Polyorchidism: report of 3 cases and review of the literature.

OBJECTIVE: To describe the embryologic, clinical, sonographic, and magnetic resonance imaging features of polyorchidism and to review the literature on similar cases. METHODS: Over a 5-year period, we encountered 3 patients who were found to have polyorchidism on scrotal sonography. All 3 patients had a painless scrotal mass. Two patients also had magnetic resonance imaging of the scrotum, and the results were correlated with the sonograms. We also performed a literature search for other reports of polyorchidism. RESULTS: One patient had 2 right testicles and a single left testicle. The second patient had 3 left testicles and 1 right testicle. In the third patient, who had 2 left testicles and 1 right testicle, microlithiasis was found in all 3 testes. The supernumerary testes were within the scrotum in all cases. All testicles were identified by sonography. Magnetic resonance imaging in 2 cases provided confirmatory data regarding the presence of an extra testicle but did not add other relevant information. Conservative treatment was chosen in all cases. CONCLUSIONS: Polyorchidism is a rare congenital anomaly. There are characteristic sonographic features of polyorchidism, and the diagnosis is often made on the basis of sonography. Magnetic resonance imaging can be used for confirmation but may be more helpful in cases complicated by cryptorchism or neoplasia. Conservative treatment is advised in uncomplicated cases.     

Testicular epidermoid cysts: sonographic features with histopathologic correlation

Testicular epidermoid cysts are rare, accounting for 1% of all testicular tumors. We present the sonographic appearances of epidermoid cysts in 3 cases, together with the histopathologic correlation. In case 1, sonography showed an intratesticular hypoechoic mass with a well-defined echogenic rim; the mass measured 1.8 x 1.5 x 1.5 cm, and there was no evidence of calcification. In case 2, sonography showed a well-circumscribed mass measuring 1.3 x 1.3 x 1.0 cm, with alternating hypoechoic and hyperechoic rings (onion-ring appearance) and no calcifications. In case 3, sonography showed a 2.4- x 2.3- x 2.3-cm, well-circumscribed, oval mass with a heterogeneous echotexture and an outer hypoechoic halo. The mass contained plaque-like regions of increased echogenicity, with peripheral acoustic shadowing from refraction artifact. Hypoechoic clefts were visualized posterior to the plaque-like areas. The triad of findings-sonographic appearance of an onion ring, avascularity on Doppler sonography, and negative results of tumor marker studies-is highly suggestive of an epidermoid cyst.     

Symptomatic wandering accessory spleen in the pelvis: sonographic findings.

We describe the case of a mobile left lower quadrant mass associated with recurrent abdominal pain; at surgical exploration, the mass was found to be an accessory pelvic spleen. Although accessory spleens are present in 10-30% of individuals, a wandering accessory spleen located in the pelvis is not frequently seen. On sonography, the mass in our patient appeared well-defined and homogeneous. Spectral analysis and color Doppler imaging demonstrated a normal vascular branching pattern and high diastolic flow due to low resistance in the vascular bed. The parenchymal resistance index of the mass was similar to that of the native spleen.     

Sonographic diagnosis of a pseudoaneurysm in an intravenous drug abuser

We report a case of a traumatic pseudoaneurysm and arteriovenous fistula in the groin of a drug abuser. Gray-scale and Doppler sonography were used to establish the diagnosis. Gray-scale sonography revealed an anechoic, ovoid, 7 x 4 cm mass posterior to the right superficial femoral artery, which was displaced anteriorly, with limited visualization of the deep femoral artery. Power Doppler sonography showed complete color filling of the mass, and turbulence was seen on conventional color Doppler sonography. The turbulence was confirmed with pulsed Doppler sonography of the mass. Pulsed Doppler imaging of the right external iliac vein also showed an arterialized spectral flow pattern.     

Sonographic findings in glomus tympanicum tumor

A glomus tympanicum tumor that is associated with a visible retrotympanic mass is the most frequent cause of pulsatile tinnitus. The preoperative diagnostic approach to this lesion includes a meticulous physical examination as well as high-resolution CT, magnetic resonance angiography, and digital angiography, which can also be used for preoperative embolization. We report the use of color transcranial Doppler sonography in the evaluation of glomus tympanicum tumor in a 67-year-old woman with a 3-year history of left tinnitus. An otoscopic examination revealed a reddish pulsatile mass behind an intact tympanic membrane. No lesions were visualized on gray-scale sonography. Contrast-enhanced color transcranial Doppler sonography showed a vascular ovoid mass that measured 2 x 1 x 1 cm; spectral analysis of the lesion revealed arterial flow with a low resistance index. Color transcranial Doppler sonography helped define the dimensions and vascular characteristics of the lesion.     

Sonographic presentation of uterine sex cord-stromal tumor.

A 24-year-old woman presented with continuous vaginal bleeding and anemia. Pelvic sonography demonstrated an enlarged uterus measuring 8.9 x 4.9 x 4.7 cm and a mass within the endometrial cavity measuring 3.0 x 1.8 cm. The mass appeared to be polypoid and echogenic, contained a small cyst, and was suggestive of a polyp. The patient underwent total vaginal hysterectomy. Pathologic examination revealed a uterine sex cord-stromal tumor. To our knowledge, the sonographic features of uterine sex cord-stromal tumor have not been previously reported. The sonographic appearance mimicked that of a polyp.     

Lymphoma of the testis and epididymis mimics chronic inflammation upon sonography

We report the sonographic findings in a case of lymphoma, which mimicked chronic inflammation. Scrotal gray-scale sonography revealed an irregularly margined, hypoechoic mass in the right testis and epididymis. Color Doppler sonography showed increased blood flow within the hypoechoic lesions in both testis and epididymis. Pathologic examination revealed a diffuse involvement of the testis and epididymis.     

Role of Doppler sonography in the evaluation of accessory spleens after splenectomy.

OBJECTIVE: Splenectomy influences the Doppler blood flow pattern in the splenic artery. Blood flow in this vessel might return to normal if an accessory spleen increases in size after splenectomy. Our objective was to evaluate the resistive index of the splenic artery depending on the presence or absence of a hypertrophic accessory spleen in splenectomized patients. METHODS: The resistive index of the splenic artery was evaluated by duplex Doppler sonography in 19 splenectomized patients (8 with a hypertrophic accessory spleen) and in 8 healthy volunteers. The resistive index was measured within 3 cm of the origin of the splenic artery, and 3 different measurements were averaged. The presence or absence of a hypertrophic accessory spleen was diagnosed on the basis of sonography, computed tomography, magnetic resonance imaging, or scintigraphy, as well as by the presence or absence of Howell-Jolly bodies on a peripheral blood smear. RESULTS: The resistive index of the splenic artery in the splenectomized patients without a hypertrophic accessory spleen (mean +/- SD, 0.82 +/- 0.06; n = 11) was significantly (P < or = .0001) higher than in splenectomized patients with a hypertrophic accessory spleen (0.63 +/- 0.06; n = 8) and in control subjects (0.63 +/- 0.05; n = 8). CONCLUSIONS: In the splenectomized patient, a hypertrophic accessory spleen is associated with a normal resistive index in the splenic artery.     

Ultrasonographic evaluation of a uterine malignant melanoma presenting as a large pelvic mass

The uterus is an extremely rare location for a primary or metastatic melanoma. We describe the ultrasonographic appearance of a malignant melanoma of the uterus presenting clinically as a large mass in a 78-year-old woman. Transabdominal sonography revealed a solid uterine mass measuring 13 x 11.5 x 8.5 cm with inhomogeneous echotexture and bright internal echoes. The tumor showed a diffuse spread inside the uterine corpus, and the endometrium was not demonstrated ultrasonographically.     

Prenatal sonographic detection of a lipomeningocele as a sacral lesion

We present a case of a lipomeningocele in a newborn. Prenatal sonography revealed dysraphia and a 3.8 x 4.3 cm, semisolid, echogenic mass that was continuous with the sacral area and bulged posteriorly under the skin. The mass was diagnosed after birth as a lipomeningocele based on the results of MRI. This diagnosis was confirmed histologically.     

Polyorchidism

Transverse division of the embryologic genital ridge explains the various forms of polyorchidism that have been reported. Most patients with supernumerary testes are asymptomatic and have painless groin or testicular masses. The majority have triorchidism, and the supernumerary testis is most frequently on the left side. The most common associated anomalies are inguinal hernia and maldescent of the testis. Testicular biopsy is essential for diagnosis.     

Sonazoid-enhanced ultrasonography for the diagnosis of an intrapancreatic accessory spleen: a case report

We report a case of an intrapancreatic accessory spleen in 59-year-old man, in which contrast-enhanced sonography (US) using Sonazoid, a second-generation contrast agent, was useful for the diagnosis. Sonazoid-enhanced US could prove both hypervascularity and the existence of reticuloendothelial cell systems in the mass, which is the key to the diagnosis of an accessory spleen. Sonazoid-enhanced US might become a standard imaging technique for the diagnosis of an accessory spleen.     

Metastatic malignant pleural mesothelioma to the breast

A 51-year-old woman suffered from dyspnea for several days before she came to an outside clinic for help. Pleura biopsy was performed and the histologic diagnosis was malignant mesothelioma. Sixteen months later, a palpable left breast lump was noted. Physical examination revealed a firm mass in the breast, measuring about 4 x 3.5 cm in size. Breast sonography showed a hypoechoic mass about 3 x 2 x 1.5 cm in size with irregular border in the middle part of the left breast. A mammogram revealed a speculated mass. Chest computed tomography was also performed, which revealed a large pleural mesothelioma and an irregular breast lesion. Incisional biopsy of the left breast lump was performed and histologic examination revealed an infiltrative growth of neoplastic polygonal cells bearing hyperchromatic and pleomorphic nuclei and a small amount of pale, pinkish cytoplasm. Further immunohistochemical study was performed and the tumor cells were positive for low and high molecular weight cytokeratin, thrombomodulin and focally positive for CEA. The final histologic diagnosis was metastatic malignant mesothelioma.     

Transvaginal sonography of postmenopausal ovaries with pathologic correlation

The sonographic appearance of 67 ovaries in 34 postmenopausal women who underwent preoperative transvaginal sonography (TVS) was correlated to findings on pathologic examination. Both ovaries were detected by TVS in 60% of the women examined; in 85%, at least one ovary was detected. The size of the normal, sonographically visualized postmenopausal ovary was 2.2 +/- 0.7 cm in transverse, 1.2 +/- 0.3 cm in anteroposterior, and 1.1 +/- 0.6 cm in longitudinal axes, with an average volume of 2.6 +/- 2.0 cm3. The average size of ovaries that were not detected by TVS was 0.7 x 0.4 cm (range, 0.3 to 1.3 cm); most of these (five of six) were atrophic on pathologic exam. The difference between actual and sonographically measured size was negligible (TVS overestimated by 0.3 cm). Four simple cysts that ranged from 0.5 to 3.5 cm were found by TVS and confirmed pathologically, as were three benign serous cystadenomas that ranged from 2.5 to 3.5 cm, one 3 x 6-cm tubal carcinoma, and one 1 X 4-cm paratubal cyst. TVS missed a 6-cm dermoid, a 2.5-cm cystadenoma, a 0.8-cm Sertoli cell tumor, and a 0.5-cm fibrothecoma that were nonpalpable but that were found on pathologic examination. None of the missed lesions were palpable preoperatively. The positive predictive value was 94% for detection of an ovarian mass; the negative predictive value for exclusion of an ovarian lesion was 92%. It is concluded that TVS can accurately delineate the ovaries in most, but not all, postmenopausal women and that only rarely will pathologic lesions not be detected by TVS.     

Sonographic findings in a case of scrotal lymphangioma in a 68‐year‐old male

Lymphangiomas are benign tumors resulting from a congenital lymphatic malformation in infant and children. Most common sites are head, neck and axilla, and scrotal lymphangioma is very rare. Lymphangiomas are classified as capillary, cavernous, and cystic type and cystic type is most common. Complete surgical excision is definitive treatment and incomplete excision leads to local recurrence. We report a case of scrotal lymphangioma in 68‐year‐old male patient. Gray‐scale sonography revealed multiseptated, hypoechoic mass abutting the upper pole of the normal right testis. Color Doppler sonography showed no remarkable blood flow in the mass. MRI demonstrated multispetated extratesticular and extraepididymal mass in the right scrotum. Surgical excision was performed and the histopathologic diagnosis was a cystic lymphangioma. In conclusion when multiseptated cystic scrotal mass was discovered in an elderly patient, scrotal lymphangioma should be included in differential diagnosis. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009     

Sonography of the low transverse incision, cesarean section: a prospective study

Using sonography, the uterine incision site was prospectively studied in 36 asymptomatic patients, two days after cesarean section. The findings were compared with those seen in 21 symptomatic, postcesarean patients. In the asymptomatic patients, the incision site was visualized as an oval symmetric region of distinct echogenicity interposed between the lower uterine segment and the posterior wall of the urinary bladder. In eight of the 36 asymptomatic patients, a small (less than 1.5 cm) round hypoechoic mass was present in or adjacent to the uterine incision and distinct from the normal incision. These probably represented insignificant hematomas. Of the 21 symptomatic patients, 17 had either a subfascial hematoma, a bladder-flap hematoma, or endometritis. Two were sonographically normal, and one showed a hematoma in the paracolic gutter. In the remaining patient, there was a 5-mm asymmetrically placed hypoechoic mass representing an insignificant hematoma. Significant bladder-flap hematomas were characteristically round, greater than 2 cm masses asymmetrically placed in or adjacent to the uterine incision. Using sonography, the normal appearance of the lower uterine incision can be distinguished from significant hematomas.     

Polyorchidism and rete testis adenoma: ultrasound and MR findings

Polyorchidism is an uncommon congenital anomaly. It is associated with an increased frequency of testicular malignancy, cryptorchidism, inguinal hernia, and torsion. Sonography may be used to confirm the clinically suspected diagnosis. We present a case of polyorchidism in which a rete testis adenoma was present in one of the testicles. Sonographic and magnetic resonance findings are illustrated. Received: 21 August 1995/Accepted: 24 August 1995     

Nomograms of fetal thyroid measurements estimated by 2-dimensional sonography

PURPOSE: To build nomograms of fetal thyroid circumference (FTC), fetal thyroid area (FTA), and fetal thyroid transverse diameter (FTTD) throughout gestational age (GA). METHOD: Between January 2006 and July 2006, FTC, FTA, and FTTD were measured once in 196 normal fetuses examined at a GA of 22-35 weeks. Inclusion criteria were a healthy mother with normal maternal thyrotropin level during pregnancy, a singleton pregnancy with normal fetal morphology on sonography, and GA confirmed via first-trimester sonographic examination. RESULTS: Mean FTC, FTA, and FTTD ranged from 3.21 cm, 0.58 cm(2), and 1.19 cm at 22 weeks to 5.11 cm, 1.69 cm(2), and 1.89 cm at 35 weeks, respectively. Linear regression analysis yielded the following formulas for FTC, FTA, and FTTD according to GA: FTC (cm) = 0.146 x GA (weeks); FTA (cm(2)) = -1.289 + 0.085 x GA (weeks); FTTD (cm) = 0.054 x GA (weeks). The following logarithmic formulas were obtained for the expected fetal thyroid measurements according to estimated fetal weight (FW): FTC (cm) = -4.791 + 1.265 x logN FW; FTA (cm(2)) = -1.676 + 0.455 x logN FW; and FTTD (cm) = 0.399 + 0.001 x logN FW. CONCLUSION: We describe new nomograms of fetal thyroid measurements throughout gestation that may be useful in case of thyroid dysfunction.     

7532例乳腺超声体检分析

目的 用高频超声对正常女性乳腺健康体检,探讨其在临床及乳腺普查方面的应用价值.方法 对2006年1月-2009年12月间7 532例健康女性乳腺体检声像图进行分析,并对各年龄段的乳腺病变超声结果分布情况进行统计.结果 共检出乳腺病变2 861例(37.98%),正常者4 671例(62.02%).所有受检者中,囊性病变...     

Accessory appendages of the left atrium as seen during 64-slice coronary CT angiography

PURPOSE: To document the frequency and variations in number and anatomical shape of accessory appendages of the left atrium as seen on 64-slice cardiac CT. METHODS AND MATERIALS: Retrospective review of the anatomy of the left atrium as depicted by cardiac CT using the acquisition protocol designed for coronary CT Angiography and performed in 166 patients over a 6-month period with a 64-slice ECG-gated CT scanner (Siemens Medical Solutions). The local IRB provided a waiver of informed consent for this retrospective study. Structures less than 5 mm in shape were excluded, as well as large accessory pulmonary veins. RESULTS: Seventeen (17) of 166 patients (10%) had 18 accessory left atrial appendages (only one patient had two). Fifteen (15) accessory appendages were located along the right upper atrial wall and measured 0.9 x 0.6 x 0.5 cm(3) +/- 0.2 x 0.2 x 0.1 (Type 1). Three (3) were located along the left lower atrial wall, and were larger (0.9-2.5 cm cross-section) (Type 2). The right upper accessory appendages were mostly shaped like small diverticuli and the left lower ones were shaped like flat cauliflower expansions. CONCLUSIONS: Accessory left atrial appendages were visualized in 10% of 166 patients during 64-slice coronary CT angiography.