Recurrence of Subepithelial Non-Muscle Invasive Bladder Cancer Following Transurethral Resection: A Case Report

Transurethral resection (TUR) is the gold standard treatment of non-muscle invasive bladder cancers. Recurrence occurs in approximately half of the patients with bladder cancer after initial TUR. Most recurrent bladder cancers present as polypoid masses with intraluminal growth originating from the mucosa. To the best of our knowledge, there has been no report on imaging findings of recurrent bladder cancers located within the subepithelial and intramural layers. Recurrent cancers within the intramural layer are difficult to detect with cystoscopy; they are also difficult to remove surgically. Imaging studies reveal the most important indicators for diagnosing subepithelial recurrent cancers. Here, we present a rare case of a recurrent bladder cancer within the subepithelial layer detected on imaging.

A Case of Xanthogranulomatous Pyelonephritis with Nephropleural Fistula Formation: Role of MRI in Diagnosis and Treatment

Xanthogranulomatous pyelonephritis (XGP) is a rare type of chronic bacterial nephritis, which rarely involves the invasion of adjacent organs or the formation of fistulas due to tissue-destructive granulomatous reactions. Although the invasions of various adjacent organs have been reported in several cases of XGP, MRI data on their features are limited. MRI has a better soft-tissue resolution than CT. Thus, it can identify the extent of extrarenal involvement in advanced XGP, and the findings can be used in treatment planning. Herein, we report a rare case of XGP with nephropleural fistula formation diagnosed using CT and MRI.

Small testes: clinical characteristics and ultrasonographic findings

The purpose of this pictorial essay is to describe the ultrasonographic and clinical findings of patients with small testes due to a wide range of causes. We retrospectively reviewed the ultrasonographic and clinical findings of various causes of small testes. We present various causes of small testes on ultrasonography including Klinefelter syndrome, testicular torsion, mumps orchitis, inguinal hernia, cryptorchidism, varicocele, and trauma. On ultrasonography, small testes in patients with testicular torsion, mumps orchitis, and trauma usually showed heterogeneous echogenicity. Atrophic testes were homogeneously hypoechoic in patients with cryptorchidism and inguinal hernia and were isoechoic to the normal testis in patients with varicocele. Klinefelter syndrome patients had small hyperechoic or hypoechoic nodules, but the echogenicity of the remnant portion of the testes was homogeneous. Ultrasonography is helpful for detecting small testes and for the differential diagnosis of the various possible causes of small testes.

Recurrence of Subepithelial Non-Muscle Invasive Bladder Cancer Following Transurethral Resection: A Case Report

Transurethral resection (TUR) is the gold standard treatment of non-muscle invasive bladder cancers. Recurrence occurs in approximately half of the patients with bladder cancer after initial TUR. Most recurrent bladder cancers present as polypoid masses with intraluminal growth originating from the mucosa. To the best of our knowledge, there has been no report on imaging findings of recurrent bladder cancers located within the subepithelial and intramural layers. Recurrent cancers within the intramural layer are difficult to detect with cystoscopy; they are also difficult to remove surgically. Imaging studies reveal the most important indicators for diagnosing subepithelial recurrent cancers. Here, we present a rare case of a recurrent bladder cancer within the subepithelial layer detected on imaging.

A Case of Xanthogranulomatous Pyelonephritis with Nephropleural Fistula Formation: Role of MRI in Diagnosis and Treatment

Xanthogranulomatous pyelonephritis (XGP) is a rare type of chronic bacterial nephritis, which rarely involves the invasion of adjacent organs or the formation of fistulas due to tissue-destructive granulomatous reactions. Although the invasions of various adjacent organs have been reported in several cases of XGP, MRI data on their features are limited. MRI has a better soft-tissue resolution than CT. Thus, it can identify the extent of extrarenal involvement in advanced XGP, and the findings can be used in treatment planning. Herein, we report a rare case of XGP with nephropleural fistula formation diagnosed using CT and MRI.

Testicular atrophy after mumps orchitis: ultrasonographic findings

Purpose@#The purpose of this study was to describe the ultrasonographic findings of testicular atrophy after mumps orchitis. @*Methods@#We retrospectively reviewed the case files of eight patients (14 to 24 years old; mean, 17 years) with mumps orchitis and testicular atrophy who were treated between January 2011 and September 2017. On gray-scale and color Doppler, the ultrasonographic features of volume, shape, echogenicity, and degree of blood flow in the testes were analyzed as part of both initial and follow-up ultrasonography. The duration between the initial diagnosis of mumps orchitis and the ultrasonographic diagnosis of testicular atrophy after mumps orchitis ranged from 25 to 230 days (mean, 95.9 days). @*Results@#Of the eight patients with testicular atrophy after mumps orchitis, the testes were affected unilaterally in seven patients (6 right-sided and 1 left-sided) and bilaterally in one patient. The affected testes (n=9) were 23%-55% (mean, 44.7%) smaller in volume (mean, 6.3±2.0 mL) than the contralateral normal testes (n=7) (mean, 10.8±2.3 mL) on follow-up ultrasonography (P=0.001). The shape of the atrophic testes was oblong in seven cases and elliptical in two cases. The atrophic testes were either heterogeneously hypoechoic with multiple hyperechoic islands (n=7) or heterogeneously hyperechoic (n=2). On follow-up color Doppler ultrasonography, the degree of vascularity of the atrophic testis was either similar to (n=3) or lower than (n=6) that of the contralateral testis. @*Conclusion@#On ultrasonography, atrophic testes after mumps orchitis tended to exhibit an oblong shape, heterogeneous low echogenicity with multiple hyperechoic islands, and decreased vascularity.

Ultrasonographic diagnosis of ovary-containing hernias of the canal of Nuck

PURPOSE: The purpose of this study is to describe the ultrasonographic findings of ovary-containing hernias of the canal of Nuck. METHODS: This was a retrospective analysis of 22 hernia cases of the canal of Nuck. The following gray scale and color Doppler ultrasonographic features were analyzed: the site and the size of the hernia, the texture of the hernia contents, and the presence or absence of blood flow in the hernia contents. RESULTS: All of the patients had swelling of the right inguinal region (n=10), left inguinal region (n=8), or both (n=2). On ultrasonography, the hernias appeared as either solid masses (n=17) or solid masses containing cysts (n=5). The mean anteroposterior diameter of the hernia sac of the canal of Nuck was 9.1 mm (range, 5 to 18 mm). The mean anteroposterior diameters of the hernia sac were 11.6 mm (range, 7.6 to 18 mm) for hernias containing an ovary, and 8.3 mm (range, 5 to 13 mm) for hernias containing omental fat. During surgery, among the 17 cases with solid-appearing hernia contents on ultrasonography, omental fat was identified in the hernia sac in four cases, but no structure was identified in 13 cases. All five cases that appeared as solid masses containing cysts on ultrasonography contained ovary tissue in the hernia sac. Among the four cases of ovary-containing hernias, color Doppler ultrasonography identified blood flow within the ovary in three cases, but no flow signal was seen in one case of incarcerated hernia. CONCLUSION: Ultrasonography may be helpful for the diagnosis of ovary-containing hernias of the canal of Nuck by detecting solid masses containing small cysts.

Preoperative Factors Predictive of Continence Recovery after Radical Retropubic Prostatectomy

PURPOSE: We assessed the factors predictive of continence recovery after radical retropubic prostatectomy performed by use a single operative technique by a single surgeon. MATERIALS AND METHODS: Preoperative factors, including age, body mass index (BMI), prostate volume, prostate-specific antigen level, and anatomical information from preoperative magnetic resonance imaging (MRI), such as membranous urethral length, thickness of the levator ani muscle, and urogenital diaphragm, were evaluated in 94 consecutive patients who underwent radical retropubic prostatectomy between April 2005 and October 2010. Patients were also categorized into four different groups according to the overlying pattern of the prostatic apex and the membranous urethra. Continence status was evaluated by direct patient questioning at 12 months after the operation. RESULTS: The overall continence rate at 12 months after the operation was 79.8%. In the age- and BMI-adjusted logistic regression analysis, the membranous urethral length and the overlying pattern of the prostatic apex were significant predictive factors of the continence rate at 12 months after the operation (p=0.006 and p=0.007, respectively). Other predictive factors were not contributory. Patients with no overlapping observed between the prostatic apex and membranous urethra had longer membranous urethral lengths (14.24+/-2.73 mm) and higher rates of recovery of continence compared with other groups. CONCLUSIONS: Membranous urethral length and shape of the prostatic apex as assessed by preoperative MRI are significantly associated with recovery of urinary continence after radical retropubic prostatectomy.

Ultrasonographic finding Paratesticular Embryonal Rhabdomyosarcoma: Case Reports

Rhabdomyosarcoma (RMS) may arise from anywhere in the body, and RMS has been recognized as one of the most frequent forms of childhood solid tumors, occurring with a frequency similar to that of Wilms' tumors and neuroblastomas. However, RMS arising in the paratesticular region is rare so that an ultrasound appearance of paratesticular RMS has rarely been reported. We report the US findings of paratesticular embryonal RMS in 15 and 19 year old males.

Ultrasonographic Findings of the Gallbladder in Patients with Acute Hepatitis A: Do They Have Clinical Relevance?

PURPOSE: To determine the association of gallbladder (GB) abnormalities on ultrasonography (US) of patients with acute hepatitis A with demographic, clinical, and biochemical factors, and with other US findings. MATERIALS AND METHODS: This retrospective study was approved by our institutional review board, which waived the requirement for informed consent. We retrospectively evaluated 152 consecutive patients with acute hepatitis A who underwent US. The diagnosis of acute hepatitis A was made during acute illness by demonstrating anti-HAV of the IgM class. US images were reviewed simultaneously by two abdominal radiologists and a consensus was reached for GB wall thickening, GB collapse, lymphadenopathy, and hepatic echogenicity. The associations between demographic, clinical, biochemical, and US findings and GB wall thickening or collapse were then assessed. RESULTS: GB wall thickening was present in 123 (81%) and GB collapse in 96 (63%) of the 152 patients. Total bilirubin level and GB collapse differed significantly (p < 0.05) between patients with and without GB wall thickening. Gender ratio, total and peak total bilirubin level, and GB wall thickness differed significantly (p < 0.05) between patients with and without GB collapse. Multivariate analysis showed that GB wall thickening was associated with GB collapse and vice versa. CONCLUSION: GB wall thickening and GB collapse are common US abnormalities associated with each other in patients with acute hepatitis A. However, GB wall thickening or collapse is not associated with any demographic, clinical, or biochemical factors, or with other US findings, in patients with acute hepatitis A.

Secondary Membranous Nephropathy with Salivary Gland Cancer / 대한신장학회지

We report here on a rare case of membranous nephropathy occurring concurrently with salivary gland cancer. A 67-year-old woman was admitted to our department for nephrotic syndrome. She was diagnosed with membranous nephropathy and this was initially managed with steroids and cyclophosphamide, which started in 2003 and continued for about 10 months, without deriving any therapeutic benefits. During the treatment, the patient was diagnosed with salivary gland cancer when an incidental salivary gland mass was discovered in 2005. The patient's urinary protein level began to decrease following resection of the malignant mass. The clinical findings represent an interesting case of secondary membranous nephropathy that was diagnosed prior to the incidental discovery of malignancy.

Quality Assessment of Ultrasonographic Equipment Using an ATS-539 Multipurpose Phantom

PURPOSE: To determine the rate of congruence and to standardize assessment of US (ultrasound) phantom images with the use of an ATS-539 multipurpose phantom for US equipment currently utilized in Korea MATERIALS AND METHODS: US phantom images were scanned with a 3.0-5.0 MHz convex transducer and were digitized by use of an analogue-digital converter. Members of a committee with consent evaluated the US phantom images from 108 types of ultrasound equipment. The dead zone, vertical and horizontal measurement, axial/lateral resolution, focal zone, sensitivity, functional resolution and gray scale/dynamic range were evaluated. Congruence or incongruence of ultrasound equipment was determined based on the results of dead zone, axial/lateral resolution and gray scale/dynamic range measurements. Other factors were evaluated for the possibility as criteria with the use of the Mann-Whitney U test and receiver operator characteristic (ROC) curve analysis. RESULTS: The dead zone, axial/lateral resolution and gray scale/dynamic range were 91.7%, 94.4% and 76.9%, respectively, for suitable US equipment. Considering all three factors, 78 types of ultrasound equipment were passed. The congruence rate of focal zone and functional resolution were 62.4% and 69.3% of the US equipment, respectively. CONCLUSION: Of the US equipment, 72.2% of the equipment was acceptable based on the dead zone, axial/lateral resolution, and gray scale/dynamic range measurements as determined with the use of an ATS-539 phantom. Focal zone and 8 mm-functional resolution can be useful as a standard in the assessment of a US phantom image.

Exophytic Benign and Malignant Hepatic Tumors: CT Imaging Features

Our objective is to describe the CT features of exophytic hepatic tumors those may pose a diagnostic challenge because of the uncertainty of tumor origin. The beak sign and the feeding artery of a tumor are useful diagnostic indicators of exophytic hepatic tumors. Two- or three-dimensional reformation images are also helpful for diagnosis. The CT features of exophytic hepatic tumors are similar to those of the usual intrahepatic tumors except for their location.

Proper Measurement of the Prostate Volume by Transrectal Ultrasound: Experimental Study about the Prostate with Focal Intravesical Protrusion of the Enlarged Central Gland

PURPOSE: To evaluate the proper volume measurement of prostate with focal intravesical protrusion of enlarged central gland by comparison between methods using craniocaudal length from top of protruded central gland and from prostate base near bladder neck to prostate apex. MATERIALS AND METHODS: We made 20 prostate models with focal intravesical protrusion (volume range: 20~50 mL, height of protrusion: about 1 cm) using devil's tongue jelly. Two radiologists measured volume of models 3 times by two kinds of methods using craniocaudal length from top of protruded central gland (method 1) and from prostate base near bladder neck (method 2) by transrectal ultrasound. The accuracy of volume measurement of models was evaluated statistically by comparing their average volume to true volume. Intra- and interobserver agreement was also evaluated. RESULTS: Average true volume of models was 31.05 mL. Each average volume using method 1 by two observers was 37.07 mL and 38.56 mL. Each average volume using method 2 was 30.69 mL and 31.55 mL. Volume measurement using method 2 was approximated to true volume of prostate statistically (p = .654, .823). There was no significant inter- and intra-observer variation in both methods. CONCLUSION: To measure the accurate volume of porstate with focal intravesical protrusion of enlarged central gland, its craniocaudal length should be measured from prostate base near bladder neck.

Radiofrequency Ablation with Epinephrine Injection: In Vivo Study in Normal Pig Livers

PURPOSE: We wanted to evaluate whether epinephrine injection prior to radiofrequency (RF) ablation can increase the extent of thermally mediated coagulation in vivo normal pig liver tissue. MATERIALS AND METHODS: Eighteen RF ablation zones were created in six pigs using a 17-gauge internally cooled electrode under ultrasound guidance. Three RF ablation zones were created in each pig under three conditions: RF ablation alone, RF ablation after the injection of 3 mL of normal saline, and RF ablation after the injection of 3 mL of epinephrine (1:10,000 solution). After the RF ablation, we measured the short and long diameters of the white zones in the gross specimens. RESULTS: Three of the RF ablations were technically unsuccessful; therefore, measurement of white zone was finally done in 15 RF ablation zones. The mean short and long diameters of the white zone of the RF ablation after epinephrine injection (17.2 mm +/- 1.8 and 20.8 mm +/- 3.7, respectively) were larger than those of RF ablation only (10 mm +/- 1.2 and 12.2 mm +/- 1.1, respectively) and RF ablation after normal saline injection (12.8 mm +/- 1.5 and 15.6 mm +/- 2.5, respectively) (p < .05). CONCLUSION: RF ablation with epinephrine injection can increase the diameter of the RF ablation zone in normal pig liver tissue.

Significance of Hypoechoic Lesion and Increased Blood Flow on Transrectal Ultrasound for Prostate Cancer Detection / 대한비뇨기과학회지

PURPOSE: A hypoechoic lesion is the most common finding of prostate cancer, but its diagnostic value is still an area of debate. The diagnostic significance of a hypoechoic lesion and the increased blood flow observed on transrectal ultrasonography (TRUS) were evaluated for the detection of prostate cancer. MATERIALS AND METHODS: The records of 266 patient's, between January 2003 and December 2005, were retrospectively reviewed. The cancer detection rates were compared according to the presence of a hypoechoic lesion in TRUS, and estimated with respect to stratification of the prostate- specific antigen (PSA) value and digital rectal examination (DRE) findings. RESULTS: The overall cancer detection rate was higher in the hypoechoic (40 of 101 cases, 39.6%) than in the isoechoic group (30 of 157 cases, 19.1%) (p10), the cancer detection rate apparently increased in those with a hypoechoic lesion in TRUS (10.3 vs. 0%, 25 vs. 13.6% and 68.2 vs. 31% respectively) (p0.05). CONCLISIONS: The hypoechoic finding on TRUS not only supports the detection of prostate cancer, but also has independent diagnostic value. However, the findings of color Doppler are not helpful in the detection of prostate cancer.

Epididymitis Complicated by Testicular Infarction: A Case Report

Testicular infarction is caused most commonly by acute testicular torsion, but rarely by epididymitis. We report color Doppler sonographic findings and Doppler spectrum in a 56-year-old man with epididymitis that was complicated by testicular infarction.

Granulomatous Prostatitis: Gray-scale Transrectal Ultrasonography and Color Doppler Ultrasonography Findings

We report here three cases of granulomatous prostatitis. All cases were confirmed by a transrectal ultrasonography (TRUS)-guided core biopsy of the prostate. Two cases received intravesical BCG therapy for a bladder tumor, and one case had no known predisposing condition. Gray-scale TRUS showed low echoic nodules in the outer gland in all cases. Color Doppler ultrasonography (CDUS) showed several dot-like blood flows within the low echoic nodules in two cases and several dot-like blood flows and short linear blood flows within the low echoic nodules in one case. Gray-scale TRUS findings of granulomatous prostatitis are similar to findings of prostate cancer. On CDUS, several dot-like blood flows or short linear blood flows were noted within the low echoic nodules in patients with granulomatous prostatitis. If low echoic nodules with dot-like or short linear blood flows are noted in patients with genitourinary tract tuberculosis or previous BCG therapy, granulomatous prostatitis should be included in the differential diagnosis. However, a prostatic biopsy is required for a final diagnosis.

Simultaneous occurrence of a granulosa cell tumor and a serous cystadenoma in the same ovary: A case report / 대한산부인과학회지

This is the first case report of a patient with a large serous cystadenoma accompanied by a juvenile granulosa cell tumor that was discovered in the remaining ovarian tissue. A 25-year-old female was presented with constipation and amenorrhea. Ultrasonography revealed a large cystic mass in the left ovary with a normal uterus. The remaining ovarian tissue seemed normal at first look after cystectomy, but showed abnormal consistency on palpation. The remaining ovarian tissue was removed and granulosa cell tumor was confirmed by pathologic examination. The patient has been followed up for 30 months without evidence of recurrence. We would like to emphasize the importance of inspection, and palpation of remaining ovarian tissue during operation to avoid risks of remaining ovarian pathology.

Radiologic Findings of Perforated Jejunal Diverticulitis: A Case Report

We report a case of perforated jejunal diverticulitis in a 68-year-old man with iatrogenic Cushing's syndrome. The patient presented with right upper abdominal pain. Ultrasonography showed a hypoechoic structure connected to a small bowel loop, and subsequent CT examination showed multiple diverticula in proximal jejunal loops with free air trapped within the mesenteric leaf. Segmental resection of the jejunal loop confirmed jejunal diverticulitis with perforation.