Kiran A. Jain

Ultrasonographic evaluation of diaphragmatic motion.

To evaluate the technical feasibility and utility of ultrasonography in the study of diaphragmatic motion at our institution.

Sonographic Spectrum of Hemorrhagic Ovarian Cysts

Objective. To present the spectrum of sonographic findings associated with hemorrhagic ovarian cysts. Methods. Experience with making specific and correct diagnosis of hemorrhagic cysts with the use of sonography was reviewed, and the spectrum of sonographic findings was identified. Results. Endovaginal sonography facilitated excellent visualization of internal architectural details of an adnexal mass, which enabled specific diagnosis of hemorrhagic cysts instead of other adnexal masses. Conclusions. A hemorrhagic cyst is a common and important entity to recognize and diagnose correctly, and because it can be confused with more ominous conditions, it is important to recognize its specific diagnostic patterns.

Ultrasound and MR imaging of fibromatosis colli (sternomastoid tumor of infancy)

Abstract The sonographic and CT findings of fibromatosis colli (sternomastoid tumor of infancy) have been described, but the MRI appearance has been reported in only one case in which the mass resolved over time. This case describes the detailed MRI findings in a biopsy-proven case of fibromatosis colli; the signal intensity of the mass on T2-weighted images was slightly less than on gradient-recalled T1-weighted images, consistent with the presence of some fibrous tissue within the muscle mass. The involved portion of the muscle was better defined on MRI than sonography. MRI was helpful in demonstrating the signal characteristics of the mass; localizing the mass to within the sternocleidomastoid muscle; and demonstrating clear surrounding fascial planes with lack of associated lymphadenopathy, airway compression, vascular encasement, bone involvement or intracranial/intraspinal extension associated with other neck masses.

Spectrum of ct and sonographic appearance of fatty infiltration of the liver

This report presents the common and unusual appearances of fatty infiltration of the liver (FIL) on ultrasound (US) and computerized tomography (CT) from pathological, proven cases. Potential diagnostic pitfalls and methods of avoiding these pitfalls will be emphasized. Generalized and the geographic pattern of FIL are well recognized. Focal FIL and focal sparring of the liver have a number of atypical appearances. Focal sparring has several distinct patterns (pseudotumor, glove pattern and possible metastasis), which may be confused with other pathologies. Likewise, focal FIL may simulate a space-occupied mass. Among the more helpful features used to distinguish focal FIL from other abnormalities include its lack of mass effect, low density on CT combined with increased echogenicity on US.

Abdominal tuberculosis in children

Four boys with abdominal tuberculosis, one of whom had acquired immunodeficiency syndrome, are presented. Abdominal imaging findings on plain radiography, ultrasonography, computed tomography, and gastrointestinal contrast studies included tuberculous peritonitis and ascites in all patients, tuberculous adenopathy in two, gastrointestinal tuberculosis in two, and omental tuberculosis in two. The radiographic features particularly characteristic of abdominal tuberculosis were: (1) low attenuating adenopathy with rim enhancement, (2) omental or ileocecal inflammatory mass, (3) high density ascites, and (4) gastrointestinal enteritis involving the ileocecal region. All patients had acidfast bacilli identified in cultures of bodily fluids and/or pathologic specimens and three patients had cultures positive forMycobacterium tuberculosis. The patient with a negative culture had a positive PPD skin test and a surgical specimen showing caseating granulomata and acid-fast bacilli in the omentum. The radiologist must maintain a high degree of suspicion for abdominal tuberculosis particularly in normal or immunosuppressed children with acquired immunodeficiency syndrome. Fine needle aspiration and biopsy of abdominal adenopathy, inflammatory mass or ascites may be necessary for diagnosis.Four boys with abdominal tuberculosis, one of whom had acquired immunodeficiency syndrome, are presented. Abdominal imaging findings on plain radiography, ultrasonography, computed tomography, and gastrointestinal contrast studies included tuberculous peritonitis and ascites in all patients, tuberculous adenopathy in two, gastrointestinal tuberculosis in two, and omental tuberculosis in two. The radiographic features particularly characteristic of abdominal tuberculosis were: (1) low attenuating adenopathy with rim enhancement, (2) omental or ileocecal inflammatory mass, (3) high density ascites, and (4) gastrointestinal enteritis involving the ileocecal region. All patients had acidfast bacilli identified in cultures of bodily fluids and/or pathologic specimens and three patients had cultures positive forMycobacterium tuberculosis. The patient with a negative culture had a positive PPD skin test and a surgical specimen showing caseating granulomata and acid-fast bacilli in the omentum. The radiologist must maintain a high degree of suspicion for abdominal tuberculosis particularly in normal or immunosuppressed children with acquired immunodeficiency syndrome. Fine needle aspiration and biopsy of abdominal adenopathy, inflammatory mass or ascites may be necessary for diagnosis.

Magnetic resonance imaging of postpartum pelvic hematomas: early experience in diagnosis and treatment planning

The purpose of this study was to determine the utility of magnetic resonance imaging (MRI) in detecting and localizing clinically non-apparent postpartum pelvic hematomas, and to describe the therapeutic implications of MRI in these patients. MRI examinations were performed on seven women with pelvic pain and/or fullness following difficult vaginal deliveries. None had clinically evident hematomas, and none were scheduled for surgery. Hematomas in the pelvis were identified with conventional T1-weighted, and conventional and fast spin echo T2-weighted sequences. Intravenous contrast was not used. Pelvic hematomas were identified in contiguity with the vagina, cervix, and bladder, within the broad ligament, and in the presacral space. In two patients, hematomas were confined to the perivaginal and pericervical regions. In three patients, perivaginal hematomas extended between the double layers of the broad ligaments. In one patient, a perivaginal hematoma extended into the perivesical space. In one patient, a hematoma was identified only within the presacral space. Based on MRI as the only contributory imaging study, five patients were treated successfully with invasive means and two patients were managed successfully with conservative means. MRI successfully detects and localizes postpartum hematomas, information that often is unavailable from the clinical examination. This information facilitates decisions regarding the need for intervention and the appropriate type of procedure when intervention is necessary for this potentially life-threatening problem. We advocate the use of MRI to evaluate patients at risk for postpartum hemorrhage following difficult vaginal deliveries.

Imaging findings in patients with-right lower quadrant pain: alternative diagnoses to appendicitis.

Patients with right lower quadrant (RLQ) pain referred for imaging studies with a clinical diagnosis of appendicitis may have other pathologic conditions mimicking appendicitis. Appropriate diagnostic imaging may establish other specific diagnoses and thereby play a significant role in determining proper medical or surgical treatment. In this pictorial essay, we present a spectrum of imaging findings in patients whose clinical features were suggestive of appendicitis, but the diagnoses of a broad spectrum of other diseases were established with the imaging studies. The differential diagnoses of diseases mimicking appendicitis are reviewed.

Magnetic resonance imaging findings in ovarian torsion

Hemorrhagic infarction of the ovary is a known complication of ovarian torsion. However, the imaging findings on magnetic resonance imaging (MRI) are not well known. One case report is available.’ Edema of the ovary is primarily due to obstruction of venous and lymphatic flow with continued arterial perfusion, which leads to diffuse enlargement and edema of the ovarian parenchyma and distension of the follicles due to transudation of fluid within them. The degree of torsion at this time is insufficient to cause ischemic necrosis, but is sufficient to elevate capillary hydrostatic pressure and to interfere with lymphatic drainage. With further progression of time, venous occlusion occurs, which is followed by arterial thrombosis.’ At this time, hemorrhagic infarction of the ovary results. MRI findings are reported in a case of a massively enlarged ovary with surgically and pathologically proven hemorrhagic infarction secondary to ovarian torsion. The findings differ from those previously reported.’

Degenerating Cystic Uterine Fibroid Mimics an Ovarian Cyst in a Pregnant Patient

Aleiomyoma or fibroid is the most common uterine neoplasm, with a prevalence of 20% to 30% in patients older than 30 years. 1 Most patients with fibroids are asymptomatic, but they may be infertile or have uterine bleeding, pain, or a palpable mass. 2 The sonographic appearance of a uterine fibroid is usually characterized by a homogeneous or heterogeneous hypoechoic uterine mass, but the appearance can be variable, with degenerative changes appearing as a diagnostic challenge. This report exemplifies how challenging the diagnosis could be with fibroid degeneration. This was a case of a large pedunculated cystic uterine fibroid mimicking an adnexal cyst in a pregnant patient.

A degenerating cystic uterine fibroid mimicking an endometrioma on sonography

terine fibroids are the most common benign uterine neoplasms, occurring in 20% to 30% of women of reproductive age. Fibroids can be a source of pain, bleeding, and infertility in many women and account for 30% of all hysterectomies performed in the United States.1 Generally, the sonographic appearance of uterine leiomyomas is characteristic; however, they can undergo various kinds of degeneration that can dramatically change their sonographic appearance and make the diagnosis quite challenging. Here we describe a case of marked cystic degeneration of an exophytic uterine fibroid, which sonographically simulated an endometrioma.