M E Pasto

Diagnostic capabilities of high-resolution scrotal ultrasonography: prospective evaluation.

The use of scrotal ultrasonography has been advanced with the development of high‐resolution real‐time equipment. A group of 284 consecutive patients referred for scrotal examination was studied ultrasonically and followed over a three‐year period. Abnormal scrotal contents were accurately detected in 98.5 per cent of cases. Separation of testicular from extratesticular pathology was 99 per cent accurate. While all malignant testicular lesions could be identified, there were examples which could not be differentiated from benign lesions prior to surgical exploration and biopsy. However, there are many examples where the ultrasound results can change clinical management of the patient.

The role of diagnostic ultrasonography in varicocele evaluation.

Twenty‐one patients with the clinical diagnosis of varicocele were evaluated with static and superficial organ scanners. The sonogram was able to image the dilated scrotal veins in all of these cases. The small, clinically subtle varicocele could be demonstrated only with high‐resolution, dedicated real‐time small‐parts scanners, whereas larger lesions could also be imaged with B‐mode contact equipment. Varicoceles are a well‐documented cause of male infertility amenable to surgical treatment. From this study it is felt that ultrasonography can accurately detect varicoceles. It can be used as a screening procedure so that only those men requiring therapy need undergo more extensive and complicated diagnostic procedures.

In utero analysis of heterozygous achondroplasia: variable time of onset as detected by femur length measurements.

Seven cases of heterozygous achondroplasia were examined in utero. Although the head shape and growth were normal, the initially normal femur length showed a decrease in growth and fell below the lower 99 per cent confidence limit in all cases. The time of presentation of achondroplasia varied between 21 and 27 gestational weeks. This study suggests that the diagnosis of achondroplasia can be reasonably made when the femur is abnormally short. When the femoral length is appropriate prior to 30 weeks, more caution should be taken in interpretation. Because of the variability in presentation, the fetus could be normal or still could be affected.

The sonographic diagnosis of focal and diffuse infiltrating intrascrotal lesions

Thirty-six examples of inflammatory and neoplastic disease of the scrotum were evaluated with ultrasound. Analysis of the images suggests that sonographic differentiation of these conditions is possible in certain instances. The ability to separate testicular from extratesticular pathology is quite accurate. In some cases, neoplastic disease of the testis can be differentiated from malignancy, although surgical intervention is often required for diagnosis.

Ultrasonographic findings in placenta increta.

Placenta increta, invasion of the myometrium by normal placental (chorionic) villi, can be life‐threatening to a mother at delivery. In two reported cases of pathologically proven placenta increta, the abnormal areas were retrospectively identified on ultrasonographic images. In both cases, there was consistent focal obliteration of the hypoechoic retroplacental zone by either tissue of echogenicity similar to that of the normal placenta or tissue of slightly decreased echogenicity. This was found to represent extension of the villi through the decidua basalis into the myometrium. The spectrum of non‐malignant invasive placentas and the specific ultrasonographic findings that should allow prospective diagnosis are discussed.

Polyorchidism diagnosed preoperatively by ultrasonography.

Polyorchidism, or multiple testes, is a rare condition that has been referred to in both medical literature and mythological folklore. Curious attributes have been ascribed to men with this condition, including supposed increased sexual prowess and virility. In the medical literature, the examples of supernumerary testicles have demonstrated only one additional testis. The first proven case of an extra testicle was by Lane, in 1895. Boggon reviewed 11 additional cases in 1933, and numerous other cases have been reported since then. To date, there has not been a preoperative ultrasonographic study that adequately describes this phenomenon.

DUPLEX DOPPLER EXAMINATION IN RENAL DISEASE: EVALUATION OF VASCULAR INVOLVEMENT

Evaluation of renal disease and transplant rejection has been limited to excretory urography, nuclear isotope flow studies and other more invasive procedures. The B-scan ultrasound findings are often nonspecific. The development of duplex pulsed Doppler sonography has permitted evaluation of both arterial and venous flow. Duplex ultrasound studies in patients with a suspected diminution in renal function demonstrated the ability to delineate normal and abnormal flow, limiting the differential diagnosis, and in some cases actually documented an abnormality before gross pathologic changes became evident.

Ultrasound for guidance of breast mass removal.

Hand‐held sonomammography was used intraoperatively to localize 52 masses in 45 women in an out patient operating suite. All but five women had a positive X‐ray mammogram. The ultrasound mammogram was able to identify all lesions. In 42 women studied by a preoperative ultrasound examination before the operating room procedure, all the masses were successfully identified. Precise localization was successfully performed in the operating room before sterile preparation in less than 10 minutes. Relocalization after incision in the sterile operating field was necessary in two cases. This technique requires no ionizing radiation and expedites outpatient surgical removal of the lesion. Of the 52 masses, there were 32 fibroadenomas, three carcinomas, three cysts, six cases of focal fibrous mastitis, and eight patients with focal fibrocystic disease. In patients with positive sonograms for nonpalpable masses, ultrasound localization is a fast, accurate alternative to X‐ray needle placement.

Postasphyxial encephalopathy in term infants. Sonographic demonstration of increased echogenicity of the thalamus and basal ganglia.

Sonographic abnormalities secondary to postasphyxial encephalopathy in neonates are reviewed. This report emphasizes an additional finding, increased echogenicity of the thalamus and basal ganglia, demonstrated in four term infants. This abnormal finding is generally noted in the second week following asphyxia. In some cases, the increased thalamic echogenicity may be a temporary finding. A representative case is described and possible pathologic correlates are discussed.

Mesenteric chylous (lymph-containing) cyst

Mesenteric cysts are uncommon entities and chyle (lymph)-containing cysts are the rarest of this group. A case report of a chylous cyst with CT demonstrating unique fat and soft tissue fluidfluid levels is presented.