Ronald R. Townsend

Frequency of ovarian cysts in patients with autosomal dominant polycystic kidney disease

Extrarenal cysts occur in patients with autosomal dominant polycystic kidney disease (ADPKD) most frequently in the liver. Ovarian cysts have been reported in women with ADPKD, but their frequency has not been determined. Therefore, we analyzed the historical data in our database of 337 women with ADPKD and 199 of their unaffected female family members (NADPKD). In addition, we prospectively studied 25 nonpregnant, premenopausal women with ADPKD and 25 nonpregnant, premenopausal, age-matched control women recruited from the general population to assess the occurrence of ovarian cysts. No women in either the control or ADPKD groups were receiving exogenous estrogen or progesterone. All women underwent sonographic examination using a 5- or 7.5-MHz vaginal probe. A normal ovarian follicle was defined as a fluid-filled structure less than 2 cm in average diameter, and an ovarian cyst as one of 2 cm or greater. From the historical data, 28% of the women with ADPKD gave a history of ovarian cysts compared with 18% of the NADPKD women (P < 0.05). In the prospective study, the mean age of the women with ADPKD was not different from that of the control women (40.9 +/- 1.2 v 39.3 +/- 1.2 years; P = not significant [NS]). There was no difference in frequency of normal follicles found in women with ADPKD or controls (80% v 96%; P = NS), nor was there a difference in the frequency of ovarian cysts found in women with ADPKD or controls (12% v 12%; P = NS). There was no difference in the calculated ovarian volumes between the women with ADPKD and controls (9.9 +/- 2. 5 v 7.2 +/- 1.2 cm3). Among the women with ADPKD, there was no correlation between mean ovarian volume and mean renal volume, nor was there a significant relationship between the occurrence of hepatic cystic disease and ovarian cysts. Therefore, a prospective imaging study suggests that ovarian cysts have no increased frequency in women with ADPKD compared with women in the general population.

Von Hippel-Lindau disease masquerading as autosomal dominant polycystic kidney disease

The diagnostic confusion in differentiating the various causes of renal cystic diseases in adults is well documented. This confusion can include misclassifications between autosomal dominant polycystic kidney disease (ADPKD) and von Hippel-Lindau disease (VHL). We describe such a case of VHL. A review of the literature and of the patients in our database regarding typical features of each disease, mean age of onset, and frequency of these features was undertaken to provide helpful differentiating features. Pancreatic cysts are one differentiating feature. In VHL, pancreatic cysts can occur in 70% of patients, often are multiple, and rarely may cause exocrine or endocrine insufficiency. Pancreatic islet cell tumors occur. In ADPKD, pancreatic cysts are found in only 9% of patients, usually are single and asymptomatic, generally occur in conjunction with cystic liver disease, and are not found in children or unaffected family members. Pancreatic malignancies do not occur with increased frequency in ADPKD. A different pattern, especially in patients without a strong family history of ADPKD, may be a clue to VHL masquerading as ADPKD. Genetic mutation screening of the VHL gene should be used in these patients.

Night call in U.S. radiology residency programs

RATIONALE AND OBJECTIVES We acquired information about resident call in radiology programs throughout the United States to allow programs to compare themselves with others and to learn of possible alternate approaches to similar clinical and educational needs. METHODS A 30-question survey was mailed to the program directors of all accredited U.S. radiology residency programs. A second mailing was sent to program directors who did not respond within 3 months. The survey addressed questions of the timing of call during residency training, the frequency of call, the nature of the call experience, and the relation to fellow and faculty call. Questions regarding available technical assistance, resident clinical activities postcall, faculty review of oncall studies, and other relevant issues were included. RESULTS One hundred sixty-six of 206 (81%) of the program directors responded. The amount and type of call taken by radiology residents was highly variable in different programs. The mean number of in-house call days per month was 2.9 (SD = 2.6), 3.3 (SD = 2.2), 2.4 (SD = 1.9), and 1.3 (SD = 1.6) for first-, second-, third-, and fourth-year residents, respectively. The nature of technical and fellow/faculty assistance available to the resident was also variable. CONCLUSION Night call in U.S. radiology residency programs is variable but tends to be concentrated in the second year of residency. Fourth-year residents take less call than other residents, especially close to the time of the written and oral board examinations. Although program directors were satisfied with many aspects of their call systems, most indicated at least one major change they would like to make.

Sonographic Detection of a Twin Ectopic Pregnancy

The use of endovaginal scanning can greatly enhance the ability to diagnose twin ectopic pregnancy, a rare phenomenon, before surgery. A case is presented in which a living twin ectopic pregnancy was detected by endovaginal ultrasound.

Sonographic Diagnosis of Gangrenous Cholecystitis

Gangrenous cholecystitis is an advanced form of acute cholecystitis that is associated with an increased complication rate. Although somewhat controversial, common belief is that patients with nongangrenous acute cholecystitis can be treated medically followed by elective surgery. However, all agree, patients with gangrenous cholecystitis should undergo emergent cholecystectomy. Ultrasound can play an important role in this situation, by helping to differentiate those patients who require emergent surgical therapy from those who do not.

Intratesticular Spermatocele in Occurrence With Seminiferous Tubular Ectasia

The sonographic findings of an intratesticular spermatocele occurring with seminiferous tubular ectasia are discussed. A literature review revealed that intratesticular spermatoceles are extremely rare. This uncommon finding, as well as the etiology and ultrasound appearance of epididymal spermatoceles, tubular ectasia, and intratesticular cysts, are included. Awareness of the appearance of these benign entities may eliminate the need for more invasive diagnostic procedures.

Bilateral Intratesticular Masses in a Patient With Congenital Adrenal Hyperplasia

Male patients with congenital adrenal hyperplasia are at risk for testicular tumors of adrenogenital syndrome (TTAGS). This case report discusses the etiology of this disease and its sonographic findings.

Atypical Sonographic Appearance of Testicular Epidermoid Cyst

A case of an epidermoid cyst with an atypical sonographic appearance is presented. Although ultrasound may aid in the diagnosis of this entity, it is not definitive.