Sonographic Patterns Research Articles

Severe postthrombotic syndrome is associated with characteristic sonographic pattern of the residual thrombosis

Postthrombotic syndrome (PTS) may affect 50% of patients with deep venous thrombosis, 5-10% of them may present severe manifestations. The causes for PTS development and severity have not been well established. This study evaluated whether PTS may be associated with the presence, and echogenicity, of the residual vein thrombosis (RVT). We included patients with a history of deep venous thrombosis in the past 58 months. These patients were further evaluated for PTS diagnosis, clinical comorbidities, plasma levels of D-dimer, serum levels of C-reactive protein and for the presence of RVT. Particularly, RVT was detected by ultrasound examination and the residual thrombi echogenicity was determined by grayscale median (GSM). Fifty-six patients were included, of which 41 presented PTS. Mild PTS was detected in 23 patients, moderate PTS in 11 and severe PTS in seven patients. Patients with severe PTS showed higher body mass index, higher abdominal circumference and higher C-reactive protein levels when compared with the other patients (P = 0.007, P = 0.002, P = 0.02, respectively). The ultrasound-generated GSM was significantly lower in patients with severe PTS compared with patients with mild-moderate PTS or no PTS (median = 24, 35 and 41, respectively; P = 0.04). A GSM value less than 25, which was consistent with a hypoechoic RVT, was the best cut-off value to discriminate patients with severe PTS from those with mild or moderate PTS and those without PTS. RVT is a common finding among patients with PTS and the echogenicity of the RVT may impact the severity of PTS.

Easily recognizable sonographic patterns of ductal carcinoma in situ of the breast

BackgroundDuctal carcinoma in situ (DCIS) is a malignant proliferation of ductal epithelium confined by the basement membrane of the involved breast ducts. The aim of this study was to categorize positive findings of DCIS of the breast on sonography. MethodsFrom 2007 to 2011, 100 pathologically proven DCIS lesions were evaluated. Four sonographic patterns used to identify DCIS have been characterized as cumulus-type, coral-type, pipe-type, and miscellaneous lesions. ResultsThe lesion numbers of nonhigh-grade and high-grade DCIS were 44 and 56, respectively. The coral type (42%) was the most commonly found lesion, followed by cumulus-type (38%), pipe-type (17%), and miscellaneous (3%) lesions. There was no significant difference between the sonographic pattern and nuclear grades. However, the coral-type group was composed of significantly more high-grade DCIS cases than the other three types (p < 0.05). ConclusionCoral-, cumulus-, and pipe-type lesions are three easily recognizable sonographic findings of DCIS. Improving the breast ultrasound technique to better demonstrate the sonographic pattern is necessary to facilitate breast lesion interpretation.

New American Thyroid Association Sonographic Patterns for Thyroid Nodules Perform Well in Medullary Thyroid Carcinoma: Institutional Experience, Systematic Review, and Meta-Analysis.

The 2015 American Thyroid Association (ATA) thyroid nodule guidelines recommend selecting nodules for biopsy based on a sonographic pattern classification. These patterns were developed based on features of differentiated thyroid cancer. This study aimed to evaluate the performance and the inter-observer agreement of this classification system in medullary thyroid carcinoma (MTC). The medical records of all patients with MTC evaluated at the authors' institution between 1998 and 2014 were retrospectively reviewed. Only patients with presurgical thyroid ultrasound available for review were included in the study. Five independent reviewers assessed the stored ultrasound images for composition, echogenicity, margins, presence of calcifications, and extrathyroidal extension for each nodule. The presence of suspicious lymph nodes was also evaluated when presurgical lateral neck ultrasound was available for review. Each nodule was classified according to the ATA sonographic patterns. Inter-observer agreement was calculated for each sonographic feature and for the sonographic patterns. To validate the findings, a systematic review of the literature and meta-analysis on the sonographic features of MTC was conducted. In this institutional cohort, the inter-observer agreement for individual sonographic features was moderate to good (κ = 0.45-0.71), and for the ATA classification it was good (κ = 0.72). Ninety-seven percent (29/30) of the MTCs were classified in the intermediate or high suspicion patterns. A total of 249 MTCs were included in the meta-analysis. Based on pooled frequencies for solid composition and hypoechogenicity, >95% of MTCs would be classified at least in the intermediate suspicion pattern, warranting the lowest-size threshold for biopsy (≥1 cm). The sonographic patterns proposed by the ATA perform well in MTC, and inter-observer agreement is good to very good.

Spectrum of sonographic changes in hereditary motor and sensory neuropathy with autosomal dominant and X-linked inheritance

Background . In the recent years interest towards nerve sonography has largely increased, specifically in terms of differentiating types of hereditary motor and sensory neuropathy (HMSN). The diagnostic possibilities of high-resolution ultrasound (HRUS) compared to standard neurophysiological tools in the peripheral nerve disorders is still a matter of debate. Objectives. Analysis of quantitative and qualitative ultrasound changes of limb nerves in patients with HMSN type 1 and its comparison with anthropometric and nerve conduction study data. Materials and methods. 44 HMSN patients were analyzed: 16 men, mean age 35,9 ± 6,8 years; 16 (37 %) with autosomal dominant type 1А, 11 (25 %) – with 1В type and 17 (38 %) with Х-linked inheritance. Control group included 44 subjects, 16 male; mean age 35,9 ± 6,8 years. HRUS parameters were analyzed bilaterally on the selected levels: cross-sectional area (CSA), visual cross sectional and longitudinal patterns of the median and ulnar nerves, C5, C6, C7 spinal nerves, tibial, peroneal and sciatic nerves. HRUS parameters were compared to standard anthropometric data, nerve conduction velocity and CMAP amplitude. Results . In all HMSN cases CSA was enlarged compared to healthy controls. Greater changes were found in patients with autosomal dominant inheritance. CSA enlargement in С5, С6, С7 spinal nerves was found in patients with HMSN 1A, С6, С7 – in HMSN 1В, С6 – in HMSN 1X, confirming the necessity to include those nerves in the sonographic protocol in patients with HMSN. Three qualitative cross sectional and longitudinal patterns of the investigated arm nerves were identified, distinct for each of the HMSN type. Absence of significant differences in CSA of the upper limb nerves among analyzed types of HMSN makes it unreliable as the differential parameter, opposite to the defined sonographic patterns. Methodological issues and absence of significant quantitative and qualitative data from the lower limb nerves makes it possible to exclude those from HRUS protocol in HMSN. Conclusions. Nerve sonography of the upper limbs could be a useful additional tool in the differential diagnosis of HMSN type 1 when applying described qualitative HRUS patterns.

Prenatal sonographic features of triploidy at 12-16 weeks.

The purpose of our study was to describe the sonographic appearance of triploidy in early pregnancy. We report the sonographic characteristics of a cohort of fetal triploid cases detected at targeted ultrasonographic vaginal examinations between 12 and 16 weeks of gestation from 2008 to 2014. Indications for fetal karyotype following ultrasound were maternal request, advanced maternal age, increased nuchal translucency, and/or fetal abnormalities. Triploidy was detected in 25 cases during the 6 years of the study period with an estimated incidence of ~1 in 5000 pregnancies. Four cases had molar changes in the placenta. Among the remaining 21 cases, a consistent sonographic pattern was noted, which included the combination of asymmetric growth restriction with abdominal circumference lagging 2 weeks behind head circumference in 21/21, oligohydramnios in 20/21, abnormal posterior fossa or enlarged fourth ventricle in 20/21, and absent gall bladder in 17/21. Other findings present in more than 50% of cases included cardiac (70%) and renal (55%) abnormalities, clenched hands (55%), and hypoplastic lungs (67%). Fetal triploidy can manifest at 12-16 weeks with molar changes in the placenta or with a cluster of unusual sonographic findings whose presence should prompt appropriate testing for diagnosis in early pregnancy. © 2016 John Wiley & Sons, Ltd.

Bedside Gastric Ultrasonography in Term Pregnant Women Before Elective Cesarean Delivery

(Abstracted from Anesth Analg, 121:752–758, 2015) Gastric content and volume assessment via bedside ultrasonography is a point-of-care treatment that provides real-time findings that may assist in the determination of aspiration risk in pregnant women. In this study, the authors assessed qualitative (empty, fluid, or solid gastric content) and quantitative (cross-section of gastric antrum [CSA]) sonographic patterns of the gastric antrum in 103 pregnant women undergoing elective cesarean delivery with neuraxial anesthesia.

Less is More: Comparing the 2015 and 2009 American Thyroid Association Guidelines for Thyroid Nodules and Cancer.

The American Thyroid Association (ATA) has recently revised its guidance pertaining to thyroid nodules and follicular cell-derived thyroid cancer. The 2015 guidelines are massive in both scope and scale, with changes in the organizational approach to risk stratification of nodules and cancer, as well as multiple sections covering new material. This review highlights the major structural and organizational changes, focusing attention on the most dramatically changed recommendations, that is, those recommendations that clinicians will find striking because they call for significant divergence from prior clinical practice. The revised approach to thyroid nodule risk stratification is based on sonographic pattern, with an emphasis on pattern rather than growth in the long-term surveillance of nodules. Accumulating data have also been incorporated into an updated risk stratification scheme for thyroid cancer that increases the size of the low-risk pool, in part because low-volume lymph nodal metastases are now considered low risk. The most fundamentally altered recommendation is that lobectomy might be considered as the initial surgical approach for follicular cell-derived thyroid cancers from 1 to 4 cm in size. The underlying theme of the 2015 ATA guidelines is that "less is more." As these new recommendations are adopted, fewer fine-needle aspiration biopsies will need to be done, less extensive surgeries will become more common, less radioactive iodine will be used either for treatment or for diagnostics, and less stimulated thyroglobulin testing will be done. Mastery of these guidelines will help clinicians know when it is reasonable to do less, thus providing responsibly individualized therapy for their patients.

Uterine fibroid characteristics and sonographic pattern among Ghanaian females undergoing pelvic ultrasound scan: a study at 3-major centres.

BackgroundUterine fibroids are the most common benign tumours affecting premenopausal women and are often associated with considerable hospitalization and morbidity.The purpose of this study was to identify the uterine fibroid characteristics and sonographic patterns of uterine fibroids among Ghanaian women undergoing abdomino-pelvic or pelvic ultrasound scan at three major diagnostic centres. The outcome is expected to help in appropriate policy formulation in women care in Ghana.MethodA total of two hundred and forty four (244) women were evaluated between November 2011–February 2012, using identical 2–5 MHz curvilinear probe of Philips HD3 ultrasound machines at three major diagnostic centers in Ghana, using a trans-abdominal pelvic approach.ResultsThe range, mean and standard deviation (SD) of the patients’ ages were 14–54 years, 31.89 years and ± 7.92 respectively. The majority, 57.8 % of the fibroids were intramural with only 4.4 % noted as sub-mucosal. Most (55.6 %) of the fibroids were located in more than one part of the uterus. The most popular (55.6 %) echo pattern of the various fibroid nodules was mixed echogenicity.ConclusionThe sonographic patterns of uterine fibroids among Ghanaian women have been assessed at three major diagnostic centres. The study shows that most Ghanaian women who have fibroids have degenerative fibroid nodules as these nodules demonstrate mixed echo patterns on ultrasound. The findings may aid in appropriate diagnosis and interventions in the country.

Abstract P4-03-09: Malignant hyperechoic lesions in breast ultrasound - Frequency and characteristics

Abstract PURPOSE Challenge current axiom regarding hyperechogenic lesions in breast US categorized as mainly benign lesions. 2) Present frequency of malignant hyperechoic lesions, describe their sonographic and histological characteristics. METHOD AND MATERIALS IRB approved retrospective review of 2369 consecutive US-guided Core biopsies between 2006 and 2014. Lesions were considered hyperechogenic when more than 90% of its volume had higher echogenicity than surrounding subcutaneous tissue. Variables assessed were: age, size, histology, mass or non-mass, margins, echogenicity, acoustic effect, orientation, location, presence of a hypoechoic center, vascularization and BI-RADS category. Qualitative variables were described by percentage distribution, mean and SD. RESULTS Thirty one (1,3%) lesions biopsied were hyperechoic: only 17 (54.8%) were benign. We found 14 patients (range, 39-81 years, mean 57,5 years) with hyperechoic cancers, accounting for 1,77% of all cancers. 12 (85,7%) were ductal and 2 (14,3%) lobular histology (mean 17,5 mm range 8-40mm). All of them exhibited a small central hypoechoic area and were partially or completely surrounded by fatty tissue. Shape, margins, orientation and vascular architecture were highly suggestive of malignancy at US, mammography and in MRI (BI-RADS 4B and 5). On histology, all lesions were surrounded by fatty tissue, with a low–cell count collagenous center with a higher peripheral cellularity, mixing and interweaving with adipose tissue. CONCLUSION Hyperechogenic breast cancers are rare (1.77%), and we challenge the current concept of high rate of benignity with a 45,2% of chances for malignancy. We propose that hyperechogenicity is given by interweaving bundles with adipose tissue, which provide higher amount of acoustic reflective surfaces, thus explaining its sonographic pattern. CLINICAL RELEVANCE/APPLICATION Hyperechogenic breast lesions should not be considered as always benign. Malignancy thresholds should not be influenced by this sonographic characteristic. We propose histopathological explanation of this sonographic pattern. Citation Format: Camacho J, Horvath E, Pizzolon MF, Pinochet MA, Gallegos M, Galleguillos C, Uchida M, Cadiz F, Silva C. Malignant hyperechoic lesions in breast ultrasound - Frequency and characteristics. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-09.

Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound.

Extra-testicular lesions are usually benign but present with nonspecific grey-scale sonography findings. This study assesses conventional sonographic characteristics in the differentiation of extra-testicular tumoural from inflammatory lesions and whether contrast-enhanced ultrasound has a role. A retrospective database analysis was performed. All patients were examined by experienced sonographers employing standard techniques combining grey-scale, colour Doppler sonography and contrast-enhanced ultrasound. Features recorded were: clinical symptoms, size, location, echogenicity, colour Doppler sonography and contrast-enhanced ultrasound enhancement. Vascularity on colour Doppler sonography and contrast-enhanced ultrasound was graded and compared. The lesions were classified as tumoural or inflammatory. The Chi-square test was used to analyse the sonographic patterns and kappa coefficient to measure the agreement between colour Doppler sonography and contrast-enhanced ultrasound. A total of 30 lesions were reviewed (median diameter 12 mm, range 5-80 mm, median age 52 years, range 18-86 years), including 13/30 tumoural and 17/30 inflammatory lesions. Lesions were hypoechoic (n = 12), isoechoic (n = 6), hyperechoic (n = 2) or mixed (n = 10). Grey-scale characteristics of tumoural vs. inflammatory lesions differed significantly (P = 0.026). On colour Doppler sonography, lesions had no vessels (n = 16), 2-3 vessels (n = 10) and ≥4 vessels (n = 4). On contrast-enhanced ultrasound, lesions showed no vascularity (n = 17), perfusion similar to testis (n = 7) and higher (n = 6). All abscesses identified (n = 9) showed no vascularity on both colour Doppler sonography and contrast-enhanced ultrasound. There was good agreement between these techniques in evaluating vascularity (κ = 0.719) and no significant difference between colour Doppler sonography and contrast-enhanced ultrasound of tumoural vs. inflammatory lesions (P > 0.05). The grey-scale appearances of extra-testicular lesions are essential for characterisation. Colour Doppler sonography and contrast-enhanced ultrasound findings are not useful in that respect. Contrast-enhanced ultrasound is excellent in establishing absence of vascularity.

Sonographic findings of immunoglobulin G4-related sclerosing sialadenitis.

We evaluated the sonographic findings of immunoglobulin G4-related sclerosing sialadenitis (IgG4-SS). Nineteen patients with IgG4-SS and 12 healthy volunteers (controls) were enrolled. The following sonographic features were evaluated: (1) enlargement of the submandibular gland by measurement of the longitudinal diameter and thickness; (2) the contour texture of the submandibular gland (smooth or rough); (3) the internal echo texture, categorized into three sonographic patterns (homogeneous, multiple hypoechoic nodule, and diffuse hypoechoic); and (4) quantitative color Doppler signaling. The longitudinal diameter and the thickness (mean ± SD) of the submandibular gland were significantly greater in patients than in controls (p = 0.005 and p < 0.001, respectively). Contour roughness was seen in 62.9 and 8.3 % of patients and controls (p < 0.001), respectively. Homogeneous echo textures alone were seen in controls, whereas multiple hypoechoic nodule patterns were seen in 60 % of the patients, and diffuse hypoechoic patterns were seen in 40 %. Color Doppler signaling (mean ± SD) was significantly higher in patients as compared with controls (p < 0.001). Patients could be distinguished from healthy volunteers using four distinctive sonographic findings, suggesting that ultrasonography would be a useful diagnostic tool for IgG4-SS.

Miliary tuberculosis: sonographic pattern in chest ultrasound.

Miliary tuberculosis (TB) is characterized by a multitude of small nodular opacities on chest radiography. Despite ultrasound of the chest gaining wider acceptance as a diagnostic tool of lung infections, sonographic changes of pulmonary miliary TB have not yet been reported. Here, we describe B-lines and comet-tail artifacts disseminated throughout multiple lung areas and a pattern of sub-pleural granularity as consistent changes seen in lung ultrasound of ten patients with pulmonary miliary TB diagnosed by chest radiography.

Ultrasonography of thyroid nodules: a pictorial review.

Thyroid nodules are a common occurrence in the general population, and these incidental thyroid nodules are often referred for ultrasound (US) evaluation. US provides a safe and fast method of examination. It is sensitive for the detection of thyroid nodules, and suspicious features can be used to guide further investigation/management decisions. However, given the financial burden on the health service and unnecessary anxiety for patients, it is unrealistic to biopsy every thyroid nodule to confirm diagnosis. The British Thyroid Association (BTA) has recently produced a US classification (U1–U5) of thyroid nodules to facilitate the decision-making process regarding the need to perform fine-needle aspiration cytology (FNAC) for suspicious cases. In this pictorial review, we provide a complete series of sonographic images to illustrate benign and malignant features of thyroid nodules according to the U1–5 classification. Specifically, we highlight morphologic characteristic of the nodule, including its echo signal in relation to its consistency, nodular size, number and contour. Additional diagnostic features such as halo, colloid, calcification and vascular patterns are also discussed in detail. The aim is to assist radiologists and clinicians in recognising sonographic patterns of benign, suspicious and malignant nodules based on U1–5 criteria, and in planning for further investigations.Main messages• Ultrasound is sensitive in identifying suspicious features, which require aspiration.• Whether nodules require aspiration should be based on sonographic features and clinical findings.• U1–5 classification of sonographic findings can help determine whether aspiration is necessary.

Cerebral Hemodynamics Patterns by Transcranial Doppler in Patients With Acute Liver Failure

IntroductionAbout half of patients with acute liver failure (ALF) show clinical signs of cerebral edema and intracranial hypertension. Neuroimaging diagnostics and electroencephalography have poor correlation with intracranial pressure measurement. ObjectiveThe objective of this study was to characterize the cerebral hemodynamics patterns with transcranial Doppler (TCD) sonography in patients with ALF. MethodWe studied 21 patients diagnosed with ALF, admitted to the intensive care unit (ICU) at the Centro de Investigaciones Médico Quirúrgicas of Cuba. All of these patients had a TCD performed on arrival at ICU, evaluating the following: systolic (SV), diastolic (DV), and medium (MV) flows velocities and pulsatility index (PI) in right middle cerebral artery (RMCA) via temporal windows. ResultsThe sonographic patterns of cerebral hemodynamics were as follows: low-flow, 12 patients (57.1%); high resistance, 5 patients (23.8%); and hyperemic, 4 patients (19%). Patients who died while waiting had lower MV RMCA (56.1 vs 58.1 cm/s) and higher PI (1.71 vs 1.41) than patients who could undergo transplantation (P = .800 and P = .787, respectively). ConclusionsIn patients diagnosed with ALF admitted to the ICU the predominating cerebral hemodynamic pattern was low-flow with resistance increase. The TCD was shown to be a useful tool in the initial evaluation for prognosis and treatment.

Is the Specificity of Benign Cytology Affected by Changing the Nomenclature of Encapsulated Follicular Variant of Papillary Thyroid Carcinoma?

Introduction: It has been recently proposed to rename the “encapsulated follicular variant of papillary thyroid carcinoma” (FVPTC) as “NonInvasive Follicular Thyroid neoplasm with papillary-like nuclear features” (NIFT). This nomenclature addresses the fact that most of these tumors behave in an indolent manner. FVPTC without suspicious sonographic features are at particularly low risk for developing regional or distant metastasis, and recurrences. We evaluated what percentage of our “false negative” (FN) fine needle aspiration biopsy (FNAB) interpretations are due to indolent FVPTC. Because thyroid cancer recurrence can occur years after the original surgery, we used the sonographic pattern as a surrogate indicator of indolent FVPTC. Materials and Methods: We reviewed the records of all thyroid FNABs with subsequent histopathology (HP) between October-2008 and May-2014 at our institution under an IRB protocol. Thyroid FNABs were classified according to the Bethesda System. Only the most recent FNAB result was considered for nodules sampled multiple times. Samples with benign FNAB and malignant HP were considered FN results. The sonographic pattern of FN nodules was assessed following the classification proposed in the provisional revised ATA guidelines for the management of thyroid nodules. Results: HP confirmation was available in 1103 of 2829 nodules biopsied. Out of 239 resected nodules with benign FNAB, 23 were “malignant” (9.6% of FN rate) (Figure 1). FVPTC was diagnosed in 12 (52%) of them. (Figure 2) Low-suspicion sonographic pattern was observed in 9 (82%) of the 11 FVPTC with available US images. (Figure 3) Conclusions: Most FN results in benign thyroid cytopathology are due to FVPTC; most of these lesions show a low-suspicion sonographic pattern, associated with an indolent behavior, for which a NIFT diagnosis would probably be more appropriate. Using the new nomenclature, and treating these nodules as “benign”, would improve our benign FNABs specificity from 90% to at least 94% on resected nodules.

A new ultrasound and clinical classification for management of prostatic abscess.

In literature, most of the published data regarding prostatic abscess (PA) are case reports, whereas there is no standardization of the diagnostic and therapeutic routines. The purpose of this study is a new classification of ultrasound imaging of PA with clinical features correlation. We retrospectively analysed the ultrasound database archives and performed a MEDLINE® research of the peer reviewed literature on diagnosis and case reports of PA using the terms "prostate and abscess". PA can be classified into five Types: Type I - PA is present focally in a prostate lobe (≤ 10 mm). Type II - PA is present in a prostate lobe (&gt; 10 mm) and/or partially overcrosses the border of the midline prostatic glandular. Type III - PA is present in both glandular lobes form of multifocal areas (≤ 10 mm). Type IV - PA is present in both glandular lobes form of multifocal areas (&gt; 10 mm). Type V - PA involving intra or extraprostatic structures (bladder, urethra, seminal vesicles and prostatic capsule). The different ultrasound imaging and diagnostic criteria are listed for each type and subtype. The sonographic pattern of PA is usually characteristic and easily differentiated from other glandular lesions. The purpose of the study was to associate the use of TRUS to a clinical standardized classification in order to facilitate PA diagnosis and localization directing the clinician treatment to the correct management and adequate therapeutic treatment.

Strain-and context-based 50 kHz ultrasonic vocalizations and anxiety behaviour in the Wistar-Kyoto rat.

Rodent ultrasonic vocalizations (USVs) are influenced by immediate, prior contexts and have emerged as important indicators that monitor an individual's 'state'. They also index direct reflections of inherent 'trait' and are suggested to constitute non-invasive read-outs of pathological conditions. Analysis of USVs emitted under particular contexts could help discern strain-specific differences and existence of individual USV profiles. USVs of the Wistar-Kyoto (WKY) strain, a putative model of depression, could indicate social communication deficits. In the cage, USV emission was significantly reduced in WKYs. An elevated plus maze exposure led to no change in USV emission in WKYs, while it significantly reduced USVs in Wistars. Re-exposure induced strain-specific differences in behaviour and total calling time. Sonographic patterns indicated that the predominant USV subtype were flat 50 kHz USVs. EPMexposure induced a reduction in peak amplitude in WKY USVs and in USV length in both strains. USV peak frequency and amplitude, genetically determined spectral features, were strain-specific, while bandwidth and temporal features such as total calling time and USV duration were context-dependent. WKY USVs demonstrated characteristic spectral structures such as increased call length and reduced peak frequency while other parameters were not quantitatively different, reflecting the shared phylogeny between Wistars and WKYs.

The presentation of lymph nodes in Hashimoto's thyroiditis on ultrasound.

Comprehensive neck ultrasound (US) examination has become an essential component of preoperative workup for patients with thyroid cancer. Regional cervical lymph nodes may be involved in cases of Hashimoto's thyroiditis (HT). This study seeks to examine the sonographic pattern of lymph nodes in patients with HT. This is a retrospective study looking at patients with confirmed diagnoses of HT on final surgical pathology who underwent preoperative comprehensive neck US. We compared preoperative ultrasound for patients with HT to euthyroid patients with goiter. Data collected included number, size and ultrasonographic features of cervical lymph nodes. We included a total of 417 patients: 202 patients with HT in the study group, and 215 patients with goiter and euthyroid status in the control group. Patients with HT had a higher number of total cervical lymph nodes than the control group (2.00±2.35 vs. 0.76±1.36 mm; P<0.0001), most notably in cervical levels III and IV (P<0.05 for both). HT seems to be associated with an ultrasonographic pattern of increased number of enlarged cervical lymph nodes, particularly in levels III, and IV.

Can chest ultrasonography differentiate between benign and malignant effusions?

The differential diagnosis of exudative pleural effusion is a major challenge for chest physicians particularly in a country with limited financial resources. The aim of this study was to evaluate the role of the sonographic features in the prediction of exudative malignant pleural effusion. This was a prospective cross-sectional study. This study was carried out between May 2013 and June 2014 in the Chest Department of Assiut University Hospital. The patients enrolled included 25 patients with malignant pleural effusion and 25 patients with other different benign causes. The sonographic appearances of pleural effusions were defined in terms of five patterns: anechoic, complex septated, complex nonseptated, pleural thickening, and pleural nodules. Among the 25 malignant exudative pleural effusions, a complex nonseptated pattern is a useful diagnostic predictor, with sensitivity, specificity, positive predictive value, and negative predictive value of 60, 68, 65, and 63%, respectively. Pleural nodules were only found in malignant effusion (100% specificity). If we define the complex septated sonographic pattern as a predictor for benign effusion, we can achieve sensitivity, specificity, positive predictive value, and negative predictive value of 52, 88, 81, and 65%, respectively. Pleural nodules and a complex nonseptated pattern in the sonographic appearance are useful predictors of malignant pleural effusions, whereas a complex septated pattern is a useful predictor in nonmalignant effusion.

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign.

To review the detailed gray-scale and Doppler ultrasonography features of histologically proven parathyroid adenomas (PAs) evaluated with high-end ultrasonography devices and to present a novel ultrasonography finding called the dual concentric echo sign in PA with histopathologic correlation which was encountered during detailed analysis. Fifty-six PAs with histopathological result were enrolled. The longest dimension, shape, distance to skin surface, internal echo and Doppler US features obtained with high-end US devices were evaluated. PAs had variable range of shape including oval, irregular, fusiform, lobulated, crescent-shaped, and nodular configuration. In nine patients the lesions were shown to have cystic components and calcifications were seen in four cases. Dual concentric echo sign was detected in 18% PAs. Histological reevaluation of this subgroup demonstrated significantly increased edema (p<0.01), and ectatic vessels (p=0.02) in the central part of the lesion compared to the rest of the PAs. The results of the study led to the conclusion that PAs have variable gray-scale and Doppler findings. Typical sonographic features like ovoid shape, homogeneously hypoechoic pattern may not be present in all PAs. Dual concentric echo sign which is a novel sonographic pattern may be suggestive of a PA.