Harry L. Zinn

Ultrasonography of Pylorospasm: Findings May Simulate Hypertrophic Pyloric Stenosis

We compared sonographic images and measurements of patients diagnosed as having hypertrophic pyloric stenosis and pylorospasm among infants with projectile vomiting. Thirty‐seven patients with hypertrophic pyloric stenosis had an unchanged pyloric length (mean, 22.5 mm) and muscle wall thickness (mean, 5.3 mm). Thirty‐four pylorospasm patients had considerable variability in measurement or image appearance during their studies. Means of their longest or largest measurements were 14.4 mm for pylorus length and 3.8 mm for muscle wall thickness. Among these, 53% had muscle wall thickness of 4 mm or greater and 18% had pyloric length of 18 mm or greater during some portion of their study. We concluded (after clinical follow‐up study confirmed our ultrasonographic diagnoses) that pylorospasm may mimic hypertrophic pyloric stenosis for at least a portion of a sonographic study. Muscle wall thickness or pyloric length measurements may overlap those accepted as positive for hypertrophic pyloric stenosis. Image or measurement variability is an important clue for diagnosing pylorospasm.

Testicular Torsion in Neonates: Importance of Power Doppler Imaging

Power Doppler sonography has been shown to have greater sensitivity to blood flow than conventional color Doppler sonography. Whether this increased sensitivity provides clinically relevant information for a diagnosis of neonatal testicular torsion has been questioned. We present the case of a newborn infant who was thought to have bilateral testicular torsion and infarction based on gray scale and color Doppler ultrasonographic findings. Power Doppler imaging and surgery proved one testicle to be viable. This case both demonstrates the value of power Doppler sonography in detecting normally low flow in the neonatal testicle and shows that the finding of hypoechoic testicles may not necessarily mean infarction. Duplex sonography and color Doppler ultrasonography play key roles in the diagnosis of testicular torsion in adolescents and adults.1 In neonates, however, since testicular blood flow normally is low and often is below the sensitivity of conventional color Doppler sonography, a definitive sonographic diagnosis can be more difficult than in adolescents.2 The clinical usefulness of power Doppler sonography in such cases is being evaluated. We present a case of testicular torsion in a neonate that appeared to show bilateral infarction on gray scale and conventional color Doppler sonographic images. Only after power Doppler imaging was the diagnosis of unilateral testicular torsion and a salvageable second testicle made.

Prenatal sonographic diagnosis of posterior urethral valves : Identification of valves and thickening of the posterior urethral wall

This report describes 2 heretofore unreported sonographic findings that may aid in the antenatal diagnosis of posterior urethral valves. Each of 2 fetuses showed a prominent or thickened posterior urethra and one or more bright echogenic lines representing valve tissue within a dilated and/or thickened posterior urethra. These findings helped solidify the antenatally suspected diagnosis of posterior urethral valves. The diagnosis was confirmed clinically and surgically during neonatal life. These 2 imaging findings may help in providing a more definitive antenatal diagnosis of posterior urethral valves and allow more expeditious therapy.

Ultrasonographic diagnosis of ectopic pregnancy: importance of transabdominal imaging.

Endovaginal sonography has greatly improved the diagnostic evaluation of suspected ectopic pregnancy. Some authors suggest imaging solely by endovaginal technique for diagnosis. We perform both a transabdominal scan for a global view of the pelvic and abdominal contents and an endovaginal sonographic examination for a higher resolution and focused view of the gynecologic structures. We report three patients with negative endovaginal examinations who had obvious ectopic pregnancies on our subsequent transabdominal examination. These cases remind us of the valuable information that can be obtained with the transabdominal approach and the complementary role it plays with endovaginal sonography.

Prenatal sonographic findings of congenital adrenal cortical adenoma.

The differential diagnosis of prenatally diagnosed adrenal masses includes neuroblastoma, adrenal hemorrhage, adrenal and cortical renal cysts, adrenal adenoma and carcinoma, subdiaphragmatic pulmonary sequestration, Beckwith-Wiedemann syndrome, duplication of the renal system, Wilms tumors, congenital mesoblastic nephroma, and mesenteric and enteric duplication cysts. The worldwide annual incidence of childhood adrenal cortical neoplasms ranges between 0.3 and 0.38 per 1 million children younger than 15 years. These neoplasms are even more unusual among infants, with only 23 cases reported in the literature.

Sonographic features associated with post-uterine artery embolization pyomyoma.

ilateral uterine artery embolization for symptomatic leiomyomata is an alternative to hysterectomy, providing good short-term relief of bulk-related symptoms and a reduction in menstrual flow.1 With increasing use of this therapeutic procedure, however, procedure-related complications have been reported. These include phenomena resulting from aberrant embolization (buttock and labial necrosis and vesicouterine fistula),2–5 in addition to prolapsed cervical myoma, uterine necrosis, ischemic uterine rupture, infectious sequelae including sepsis, volvulus, inadvertent embolization of a malignant leiomyosarcoma, and ovarian dysfunction.6–11 We present unusual sonographic features of post–uterine artery embolization pyomyoma.

Transvaginal sonographic findings of a large intramural uterine hematoma associated with iatrogenic injury sustained at termination of pregnancy

We report a case in which a patient presented with severe right lower abdominal pain associated with nausea and vomiting 3 days after termination of pregnancy. Transvaginal ultrasonography showed a large intramural mass in the anterior aspect of the lower segment of an acutely retroflexed uterus. Computed tomography and magnetic resonance imaging findings were consistent with an intramural hematoma as a result of iatrogenic injury sustained during the preceding termination of pregnancy. The patient was managed expectantly. Systematic review of the literature confirmed that this is the first report of sonographic findings associated with an intramural uterine hematoma some days after the injury sustained at termination of pregnancy. This case supports utilization of real‐time ultrasound guidance during intrauterine surgery of selected cases to decrease procedure‐related morbidity. Copyright

Sonographic and Magnetic Resonance Imaging Findings of an Isolated Vaginal Leiomyoma

Leiomyomas represent the most common uterine neoplasms, noted clinically in 20% to 30% of all women older than 30 years, and are found in 75% of hysterectomy specimens. 1 Although rare, the most common mesenchymal neoplasm of the vagina is the leiomyoma. 2 The mean patient age at detection of a vaginal leiomyoma, is approximately 40 years, with a reported range between 19 and 72 years. 2 Vaginal leiomyomas vary from 0.5 to 15 cm in diameter, averaging approximately 3 cm in size, and may occur anywhere within the vagina, usually in a submucosal location. Although these rare lesions are often asymptomatic, larger tumors may be associated with pain, dystocia, dyspareunia, or obstructive urinary symptoms. We report the sonographic and magnetic resonance imaging (MRI) findings of a patient with an isolated vaginal wall leiomyoma.

Gestational diabetes leading to diagnosis and management of multiple endocrine neoplasia type 2a.

BACKGROUND: Multiple endocrine neoplasia (MEN) type 2a is an autosomal dominant syndrome caused by specific proto-oncogene mutations characterized by medullary carcinoma of the thyroid, pheochromocytoma, and, occasionally, multiglandular parathyroid hyperplasia, which rarely complicates pregnancy. Secondary diabetes rarely has been reported in association with principal endocrinopathies complicating pregnancy. CASE: A 34-year-old primiparous woman with recently diagnosed gestational diabetes had repeated episodes of dizziness at 30 weeks of gestation, initially attributed to glyburide. Continued episodes of dizziness and later-appearing bouts of severe headache, palpitations, diaphoresis, severe hypertension, and marked tachycardia led to diagnosis and management of MEN type 2a complicating pregnancy. CONCLUSION: Patients with MEN type 2a complicating pregnancy may present with gestational diabetes.

Color Doppler Imaging and 3-Dimensional Sonographic Findings of Urinary Bladder Leiomyoma

Leiomyomas of the genitourinary tract may originate from the renal pelvis, bladder, urethra, or epididymis. 1 Interestingly, leiomyomas of the bladder are more common among women (76% of cases).2 Development is usually endovesical (63%), yet extravesical (30%) and intramural cases are not rare.3 Patients may be asymptomatic or may have obstructive urinary symptoms, irritative symptoms, hematuria, flank pain, or, rarely, dysmenorrhea or dyspareunia. 2-5 Leiomyomas of the bladder have been reported in association with neurofibromatosis type 1, in which leiomyomas occur most often in the gastrointestinal tract (proximal small bowel) and tend to be multiple.6 Rarely, urinary bladder leiomyomas have been diagnosed during pregnancy 7,8 and in a woman with a previous hysterectomy. 9 Diagnostic imaging modalities used include both transabdominal and transvaginal sonography, computed tomography, and magnetic resonance imaging.10-12 Although asymptomatic, nonobstructive, and nonproblematic leiomyomas may be managed expectantly, treatment is surgical by a transurethral approach, laparoscopy, or laparotomy 1-4 We present color Doppler imaging and 3-dimensional sonographic findings of a woman with a urinary bladder leiomyoma.