Ultrasonic Appearance Research Articles

Chorioangioma

Chorioangiomas are common, benign placental tumors that rarely result in perinatal compli- cations unless large or strategically located. A characteristic ultrasonic appearance usually permits easy diagnosis. In the current case, an atypical chorioangioma was observed in close proximity to the cord insertion, leading to diagnostic difficulties. The clinical implications of chorioangiomas and their differen- tial ultrasonic diagnosis are discussed.

Granulosa Cell Tumors in two cycling mares

The granulosa-theca cell tumor (GTCT) is the most common ovarian tumor of the horse. 4,7 Mares with a GTCT may exhibit continuous or intermittent estrus, stallion-like behavior or may remain anestrus. 4 The hormone secretory profile of the tumor dictates the behavior expressed, with mares having elevated plasma testosterone concentrations (>100 pg/ml) exhibiting stallion-like behavior. 7 The ultrasonic appearance of the affected ovary ranges from a homogenous echogenic mass to a multicystic or 'honeycomb' pattern. 1 The contralateral ovary is usually small and inactive, 4,7 although one mare with a functional contralateral ovary was recently described. 2 Mares with an inactive contralateral ovary resume normal cyclic ovarian activity 2-16 months after removal of the affected ovary 4 Clinical diagnosis of a GTCT is based on history, behavior, presence of a unilaterally enlarged ovary with an inactive contralateral ovary, and in some cases, elevated plasma testosterone concentrations. This report documents the presence of a granulosa cell tumor in two mares which exhibited normal follicular development, ovulation and luteal function in the contralateral ovary.

Neonatal renal venous thrombosis: Sequential ultrasonic appearances

The ultrasonic appearances of three cases of renal venous thrombosis are shown. Initially the kidney is enlarged, echogenic and shows echogenic streaking that has a vascular or perivascular distribution. Subsequently thrombosis of renal veins or the inferior vena cava may be demonstrated and ultimately the kidney may recover or atrophy. The ultrasonic appearances will depend on the severity of the thrombosis and the stage at which the examination is performed.

B-mode real time ultrasonographic imaging of the testis and epididymis of sheep and goats

Ten male goats and five rams were examined from 11 and 15 weeks of age, respectively, for six months to study the ultrasonic appearance of normal testes and epididymides before and after puberty. Five adult rams with lesions of these organs were also examined. A portable, B-mode, real time scanner fitted with a 7.5 MHz, linear array transducer was used. The testis appeared as a homogeneous and moderately echogenic structure with a centrally located mediastinum testis represented by an hyperechogenic line in images taken in the longitudinal plane and by an almost circular spot in transverse images. The testicular capsule and skin were evident as a distinct hyperechogenic line encircling the testicular parenchyma. A thin non-echogenic layer of fluid, presumably between two layers of tunica vaginalis, was observed. The tail of the epididymis was more heterogeneous and less echogenic than the testis. The epididymal head was also less echogenic but homogeneous in texture, and the body of the epididymis was difficult to image. The pampiniform plexus was easily identified as numerous convoluted sonolucent tubular structures. The ultrasonic images of possible cases of epididymitis, spermatocele, testicular cyst and abscess and scrotal hernia are described.

Renal sonography in long standing Lesch-Nyhan syndrome

The Lesch-Nyhan syndrome is an x-linked defect of purine metabolism resulting in its classical form in major neurodevelopmental abnormality, hyperuricaemia, and hyperuricosuria. Uric acid calculi and crystalluria are common. Allopurinol is the main method of reducing serum and urinary uric acid levels, but results in xanthinuria and oxypurinoluria, both of which may cause crystal nephropathy and calculi. The variable ultrasonic appearances of multiple calculi and increased medullary echogenicity in four cases of long-standing treated disease and the nature of the renal disorder, which is at least partially iatrogenic, are described.

Primary lymphoma of prostate:Transrectal ultrasonic appearance

In the case presented, primary lymphoma of the prostate was diagnosed by ultrasonically guided transrectal biopsy. Primary lymphoma of the prostate should be included in the differential diagnosis of a hypoechoic lesion found on ultrasonic evaluation of the prostate in a young adult.

Ultrasonic appearances of the early changes in fibrodysplasia ossificans progressiva

Progressive heterotopic ossification and congenital skeletal anomalies characterize the very rare and relentless condition of fibrodysplasia ossificans progressiva (FOP) or myositis ossificans progressiva (MOP)(McKusick, 1972). These patients frequently present with subcutaneous masses which are often painful (Lindhout & Golding, 1985) and therefore ultrasound may be used in the initial investigation. We report a case of FOP presenting with recurrent soft-tissue swellings and demonstrate the ultrasonic appearances not previously documented in this condition. A 5-year-old boy first presented with a history of pain in his right knee following a minor injury. Radiographs showed an apparent simple exostosis arising from the medial side of the proximal tibial metaphysis (Fig. 1); no further investigations were performed at this time. He presented again several months later with a swelling in the subcutaneous tissues of the left anterior thigh and with pain on walking. No soft-tissue abnormality was identified on the radiographs. Ultrasonic examination using a Diasonics 5 MHz rotating transducer demonstrated an increase in the thickness of the soft tissues and a well defined hypoechoic lesion with an echogenic central region in the deep compartment of the anterior thigh (Fig. 2). When radiographs were repeated 3 months later ossification had taken place in this area (Fig. 3.). Further similar swellings developed in the para-vertebral tissues of the lumbar region and around the right scapula. Ultrasound now demonstrated separation of the normal muscular fasicular planes by echogenic material together with increase in the muscle size (Fig. 4).

Duplex Doppler Examination of a Perinephric Abscess in a Renal Transplant

Perinephric abscess has no characteristic ultrasonic appearance or location. Differentiation from urinoma, lymphocele, or hematoma depends on clinical and laboratory findings. Therapy consists of percutaneous catheter drainage, surgical drainage, and antibiotic therapy. Acute rejection is the most common cause of decreased diastolic flow during the immediate postoperative period. Acute tubular necrosis does not usually alter blood flow unless it is severe. Duplex doppler ultrasonic assessment of the renal transplant during the immediate postoperative period may provide a valuable baseline for comparison if complications develop. Baseline and follow-up ultrasonography to evaluate diastolic flow can help determine whether a posttransplant patient should receive emergency or conservative therapy for complications.

Sonographic imaging of the fetal azygous vein. Normal and pathologic appearance.

Sonologists should be familiar with the frequency of resolution and the ultrasonic appearance of the normal fetal azygous vein. In this study, 66 consecutive uncomplicated pregnancies were scanned to determine the frequency of imaging the fetal thoracic azygous vein. Between 21.7 and 30 gestational weeks, the azygous vein could be imaged in 50% of the cases and measured 1-2 mm in caliber. In the last 10 weeks of pregnancy, the azygous vein could be imaged in 98% of the cases and measured 2-4 mm. A case of fetal azygous continuation of the inferior vena cava is shown where the vein was abnormally dilated to a caliber of 8 mm.

Ultrasonic detection of a retroperitoneal haematoma causing duodenal obstruction following ureterolithotomy

Many authors have documented the clinical features and ultrasonic appearances of retroperitoneal haematomas which are usually a result of blunt epigastric trauma, bleeding diatheses or leaking aneurysms (McVerry et al, 1977; Foley & Teele, 1979; Shirkoda et al, 1983; Mittelstaedt, 1987). With adequate perioperative drainage, retroperitoneal haemorrhage is an uncommon complication of ureteric surgery (Straffon, 1986), although there may be an increased risk where the surgery is complicated. We present a case of duodenal obstruction resulting from a retroperitoneal haematoma following ureteric surgery diagnosed by ultrasound. A 51-year-old man, with a history of several previous operations for bilateral recurrent urinary calculi, presented with a 2-month history of intermittent right renal colic and an intravenous urogram confirmed a calculus in the distal right ureter. Following unsuccessful attempted dormia basket removal, an open ureterolithotomy was performed to remove the impacted calculus. Although scarring and adhesions from previous surgery made the operation technically difficult, he made a satisfactory recovery and was discharged after 10 days. Four days later he was re-admitted with a history of bile stained vomiting and upper abdominal distension. Abdominal examination revealed some epigastric swelling and satisfactory healing of his right lower abdominal wound. His serum amylase was normal. A barium meal confirmed an obstruction at the mid-portion of the second part of the duodenum, and appearances suggested an extramural lesion (Fig. 1). Delayed radiographs showed passage of barium distally indicating an incomplete obstruction.

Ultrasound as an aid to diagnosis of granulosa cell tumour in the mare

The ultrasonic appearance of seven cases of granulosa cell tumour is described, and compared with an ovarian haematoma and an ovarian serous cystadenoma. The granulosa cell tumours varied from being uniformly dense to having one or several large fluid filled cysts. Some tumours resembled the haematoma or cystadenoma and also, in some aspects, normal ovarian structures such as corpora haemorrhagica or follicles in early pregnancy. There was no typical ultrasonographic appearance of the granulosa cell tumours which enabled definitive diagnosis. However, ultrasound may be a diagnostic aid when used in conjunction with the history and findings on rectal palpation.

Leiomyoma of bladder report of 2 cases and demonstration of ultrasonic appearance

Two cases of bladder leiomyoma are reported. Both are women who presented witha palpable mass on pelvic examination, one asymptomatic and the second with significant bladder outlet obstruction. Results of ultrasound examinations are presented. Complete local resection: was curative in both patients.

USE OF TRANSRECTAL ULTRASOUND TO EVALUATE DIRECT TUMOUR SPREAD AND LYMPH NODE STATUS IN PATIENTS WITH RECTAL CANCER

The accuracy of ultrasound in predicting the extent of local tumour spread through the rectal wall and in identifying involved perirectal lymph nodes was evaluated prospectively in 25 patients with rectal cancer. For each patient, the ultrasonic appearances recorded on videotape were compared with operative findings and/or the histology of the tumour. The extent of direct spread was classified into four curable and two incurable categories and was correctly predicted in 20 of 25 patients (80% accuracy). Lymph node status was correctly predicted in 16 of 20 patients (80% accuracy). These results suggest that pre-operative assessment of patients with rectal cancer using transrectal ultrasound is a useful technique which may assist the surgeon in his choice of operation and in the selection of those patients who may benefit from pre-operative radiotherapy.

Transabdominal ultrasound screening for early ovarian cancer.

To assess the value of ultrasonography in a screening procedure for early ovarian cancer. Prospective study of at least 5000 self referred women without symptoms of ovarian cancer. Each woman was scheduled to undergo three annual screenings (consisting of one or more scans) to detect grossly abnormal ovaries or non-regressing masses. The ovarian screening clinic at King's College Hospital, London. 5479 Self referred women without symptoms (aged 18-78, mean age 52). Women with a positive result on screening were referred for laparoscopy or laparotomy, or both. Findings at surgery and from histology of abnormal ovaries. A total of 14,594 screenings (15,977 scans) were performed. A positive result was obtained at 338 screens (2.3%) comprising 326 subjects (5.9%). Five patients with primary ovarian cancer (four stage Ia, one stage Ib; two at first screening three at second) were identified (prevalence 0.09%). An additional four patients had metastatic ovarian cancer (three at first screening, one at second). The apparent detection rate was 100%. It was not possible to differentiate between the ultrasonic appearance of early malignant and benign tumours. The rate of false positive results for primary ovarian cancer was 3.5% at the first screening, 1.8% at the second, and 1.2% at the third. Overall the rate of false positive results was 2.3%; the specificity was 97.7% and the predictive value of a positive result on screening was 1.5%. The odds that a positive result on screening indicated the presence of an ovarian tumour, any ovarian cancer, or primary ovarian cancer were about one to two, one to 37, and one to 67 respectively. Ultrasonography can be used to screen women without symptoms for persistent ovarian masses that will include early ovarian cancer.

ULTRASONOGRAPHY OF THE NORMAL CANINE GASTROINTESTINAL TRACT

The normal sonographic appearance of stomach, small bowel, and colon was determined in normal dogs of small, medium, and large breeds. In all dogs studied, the stomach wall ranged from 3 mm to 5 mm in thickness, and the small and large bowel wall ranged from 2 mm to 3 mm in thickness. Peristalsis was routinely observed in the stomach and small bowel, but not in the colon. Ultrasonic identification of five gastrointestinal wall layers corresponding to the mucosal surface, mucosa, submucosa, muscularis propria, and subserosa/serosa was possible. Specific segments of the gastrointestinal (GI) tract were isolated and scanned in a water bath. In one dog, ultrasonic and histologic findings were compared and confirmed the anatomical identification found with ultrasound. Similarities and differences between the ultrasonic appearance of the GI tract of humans and small animals are discussed.

Ultrasonic demonstration of the elbow fat pads

Elevation of the fat pads around the elbow joint is a well recognised radiological sign of a joint effusion which may be due to trauma or other inflammatory process. There are occasions when plain radiographs fail to demonstrate this sign. A case is reported in which elevation of the posterior fat pad and an elbow joint effusion were demonstrated ultrasonically. Comparative ultrasound examination of the normal elbow in this patient and examination of 40 normal elbows, in adults and children, consistently demonstrated the normal anterior and posterior fat pads except in one patient aged 4 days where the fat pads could not be clearly seen. The normal ultrasonic appearances are described. Ultrasound examination may be useful in patients where plain radiographs have failed to demonstrate the position of the fat pads.

Ultrasonic appearance of Asherman's Syndrome in the third trimester of pregnancy

The aim of this case report is to demonstrate a peculiar ultrasonic finding in the third trimester of a pregnancy, which turned out to be a typical image of an intrauterine adhesion during pregnancy

Characterization of plasma progesterone concentrations for two distinct luteal morphologies in mares

Plasma progesterone concentrations in mares were determined in two experiments during the time that the luteal glands were detectable by transrectal ultrasonography. In both experiments, corpora lutea were classified into two tupes of morphologies based on their ultrasonic appearance: centrally nonechogenic luteal glands (fluid-filled) and uniformly echogenic luteal glands (non-fluid-filled). In Experiment 1, daily blood samples were taken from horse mares during August through October and May through July. There were no significant effects of season or luteal morphology on progesterone concentration. There was a significant main effect of day, but no day-by-season or day-by-morphology interactions. Progesterone increased significantly between Days 1 and 3 (mean progesterone concentration, 2.5 vs 5.2 ng/ml, respectively), between Days 3 and 4 (5.2 vs 7.8 ng/ml), and between Days 4 and 5 (7.8 vs 11.0 ng/ml). Progesterone did not decrease significantly until between Days 11 and 15 (11.6 and 6.1 ng/ml). Subsequent decreases occurred between Days 15 and 16 (6.1 vs 3.9 ng/ml), and Days 16 and 17 (3.9 vs 2.5 ng/ml). In Experiment 2, blood samples were obtained from pony mares at 1 2 - h intervals for 3 h before and 2 h after the defined onset of luteal development (end of evacuation of the ovulatory follicle). Additional blood samples were taken at 5, 8 and 12 h after the onset of luteal development, and thereafter at 12-h intervals for 5d. There were no significant differences between centrally nonechogenic luteal glands (n = 7) and uniformly echogenic luteal glands (n = 5) during the first 5 d of luteal development. There was no time-by-morphology interaction, but there was a significant time effect. The first significant increase in progesterone concentration occurred between Hours 12 and 24 (0.5 vs 1.1 ng/ml). Additional increases were detected between Hours 24 and 36 (1.1 vs 2.6 ng/ml), Hours 36 and 48 (2.6 vs 4.3 ng/ml), Hours 48 and 60 (4.3 vs 6.1 ng/ml), Hours 60 and 72 (6.1 vs 9.4 ng/ml), and Hours 72 and 96 (9.4 vs 13.8 ng/ml). The hypothesis was supported that fluid-filled corpora lutea do not differ from non-fluid-filled corpora lutea with regard to progesterone production.

Sonographic appearance of occipital fetal hair

The sonographic characteristics and the frequency of the presence or absence of fetal hair in the occipital region was determined from 16 weeks to 42 weeks of menstrual age. Our results suggest that the ultrasonic appearance of occipital hair is first noted at approximately 24 weeks of menstrual age and there is a progressive increase in frequency of hair presence as pregnancy approaches term. The normal ultrasonic characteristics of occipital fetal hair are described, and the differential diagnoses between normal fetal hair and malformations such as meningocele, encephaloceles, or cystic hygromas is discussed.

Early ultrasonic appearance of fetal bladder outlet obstruction

A case in which fetal ultrasonography detected increased fetal bladder size at 11 weeks' gestation is reported. A subsequent scan at 13 weeks' gestation showed increased fetal bladder size along with bilateral hydronephrosis, which confirmed the diagnosis of fetal bladder outlet obstruction.