is untwisted. There may be increased flow if there has been inflammation or it has de-torted.

Diagnosis of endometriosis with imaging: a review

Endometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, painful defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed.

Malignant mesothelioma of the tunica vaginalis Testis: Unusual sonographic appearance

Malignant mesothelioma of the tunica vaginalis testis is a rare and aggressive neoplasm. It is similar to malignant mesothelioma of the peritoneum, usually associated with asbestos exposure. We present an unusual case in which the tumor was a mix of a hypoechoic solid nodule and a cystic component with low-level internal echoes.

Clinical Significance of Ductal Dilatation on Breast Ultrasonogram

With the advent of high-resolution ultrasound (US), dilatation of the lactiferous ducts can be easily demonstrated at routine breast US examination. The purpose of this study was to prospectively evaluate the clinical significance of ductal dilatation detected on breast US study. During a period of 12 months, we examined 16,336 nonlactating women referred for breast US; about 2.5% of them had a known history of nipple discharge. Routine whole breast US examinations were performed by using high-resolution US scanners. More attention was paid to detect and document the dilated ducts in the breasts. Among the 16,336 nonlactating women, 478 (2.9%) had duct dilatation (defined as duct diameter > 2.0 mm). Patients with dilated ducts were either followed-up for at least 2 years or were aspirated or biopsied according to their US findings. Of the 478 women with duct dilatation, 387 (81.0%) had no significant internal echoes in the dilated ducts, 48 (10.0%) had low-level internal echoes inside the ducts, and 39 (8.2%) had medium-level to relatively high-level internal echoes. Solid nodules in the ducts were demonstrated in 26 (5.4%) women, and calcified material in five (1.0%). For patients with intraductal echoes, US-guided aspiration or biopsy was performed to determine the duct contents; 18 of 26 intraductal nodules were shown to be intraductal papilloma cytologically and/or histopathologically, two were shown to be intraductal carcinoma in situ, and five were epithelial hyperplasia or atypical ductal hyperplasia. The majority of the other 61 women with internal echoes were found to have inspissated secretions (50/61, 82.0%), while the remaining 11 showed no cellular component inside, but the findings were inconclusive. Multiple dilated ducts depicted on US are rarely associated with intraductal tumors (p < 0.001). If US can demonstrate solid nodules in the dilated duct, the possibility of intraductal tumor, especially papilloma, should be considered first. Routine and cautious evaluation of the dilated duct may depict intraductal tumor even in women without nipple discharge, and may facilitate surgical intervention without unnecessary delay.

Successful pregnancy after conservative management of bilateral ovarian abscesses

An ovarian abscess is a rare gynecological finding. It is a primary infection of the ovary without tubal involvement. We report a case of bilateral ovarian abscesses that had developed in long-standing ovarian cysts. Mrs V, a 26-year-old nulliparous woman, presented with a history of continuous pain in the lower abdomen for 1 year and of a fever for 2 months. Her menstrual cycles were regular, with average flow, but associated with dysmenorrhea. At the onset of pain 1 year previously, pelvic ultrasound showed cystic masses of 7=6 cm, with thin septae and low-level internal echoes in both adnexa. A repeat scan 4 months later showed the same findings and the pain had persisted. The patient was empirically given a course of antitubercular drugs based on positive ELISA for Mycobacterium tuberculosis. There was no relief in pain or decrease in cyst size. Soon after stopping the antitubercular drugs she developed a high-grade fever with chills, for which she was admitted to another hospital and received the antibiotics ampi-

Endometriosis: Radiologic-Pathologic Correlation

Endometriosis is an important gynecologic disorder primarily affecting women during their reproductive years. Pathologically, it is the result of functional endometrium located outside the uterus. It may vary from microscopic endometriotic implants to large cysts (endometriomas). The physical manifestations are protean, with some patients being asymptomatic and others having disabling pelvic pain, infertility, or adnexal masses. Symptoms do not necessarily correlate with the severity of the disease. Ultrasonographic (US) features are variable and can mimic those of other benign and malignant ovarian lesions. Low-level internal echoes and echogenic wall foci are more specific US features for endometriomas. Magnetic resonance imaging improves diagnostic accuracy, with endometriotic cysts typically appearing with high signal intensity on T1-weighted images and demonstrating "shading" on T2-weighted images. The ovaries are the most common sites affected, but endometriosis can also involve the gastrointestinal tract, urinary tract, chest, and soft tissues. Small implants and adhesions are not well evaluated radiologically; therefore, laparoscopy remains the standard of reference for diagnosis and staging. Both medical and surgical treatment options are available depending on the patient's specific case.

Unusual breast lesions: radiologic-pathologic correlation.

Unusual lesions of the breast can present a diagnostic challenge. These lesions include systemic diseases, benign tumors, and primary and metastatic malignancies. Lymphadenopathy is the most common mammographic finding associated with collagen vascular disease. Wegener granulomatosis may manifest as an irregular, high-density mass simulating breast cancer. Diabetic fibrous mastopathy manifests at mammography as very dense breast tissue and at ultrasonography (US) as an irregular, hypoechoic mass with striking posterior acoustic shadowing simulating malignancy. Fibromatosis simulates malignancy at mammography as an irregularly shaped, uncalcified, high-density mass and at US as an irregular, hypoechoic mass with posterior acoustic shadowing. At US, granular cell tumor may manifest as a solid, poorly marginated mass with marked posterior acoustic shadowing or may appear more benign. At mammography, hamartomas are typically well-circumscribed, round to oval masses with a thin, radiopaque pseudocapsule; at US, they manifest as a sharply defined, heterogeneous oval mass or as normal glandular tissue. Phyllodes tumor manifests at mammography as a large, well-circumscribed oval or lobulated mass; at US, it usually manifests as an inhomogeneous, solid-appearing mass. At mammography, primary breast lymphoma manifests as a relatively circumscribed mass or a solitary, indistinctly marginated, uncalcified mass. Metastatic lesions may manifest mammographically as single or multiple masses or as diffuse skin thickening; at US, they tend to have circumscribed margins with low-level internal echoes. Radiologists should be familiar with the characteristic mammographic appearances of these lesions and should consider benign and systemic causes in the differential diagnosis when malignant-appearing findings are encountered.