Dermoid cysts of the ovary: their ultrasonographic appearances.

Ultrasonograms of 45 patients with 51 surgically proved benign cystic teratomas (dermoid cysts) of the ovary were reviewed to evaluate the ultrasonographic appearance of this entity. Contrary to several recent reports stressing a "typical" appearance for ovarian dermoid cysts, ie, an echogenic focus with acoustic shadowing situated within a predominantly cystic mass, the authors observed a much broader spectrum of appearances. Thirty-three percent of the cases demonstrated "typical" findings, 23.5% were predominantly solid, 20% were almost entirely cystic, and 23.5% were not visible. Ultrasound and conventional radiography in patients with dermoid cysts were compared: Ultrasonography contributed significantly to the correct diagnosis in the majority of cases. Because ultrasonography lacks ionizing radiation, and its use may reveal unrelated pelvic pathology, it should be the initial diagnostic modality in the examination of patients with suspected dermoid cysts of the ovary.

Vaginitis emphysematosa. Importance of its radiologic recognition.

Vaginitis emphysematosa (VE) is a benign, self-limited condition characterized by a myriad of gas-filled spaces in the subepithelial lining of the vaginal wall, which give it a distinct radiographic appearance. Failure to make the correct diagnosis may lead to an inappropriate course of treatment, including surgery. Although it is considered rare, we have encountered five cases of VE in the course of a year.

Scrotal ultrasonography and the management of testicular trauma.

The early surgical repair of testicular injuries has reduced morbidity and increased testicular salvage. Orchiectomy can be avoided in about 90 per cent of cases. Ultrasound has increased our ability to diagnose parenchymal injury preoperatively and thus to advise the frightened patient more authoritatively and assure ourselves of the necessity of surgical exploration. In most cases, the patient can expect a short convalescence and preservation of his injured gonad.

Sonourethrography in the evaluation of urethral stricture disease.

Ultrasonography of the anterior urethra offers a dynamic three-dimensional study that can easily be repeated. It holds the promise of defining accurately, not only the exact length and severity of the strictured urethral segment, but also the extent of urethral fibrosis and the anatomy of the periurethral structures. A significant reduction in the incidence of recurrent stricture may be obtained by selecting patients for treatment on the basis of the findings of sonourethrography. Moreover, the potential exists for the use of this imaging method during internal urethrotomy to ensure a more accurate and aggressive incision of the stricture.

Ultrasonography of the acute abdomen.

During the past decade, noninvasive imaging has assumed an increasingly prominent role in the evaluation of patients who have acute abdominal conditions. Ultrasonography is often the initial diagnostic imaging modality used to examine patients who are clinically suspected of having acute cholecystitis, choledocholithiasis, and acute appendicitis. This article focuses on the clinical considerations and the ultrasonographic findings that relate to each of these conditions. In addition to describing the ultrasonographic appearances for each of these entities, this article also emphasizes useful scanning techniques that will provide optimal images.

Ultrasound evaluation of ectopic pregnancy.

The combined use of a serum radioimmunoassay pregnancy test and high resolution utrasonography allows a more direct approach to be made in the diagnosis of ectopic pregnancy. It is important for ultrasonographers to understand the limitations of the more readily available immunologic pregnancy tests in order to avoid misinterpreting ultrasonograms in the event that a pregnancy test is either falsely positive or falsely negative. Clinical suspicion is mandatory if the early diagnosis of ectopic pregnancy is to be made. The referring physician should take advantage of the highly accurate information resulting from the combined findings of a positive serum HCG and the ultrasonographic images. If the statistics regarding diagnostic delay and tubal rupture are to be improved, these tests should be obtained when a patient is initially evaluated. It is important to recognize that the ultrasonographic interpretation rests primarily upon the uterine findings. A normal viable intrauterine pregnancy essentially excludes the diagnosis of ectopic pregnancy. Other uterine appearances may result from an early intrauterine pregnancy, an abnormal intrauterine gestational event, or, as in approximately 1 per cent of pregnancies, an ectopic gestation. Subsequent evaluation in suspicious cases may require a variety of tests including serial HCG determinations, repeat ultrasound examination, uterine dilatation and curettage, culdocentesis, or laparoscopy. It is impossible to recommend a specific schematic approach for any given patient. In part, the pattern of management depends upon availability of tests, the presence or absence of adnexal or cul-de-sac findings, and, of course, the clinical status of the patient.U

Gynecologic ultrasound.

For most women, pelvic sonography using a transvaginal probe is the imaging modality of choice for evaluating the uterus and adnexae. It is reliable for detecting ovarian cysts and other adnexal masses, and it can often determine if a lesion can be observed on serial examinations or if it requires more urgent attention. Uterine ultrasound is reliable for evaluating both the normal and abnormal endometrium and myometrium. In cases that are technically limited, or in those that are difficult to interpret, a tailored MR imaging examination often can be helpful.

Diagnostic evaluation of patients with suspected cholecystitis.

In this article, imaging techniques for examining patients with suspected cholecystitis are discussed. In particular, acute cholecystitis and the roles of ultrasonography and radionuclide imaging are stressed, including each of their specific advantages and limitations.

Large calcifications in ovaries otherwise normal on ultrasound.

OBJECTIVE: To evaluate calcifications >or= 5 mm in length in ovaries that are otherwise normal on ultrasound, and to determine whether such large ovarian calcifications are an indicator of ovarian neoplasm. METHODS: This was a retrospective study reviewing pelvic ultrasound results at our unit between October 1994 and April 2002 to identify patients with ovarian calcifications that were >or= 5 mm in maximum length in otherwise normal ovaries, and who also had follow-up imaging studies. Patient medical histories were reviewed, calcification characteristics, including number, size, shape and laterality of calcifications, were recorded and follow-up imaging studies were reviewed to assess change in size of the calcification and to see if a neoplasm had developed. RESULTS: The study group consisted of 28 patients. The mean length of imaging follow-up was 35.2 +/- 30.7 months. The mean size of the calcifications was 7.4 +/- 2.3 (range, 5-13) mm. The calcification remained stable in all 28 patients and no ovarian neoplasms developed in any of the patients. Histological confirmation was available in one patient and this revealed dystrophic calcification in a corpus albicans. CONCLUSION: Calcifications ranging from 5 to 13 mm in length in otherwise normal ovaries remain stable on follow-up imaging and are not an indicator of current or future ovarian neoplasm. Published by John Wiley & Sons, Ltd.

Placenta previa: avoiding false-negative diagnoses.

A retrospective analysis of 102 patients with clinically suspected placenta previa revealed that ten women (10%) were correctly diagnosed as having placenta previa, while two women (2%) had false-positive diagnoses. Three of the ten women who were correctly diagnosed as having placenta previa had scans that could easily have been misinterpreted as normal. Because a false-negative diagnosis of placenta previa is clinically much more serious than a false-positive diagnosis, these cases are elaborated upon. Recognition of a laterally positioned placenta previa and observation of blood in the region of the internal cervical os should minimize false-negative diagnostic errors.

Ultrasonographic evaulation of breast masses.

B-mode ultrasonic contact scanning should be performed in conjunction with mammography in any patient with a palpable breast mass that is 1 cm or larger in diameter. Patients with masses that appear cystic on the sonogram should undergo needle aspiration of their masses. The fluid should then be cytologically examined for confirmation of its benign nature and repeat sonograms obtained to ensure that the mass has completely disappeared. Patients with masses appearing either solid or complex ultrasonographically should undergo surgical biopsy.

Ultrasound of gynecologic pathologies.

Since the introduction of vaginal transducers and color Doppler ultrasound, there has been renewed interest in evaluating the female pelvis. Several recently published manuscripts presented convincing material that suggests benign and malignant ovarian and uterine pathologies can be distinguished from each other on the basis of their vascularity. Duplex Doppler signals obtained from malignant tumors tend to demonstrate a low resistance pattern with continuous blood flow throughout the cardiac cycle. Benign lesions, in contrast, tend to display a more resistive pattern. The role of ultrasound in pediatric gynecologic conditions has also been nicely summarized in several recent papers. These are also discussed.

Sonography of the low-lying placenta: value of Trendelenburg and traction scans.

In later stages of pregnancy, acoustic shadowing from a fetal head may obscure the termination of a low-lying placenta and prevent sonographic imaging of the internal cervical os. The evaluation of a marginal or partial placenta previa in this setting may be difficult. Placing the mother in Trendelenburg position and applying gentle upward traction on the fetal head allows amniotic fluid to cover the lower uterine segments. This provides an acoustic window to visualize the relation of the termination of the placenta to the internal os. This technique was evaluated prospectively in a series of 217 patients and was successful in 49 of 50 patients in whom conventional studies failed to image the termination of the placenta or the region of the internal os.

The importance of ultrasonic side-lobe artifacts.

Transducer side lobes consist of multiple low-intensity sound beams located outside of the main ultrasound beam. Although the echoes generated by side lobes originate outside of the main beam, they appear as specular or diffuse artifactual echoes within the beam. They are visible with both static and real-time equipment. Specular side-lobe artifacts occur near strong, curved, highly reflecting surfaces such as the diaphragm, or near large cystic masses such as the urinary bladder or gallbladder. Diffuse artifacts originate from bowel gas adjacent to cystic structures. These echoes can be confused with particulate material or sludge in organs such as the urinary bladder and gallbladder, or in abnormal cystic masses. We illustrate the genesis of these artifactual echoes and provide clinical examples of commonly visualized side-lobe artifacts.

Sonographic evaluation of ectopic pregnancy: an update.

This review addresses the use of state-of-the-art sonography to evaluate patients with possible ectopic pregnancy (EP). The technical aspects for optimizing the examination are emphasized, and the role of color and pulsed Doppler imaging is discussed. The various sonographic criteria used to diagnose EP are critically analyzed. In addition, imaging findings for some of the more unusual forms of EP are discussed. The role of sonography in the treatment of EP is briefly considered.

The pseudo-dilated common bile duct: ultrasonographic appearance created by the gallbladder neck.

A retrospective analysis of 111 ultrasonograms was performed in order to evaluate the relationship of the gallbladder neck to the common bile duct and portal vein. Of the 100 studies deemed technically adequate, eight contained scans that demonstrated a potentially confusing pattern of a pseudo-dilated common bile duct caused by either a redundant or folded neck of the gallbladder. Recognition of this entity as well as the use of real-time ultrasound equipment should minimize false-positive diagnoses of extrahepatic bile duct dilatation.

Sonography of ovarian fibromas.

Sonographic findings are described in four women with ovarian fibromas. Three of the four women were postmenopausal. Three had only minimal symptoms; the other presented with acute right lower quadrant pain caused by torsion of the tumor. The tumors were large, ranging from 9 to 16 cm in diameter. A distinctive sonographic appearance was found, with a predominantly hypoechoic, solid mass producing striking sound attenuation.