Testicular Sonographic Color Doppler Dynamic Tissue Perfusion Measurements in Adolescents with Varicocele.

AIM: The aim of the study was an assessment of the effects of varicocele on testis parenchyma and microcirculation with the use of the dynamic tissue perfusion measurements. METHODS: Color Doppler sonographic dynamic testis parenchyma perfusion measurements were performed with Pixel-Flux software in 30 children with left testis varicocele. The right testes without varicocele comprised the control group. RESULTS: Testicular parenchymal perfusion in testes with varicocele was reduced when compared to the control testes. The differences were found in all measured perfusion parameters. Statistical significance was found in the case of mean velocity and resistance index parameters. According to the grade of varicocele, the perfusion was the most reduced in patients with grade III of varicocele. CONCLUSION: Testicular parenchymal perfusion decreases in patients with varicocele, mostly in higher grades of varicocele. In case of validation, the method can be used in determining the damage of the testis with varicocele and the need for surgery.

Nuck Canal Hernias, Typical and Unusual Ultrasound Findings.

BACKGROUND: Inguinal hernia in girls is a very rare condition. The cause of this pathology is incomplete closure of the processus vaginalis of the peritoneum, in girls named the canal of Nuck. Failed obliteration of this canal could result in hernia or hydrocele. Also less frequent findings, such as uterus herniated to the canal, were observed. OBJECTIVE: The purpose of this study was to describe the possible findings in female inguinal hernias and its ultrasound appearance. METHODS: Thirty-five patients with surgically confirmed hernias of the canal of Nuck were identified at our institution between January 2007 and November 2015. All the patients underwent ultrasonography before surgery. RESULTS: In 14 cases, there was hydrocele of the canal of Nuck. In 9 cases, intestinal hernia was found. In 10 patients, the hernia content appeared as mass-containing cysts and was confirmed at surgery as ovary. In 1 patient, the ovary was herniated together with uterus. In 1 patient, atypical hypoechoic lesion was found, which turned out to be angiofibrolipoma. In all patients, ultrasound diagnosis was confirmed by surgery. CONCLUSIONS: Ultrasound examination performed with high-frequency transducer is an examination of choice in female patients with pathological mass in inguinal region.

Ultrasound image of malignant bone tumors in children. An analysis of nine patients diagnosed in 2011-2016.

INTRODUCTION: The diagnostic process of bone tumors, including malignant ones, is based on conventional radiological methods, such as radiography and computed tomography, and with precise assessment of local advancement in magnetic resonance imaging. Ultrasonography is not included in the diagnostic algorithms as a tool suitable to detect this type of pathology. More and more frequent usage of musculoskeletal ultrasound in children as the first imaging method or, in some cases, as the only diagnostic method, makes it necessary to be familiar with sonographic presentation of bone tumors to suggest this diagnosis early enough and, after its verification, start treatment without a significant delay. Aim: The aim of this study was to determine changes in the sonographic image that might indicate a bone malignancy and suggest the need to extend the diagnostic process in this direction. MATERIAL AND METHOD: This article discusses 10 bone tumors in 9 children who had an ultrasound scan performed at the beginning of the diagnostic process before the histopathological diagnosis was established and treatment initiated. The assessment involved ultrasonographic features indicating the presence of a tumor. Results: In the group of 9 patients, 8 malignant bone tumors were diagnosed in ultrasonography and later verified histopathologically: 4 osteosarcomas and 4 Ewing's sarcomas. In one case, two bone tumors were detected in ultrasonography without specification of their nature (malignant/benign, primary/secondary). MATERIAL AND METHOD: In the analyzed cases, ultrasonography enabled the correct diagnosis of a focal bone lesion, and in most cases (8/9) it presented an image that suggested its malignant nature and the necessity of further diagnosis and treatment.

The standards of an ultrasound examination of the prostate gland. Part 2.

The paper discusses the rules of the proper performing of the ultrasound examination of the prostate gland. It has been divided into two parts: the general part and the detailed part. The first part presents the necessary requirements related to the ultrasound equipment needed for performing transabdominal and transrectal examinations of the prostate gland. The second part presents the application of the ultrasound examination in benign prostatic hyperplasia, in cases of prostate inflammation and in prostate cancer. Ultrasound examinations applied in the diagnostics of benign prostatic hyperplasia accelerated the diagnosis, facilitated the qualification to surgery and the selection of the treatment method. The assessment of the size of the prostate gland performed using the endorectal ultrasound examination is helpful in making the choice between transurethral electroresection and adenomectomy. In prostate inflammation this examination should be performed with particular gentleness due to pain ailments. The indication for performing the examination in acute inflammation is the suspicion of prostate abscess. In chronic, exacerbating prostatitis it is possible to perform an intraprostatic antibiotic injection. In the recent years increased morbidity and detectability of prostate gland cancer is observed among men. In Poland it ranks second (13%) among diseases occurring in men. The indication for an endorectal examination is the necessity to assess the size of the prostate gland, its configuration, the echostructure in classical ultrasonography, the vascularization in an ultrasound examination performed with power doppler and, if possible, the differences in the gland tissue firmness (consistency) in elastography. The ultrasound examination is used for performing the mapping biopsy of the prostate gland - from routine, strictly defined locations, the targeted biopsy - from locations suspected of neoplastic proliferation and the staging biopsy - from the neurovascular bundles, the seminal vesicles, from the apex of the prostate and from the periprostatic tissue - this type of biopsy is supposed to help in determining local staging of the neoplastic disease. The ultrasound examination is also helpful during the treatment of the neoplasm performed using brachytherapy or using the method of ultrasonic ablation which is still in the phase of clinical trials.

The role of ultrasound in the management of undescended testes before and after orchidopexy - an update.

The aim of this study was to evaluate the testicular volume and structure using ultrasound (US) before and up to 3 years after orchidopexy in children with different age.A total of 128 patients underwent orchidopexy for undescended testes. Afterwards, patients were invited for annual follow-up and control scrotal US. The total number of analyzed testes after orchidopexy was 184. Patients were divided according to age at the time of surgery: group I (2-4 years old), group II (5-7), and group III (8-10). In all patients, the testicular volume ratio was calculated as the operated testes volume versus the control testes mean volume.There was an increase in the median ratio in all age groups, from 0.86 to 0.95 in group I, 0.82 to 0.92 in group II and 0.78 to 0.90 in group III. In group of the patients 2 to 4 years old the growth of the ratio 3 years after surgery was statistically significant.Abnormalities in the structure of the testes, which may indicate severe damage to the testis, were seen in approximately 20% of patients on initial exams. On follow-up exams, this type of structure remained in 7% of patients. Testes with an initial ratio <0.25 and inhomogeneous structure did not show any significant growth.Scrotal US can be used for an accurate comparative assessment of the structure and growth of the testes before and after orchidopexy.Abnormalities in the structure of the testes may identify testes requiring more advanced methods of evaluation.

A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: An observational study.

Treatment of hypertrophic scars arising as a result of thermal burns in children is still a big problem. The results of the treatment are not satisfactory for patients and parents, and new methods of treatment are still investigated.We present the use of one of the most modern carbon dioxide (CO2) lasers (Lumenis Encore laser equipped with a Synergistic Coagulation and Ablation for Advanced Resurfacing module) in the treatment of hypertrophic scars in children after burns.From March to April of 2013, a group of 47 patients aged 6 to 16 years underwent 57 laser surgery treatments. The average time from accident was 7.5 years. The results of treatment were investigated in 114 areas. The assessed areas were divided into 2 groups: 9-cm area 1, where the thickness of the scar measured by physician was the lowest and 9-cm area 2, where the thickness of the scar was the biggest. The results were considered on the Vancouver Scar Scale (VSS) independently by the surgeon and by parents 1, 4, and 8 months after the procedure. In addition, ultrasound evaluation of the scar thickness before and after laser procedure was made.VSS total score improved in all areas assessed by both the physician and parents. The biggest change in total VSS score in area 1 in the evaluation of the investigator was obtained at follow-up after the 1st month of treatment (average 7.23 points before and 5.18 points after the 1st month after surgery-a difference of 2.05 points). Scar ratings by parents and the physician did not differ statistically (P < 0.05). In the ultrasound assessment, the improvement was statistically significant, more frequently for both minimum and maximum thickness of the scars (B-mode measures) (P < 0.05).The use of a CO2 laser in the treatment of hypertrophic scars in children is an effective and safe method. The use of a CO2 laser improves the appearance and morphology of scarring assessed using the VSS by both the parents and the physician. The treatment also reduced the thickness of scars evaluated by ultrasound.

The standards of an ultrasound examination of the prostate gland. Part 1.

The article discusses the principles of the proper performance of the ultrasound examination of the prostate gland. The paper has been divided into two parts: the general one and the detailed one. The first part presents the necessary requirements referring to the ultrasound apparatus for performing transabdominal examinations of the urinary bladder and the prostate gland as well as for transrectal examinations of the prostate gland. The paper also describes the techniques of performing both examinations together with the methods of measuring the capacity of the urinary bladder and the volume of the prostate gland. It also mentions the most frequent indications for performing the examinations as well as diagnostic algorithms applied in case of finding irregularities. The transabdominal ultrasonography is a part of the examination of the abdominal organs and it should be performed in patients complaining of dysuric symptoms. An addition to the examination, especially when the prostate gland is enlarged, should be the measurement of the capacity of the urinary bladder and the assessment of the amount of residual urine after voiding. The indications for the endosonographic examination of the prostate gland are patological changes found in the per rectum examination, elevated concentration of the prostate-specific antigen in the blood serum, cancer and inflammations of the prostate gland if an abscess is suspected, qualification for surgery in the course of benign prostatic hyperplasia and the diagnostics of disorders of ejaculation. A standard procedure performed in case of prostate cancer for the purpose of obtaining specimens for the histopathology examination is biopsy carried out with transrectal ultrasound imaging. The paper presents the indications and techniques of performing prostate biopsy, as well as the types of biopsies together with the necessary preparation and the protection against its side effects for the patient. The paper also lists the necessary elements of the description of the presented procedures. The second part of the paper presents the application of the ultrasound examination in benign prostatic hyperplasia, in cases of inflammation and in prostate cancer.

Two-dimensional (2D), three-dimensional static (3D) and real-time (4D) contrast enhanced voiding urosonography (ceVUS) versus voiding cystourethrography (VCUG) in children with vesicoureteral reflux.

BACKGROUND: Two-dimensional (2DUS) contrast enhanced voiding urosonography has been used in the diagnosis and treatment monitoring of the vesicoureteral reflux in children for over 15 years. The opportunity of performing this examination with the use of three-dimensional static (3DUS) and real-time (4DUS) techniques opens up new diagnostic horizons. OBJECTIVE: To analyze if 3DUS/4DUS bring additional information leading to an increased detection rate or change in the grading of reflux compared to 2DUS and voiding cystouretrography. MATERIAL AND METHODS: We evaluated 69 patients (mean 4.1 years) who underwent 2DUS/3DUS/4DUS contrast enhanced voiding urosonography (ceVUS) and voiding cystourethrography (VCUG) for the diagnosis and grading of vesicoureteral reflux. RESULTS: 2DUS and 3DUS/4DUS urosonography diagnosed 10 more refluxes (7.25%) than cystourethrography and in 3 refluxes (2.17%) detected a higher grade. In 9 refluxes (6.52%) 3DUS/4DUS urosonography and cystourethrography diagnosed a higher grade than 2DUS. There was a statistically significant difference between cystourethrography and 3DUS/4DUS urosonography when the number of detected refluxes and differences in grading were compared. 4DUS enabled a better visualization of reflux than 3DUS. CONCLUSIONS: 3DUS/4DUS techniques bring additional information leading to a change in reflux grading compared to 2DUS and a detect higher number of refluxes compared to cystourethrography.

Esophageal Duplication Cyst Treated Thoracoscopically During the Neonatal Period: Clinical Case Report.

Esophageal duplication cysts (EDCs) are rare developmental anomalies. They may occur anywhere along the esophagus with the predominant location in the thoracic segment. Presently, most are diagnosed prenatally or in early childhood. The prevalence of EDCs is estimated at 1 in 8200 live births. Usually, cysts are asymptomatic in the neonatal period, but they may cause respiratory distress or feeding difficulties depending on the size and location of the lesion.This report presents a female neonate with a cyst located in the right pleural cavity recognized prenatally. Computed tomography confirmed the diagnosis and revealed a round cystic mass in proximity to the left lung base. Thoracoscopic cyst excision was undertaken on day 15 after delivery. The postoperative period was uneventful. Histological cyst examination confirmed the diagnosis of foregut duplication.This case underlines the importance of early diagnosis and treatment of EDC, before symptoms and complications arise, and confirms that surgery in the neonatal period is safe and effective.

Testicular adrenal rest tumors in boys with congenital adrenal hyperplasia: 3D US and elastography--do we get more information for diagnosis and monitoring?

BACKGROUND: Testicular adrenal rest tumors (TART) are the nodular testicular lesions deriving from the adrenal remnant tissue reported in boys and men with congenital adrenal hyperplasia. Until now, the diagnostics of TART have been based on a combination of clinical features, imaging methods (primarily two dimensional ultrasound--2D US), response of the foci to glycocorticosteroid (GCS) therapy and exclusion of the neoplastic process. Application of 2D US supplies however a limited range of information about the volume, demarcation, structure and vascularization of the lesions. OBJECTIVE: To define whether the use of 3D US, power Doppler and elastography changes the algorithm of the diagnostics and monitoring or treatment of TART. MATERIAL AND METHODS: In this study, modern ultrasound techniques such as 3D US and elastography were introduced in two boys with TART. RESULTS: The 3D power Doppler option gives the opportunity for accurate assessment of the volume of testes and adrenal tissue foci and their vascularization. Sonographic elastography allows the assessment of stiffness of adrenal tissue areas compared to normal testis parenchyma. CONCLUSION: The use of these modern techniques enables more adequate and advanced diagnostics, and more precise monitoring of the effects of treatment in patients with TART.

Ultrasound presentation of abdominal non-Hodgkin lymphomas in pediatric patients.

INTRODUCTION: Burkitt's lymphoma accounts for approximately 25% of lymphomas diagnosed in children of developmental age. The tumor is localized mainly in the intestine (usually in the ileocecal region), mesenteric lymph nodes and extraperitoneal space. The clinical symptoms are non-specific and include: abdominal pain, vomiting, gastrointestinal bleeding, and acute abdomen suggesting appendicitis or intestinal intussusception. On ultrasound examination, Burkitt's lymphoma may manifest itself in various ways, depending on the origin of the lesion. AIM: The aim of this paper was to review the ultrasound manifestation of abdominal Burkitt's lymphoma in children. MATERIAL AND METHODS: The analysis included 15 pediatric patients with Burkitt's non-Hodgkin lymphoma in the abdominal cavity. The mean age of the patients was 9.5. Abdominal and gastrointestinal ultrasound examinations were conducted using a Siemens scanner with a convex transducer of 3.5-5 MHz and linear array transducer of L4 - 7.5 MHz. RESULTS: Ultrasound examinations conducted in the group of 15 patients revealed pathological masses localized in the gastric wall in 3 patients (20%), in the ileocecal region in 10 patients (67%) and a disseminated process in 2 patients (13%). In 12 patients with a diagnosed Burkitt's non-Hodgkin lymphoma in an extragastric localization, differences in the morphology of the lesions were observed. CONCLUSIONS: The clinical and ultrasound picture of abdominal Burkitt's lymphoma in children is variable. A careful ultrasound assessment of all abdominal organs conducted with the use of convex and linear probes increases the chances of establishing an adequate diagnosis.

Errors in the ultrasound diagnosis of the kidneys, ureters and urinary bladder.

The article presents the most frequent errors made in the ultrasound diagnosis of the urinary system. They usually result from improper technique of ultrasound examination or its erroneous interpretation. Such errors are frequent effects of insufficient experience of the ultrasonographer, inadequate class of the scanner, insufficient knowledge of its operation as well as of wrong preparation of patients, their constitution, severe condition and the lack of cooperation during the examination. The reasons for misinterpretations of ultrasound images of the urinary system may lie in a large polymorphism of the kidney (defects and developmental variants) and may result from improper access to the organ as well as from the presence of artefacts. Errors may also result from the lack of knowledge concerning clinical and laboratory data. Moreover, mistakes in ultrasound diagnosis of the urinary system are frequently related to the lack of knowledge of the management algorithms and diagnostic possibilities of other imaging modalities. The paper lists errors in ultrasound diagnosis of the urinary system divided into: errors resulting from improper technique of examination, artefacts caused by incorrect preparation of patients for the examination or their constitution and errors resulting from misinterpretation of ultrasound images of the kidneys (such as their number, size, fluid spaces, pathological lesions and others), ureters and urinary bladder. Each physician performing kidney or bladder ultrasound examination should possess the knowledge of the most frequent errors and their causes which might help to avoid them.

2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and monitoring of treatment of vesicoureteral reflux in children - can it replace voiding cystourethrography?

INTRODUCTION: Vesicoureteral reflux appears in 20-50% of pediatric patients with recurrent urinary tract infections. The most common method of diagnosing this disease is voiding cystourethrography. However, contemporary pediatric radiology does not favor this method due to exposure to X-radiation. AIM: The aim of this study was to assess the usefulness of 2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and treatment monitoring of vesicoureteral reflux in children and the possibility of using contrast-enhanced voiding urosonography to replace voiding cystourethrography. MATERIAL AND METHODS: Voiding cystourethrography and contrast-enhanced voiding urosonography were conducted in 80 pediatric patients in order to assess sensitivity, specificity, positive and negative predictive values as well as the number of vesicoureteral refluxes detected by each of the two methods. The second stage of the study involved performing voiding urosonography in an extended protocol in 58 children in order to determine the usefulness of three-dimensional (3D/4D) examinations in the assessment of vesicoureteral reflux and the ability to assess the urethra. RESULTS: The concordance between the two methods was 86.95%. The sensitivity of voiding urosonography was 84.51%, specificity - 90.99%, positive predictive value - 85.71% and negative predictive value - 90.17%. A 3D/4D assessment of the urinary bladder and transperineal 2D morphological assessment of the urethra were possible in all patients (100%). Assessment of the urethra during micturition with the use of 2D/3D/4D techniques was possible in all patients in whom voiding was elicited (95.83%), and 3D/4D assessment of vesicoureteral reflux was possible in all patients with reflux (100%). Although the application of 3D/4D techniques allowed accurate specification of the grade of reflux in all cases (100%), it appeared particularly useful in differentiating between grades II and III (70.97%). CONCLUSIONS: Contrast-enhanced voiding urosonography allows the diagnosis and monitoring of treatment of vesicoureteral reflux in pediatric patients as well as assessment of the urethra in both girls and boys. The method is characterized by high sensitivity and specificity. Moreover, it is safe, relatively inexpensive and can replace voiding cystourethrography.