Comparison of sonograms and liver histologic findings in patients with chronic hepatitis C virus infection.

Gray scale ultrasonographic images of the liver were correlated with histologic findings in patients with chronic hepatitis C virus infection. The gray scale patterns of 64 livers with chronic hepatitis C virus infection were categorized as normal, fatty, fibrofatty, fibrotic, or inflammatory and were graded as mild, moderate, or severe. Liver biopsy specimens also were analyzed for the presence of fat, inflammation, and fibrosis and graded similarly. No correlation was found between fatty and fibrofatty sonographic findings with any of the three histologic patterns. Correlations were found between fibrotic sonographic findings and both fibrotic and inflammatory histologic findings (r = 0.27; P = 0.03). Although some pathologic features of liver disease were detected by ultrasonography, no useful correlation was noted between results of sonography and histologic examination.

Prevalence of asymptomatic cholelithiasis and risk of acute cholecystitis after kidney transplantation.

Prophylactic cholecystectomy for asymptomatic cholelithiasis is sometimes required before transplantation. However, there is little indication in the literature that transplant recipients are at any greater risk than individuals in the general population. Between January 1990 and December 1993, 211 renal transplant recipients underwent duplex sonography. All were asymptomatic. Twenty-one had positive findings: gallstones were found in 15 patients (7.11%) and sludge was found in 6 (2.84%). Of gallstone patients, seven (3%) were men and eight (4%) were women. One gallstone patient also had diabetes mellitus. The mean age by gender of the patients with calculi was 54 years for men and 38 years for women. Thirteen of the 15 patients with calculi (87%) have remained asymptomatic. Two patients (one diabetic) developed acute cholecystitis and underwent uncomplicated laparoscopic cholecystectomy. Patients with sludge were similar in gender and age to patients with gallstones; one patient had diabetes. No sludge patients became symptomatic. The incidence and morbidity of gallstones after kidney transplantation are low. Prophylactic cholecystectomy in asymptomatic patients before transplantation is not justified.

Testicular feminization: radiologic considerations in a unique form of cryptorchidism.

A case report of complete testicular feminization is presented. The medical and radiological characteristics of this condition which distinguish it from male cryptorchidism and other disorders of sexual differentiation are discussed. To our knowledge, only three previous case reports have been published in the radiology literature. Our report is the first to describe MRI findings.

Venous invasion in renal vein leiomyosarcoma: case report and review of the literature.

Tumors arising from veins are rare, usually present with nonspecific clinical and imaging findings and almost universally show histology of leiomyosarcoma. This twentieth reported case of primary renal vein leiomyosarcoma demonstrates invasion of the renal vein with endoluminal propagation of tumor into the infrahepatic inferior vena cava (IVC), an unreported manifestation. The combination of CT, ultrasound, and angiographic studies allowed differentiation from renal cell carcinoma by suggesting a tumor arising from the renal vein.

Sonographic appearance and significance of arcuate artery calcification.

During routine pelvic ultrasonography, we observed calcification of the arcuate branches of the uterine artery in eight patients. Calcification was manifest as symmetric, hyperechoic foci with acoustic shadowing in the periphery of the uterine myometrium. Uterine arterial calcification is important to recognize, as patients often have severe underlying systemic disease. Arcuate artery calcification can be differentiated from other pathologic causes of calcification in the uterus.

Utero-vaginal hypoplasia. Sonographic, embryologic and clinical considerations.

Congenital absence of hypoplasia of the uterus is a cause of primary amenorrhea in approximately 15% of cases. Ultrasound is often employed as an early imaging modality in the evaluation of patients with primary amenorrhea. Demonstration of total absence or marked hypoplasia of the uterus in the presence of normal ovaries during pelvic ultrasound examination, suggests the diagnosis of congenital uterine aplasia or hypoplasia. Sonography may obviate the need for laparoscopy and for other imaging modalities. A case report of uterovaginal hypoplasia in association with anal atresia and recto-vaginal fistula is presented, and the value of ultrasound in the diagnosis of this entity is discussed. The embryology and clinical features of this anomaly are also reviewed.

Time-related increase in hematocrit on chronic hemodialysis: uncertain role of renal cysts.

We studied the long-term changes in hematocrit in 283 center hemodialysis patients. Mean duration of dialysis (+/- SD) was 53.8 +/- 43.4 months, with a range of 6 to 176 months. The correlations of hematocrit with clinical factors, laboratory values, and renal cystic changes were investigated. Time on dialysis was the strongest single predictor of hematocrit for the whole group (r = 0.351, P less than 0.001) and for men and women analyzed separately. Longitudinal 5-year (n = 83) and 10-year (n = 21) data showed a continuous increase in hematocrit levels over time (r = 0.414, P less than 0.001 over 10 years). Patients at the dialyzer reuse center (n = 224) had higher hematocrit levels than those at the center that did not reuse (n = 59). Although time on dialysis was strongly correlated with increasing extent of renal cystic change (r = 0.387, P less than 0.001), the correlations of cyst extent and time on dialysis with hematocrit were not independent by multiple regression analysis. We conclude that hematocrit increases progressively over time in patients on chronic hemodialysis. The mechanisms responsible for this do not seem to involve cystic transformation of the kidneys and remain unclear.

Renal peripelvic multicystic lymphangiectasia.

Renal peripelvic multicystic lymphangiectasia is an unusual benign peripelvic fluid collection. The sonographic appearance, etiology, and differential diagnosis of peripelvic fluid collections are reviewed.

Prostatic carcinoma metastasis to the kidney: diagnosis by thin needle aspiration biopsy.

Renal metastasis of prostatic origin is uncommon. The routes of metastatic spread are discussed. The efficacy and safety of thin needle aspiration biopsy in obtaining a premortem diagnosis are stressed.

Uterine perforation and embedding by intrauterine device: evaluation by US and hysterography.

Uterine perforation and deep embedding by an intrauterine device (IUD) require exact determination of its location as a necessary step to safe and effective retrieval. Six cases of uterine perforation and four of embedding by an IUD were studied with ultrasonography (US) and hysterography. While US findings suggested the correct diagnosis of perforation in five of the six cases, hysterography yielded more exact diagnostic information. Deep embedding could only be diagnosed with hysterography. A classification of the types of perforation and an algorithm for diagnosing ectopic IUD are presented. Undue reliance on the sonographic appearance of an IUD in the center of the uterine image may lead to hazardous attempts at transvaginal removal of a device that is partly intramural. In this study, hysterography offered the most precise diagnostic information.

Uremic renal cystic disease: value of sonographic screening.

A high incidence of bilateral cystic disease occurs in patients who have uremia of chronic renal disease that is being treated by intermittent hemodialysis. Complications of uremic cysts include cyst rupture, cyst hemorrhage, and the development of solid adenomatous or adenocarcinomatous lesions. Obtaining screening sonograms of the native kidneys of patients who have undergone transplantation and of the kidneys of patients who are receiving treatment by hemodialysis may be justified as a baseline for the routine monitoring of these high risk patients.