Thyroid incidentalomas. Prevalence by palpation and ultrasonography.

BACKGROUND: Thyroid nodules are commonly identified on autopsy examination. There are relatively few descriptions, however, of the frequency with which thyroid nodules are encountered incidentally during the course of other investigations. METHOD: Prospective study to examine the prevalence of thyroid nodules in asymptomatic North American subjects, with palpation findings compared with findings on high-resolution ultrasonography. RESULTS: Palpable nodules were identified in 21 (21%) of 100 subjects, with nine solitary nodules (9%) and 12 multiple nodules (12%). In comparison, only 33 subjects were found to be free of any nodules by ultrasonography. Of the 67 subjects with abnormal ultrasound findings, 22 had solitary nodules (22%) and 45 had multiple nodules (45%). The prevalence of nodules was greater in women (72%) than in men (41%) (P < .02). A concordance rate of 49% was noted between ultrasound and findings by palpation. CONCLUSIONS: The data indicate that thyroid abnormalities are very common incidental findings, emphasizing the need for a conservative approach when such lesions are encountered incidentally.

Rapid development and spontaneous regression of pancreatic pseudocysts documented by ultrasound.

Three cases of pancreatic pseudocyst were followed serially by ultrasound examination. The entity was found to be more dynamic than has been generally thought. The rapid development and spontaneous regression of pancreatic pseudocysts was documented. The timing of surgical intervention in these cases must be reevaluated.

Reexamination of the deleterious effects of gastrointestinal contrast material on abdominal echography.

Diagnostic ultrasound examinations of the abdomen are usually performed prior to barium studies due to deleterious effects of gastrointestinal contrast material on abdominal echography, as demonstrated by Leopold. The authors repeat the classic in vitro study, extending the time of the experiment. As barium settles, ultrasound is able to penetrate barium filled masses. A clinical case of barium filled stomach secondary to gastric outlet obstruction is presented in support of the in vitro findings. Patients with persistent collections of barium of one or two days' duration may undergo abdominal ultrasonic examinations.

Computed body tomography and gray scale ultrasonography: anatomic correlations and pitfalls in the upper abdomen.

From over 1,000 computed body tomographic and 10,000 gray scale ultrasonographic studies of the abdomen, a number of close anatomic relationships leading to the commonest pitfalls in diagnosis are reviewed. Scanning techniques developed to prevent interpretive errors are described.

Computed tomography and gray scale ultrasonography of the adrenal gland: a comparative study.

A prospective analysis of computed tomography and gray scale ultrasonography of the adrenal gland in 34 patients is presented. The diagnostic probabilities were similar for both modalities. Pitfalls common to both procedures and specific to one technique are demonstrated. The relative role of computed tomography and gray scale ultrasonography in evaluation of adrenal abnormalities is discussed in light of specific pathologies and other noninvasive imaging procedures.

Color doppler imaging of the gallbladder wall in acute cholecystitis: sonographic-pathologic correlation.

BACKGROUND: The purpose of this study was to evaluate the usefulness of color Doppler imaging (CDI) in suspected cases of acute cholecystitis. METHODS: Twenty-two patients suspected of having acute cholecystitis were prospectively evaluated over a 12-month period using gray-scale and color Doppler technique. Gallbladder wall thickness was greater than 2 mm in all patients included in the study. Pathologic correlation was obtained in 17 patients, with clinical or sonographic follow-up in five for a period of 6-/011001/months. CDI was considered positive only if the mid to fundal wall demonstrated flow. Sonographic Murphy's sign and laboratory values were recorded. RESULTS: Eight patients had acute cholecystitis. All had positive color Doppler flow. Wall thickness in these patients ranged between 4 and 10 mm. Three patients with necrotizing acute cholecystitis had no flow within 6-8-mm walls. Six patients with pathologically proven chronic cholecystitis had no evidence of increased flow within thickened walls. Five patients with presumed chronic cholecystitis (thickened wall without increased color flow) were treated medically, and their symptoms resolved. CDI was more sensitive in predicting acute cholecystitis than was the sonographic Murphy's sign and/or laboratory values. CONCLUSION: CDI demonstrates hyperemic changes in thickened gallbladder walls and is an important adjunct in the diagnosis of acute cholecystitis.

Antepartum diagnosis by ultrasound of placental implantation on a uterine septum.

A routine ultrasound examination in a 23 year old female at 34 weeks' gestation revealed placental implantation on a uterine septum. The clinical significance and potential complications of this unusual placental location are discussed.

Correlation of the ultrasonic appearance of the portal vein with abdominal arteriography.

The ultrasonic appearance and location of the portal vein is documented by correlation with abdominal arteriography. Five patients were studied by both methods. Various characteristic appearances of the portal vein are presented. The importance of localization of the portal vein during an ultrasonic pancreatic examination is discussed.

Ultrasonographic demonstration of popliteal cysts in rheumatoid arthritis. A noninvasive technique.

Ultrasound scanning techniques detected popliteal cysts in 14 of 24 knees affected with rheumatoid arthritis and associated with an anterior effusion. Serial scans demonstrated the persistence of cysts when effusion was not controlled by intraarticular steroid and lidocaine, and regression of cyst following control of effusion with anterior synovectomy. As the technique is noninvasive, painless, and reproducible, ultrasound scanning should be the technique of choice for the detection and assessment of popliteal cysts.

Cholecystosonography--the junctional fold.

Three cases are presented in which a fold occurred along the posterior wall of the gallbladder at the junction of the body and infundibulum at cholecystosonography. On the initial supine scans, this finding suggested a small polyp in 1 case and a calculus in the other 2. Familiarity with this normal variant as well as adherence to correct scan methodology should help to further reduce erroneous diagnoses.

Ultrasonographic spectrum of choledochal cysts in children.

Four different sonographic patterns which may be encountered in choledochal cyst are described. The most common form is concentric dilatation of the common bile duct (Type I). Rarely eccentric dilatation of the common bile duct, diverticulum, may be seen (Type II). Both forms of the disease may (Types IB and IIB) or may not (Types IA and IIA) be asso"iated with intrahepatic biliary dilatation.

Spontaneous regression of interval benign cysts of the breast.

PURPOSE: To evaluate the natural history of nonpalpable interval breast cysts detected at mammography and diagnosed at sonography in an asymptomatic female population. MATERIALS AND METHODS: The imaging records of 5,000 consecutive patients (aged 35-77 years [mean, 51 years]) seen in one breast center over a 6-month period were reviewed. Serial studies of those patients with documented evidence of interval benign breast cysts were evaluated for the subsequent course of such lesions with regard to regression, stability, or enlargement seen at mammography. RESULTS: Interval cysts were found in 53 patients (68 cysts), approximately 1% of the studied population. More than half of these lesions spontaneously regressed in 1 year, most of them completely. By 2 years, nearly two-thirds had regressed. By 5 years, only 12% of the lesions had not shown regression. CONCLUSION: Interval breast cyst formation is not uncommon, and most of these benign lesions will undergo spontaneous regression or remain stable. Further intervention is not required for interval benign cysts.

Transvaginal sonographic diagnosis of sigmoid diverticulitis.

The development of the transvaginal technique has allowed for high-resolution, detailed evaluation of the female pelvis. Although not previously emphasized, gut pathology can also be recognized with this technique. We report two cases of sigmoid diverticulitis which were prospectively diagnosed using endovaginal sonography. In both patients, pelvic sonogram was the first imaging study performed for evaluation of nonspecific abdominal pain.

Ultrasonic diagnosis of a popliteal artery aneurysm.

Ultrasound techniques are very effective in screening painful masses of the popliteal space. These techniques easily differentiate popliteal cysts from thrombophlebitis, and in addition permit sequential evaluation without patient discomfort or invasion. We report its use in diagnosing a popliteal artery aneurysm, another cause of a painful popliteal mass.

Congenital hydrocephalus in two pregnancies following the birth of a child with a neural tube defect: aetiology and management.

A family is described with congenital hydrocephalus occurring in two pregnancies following the birth of a child with a neural tube defect (NTD). Prenatal diagnosis of hydrocephalus at mid-gestation was achieved by ultrasonography. The increased frequency of hydrocephalus among sibs of probands with a NTD and vice versa suggests that, following the birth of a child with either malformations, subsequent pregnancies should be monitored at mid-gestation by amniotic fluid AFP and serial ultrasound examination.

Ultrasonography of the diaphragmatic crura.

The diaphragmatic crura are being recognized with increasing frequency on routine sonograms. In a study of 100 random patients the right crus was seen in parasagittal scans in 50% of patients and in transverse scans in approximately 90%. The left crus was not specifically identified on parasagittal scans, but was visible in about 50% of patients on transverse scans. Longitudinal coronal approaches can significantly improve visualization of the crura.

The ultrasonic and biochemical diagnosis of pancreatitis in children.

Pancreatic ultrasonography and the determination of serum amylase and amylase creatinine clearance ration were performed on 17 normal children and on 35 children with abdominal pain. In all 17 normal subjects the echodensity of the pancreas was equal to or greater than that of the liver. Nineteen patients with abdominal pain had reduced echodensity of the pancreas when compared to that in normal children, and two of the 19 had pseudocysts. Serum amylase values and/or amylase creatinine clearance ratio correlated poorly with ultrasonic and clinical evidence of pancreatitis.

Correlation of biparietal and fetal body diameters: 12--26 weeks gestation.

One hundred thirty-four obstetrical diagnostic sonographic examinations were performed on patients of 12--26 gestational weeks. The following abdominal diameter measurements were obtained: (1) anteroposterior transverse diameter; (2) right-to-left transverse diameter; (3) average of (1) and (2); and (4) greatest longitudinal diameter. These measurements were plotted against the respective biparietal diameters, and normal statistical distribution curves were developed. These curves have proven helpful in cases with a questionable disproportionate relation between the fetal head and body size in early pregnancy. The data have facilitated identification of fetal abnormalities sufficiently early in the pregnancies to permit advising therapeutic abortion. Five cases outside the normal range are discussed and compared to normal. In several cases, the sonographic results played a major role in the decision-making process of the patient involved.

A multidisciplinary approach to the early detection of ovarian carcinoma: rationale, protocol design, and early results.

OBJECTIVE: This study was undertaken to determine the feasibility of currently available tests to detect ovarian cancer at a curable stage. By studying women at risk for the disease on the basis of their family histories of cancer, we hope to gain insight into the genetics and biologic characteristics of ovarian cancer. STUDY DESIGN: Asymptomatic women with a family history of cancer are interviewed by geneticists to obtain accurate pedigree and epidemiologic data. Screening tests including transvaginal ultrasonography, color Doppler imaging, CA 125 measurement, and other investigative biomarkers are performed between cycle days 3 and 8 and repeated biannually. RESULTS: A total of 597 women without symptoms were screened between July 1991 and June 1992. Cystic or complex adnexal masses were detected in 6.2% of patients. A pulsatile index value < 1.0 was measured in 80% of premenopausal patients and 24% of postmenopausal patients, whereas a resistance index value < 0.4 occurred in 12% of premenopausal and 3% of postmenopausal patients. A CA 125 level > 35 U/ml was found in 11.4% of the study participants. To date, one stage IA borderline ovarian tumor and one endometrial carcinoma have been found. CONCLUSIONS: Ovarian cancer screening needs to be investigated in a controlled fashion to determine means that will ultimately improve the survival from the disease.