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.

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.

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.

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.

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.

Transitional Cell Carcinoma Involving the Prostate: Transrectal Gray-scale and Color Doppler Ultrasonography Findings

We report here on three cases of prostatic transitional cell carcinoma (TCC), two confirmed by transrectal ultrasonography (TRUS)-guided core biopsy and one by transurethral resection of the prostate. TCC was found in the right distal ureter in one case, in the urinary bladder in another, and was confined within the prostate in the third. On gray-scale ultrasonography (GSUS), two cases showed focal, low echoic lesions in the outer gland, and differentiation between the inner and outer glands was difficult. The third case showed no definite focal prostatic lesion. On color Doppler ultrasonography (CDUS), two cases showed diffusely increased blood flow in the entire prostate, and the third showed focally increased blood flow in the inner gland. The serum prostatic specific antigen (PSA) levels were normal in all three patients. The GSUS and CDUS findings of TCC involving the prostate were similar to those of prostatic cancer. In the case of normal serum PSA levels, the presence of focal, low echoic lesions and increased blood flow of the prostate in those patients with previous or current TCC in the bladder or upper urinary tract may be the distinguishing manifestations of TCC involving the prostate.

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.

Santorinicele without Pancreas Divisum: Diagnosis with Multi-Detector Row CT and MR Cholangiopancreatography

A santorinicele is a cystic dilatation of the dorsal pancreatic duct at the minor papilla, and has been reported in patients with pancreas divisum and pancreatitis. Santorinicele without pancreas divisum is extremely rare, with only one case being previously reported. We present here a case of santorinicele that was observed as a cystic dilatation of the distal dorsal pancreatic duct at MCDT, and had communication between the ventral and dorsal pancreatic ducts. Additionally, MRCP and ERCP firmly confirmed the presence of a santorinicele.

Ultrasonographic Findings of Acute Renal Vein Thrombosis in Experimental Rabbit Model: Focus on Renal Doppler Sonography

PURPOSE: To evaluate Doppler sonographic findings of acute renal vein thrombosis in rabbit model induced by renal vein ligation, with an emphasis on the changes in resistive index (RI) on serial follow-up. MATERIALS AND METHODS: Conventional and Doppler sonographies were performed immediately after ligation and 24, 48, and 72 hours after ligation in 12 rabbits weighing 4.5-5.0 kg. We focused on changes in kidney size and echogenicity with conventional sonography and resistive index by time interval and Doppler waveforms with Doppler sonography. RESULTS: Kidney size increased markedly immediately after ligation, and increased slowly until 48 hours after ligation with no change observed afterwards. Echogenicity increased both in the renal cortex and the medulla. RI increased remarkably to an average of 1.38 immediately after ligation, and increased to a peak average of 1.64 48 hours after ligation. After 72 hours RI decreased slightly to 1.59. Reverse 'plateau-like' diastolic waveform was seen in 27 trials (56%) on follow up Doppler sonograms. CONCLUSION: The increase in RI was thought to be due to the increase in renal arterial vascular resistance caused by venous outflow obstruction. The decrease in RI with time suggested adaptation of intrarenal circulation to renal vascular change. Also, the reverse 'plateau-like' diastolic waveform was the predominant waveform.

Radiological Findings of Male Urethral Duplication Associated with Bladder Duplication: Case Report

Urethral duplication or accessory urethra is a rare congenital anomaly. Even rarer, is its association with bladder duplication. We report a case of urethral duplication associated with bladder duplication in a seven-year-old boy who underwent retrograde urethrography, sonography and magnetic resonance (MR) imaging. While retrograde urethrography can demonstrate the extent of the duplicated urethra, MR imaging and sonography can provide detailed information on the anatomy of the adjacent tissues as well as urethral duplication.

Unilocular Extrahepatic Biliary Cystadenoma Mimicking Choledochal Cyst: A Case Report

We report here on a case of extrahepatic biliary cystadenoma arising from the common hepatic duct. A 42-year-old woman was evaluated by us to find the cause of her jaundice. Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct. Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated. Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.

Focal Nodular Hyperplasia with Retraction of Liver Capsule: A Case Report

Focal nodular hyperplasia (FNH) is characterized by the presence a central scar with radiating fibrous septa. Our case had a capsular retraction, which was the result of an extension of the central scar to the surface. In addition, a hypointense scar on the T2-weighted image and a minimal enhancing central scar on the enhanced T1-weighted image, which was due to dense, sclerotic collagenous tissue, were observed. We report the first case of FNH with a capsular retraction.

Peribiliary Cysts with Intrahepatic Bile Duct Obstruction: A Case Report

Peribiliary cysts involve cystic dilatation and necroinflammatory change in the peribiliary glandular tissue of the larger biliary tree in association with portal hypertension or severe hepatobiliary disease. They are usually asymptomatic and found incidentally. However, rare cases causing symptoms or the mass effect of bile duct compression require differential diagnosis. They may be benign or malignant lesions resulting from narrowing of the bile duct and involving dilatation of the proximal intrahepatic bile duct. We recently encountered a case of peribiliary cysts associated with intrahepatic duct dilatation, and confirmed by surgery, and present the imaging and pathologic findings. Sonography and CT revealed the presence of multiple cystic lesions along the hepatic hilum, and the larger left portal tract and left intrahepatic ducts were dilated. Histopathologic examination indicated that the cysts were compressing the central bile duct.

Intramuscular Bronchogenic Cyst of Gastric Body: A Case Report

Developmental foregut cysts, whether bronchogenic, esophageal, gastroenteric or pericardial, are frequently encountered in the mediastinum, and are also occasionally found in the upper abdomen, where they can mimic adrenal, pancreatic, renal or gastric masses. We present the computed tomographic (CT) and histologic findings of an intramuscular bronchogenic cyst of the gastric body, mimicking a retroperitoneal cystic mass. CT scanning demonstrated the presence of a relatively hyperattenuating cystic mass without enhancement. Histologic examination revealed a bronchogenic cyst secreting mucoid materials.

Primary Sclerosing Cholangitis in Patients with Ulcerative Colitis: Two Case Reports

Primary sclerosing cholangitis, a chronic cholestatic liver disease, is uncommon and is characterized byinflammation and fibrosis of the bile ducts. It frequently occurs in association with ulcerative colitis. Wedescribe two cases of primary sclerosing cholangitis in patients with ulcerative colitis.

Spiral CT for the Measurement of Hepatic Metastatic Mass from Gastrointestinal Malignant Tumor: Relative Value of Arterial, Portal and Delayed Phase Scanning

PURPOSE: To evaluate the relative value of arterial, portal and delayed phase images in the measurement of hepatic metastatic mass arising from gastrointestinal malignant tumor using spiral CT. MATERIALS AND METHODS: Thirty-three with 45 metastatic tumors of the liver underwent tri-phasic spiral CT. For this purpose one or two lesions were chosen in each patient whose primary tumor was shown to be stomach cancer(n=15), colon cancer(n=16), or ileal cancer(n=1). Tumor size ranged from 1 to 12.2 (mean, 4.3)cm. Arterial, portal and delayed phase images were obtained at 30 -35 seconds, 70 -75 seconds, and 3 minutes, respectively, after the injection of contrast materials. Using a work station, two radiologists independently measured the longest diameter of the selected lesions, and a second measurement was taken three days later. Contrast, as well as intra-and interbserver differences among the three phases, was statistically analysed. RESULTS: Intra- and interobserver difference were, espectively, 2.3 and 3.8 mm during the portal phase; 3.3 and 4.6 mm during the arterial phase; and 2.9 and 4.5 mm during the delayed phase. ANOVA with Tukey's multiple comparison showed that none of these differences were statistically significant. Contrast between mass and liver parenchyma was especially clear during the portal phase (p=0.0001, using the Kruskal-Wallis CONCLUSION: Intra- and interobserver differences in the measurement of hepatic metastatic tumors were statistically insignificant during all three phases. The least difference and best contrast were seen during the portal phase.

Comparison of CT & MRI Findings in the Staging of Rectosigmoid Carcinoma According to New AJCC Classification

PURPOSE: To evaluate the diagnostic accuracy of computed tomography(CT) and magnetic resonance imaging(MRI)in the staging of rectosigmoid carcinoma according to the new AJCC classification. MATERIALS AND METHODS: BetweenAugust 1997 and October 1998, 36 patients with pathologically proven rectosigmoid carcinoma who underwent preoperative CT and MRI were evaluated. CT scans were performed with spiral CT in 27 cases and with conventional CT in nine. In all cases, MR images were obtained using a 1.5T unit and a body arrayed coil. T1- and T2-weightedimages were obtained in axial, sagittal, and coronal planes. On the basis of the results of CT scanning and MRI,tumor stage was determined by two radiologists using the AJCC cancer staging manual(1997). They reached aconsensus and compared their results with the pathologic stage. The T-stage was T1 in three cases, T2 in two, T3in 26, and T4 in five. The N-stage was N0 in 16 cases, N1 in seven, and N2 in 13. RESULTS: In the case of CT, thediagnostic accuracy of T-staging was 67%, and that of N-staging, 44%. For MRI, the corresponding figures were 83%and 67%. For T-staging, MRI was more accurate than CT(P=0.006), but for N-staging, the diagnostic accuracy of CT and MRI was statistically equivalent (P>0.05). CONCLUSION: MRI using a body arrayed coil is a useful preoperative diagnostic tool for the local staging of rectosigmoid carcinoma.

Staging of Colorectal Carcinoma by Spiral CT with Water Enema: Correlation with Pathologic Staging Using New AJCC Classification

PURPOSE: In cases of colorectal cancer, to correlate the spiral CT staging with water enema with thepathologic staging according to the new AJCC classification. MATERIALS AND METHODS: Ninety four patients withpathologically proven carcinoma of the colon who had un-dergone spiral CT with water enema were evaluated. CTscans were obtained after enema involving about 600-1,200mL of water. Scanning was performed from thediaphragmatic dome to the symphysis pubis using 10mm collimation thickness, 12mm table feed, and 10mmreconstruction interval. The TNM stage, as seen on spiral CT, was determined without reference to the pathologicresults. Staging was performed according to the new AJCC cancer staging manual(1997). The pathologic T-stage wasT1 in four cases(4.3%), T2 in 11(11.7%), T3 in 72(76.6%), and T4 in seven(7.4%). The pathologic N-stage was N0 in57 cases(60.6%), N1 in 25 cas-es(26.6%), and N2 in 12(12.8%). The pathologic M-stage was M0 in 90 cases(95.7%) andM1 in four(4.3%). RESULTS: The detection rate of colon cancer using spiral CT with water enema was 97.9%. At theT-stage, pathologic correlation was good in 68.1% of cases(64/94). Nine patients(9.6%) were overstaged and21(22.3%) were understaged. At the N-stage, pathologic correlation was good in 54.3% of cases(51/94), with 27pa-tients(28.7%) overstaged and sixteen(17.0%) understaged. At the M-stage, pathologic correlation was good in95.7% of cases(90/94). Four patients(4.3%) were overstaged. CONCLUSION: The accuracy of staging of colorectalcarcinoma by spiral hydro-CT was 68.1% at the T-stage, 54.3% at the N-stage, and 95.7% at the M-stage. As seen onspiral CT with water enema, the T-stage tended to-wards understaging and the N-stage towards overstaging.