Utility of venous compression in deep venous thrombosis evaluation revisited.

OBJECTIVE: Ultrasound venous compression (UVC) is considered the gold standard for confirmation of deep venous thrombosis (DVT) of the lower extremities. The objective of this study was to assess the contribution and significance of venous compression in comparison to color flow duplex (CFD) ultrasonography alone in the diagnosis of DVT. METHODS: Retrospective analysis was performed of all DVT studies during two years period. DVT examinations were performed with a 5.8-7.6 MHz linear broadband transducer following the American Institute of Ultrasound in Medicine guidelines for the performance of DVT examination. The images were categorized as normal, partial thrombus, or complete thrombus. RESULTS: A total of 428 patients comprised the study group. In total, 467 DVT examinations were performed (39 patients had bilateral examinations). Of the lower extremity examinations, 347/467were normal and 120/467 were abnormal. Complete thrombus was evident in 49/120 patients, while 71/120 patients had partial thrombus. We observed the thrombus on gray scale imaging in all 120 positive patients. No patient had venous compression negative for thrombus and CFD positive for thrombus. There was one patient with visualization of thrombus on gray scale imaging and complete venous compression (negative for thrombus). CFD examination of this patient was also negative for thrombus. CONCLUSION: UVC did not provide any additional information for the diagnosis of DVT. If CFD demonstrates the presence of DVT, venous compression is not necessary, although it can further confirm the presence of DVT. No additional DVTs were diagnosed by using venous compression alone (Tab. 2, Fig. 2, Ref. 27).

Antopol-Goldman lesion of the kidney diagnosed by radiology: a case report of observation.

Antopol-Goldman lesions are extremely rare and are characterized by subepithelial hematoma in the renal pelvis. There have been at least 28 case reports in the literature, with all being diagnosed histologically after partial or total nephrectomy for a presumed malignancy. We report the first case in the literature to be diagnosed by radiological imaging and followed on an observatory basis.

[Benign space-occupying cysts in the testis. An overview]. / Benigne zystische Raumforderungen des Hodens. Eine Ubersicht.

Testicular cysts are increasingly diagnosed in the course of scrotal ultrasound examination. Among other things this is due to the general availability of modern high-resolution ultrasound devices. Benign and malignant diseases with testicular cyst formation need to be differentiated by differential diagnosis and by their aetiology. Benign diseases with cystic space-occupying lesions of the testicle are tubular ectasia of the rete testis, cystic dysplasia, epidermoid cysts, simple intraparenchymatous testicular cysts and cysts of the tunica albuginea. Testicular dermoid cyst was long misleadingly regarded as potentially malignant, but is now classified as benign. On diagnosis of a benign lesion of the testis an organ-conserving surgical therapy or an observational watch-and-wait strategy can be recommended in most cases.

Pararectal paraganglioma.

Paragangliomas are neoplasms that arise from neural crest cells and histologically resemble their adrenal counterpart, the phaeochromocytoma. The majority of extra-adrenal tumours develop within the abdomen and are associated with the coeliac, superior and inferior mesenteric ganglia, which run parallel to the aorta. The organ of Zuckerkandl origin is most common. Pararectal paragangliomas are extremely rare. This case report presents ultrasound, magnetic resonance and histological features of such a case.

Benign intratesticular cystic lesions: US features.

Benign intratesticular lesions are rare, but recognition is important to avoid unnecessary surgical intervention. The ultrasonographic (US) features that help differentiate benign from malignant intratesticular lesions are emphasized by the authors. Benign lesions include intratesticular simple cysts, tubular ectasia, epidermoid cyst, tunica albuginea cyst, intratesticular varicocele, abscess, and hemorrhage (infarction). US features of cystic malignant neoplasms that help in differentiation of them from benign cystic lesions are also presented. The US appearance of epidermoid cysts varies with the maturation, compactness, and quantity of keratin present. Of the cystic malignant testicular tumors, which can occur anywhere in testicular parenchyma, teratomas are the most frequent to manifest as cystic masses. An abnormal rind of parenchyma with increased echogenicity usually surrounds these lesions. An intratesticular spermatocele communicates with the seminiferous tubules, whereas simple ectasia of the rete testis does not do so directly. These cysts contain spermatozoa and can be septate. The US findings of intratesticular varicocele are similar to those of extratesticular varicocele and include multiple anechoic, serpiginous, tubular structures of varying sizes. Improvements in gray-scale and Doppler US technology allow subtle distinctions between benign and malignant testicular lesions that were not possible a decade earlier.

Reversal of diastolic plateau in partial testicular torsion.

Testicular torsion is a urologic emergency. The ability of color and power Doppler sonography to diagnose partial testicular torsion definitively remains uncertain. We present a case in which color Doppler findings were indeterminate and the diagnosis of partial testicular torsion was made on the basis of spectral waveform analysis. The characteristic findings in the spectral waveform were asymmetry between the 2 testes, with a higher intratesticular resistance index on the affected side, and reversal of the diastolic plateau on the affected side.

Testicular epidermoid cysts: sonographic features with histopathologic correlation.

Testicular epidermoid cysts are rare, accounting for 1% of all testicular tumors. We present the sonographic appearances of epidermoid cysts in 3 cases, together with the histopathologic correlation. In case 1, sonography showed an intratesticular hypoechoic mass with a well-defined echogenic rim; the mass measured 1.8 x 1.5 x 1.5 cm, and there was no evidence of calcification. In case 2, sonography showed a well-circumscribed mass measuring 1.3 x 1.3 x 1.0 cm, with alternating hypoechoic and hyperechoic rings (onion-ring appearance) and no calcifications. In case 3, sonography showed a 2.4- x 2.3- x 2.3-cm, well-circumscribed, oval mass with a heterogeneous echotexture and an outer hypoechoic halo. The mass contained plaque-like regions of increased echogenicity, with peripheral acoustic shadowing from refraction artifact. Hypoechoic clefts were visualized posterior to the plaque-like areas. The triad of findings-sonographic appearance of an onion ring, avascularity on Doppler sonography, and negative results of tumor marker studies-is highly suggestive of an epidermoid cyst.

Intratesticular varicocele.

Varicocele is a common condition, occurring in approximately 15% of males. We present a case of intratesticular varicocele with concomitant extratesticular varicocele. A routine sonographic examination of the left testis revealed multiple hypoechoic, serpiginous, tubular intratesticular structures of various sizes with low-level internal echoes. Duplex Doppler and color flow examination confirmed a low-flow venous pattern with phasic variation that increased during Valsalva's maneuver. These findings were consistent with intratesticular varicocele. Varicocele was also present in the left pampiniform plexus. The main differential considerations in a patient with intratesticular varicocele include cyst, hematoma, epidermoid cyst, and tubular ectasia.

Neurosonographic abnormalities associated with maternal history of cocaine use in neonates of appropriate size for their gestational age.

PURPOSE: To determine whether increased incidence of neurosonographic abnormalities (predominantly of the basal ganglia and thalamus) in cocaine-exposed neonates who are small for their gestational age is attributable to the cocaine or to neonatal size. METHODS: Neonates whose sizes were appropriate for their gestational age with no evidence of hypoxia or respiratory distress were identified prospectively by a maternal history of cocaine use. Scans were performed within 72 hours of birth using a 7.5-MHz transducer following a standard protocol. The images were analyzed without access to patient information. Forty study neonates were compared with 34 control subjects who were appropriate in size for their gestational age, scanned using the same protocol. Comparisons were made using Fisher Exact Test, t test, and logistic regression. RESULTS: No control infant had neurosonographic abnormalities. In the study group, gestational age ranged from 27 to 41 weeks. Of the 40 study neonates, 14 (35%) had one neurosonographic abnormality; two had two abnormalities. The predominant lesion was focal echolucencies, mainly in the area of the basal ganglia (10 of 40, 25%). Other findings were caudate echogenicity (3 of 40, 7.5%), ventricular dilation (2 of 40, 5%) and one "moth-eaten" appearance of the thalamus. Lesions were more likely approaching term and were not related to prematurity or alcohol use. CONCLUSION: Apparently normal neonates with a maternal history of cocaine use are likely to have degenerative changes or focal infarctions in their basal ganglia attributable to cocaine. Neurosonography should be used to evaluate these neonates. The long-term significance of these lesions needs further evaluation.

Neurosonographic imaging of small-for-gestational-age neonates exposed and not exposed to cocaine and cytomegalovirus.

We sought to prospectively identify the role of neurosonography in the evaluation of a consecutive group of small-for-gestational-age (SGA) neonates, and also to identify the association of neurosonographic findings with cocaine exposure and cytomegalovirus (CMV) infection. Neurosonographic imaging was performed in 180 SGA neonates within 72 hours of birth. Urine samples were screened for CMV and cocaine metabolites (CM) in all cases. Sixty-five neonates (37.5%) had an abnormal neurosonographic appearance. Nine neonates were positive for CMV and 31 neonates were positive for CM. Focal echolucencies (27), ventricular dilation (27), and subependymal hemorrhages (12) were the most common neurosonographic abnormalities. The first two were more common with CM (p < .05). An abnormal neurosonographic pattern was seen more often in SGA neonates with CM (54.8%, 17 of 31; p < .05) and CMV (67%, 6 of 9; p < .01) as compared with the rest (32.6%, 44 of 135; p < .01). Among those without CM or CMV, prematurity was associated with an increased risk for abnormality (p < .001 between groups), specifically subependymal hemorrhage, ventricular dilation, and porencephalic cysts. Five CMV-positive neonates showed periventricular, echogenic foci mainly in the area of the frontal horn. Two new findings with SGA were caudate nucleus echogenicity and a "moth-eaten" appearance of the thalamus, each found in three infants. Neurosonographic imaging is useful in the evaluation of SGA neonates. Focal echolucencies and caudate echogenicity suggest maternal cocaine use, and periventricular echogenic foci strongly suggest fetal CMV infection.