Complete epididymal separation presenting as polyorchidism

We describe an unusual case of a 21-month-old boy with complete separation of the testis and epididymis. Two homogeneous structures were observed in the scrotum of a newborn boy in addition to a third structure. Polyorchidism was suspected, but follow-up sonographic studies showed a decrease in the echogenicity of the left scrotal structure. Surgical exploration revealed the testis and epididymis to be completely separated, with no duplicated testis. Orchidopexy was then performed.     

Sonographic features of xanthogranulomatous pyelonephritis

PURPOSE: The purpose of this study was to describe the various sonographic features of xanthogranulomatous pyelonephritis (XGP). METHODS: We retrospectively reviewed the CT, sonographic, and medical records of patients diagnosed with XGP from January 1981 to December 1998. Twenty-seven patients for whom XGP was histopathologically confirmed were included in the study. There were 12 men and 15 women, with an age range of 21-86 years (mean, 57 years). All patients had undergone sonography of the kidneys. The renal size, shape, and outline were recorded. The presence of perinephric fluid accumulation, of obstructive uropathy, or of internal echoes in the dilated collecting system and the echotexture of the renal parenchyma were documented. RESULTS: We categorized the XGP into 4 groups on the basis of the sonographic features: (1) diffuse hydronephrotic, 12 patients (44%); (2) diffuse parenchymal, 9 patients (33%); (3) diffuse contracted, 4 patients (15%); and (4) segmental or focal, 2 patients (7%). A localized perinephric fluid collection was present in 4 patients (15%). The preoperative sonographic diagnoses were pyonephrosis (n = 14, 52%), renal pelvic tumor with possible associated infection (n = 5, 19%), renal parenchymal mass (n = 2, 7%), hydronephrosis (n = 2, 7%), and chronic pyelonephritis with renal atrophy (n = 4, 15%). XGP was considered a possible diagnosis in only 11 patients (41%). CONCLUSIONS: XGP has no specific sonographic features but is suggested by parenchymal thinning and hydronephrosis, sonographic signs of chronic obstructive uropathy caused by stones; echoes in the dilated collecting system; and a perinephric fluid collection. CT, needle biopsy, or both are recommended to further evaluate and confirm sonographically suspected XGP.     

Sonographic features of acute colonic diverticulitis

Acute colonic diverticulitis is a common cause of acute abdominal symptoms, especially in elderly patients. Sonography is frequently used as the initial imaging modality because of its ready availability. This pictorial essay aims to provide an overview of the sonographic features of acute colonic diverticulitis and of the more common differential diagnosis. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009     

Sonographic features of colon carcinoma seen with high-frequency transabdominal ultrasound

To assess the value of high-frequency ultrasonography as a diagnostic imaging procedure in patients with colon carcinoma, we first evaluated the sonograms of 37 patients who had been already diagnosed with contrast enema and/or colonoscopy as having colon carcinoma. As a result, the sonographic criteria for diagnosis of a possible colon carcinoma were (1) a localized and irregular thickening of the colonic wall with heterogenous low echogenicity, (2) an irregular contour, (3) a lack of demonstrable movement or change of configuration of the bowel on real-time scanning, and (4) absence of wall stratification. During the last 4 years, 41 consecutive patients had findings meeting our sonographic criteria. In 37 patients (90%), the presence of colon carcinoma was confirmed by contrast enema and/or colonoscopy. Our study suggests that high-frequency real-time ultrasonography may be a useful imaging technique in diagnosis of colon carcinoma. © 1994 John Wiley & Sons, Inc.     

Sonographic features of mucus-producing carcinoma of the gallbladder

Few cases of mucus-producing carcinoma of the gallbladder have been reported; accordingly, sonographic features of this entity have not been well described. We discuss two cases of gallbladder carcinoma with marked secretion of mucus that we followed using ultrasound. Acute cholecystitis in these cases resulted from obstruction of the cystic duct by the copious secretion of mucus. Ultrasonography revealed debris-like echoes floating in the lumen of the gallbladder with buoyant migration. Mucus appeared as highly echoic smoke-like or cloud-like masses. Color flow imaging showed no vascularity. The mucus echoes disappeared spontaneously between attacks of cholecystitis. A surgical specimen showed a tumor associated with abundant mucous in the gallbladder. We conclude that mucus-producing carcinoma of the gallbladder should be considered when numerous smoke-like echoes appear in the gallbladder. An accurate diagnosis can be obtained by careful observation using ultrasonography.     

泌尿生殖道支原体属感染特点及耐药性分析

目的探讨泌尿生殖道支原体属感染状况及对抗菌药物的耐药情况,指导临床合理用药。方法采用支原体培养药敏试验试剂盒,对临床收集的1852例泌尿生殖道感染患者标本进行支原体属培养及10种抗菌药物的体外药敏试验。结果在1852例受检患者标本中检出支原体阳性782例,总阳性率为42．2％。其中解脲脲原体（Uu）单一感染617例,占78．9％;人型支原体（Mh）单一感染28例,占3．6％;Uu和Mh混合感染137例,占17．5％。21～30岁年龄段患者支原体培养阳性率为42．9％,明显高于其他年龄段。药敏试验结果显示,Uu阳性者对交沙霉素、多西环素、米诺环素、克拉霉素较敏感,敏感率分别为95．7％、92．9％、92．8％和91．6％,而耐药率在70．0％以上的有大观霉素、阿奇霉素、环丙沙星、罗红霉素。结论治疗泌尿生殖道支原体属感染应首选交沙霉素和多西环素等敏感性高的药物,避免使用大观霉素、阿奇霉素等耐药性高的药物。临床上对疑似泌尿生殖道感染的患者进行支原体属的培养和药敏试验,对支原体属感染的抗菌治疗有重要的临床意义。     

Inflammatory fibroid polyp presenting with intestinal invagination: Sonographic and correlative imaging findings

We report a case of a large inflammatory fibroid polyp of the small bowel presenting with intussusception in a 22‐year‐old man. Sonography demonstrated a solid, mobile, homogeneous, echogenic mass surrounded by the typical mural layers of an invaginated ileum. CT demonstrated a well‐defined intraluminal solid mass with an attenuation of 17 HU. The pathologic diagnosis after segmental ileal resection was ileal inflammatory fibroid polyp. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:89–91, 1999.     

超声诊断胎儿先天性泌尿系畸形

目的 探讨超声诊断胎儿先天性泌尿系畸形的临床价值。方法按产科超声检查常规对32例孕24～41周的孕妇进行彩色多普勒超声检查。结果本组32例胎儿先天性泌尿系畸形超声检查28周前检出23例，28周后检出9例。其中双肾发育不全6例，单侧肾缺如3例，肾积水11例，多囊肾5例，肾多发囊肿5例，肾发育异常1例，一侧异位肾1例，合并其他系统畸形7例。全部病例引产后证实20例；出生后，随访及手术证实10例，失访2例。结论胎儿先天性泌尿系畸形超声检查，对胎儿畸形的检出、预后的判断及临床措施的选择有重要的实用价值。     

Sonographic detection of a patency capsule prior to capsule endoscopy: Case report

To avoid retention of the capsule used in capsule endoscopy (CE), the patency capsule (PC), a self‐disintegrating sham capsule, is administered prior to CE in patients suspected of small intestinal stenosis. If the PC is excreted intact within 30 hours of ingestion, the patient can undergo CE without retention. However, if the PC is not excreted within 30 hours, its location must be confirmed as in either the small intestine or the colon because of the potential for small intestinal stenosis in the former case. It is often difficult to confirm the location of the PC by abdominal radiograph. We report the case of one patient who did not excrete the PC within 30 hours and for whom it was difficult to distinguish whether the PC was in the small intestine or the colon on abdominal series. Abdominal sonography revealed the PC in the colon and subsequent CE was performed without complication. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42 :554–556, 2014     

Sonographic features of intra-abdominal abscess caused by spilled stones during laparoscopic cholecystectomy

Spillage of stones into the abdominal cavity resulting from perforation of the gallbladder is one of the common complications of laparoscopic cholecystectomy. Although many surgeons know that stones left in the abdominal cavity can cause late visceral abscess requiring surgical treatment, the sonographic features of such abscesses have not yet to be thoroughly investigated. We investigated the sonographic features of intra-abdominal abscesses caused by spilled stones after laparoscopic cholecystectomy using Hitachi Model EUB-525 (3.5 MHz) and Aloka Model SSD-5500 (3.75 MHz) ultrasound systems. Two thousand thirty-six laparoscopic cholecystectomy procedures were carried out at this institution from 1990 through 2001. During this period, we encountered seven cases of intra-abdominal abscess. Three of these cases were symptomatic, but abscess, granulation, or both, were found incidentally by ultrasonography in the other four patients during routine annual health examinations. Laparotomy and open drainage of pus and gallstones from the intra-abdominal abscess were necessary in five cases. Ultrasonography revealed a mass in six of the seven patients. The abscesses were located in either the right subphrenic or subhepatic space on the surface of the liver and were sometimes difficult to distinguish from liver tumors. Ultrasound showed the abscesses as oval, low-echoic, solid masses with posterior enhancement. They ranged from 20 to 58 mm in diameter, had clear margins and highly echoic peripheral rims, and showed lateral shadowing. The lesions also contained several highly echoic spots with acoustic shadows that were thought to be the spilled stones. We conclude that visceral abscess should be considered after laparoscopic cholecystectomy, and that careful observation using ultrasonography is required, especially when the gallbladder is perforated and bile and stones have spilled out.     

Sonographic features of Ebstein anomaly associated with hydrops fetalis: a report of two cases

Ebstein anomaly, an abnormally low insertion of the tricuspid valve, occurs in 0.5% of patients with congenital heart disease. In rare cases, this disorder may be complicated by congestive heart failure in utero and hydrops fetalis. This article reports the prenatal sonographic features of 2 cases of Ebstein anomaly associated with hydrops fetalis. In both cases, fetal echocardiography was performed at 34 weeks of gestation. The 4-chamber view showed fetal cardiomegaly and pericardial effusion. In both cases, the annular attachment of the tricuspid valve leaflets was difficult to demonstrate and so distal that it could easily be confused with papillary muscle in the right ventricular wall. Poor fetal cardiac hemodynamics with severe tricuspid regurgitation was demonstrated by pulsed Doppler imaging. Pulmonary regurgitation was also clearly demonstrated in both cases. Preterm delivery with stillbirth occurred in both cases. Autopsies confirmed the very distal displacement of the tricuspid valve insertion, close to the apex, and enlargement of the right atrium.     

Sonographic features of mucinous biliary papillomatosis: Case report and review of imaging findings

Because of its indolent course, high recurrence rate, and risk of malignant transformation, mucinous biliary papillomatosis is an important consideration in the differential diagnosis of bile duct obstruction. We report a case of mucinous biliary papillomatosis and review the sonographic and other imaging findings previously reported in the literature. On sonography, these tumors appear as nonshadowing intrabiliary masses that are clearly defined and associated with proximal biliary dilatation. They may be multiple and associated with mucoid sludge. The imaging findings reflect the macroscopic appearance of a doughy papilliferous tumor of a bile duct. Associated findings include cholelithiasis, choledocholithiasis, and gallbladder dysplasia. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound26:151–154, 1998.     

Infiltrating syringomatous adenoma of the nipple: Sonographic and mammographic features with pathologic correlation

We report the case of a 39‐year‐old woman complaining of painless unilateral nipple enlargement for 3 weeks. She had no family history of breast cancer. Clinical examination revealed left nipple enlargement without pain, erythema, or skin changes m no associated palpable breast or axillary masses. Ultrasound showed several bright foci in the left nipple suggestive of microcalcifications. Neither solid nor cystic masses were detected. The mammogram performed subsequently confirmed the presence of multiple pleomorphic microcalcifications within the nipple. Wedge biopsy showed a syringomatous adenoma. Wide local excision of the nipple was performed. The postoperative course was uneventful. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42 :427–429, 2014     

乳腺淋巴瘤的超声图像特征

目的:回顾性分析乳腺淋巴瘤的超声和病理表现,提高超声对乳腺淋巴瘤的诊断水平。方法:复习2002~2007年经活检或手术病理证实的乳腺淋巴瘤10例的超声图文报告及病理报告,分析超声图像特征。结果:10例病理均为非霍奇金氏淋巴瘤(NHL)。乳腺肿块大小1~13cm,超声表现为单发5例,多发5例,共发现肿块17个;声像图表现为低回声肿块16个,不均匀高回声肿块1个,其中极低回声有类似囊肿样表现近似无回声肿块12个,形态不规则及不均匀肿块16个,形态规则均匀肿块1个,后方回声增强肿块17个,内部血流丰富肿块15个,多为高阻血流(2/3),伴发同侧腋窝淋巴结肿大7例。结论:肿块回声极低类似囊肿样,后方回声增强,血流信号丰富是乳腺淋巴瘤的超声图像特征,有较强的诊断价值。