Ultrasound as an adjunct to radiography in minor musculoskeletal pediatric trauma.

PURPOSE: To assess the value of ultrasound as an adjunct to radiography in minor musculoskeletal pediatric trauma. METHODS: Fifty children with 53 suspected fractures were referred for upper and/or lower limbs X-rays, followed by ultrasound. On radiography, we noted presence of fracture, of soft tissue thickening, or absence of any lesion. On ultrasound, we noted presence of fracture, of soft tissue lesion, or absence of lesions. RESULTS: A fracture was seen on both examinations in 25 patients with 28 fractures.In 4 patients where only soft tissue thickening was seen on radiography, ultrasound showed fracture in 1 patient, hematoma in 1 patient and was normal in 2 patients. In another patient with a doubtful diagnosis of fracture on radiography, ultrasound was normal. In 20 patients with normal X-rays, ultrasound showed fracture in 6 patients, hematoma in 7 patients and was normal in 7 patients. CONCLUSION: Ultrasound was helpful as an adjunct to radiography, it yielded additional bone (7/50 patients) and soft tissue (8/50 patients) diagnostic information in 30% of patients. However, ultrasound remains operator-dependent and can be used only in particular circumstances, especially in children with normal X-rays and a high index of clinical suspicion for an occult or subradiological fracture.

Spontaneous detorsion of the ovary: can it be diagnosed by MRI?

PURPOSE: To determine whether recent progress in imaging has made it possible to diagnose spontaneous detorsion, which is an accepted concept in the gynecological literature but until now has been a presumptive diagnosis that could not be confirmed because of the lack of imaging proof. MATERIALS AND METHODS: We searched for patients who had a diagnosis of spontaneous detorsion on MRI between January 2000 and January 2003, and selected only patients who met a selection of strict criteria, including mainly enlargement and hyperintensity of ovarian stroma on T2-weighted (T2W) images, clinical findings compatible with torsion and detorsion, and return of the stroma to normal size on follow-up examinations. Other signs of torsion, such as tubal thickening, were appreciated but not mandatory. Clinical follow-up for at least three years was available. RESULTS: Four patients met the study criteria. No stabilizing procedure was performed in the ovaries. One patient recurred and lost her ovary. CONCLUSION: The diagnosis of torsion followed by spontaneous detorsion was made with high probability in a selected number of patients. The clinical management of such patients remains a matter of debate. Laparoscopy with oophoropexy would be useful for young patients in whom close follow-up cannot be achieved.

Variable MR findings in ovarian functional hemorrhagic cysts.

PURPOSE: To describe the magnetic resonance (MR) findings in ovarian functional hemorrhagic cysts (FHC). MATERIALS AND METHODS: A total of 21 patients with 22 FHC, proven by follow-up ultrasound (US) in 11 women and surgery in 10 women, had US and MR examinations within 24 hours. The study was limited to cysts with obvious an echogenic pattern. All patients had T2-weighted fast spin echo (FSE), T1-weighted spin echo (SE), and T1-weighted SE fat-suppressed sequences. RESULTS: Four cysts (18%) were hypointense on T1-weighted-images without and with fat suppression, and hyperintense on T2-weighted-images. Five cysts (23%) were hypointense on T1-weighted images without and with fat suppression but heterogenous on T2-weighted images. Five cysts (23%) were hypointense on T1-weighted images but showed intermediate signal intensity on T1-weighted fat suppression images and heterogenous signal intensity on T2-weighted images. Two cysts (9%) were entirely intermediate on T1-weighted images. Five cysts (23%) displayed high signal intensity occupying less than 30% of the cystic content on T1-weighted images and one cyst (5%) displayed high signal intensity occupying more than 30% of the cystic content. CONCLUSION: Despite an obvious echogenic pattern on US, 64% of FHC were hypointense on T1-weighted images and 18% were also hyperintense on T2-weighted images. Only 36% demonstrated intermediate or high signal intensity on T1-weighted images.

Multilocular adenomatoid tumor of the ovary: ultrasonographic findings.

We report the sonographic findings of a rare benign ovarian tumor in a 69-year-old woman. Transvaginal ultrasonography showed a cystic multilocular lesion with a vascularized central solid portion of the left ovary. Surgery revealed an adenomatoid tumor. Adenomatoid tumors are benign lesions of mesothelial origin, usually solid in nature and rarely located in the ovaries. (c) 2005 Wiley Periodicals, Inc. J Clin Ultrasound 33:233-236, 2005.

Adnexal torsion: magnetic resonance findings in the viable adnexa with emphasis on stromal ovarian appearance.

PURPOSE: To evaluate ultrasound (US) and magnetic resonance (MR) findings in the viable twisted adnexa. MATERIALS AND METHODS: Ten patients underwent US and MR studies before surgical detorsion. Corrected cross-sectional area of the ovary was defined as cross-sectional area minus areas of cysts and follicles superior to 1 cm. On T2-weighted images, signal intensity of the stroma was graded as type 1 when it was equal to that of urine and type 2 when it was less than that of urine but markedly more than the contralateral side. RESULTS: The tube was twisted in six cases and the ovary in nine cases. All adnexa were viable. The largest ovarian cross-sectional area and the largest corrected ovarian cross-sectional area of the twisted ovary were significantly larger than those of the contralateral ovary (P = 0.043 for US; P = 0.012 and 0.017, respectively, for MR). These ovaries contained types 1 and 2 hyperintensity in six cases and only type 2 hyperintensity in three cases. Tubal thickening was seen on MR in five cases. CONCLUSION: Tubal thickening, enlargement of ovarian stroma as reflected by the corrected cross-sectional area, and hyperintensity of this stroma on T2-weighted images probably related to edema were useful findings in these viable torsions.