Usefulness of transabdominal ultrasonography in excluding adnexal disease.

OBJECTIVES: To investigate the final diagnoses and examine the rate of detection of normal ovaries in patients with negative results for adnexa on transabdominal ultrasonography (TAUS) using current machines. METHODS: Of 188 eligible patients who underwent TAUS to assess lower abdominal pain, 158 were subsequently evaluated using other imaging modalities, surgical procedures, follow-up, or questionnaire data. Of these patients, 135 patients with negative results for adnexa on TAUS were included in the investigation of the final diagnoses. The rate of detection of normal ovaries on TAUS was calculated on a per-ovary basis in these patients. RESULTS: One hundred thirty-three (98.5%) and two (1.5%) patients were finally diagnosed with non-adnexal diseases and adnexitis, respectively. The rate of detection of 270 ovaries in 135 patients was 38.9%, while that of 148 ovaries in 74 patients between 16 and 45 years of age was 66.2% and that of 122 ovaries in 61 patients over 45 years of age was 5.7% (P < 0.001). CONCLUSIONS: TAUS appears to be the first step for ruling out adnexal disease in patients with lower abdominal pain. The rate of detection of normal ovaries is good in younger patients.

Evaluation of whether the ultrasonographic onion skin sign is specific for the diagnosis of an appendiceal mucocele.

PURPOSE: To evaluate whether the onion skin sign on ultrasonography (US) of the lower abdomen is specific for the diagnosis of an appendiceal mucocele. METHODS: Our study included 231 lesions from 229 patients in whom transabdominal US detected lesions in the lower abdomen and who had definitive pathological diagnoses in the small bowel, ileocecal valve, cecum, appendix, mesentery, adnexa uteri or pelvic cavity outside the major organs. Patients with metastatic tumors were excluded. We reviewed the reports and images from transabdominal US and checked for the presence of the onion skin sign. The sensitivity, specificity, and accuracy of the sign for the diagnosis of an appendiceal mucocele were calculated. RESULTS: Five (2.2 %) of the 231 lesions showed the onion skin sign on US and all were diagnosed with an appendiceal mucocele. The sensitivity, specificity, and accuracy of the sign for the diagnosis of an appendiceal mucocele were 63, 100, and 99 %, respectively. CONCLUSIONS: The onion skin sign in the lower abdomen appears to be specific for the diagnosis of an appendiceal mucocele. In cases where the onion skin sign is obviously present in the lower abdomen on US, an appendiceal mucocele should be considered as the leading diagnosis.

Ultrasonography for ureteral stone detection in patients with or without caliceal dilatation.

PURPOSE: To evaluate the relationship between the degree of hydronephrosis and the detection rates of ureteral stones with ultrasonography (US). METHODS: Of 250 consecutive patients with suspected ureterolithiasis, 214 who were diagnosed with ureterolithiasis were enrolled in this study. First, both kidneys were observed by US to evaluate the intrarenal collecting systems. Thereafter, the possible course of the ureters and the bladder were searched to find any stones. RESULTS: Stones were clearly observed in 80 (73%) of 109 patients with caliceal dilatation, whereas stones were clearly observed in 46 (44%) of 105 patients without dilatation (P < 0.05). Of the former 80 patients, 31 (39%) had stones in the ureterovesical junction (UVJ), whereas 51 (64%) had stones in the more proximal ureter. Of the latter 46 patients, 37 (80%) had stones in the UVJ or the bladder, whereas 9 (20%) had stones in the more proximal ureter. CONCLUSION: The US detection rate of ureteral stones was high in patients with caliceal dilatation. The whole ureter should be scanned in patients with caliceal dilatation for detection of ureteral stones. Even when patients have no caliceal dilatation, it is still considered to be useful to scan the UVJ and the bladder.