Typical Sonographic Features Research Articles

Ultrasound of palpable lesions: a pictorial review.

Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.

Detection of Pneumothorax in Severe Acute Respiratory Distress Syndrome-Lung Ultrasound Pitfalls.

Lung ultrasound is gaining popularity as a quick, easy, and accurate method for the detection of pneumothorax. The typical sonographic features of pneumothorax are the absence of lung sliding, the presence of a lung point, the absence of a lung pulse, and the absence of B-lines. However, we found that in some cases, each of these elements might be misleading.

Sonographic Features of Atypical and Initially Missed Parathyroid Adenomas: Lessons Learned From a Single-Center Cohort.

Awareness of typical and atypical ultrasonographic (US) features of parathyroid adenomas (PAs) is crucial since US is the most widely used first-line imaging modality. The purpose of this study was to describe the atypical features of PAs on US and other possible factors leading to a false negative examination in a large single-center cohort. The US records of 457 PAs in 445 patients with biochemically proven primary hyperparathyroidism (PHPT) were evaluated in a prospectively maintained database. Atypical size, composition, shape, echogenicity, location, and vascular pattern on US were noted. For patients who previously had at least one negative US examination in referring centers, the main possible reason was defined accordingly. The study group included 359 female and 86 male patients with PHPT. Typical sonographic features were observed in 231 PAs (51%), whereas 226 (49%) had at least one atypical US feature. The most common atypical features were atypical size (29%), followed by atypical echogenicity (19%), shape (8%), location (7%), and composition (7%), respectively. There were 122 initially missed PAs in all groups. The most frequent main atypical US features leading to false negative examinations were atypical size (22.1%) and atypical location (18.8%). Inexperience was third most common reason (16.3%) for false negative US examinations. Almost half of PAs have at least one atypical feature on US. Awareness of the high prevalence of atypical US features could increase the accuracy of US examination and potentially decrease demand for more expensive second-line imaging modalities.

The sonographic features of preoperative ultrasonography of metastatic tumors of thyroid cancer confirmed by surgical pathology

Abstract. This study aimed to analyze the sonographic features of metastatic tumorsin patients with thyroid cancer that underwent preoperative ultrasonogra-phy. One hundred and three thyroid cancer patients whose metastases were con-firmed by surgical pathology in The First People’s Hospital of Wenling from January 2020 toDecember 2021 were enrolled. All patients received preoperative ultra-soundexaminations, and the sonographic features were analyzed. Ultrasound ex-aminationshowed 83.50% of cervical lymph node metastasis (CLNM), 24.27% of soft tissueinvasion (STI), 3.88% of distant organ metastasis (DOM), 8.74% of CLNM + STI, 0.97% of CLNM + DOM, and 0.97% of CLNM + STI+DOM. Unilateral CLNM accounted for 72.09%, while bilateral CLNM accounted for 27.91%. The mean longdiameter of metastatic lymph nodes was (1.83±0.63) cm, and the mean short di-ameterwas (1.03±0.42) cm. Metastases to zone II, III, IV, V, VI, and VII accounted for 8.14%, 48.84%, 23.26%, 4.65%, 11.63%, and 3.49%, respectively. The L/T ratio of lymph nodes in 65 cases was lower than 2; 45 of 70 solid metastases exhibited solidhyperechoic, 15 multifocal hyperechoic, seven unifocal hyperechoic, and three diffusely distributed solid hyperechoic images. There were 25 patients with STI thatexperienced invasion of the thyroid capsule, ten patients experienced the invasion of the cervical fatty muscles, two patients had invasion of the trachea, and one pa-tienthad invasion of the thyroid cartilage. Of the four patients with DOM, one had parotidmetastasis, one had submandibular metastasis, one had axillary metastasis, and onehad uterine metastasis. The most common metastatic sites of thyroid can-cer arecervical lymph nodes. However, there were also metastases in the soft tissues anddistant organs. The ultrasonography exhibited typical sonographic features. An adequate familiarity with these sonographic features can aid in detecting suspiciousmetastases in time, which is crucial to the clinical diagnosis, treatment, and prog-nosticassessment.

A novel tool for predicting the risk of central lymph node metastasis in patients with papillary thyroid microcarcinoma: a retrospective cohort study

IntroductionCentral lymph node status in papillary thyroid microcarcinoma (PTMC) plays an important role in treatment decision-making clinically, however, it is not easy to predict central lymph node metastasis (CLNM). The present work focused on finding the more rational alternative for evaluating central lymph node status while identifying influencing factors to construct a model to predict CLNM incidence.MethodsIn this study, we retrospectively analyzed the typical sonographic and clinicopathologic features of 546 PTMC patients who underwent surgery, among which, the data of 382 patients were recruited in the training cohort and that of 164 patients in the validation cohort. Based on the outcome of the training cohort, significant influencing factors were further identified through univariate analysis and were considered as independent variables in multivariable logistic regression analysis and incorporated in and presented with a nomogram.ResultsIn total, six independent predictors, including the age, sex, tumor size, multifocality, capsular invasion, Hashimotos thyroiditis were entered into the nomogram. Both internal validation and external validation revealed the favorable discrimination of our as-constructed nomogram. Calibration curves exhibited high consistency. As suggested by decision-curve analyses, the as-constructed nomogram might be applied in clinic. Besides, the model also distinguished patients according to risk stratification.ConclusionsThe novel nomogram containing remarkable influencing factors for CLNM cases was established in the present work. The nomogram can assist clinicians in clinical decision-making.

Evaluation of ultrasonography in fetal intestinal malrotation with midgut volvulus.

To investigate the clinical significance of prenatal diagnosis and prognostic evaluation of fetal intestinal malrotation with midgut volvulus via ultrasonography. Ultrasonographic findings and clinical outcomes of fetal intestinal malrotation with midgut volvulus prenatally diagnosed via ultrasound at the Zhangzhou Hospital Affiliated of Fujian Medical University from January 2013 to May 2020 were summarised and analyzed. Eleven cases of fetal intestinal malrotation with midgut volvulus were accurately prenatally diagnosed according to the specific ultrasound signs, such as 'whirlpool sign' and 'twining sign'. Indirect and nonspecific ultrasonographic signs included ascites in four cases and echogenic bowel in nine, all of which were accompanied by intestinal dilatation at various degrees. Among all cases, two were complicated with other system abnormalities, and one had a chromosome abnormality. Three pregnant women chose termination of pregnancy, and eight neonates were transferred to the pediatric department for surgery after obtaining written informed consent. An accurate prenatal diagnosis was confirmed postoperatively, and the fetus recovered well postoperatively. S: : Fetal intestinal malrotation with midgut volvulus has typical sonographic features, and ultrasonography is the method of choice for prenatal diagnosis of this disease. Fetal intestinal malrotation with midgut volvulus is a non-fatal congenital malformation that can be treated. Prenatal diagnosis is essential for early postnatal treatment, and early surgery can often obtain good efficacy and prognosis.

Цефалоспорин-асоційований біліарний псевдолітіаз у дітей

Стаття присвячена біліарному холелітіазу, асоційованому з застосуванням цефалоспоринів, у дітей. В огляді представлений аналіз епідеміологічних даних, розкриті механізми формування біліарного сладжа, систематизовано чинники ризику розвитку, охарактеризовані особливості клініки, діагностики та лікування псевдолітіазу в дітей. Для написання огляду здійснювався пошук інформації з використанням баз даних Scopus, Web of Science, MedLine, PubMed, Google Scholar, CyberLeninka, РІНЦ.

Long-Term Medical Therapy after Laparoscopic Excision of Ovarian Endometriomas: Can We Reduce and Predict the Risk of Recurrence?

Objectives: Up to 32% of women experience anatomic recurrence after conservative surgery for endometriomas, while pain recurs in 10–40% of cases. Long-term postoperative hormonal therapy is recommended to prevent disease recurrence. We evaluated the efficacy of long-term therapy with estroprogestins (EPs) or progestins (Ps) in preventing endometrioma recurrence, as identifiable cysts and subjective symptoms, after laparoscopic excision. Design: This retrospective cohort study included 375 women submitted to laparoscopic endometrioma excision. Women were followed up at 6 and 12 months and then yearly after surgery. Based on postoperative medical therapy, women were divided into 4 groups: nonusers, cyclic EP users, continuous EP users, and progestogen users. Materials, Setting, Methods: Anamnestic and anthropometric characteristics were collected as well as clinical and surgical data. Gynecological examination, and transvaginal and transabdominal ultrasound scans were performed. Pain (numerical rating score >5) and endometrioma recurrence at ultrasound (ovarian cyst with typical sonographic features ≥10 mm in mean diameter) were recorded at each examination. The reoperation rate in women with recurrence was investigated. Results: The median follow-up was 3.7 years with a maximum of 16.7 years. Most patients used EPs (119 cyclic and 61 continuous users), 95 used P, and 100 were nonusers. In 135 women (36%), endometriotic cyst recurrence was diagnosed, with a mean diameter of 18.7 ± 10.8 mm (range 10–55 mm). The median recurrent cyst-free time was 7.9 years (95% CI 5.8–10.8). Dysmenorrhea was the first symptom to reappear, affecting 162 patients (43.2%). Upon multivariable regression analysis, continuous users had a lower risk of relapse (OR 0.56, 95% CI 0.32–0.99), in terms of both cysts and symptom recurrence, than patients who received no medications. The reoperation rate was 16.2%. Limitations: The main limitation of this study is its retrospective design. Also, women switching therapies throughout the follow-up period were sorted into one of the study groups based on the longest treatment taken, without considering the discontinuation rates. Conclusions: Long-term EPs, administered in a continuous regimen and starting immediately after conservative surgery for endometriomas, seem to reduce the disease recurrence risk.

Lipoma Arborescens of the Subdeltoid Bursa Associated With Rotator Cuff Tear: A Case Report

Lipoma arborescens is a rare synovial lesion characterized by villous proliferation of the synovial membrane and replacement of subsynovial tissue with mature fat cells. The knee joint is the most frequently affected site, particularly in the suprapatellar pouch. However, there have been few reports regarding shoulder involvement, including the glenohumeral joint and subacromial subdeltoid bursa, associated with rotator cuff tear. This article reviews the case of a 67-year-old man who presented with lipoma arborescens of the left shoulder, associated with a rotator cuff tear. Sonography revealed a fluid collection with thickening of the synovial membrane with hyperechoic villous proliferation, located in the subdeltoid bursa. An arthroscopic synovectomy and rotator cuff repair were performed. Arthroscopic findings included yellow frond-like synovial proliferation of the synovium. Postoperatively, the patient was asymptomatic, and the lesion did not recur. Although magnetic resonance imaging is the first-line imaging modality for diagnosis of this lesion, sonography may be used initially for evaluation of chronic joint swelling. In addition, it can be useful for detection of recurrence after synovectomy. This case illustrates the typical sonographic features of lipoma arborescens.

Triple-negative invasive breast carcinoma: the association between the sonographic appearances with clinicopathological feature

In this study, we aimed to evaluate the clinical and pathological factors that associated with sonographic appearances of triple-negative (TN) invasive breast carcinoma. With the ethical approval, 560 patients who were pathologically confirmed as invasive breast carcinoma were reviewed for ultrasound, clinical, and pathological data. Logistic regression analysis was used to identify the typical sonographic features for TN invasive breast carcinomas. The effect of clinical and pathological factors on the sonographic features of TN invasive breast carcinoma was studied. There were 104 cases of TN invasive breast carcinoma. The independent sonographic features for the TN subgroup included regular shape (odds ratio, OR = 1.73, p = 0.033), no spiculated/angular margin (OR = 2.09, p = 0.01), posterior acoustic enhancement (OR = 2.09, p = 0.004), and no calcifications (OR = 2.11, p = 0.005). Higher pathological grade was significantly associated with regular tumor shape of TN breast cancer (p = 0.012). Higher Ki67 level was significantly associated with regular tumor shape (p = 0.023) and absence of angular/spiculated margin (p = 0.005). Higher human epidermal growth factor receptor 2 (HER2) score was significantly associated with the presence of calcifications (p = 0.033). We conclude that four sonographic features are associated with TN invasive breast carcinoma. Heterogeneity of sonographic features was associated with the pathological grade, Ki67 proliferation level and HER2 score of TN breast cancers.

The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm.

Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary cervical cystic lesions. There are no established guidelines for the diagnostic evaluation. Retrospective review of the clinical, cytological, radiological, and pathological records of all adult patients (> 18years) operated on for second branchial cleft cysts (BrCC) between 1/2008-2010/2016. Patients with apparent primary H&N malignancy, history of H&N cancer or irradiation, preoperative fine needle aspiration (FNA) of highly suggestive or confirmed malignancy, missing pertinent data, or age less than 18years were excluded from analysis. 28 patients were diagnosed as having BrCC. The diagnosis was based on clinical findings, FNA cytology, and typical sonographic features. The histologic analysis determined an overall rate of malignancy of 10.7% (3/28): two patients had metastatic papillary thyroid carcinoma, and one patient had metastatic tonsillar squamous cell carcinoma. Purely cystic features on pre-operative ultrasound was the only significant predictor for true BrCC on final histology (p = .02). Occult malignancy is not rare among adult patients presenting with a solitary cystic mass of the lateral neck. A diagnostic algorithm is proposed. Further studies are needed to establish the appropriate workup and management of an adult patient presenting with a solitary cystic mass of the lateral neck.

Prenatal Ultrasound Diagnosis of Diastematomyelia at 11–14 Week Scan

AbstractDiastematomyelia is a rare form of congenital spinal anomaly in which the spinal cord is longitudinally split by a rigid or fibrous septum. Prenatal diagnosis of this condition has mainly been reported in the mid trimester. The authors report two cases of diastematomyelia detected at the 11–14 week scan with a brief review of literature. One case detected in the late first trimester was associated with open spina bifida, and the other detected at 12 weeks was a case of isolated diastematomyelia. Though the sonographic features of diastematomyelia are the same in the first and the second trimester, the findings are better appreciated in late first trimester as the ossification in vertebral bodies is minimal before 12 weeks of gestation. Both of the cases presented with typical sonographic features and the ultrasound findings correlated well with postnatal examination. Intracranial signs were pivotal in arriving at the diagnosis of associated open spina bifida in first trimester.

The Sonographic Features of the Thyroid Gland After Treatment with Radioiodine Therapy in Patients with Graves' Disease

The aim of the study was to describe the typical sonographic features of the thyroid gland in patients with Graves' hyperthyroidism after radioiodine therapy (RIT). Thirty patients (21 female and 9 male) with a mean age of 53 y (standard deviation [SD] ± 11.3) and with previous Graves' disease who had been successfully treated with RIT were enrolled in the study. All were hypothyroid or euthyroid after treatment. The thyroid ultrasound was carried out by a single experienced operator with an 8-MHz linear transducer. Volume, vascularity, echogenicity and echotexture of the glands were noted. The presence of nodules and lymph nodes was also documented. The mean volumes of the right lobe were 2.4 mL ± 2.9 SD (0.6–14) and the left lobe were 1.8 mL ± 1.9 SD (0.4–9.1), with a mean total volume of 4.2 mL ± 4.7 SD (1.3–19.1). Of those who had a pre-treatment ultrasound (23%), the percentage reduction in volume was 87% (p < 0.05); 93% of the glands were hypovascular, with the remaining 7% showing normal vascularity. The glands were hyperechoic and of coarse echotexture. Overall, the sonographic features of the post-RIT gland included a significantly reduced mean total volume of 4.2 mL, hypovascularity, coarse echotexture and hyperechogenicity.

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.

Sterno Clavicular Joint Osteoarthritis in a Patient With Rheumatoid Arthritis

Osteoarthritis of the sternoclavicular joint (SCJ) is a common entity. Plain radiographs and computed tomographic scans are the modalities commonly used for diagnosis of SCJ osteoarthritis. Classical imaging findings are joint space narrowing, marginal sclerosis, and osteophyte formation. Widespread application of ultrasonography (US) in the evaluation of multiple musculoskeletal pathologies has been made recently. However, the sonographic features of SCJ osteoarthritis have not been reported. We report a case of unilateral SCJ osteoarthritis in a patient with rheumatoid arthritis (RA) and describe its typical sonographic features.

Diagnostic Breast Imaging: Mammography, Sonography, Magnetic Resonance Imaging, and Interventional Procedures, 3rd edition

I was delighted to be asked to review this book – not least because it means I get to add to my collection the 3rd edition update of a book that has been on my shelf ever since I first started imaging the breast. If I could only have one breast imaging book – this would be it. The authors write in an eloquent and accessible manner, and the quality of their supporting diagrams and clinical images is high. I have concentrated on reviewing the sonographic content as being of most relevance to the Ultrasound audience – I carefully did not say of most interest as the rest of the book is just as interesting to anyone who undertakes breast sonography. Section 1 of the book ‘Methods’ contains Chapter 4, which is dedicated to sonography. This chapter starts off explaining the main clinical applications of breast ultrasound, noting its importance in the diagnosis of cysts, differentiation of solid masses, assessment of young women and evaluation of the axilla. The interdependent relationship between X-ray mammography and ultrasound imaging in the detection of breast cancer is described. Next, the authors cover ultrasound ‘Equipment Requirements’ and ‘Examination Technique’. This is the ‘science and technology’ bit where the authors have done an excellent job of making the ‘physics’ of breast ultrasound accessible to all. It’s not a detailed scientific text, and there is some repetition, but it does cover basic principles in enough detail to give the novice practitioner an appreciation of what physical parameters and operator-dependent controls and techniques are important for optimising image quality to give good diagnostic performance. Compound and harmonic imaging are covered alongside the (limited) role of Doppler. Elastography is mentioned, but there is more on this in Chapter 6 ‘Emerging technologies in breast imaging’ alongside mention of 3D and automated whole breast ultrasound; one omission is no mention of emergent contrast enhanced ultrasound techniques. The second half of Chapter 4 describes and illustrates the typical sonographic features of the normal breast and axilla and a range of characteristic benign and malignant appearances. The principles of image interpretation and differential diagnosis using sonographic criteria are explained with a useful summary table provided. The authors carefully and critically review published case series and offer cautionary examples of ‘overlapping’ characteristics, advocating a multifactorial approach to patient management, where ultrasound findings are considered alongside other available information, such as patient age and family history and within the context of triple assessment (clinical examination, alternate imaging i.e. mammography, and tissue sampling). Ultrasound-guided interventional techniques are covered in Chapters 7 (biopsy) and 8 (localisation) where the authors critically review alternative procedures and clinical indications, before describing and illustrating how to perform the procedures under image guidance. These descriptions are not extended step-by-step guides and assume a working knowledge of intervention device operation. Sample handling, documentation and interpretation of the histopathological result are included. The sonographic appearances of a wide range of normal, variant, benign and malignant conditions are described and illustrated in Section 2 of the book ‘Appearances’. In Chapters 9–22, the authors have adopted a holistic approach, integrating pathophysiological definitions, aetiology, clinical evidence, imaging and histological indications and findings and significance for patient management. Of particular interest to sonographers, lymph nodes (ultrasound technique and image interpretation) are covered in Chapter 17, implants in Chapter 20 and the male breast in Chapter 22. The final section of the book contains two chapters which cover (the role of ultrasound for) breast screening and assessment of mammography screen-detected abnormalities. The publishers claim this is a systematic and pragmatic guide – I agree. The authors offer a range of personal opinion and insight borne of many years’ practical experience, pointing out the relative merits of their advice from both practitioner and patient perspectives. As I said at the outset, if I could only have one breast imaging book, this would be my first choice.

Early prenatal diagnosis of the OEIS complex with different appearance in early compared with late pregnancy before spontaneous rupture of the cloacal membrane

The OEIS complex is a rare variant of the exstrophy–epispadias complex. It is most often diagnosed in second trimester screening by typical sonographic features of omphalocele together with exstrophy of the fetal bladder, imperforate anus and spinal anomalies that have created its acronym. Firsttrimester sonography is now widely accepted not only as screening for aneuploidies but also for major structural anomalies. The typical feature of each disorder must be kept in mind as several structural defects show different sonographic features in the first compared with the second trimester. For example, whereas spina bifida is indirectly diagnosed by scalloping of the frontal bones (‘lemon sign’) and caudal displacement of the cerebellum (‘banana sign’) in the second trimester, the characteristic indirect feature of spina bifida in first trimester is the absence of the intracranial translucency and the displacement of the brain stem, respectively. Furthermore, direct visualization of the spinal defect in early gestation is difficult, in particular due to the small size of the cele during the first trimester. The same is true for fetal exencephaly–anencephaly: in the first trimester, the cerebral lobes are present and floating in the amniotic fluid, resembling the face of Mickey Mouse in the coronal plane; whereas in the second trimester, lack of any tissue and cranium above the level of the orbits due to perishing of the fetal brain similar a frog head or frog eye appearance by the bulging orbits. Similar, cloacal extrophy and lower urinary tract obstruction (LUTO) show another clinical picture in the first trimester than in the second trimester, as both present as large cystic mass in the abdomen in the first trimester and change appearance upon their rupture. A 35-year-old gravida II/para I was referred for fetal assessment at 14 + 1weeks of gestation due to a large cystic mass initially diagnosed in 12 + 5weeks of gestation in the lower abdomen of the fetus (Figure 1A). Medical history and course of the pregnancy had been uneventful. Detailed ultrasound examination of the fetus revealed inappropriate fetal growth (BPD: 26.1mm; CRL: 69.8mm) and a 41 × 34mm large cystic structure in the lower abdomen with an intact lower abdominal wall. The membrane of the cyst was very thin similar to an amnion membrane and occupied the entire abdomen of the fetus pushing the adjacent organs cranially (Figure 1A). No urinary bladder could be visualized. Amniotic fluid was in normal range. Differential diagnoses included LUTO due to posterior urethral valves, a nonruptured cloacal membrane and an amniotic band syndrome affecting the infraumbilical part of the body. Vesicocentesis is a useful diagnostic procedure for evaluation of the tubular renal function and has been shown to be a sufficient treatment in some case of megacystis. Hence, puncture of the cyst with drainage of 25ml fluid was performed revealing features of fetal urine (sodium level: 118mmol/L; chloride level: 105mmol/L; β2-microglobulin level: 6.40mg/L; cystatin C: 0.96mg/L). After puncture of the cyst, repeated ultrasound examination showed a decompression of the abdominal organs and a thick-walled folded membrane floating within the amniotic fluid in front of the ventral abdominal wall of the fetus (Figure 1B). The fetus showed classical features of the OEIS complex with a large infraumbilical anterior midline defect with a protruding omphalocele, (elephant-trunk appearance), bladder exstrophy below the omphalocele in an area of 3.7mm and sacral spina bifida as well as a singular umbilical artery. Consequently, the diagnosis of an OEIS complex with intact cloacal membrane was made. Two weeks later, a missed abortion was diagnosed and labor was induced. Postnatal visual examination of the fetus was performed and confirmed the diagnosis of OEIS.

Adrenal Cysts: Natural History by Long-Term Imaging Follow-Up

The purpose of this article is to determine the natural history of adrenal cysts on the basis of long-term imaging follow-up. This retrospective study included patients with adrenal cysts who had at least 12 months of imaging follow-up (1993-2010). Medical records were reviewed. Two radiologists reviewed imaging examinations in consensus and recorded wall thickness (thin, ≤ 3 mm; thick, > 3 mm), septations, and calcification. CT attenuation value, MRI signal intensity, the presence or absence of enhancement, and typical sonographic features were used to confirm fluid content of the lesions. Cyst wall enhancement was recorded (thin, ≤ 3 mm and smooth; thick, > 3 mm). Cyst diameter on the initial and most remote follow-up examinations was compared. The Wilcoxon matched-pairs signed rank test was applied to assess statistically significant differences in size and CT attenuation on follow-up examinations. Twenty patients with unilateral adrenal cysts (seven male and 13 female patients; mean age, 44 years; range, 10-75 years) had a mean imaging follow-up period of 64 months (range, 12-198 months). CT, MRI, and ultrasound examinations were obtained in 19, 11, and 13 patients, respectively. Cysts were diagnosed by lack of enhancement on CT or MRI in 12 patients, typical sonographic features in three patients, and combination of CT and sonographic or MRI features in five patients. Signal intensities typical for fluid were found on all MRI examinations, attenuations of less than 20 HU on 17 of 19 (89%) CT examinations, and features of either simple or mildly complicated cysts on all sonograms. Thin walls, wall calcifications, and thin septations were found in 20 (100%), 12 (60%), and four (20%) lesions, respectively. During the follow-up of 20 lesions, the median cyst diameter increased by 26.0% (interquartile range, 6.8-68.4%) in 12 (60%) patients, decreased by 32.9% (interquartile range, 7.1-42.8%) in six (30%) patients, and was unchanged in two (10%) patients. The median baseline CT attenuation values did not significantly change on follow-up CT examinations (p = 0.72). No patient developed a complication of adrenal cyst. Four patients had histologically confirmed benign adrenal cysts. Interval enlargement of an adrenal cyst is frequent and as an isolated finding does not indicate malignancy or presence of a complication. However, some adrenal cysts may decrease or remain stable in size over time.

Use of Laparoscopic Ultrasonography in Surgical Procedures of Hepatobiliary and Pancreatic Diseases

Brief Description of the Purpose of the Report: The aim of our report is to describe the typical ultrasonographic features of gallbladder infestation by Clonorchis sinensis. Medical History: A 34 year-old-man, recently returned from China, was hospitalized for fever, jaundice and epigastralgia. He reported an ingestion of Yusheng, a Chinese raw fish salad. Objectively, he had fever and positive Murphy’s sign. Laboratory workout documented an increase of inflammatory and cholestasis markers. Ultrasound showed a distended gallbladder with thickened walls and lumen occupied by stratified material compatible with biliary sludge. In the dependent portion of the gallbladder, a flocculent, nonshadowing and floating group of echos was appreciated. It changed in position in reaction to a light blow with the transducer. Diagnosis: The sonographic aspects were consistent with previous reports of gallbladder infections by Clonorchis sinensis [1]. The report was confirmed by a stool examination, positive for Clonorchis sinensis. After treatment with mebendazole, the patient became asymptomatic. Discussion and Summary of the Case: The gallbladder involvement by parasites is unusual, but should be considered in the differential diagnosis in the presence of a suggestive history and typical sonographic features. Early medical treatment is associated with a rapid clinical improvement, thus avoiding any surgical approach.

Can excisional biopsy be avoided for papillary breast lesions with typical benign sonographic features and concordant core needle biopsy (CNB)?

26 Background: The role of surgical excision in the management of papillary lesions remains controversial. Some studies have documented upgrade rates to malignancy or atypia as high as 17%. However, due to the inclusion of atypia or malignancy at percutaneous and other differences in methodology, these rates may have been over-estimated. This study was designed to determine sonographic features that can help to decide if a lesion warrants excision or standard follow-up. Methods: With institutional review board approval, we retrospectively reviewed 113 benign papillomas without atypia that were diagnosed at US-guided CNB at Foothills Medical Centre from 2005 to 2010. Surgical pathology for 62 of these lesions were assessed. Two radiologists who were blinded to the diagnosis reviewed the sonographic images to determine the likelihood of benignity. Statistical analysis was performed using chi-square and z-score tests. Results: In our study, 5.3% of benign papillomas were upgraded. The sonographic features associated with a higher likelihood of upgrade were intracystic type [LR+ 5.67, 95% CI (1.47,12)], non-periareolar location [LR+ 2.30, 95% CI (1.04,5.06)], complex echogenic pattern [LR+ 3.10, 95% CI (1.00,9.63)], and radiologist’s impression of unlikely benign (final BiRADS) [LR+ 1.48, 95% CI (1.01,1.90)]. Although no feature was statistically significant for greater likelihood of benignity, the sonographic features that may better predict benign pathology at excision include lesions &lt;1cm in size [LR- 0.52], homogeneously solid [LR- 0.63], smooth margin [LR- 0.69] and periareolar location [LR- 0.47]. Conclusions: The management of benign papillomas diagnosed with CNB remains controversial with a lack of agreement among published articles. Our study identifies characteristic sonographic features that are associated with higher likelihood of malignancy, warranting surgical excision. Conversely, it may not be unreasonable to place patients with lesions that are stratified as low risk into standard radiographic follow-up. As the confidence intervals span 1.00 for latter, further study is necessary to confidently recommend follow-up in place of excision.