Pseudoaneurysms: Different ultrasound patterns, aetiologies and locations.

Pseudoaneurysms are frequent vascular anomalies. This review article aims to describe the unique specific aspect of pseudoaneurysm (PSA) that allows to make the diagnosis using different modalities: colour Doppler ultrasound, computed tomographic angiography, magnetic resonance angiography and conventional angiography. It is essential to know the various aetiologies of PSA: iatrogenic, traumatic, dissecting and anastomotic; different locations and the possible complications, information to help clinicians choose the best treatment. Our review is supported by illustrated series of cases.

High-Intensity Transient Signals Detected in a Renal Allograft.

High-intensity transient signals (HITS) are signals recorded by the Doppler ultrasounds, reflecting either the passage of microemboli, both solid or gaseous in the vessels, or artifacts. Their identification during Duplex US highlights the need for further evaluation to rule out a potential embolic source. A 49-year-old female was referred to our hospital for renal transplantation. The Doppler ultrasound done on day 4 after the surgery revealed the presence of high-intensity transient signals (HITS) suggesting the passage of an emboli. Renal magnetic resonance angiography (MRA) confirmed the presence of peripheral parenchymal defects suggestive of a distal embolus. A better understanding and recognition of this radiological sign are essential in order to initiate appropriate patient management when needed. In this report, we review the importance of HITS and present a case in which HITS were detected in an unusual location: an allograft kidney artery.

Longitudinal pulsatility in arterial occlusion.

This pictorial essay aims to generate attention and inform sonographers and clinicians by remembering the "longitudinal pulsatility" as an evocative B-mode echographic sign of arterial occlusion, when the artery exhibits a systolic axial motion instead of its normal radial pulsatility.

Intracranial aneurysm and recessive polycystic kidney disease: the third reported case.

OBJECTIVE: To highlight the possible association of intracranial aneurysm with autosomal recessive polycystic kidney disease. DESIGN, SETTING, AND PATIENT: To our knowledge, this association has been reported only twice in the medical literature. We herein report the case of a 21-year-old man with autosomal recessive polycystic kidney disease, presenting with subarachnoid hemorrhage secondary to a ruptured intracranial aneurysm, at our institution. RESULTS: In the presence of only 3 cases in the medical literature, one might conclude they are a simple coincidence. However, should this association exist, such as with the dominant form, then the neurologic prognosis and even the life of young patients may be at stake. CONCLUSIONS: Given the devastating consequences of intracranial bleeding in young patients, early neurologic screening may be warranted.

Ultrasonography: highly accuracy technique for preoperative localization of parathyroid adenoma.

OBJECTIVES/HYPOTHESIS: This study evaluates the accuracy of ultrasonography in guided unilateral parathyroidectomy to treat primary hyperparathyroidism. STUDY DESIGN: Retrospective study. METHODS: Two hundred fifty-three patients with primary hyperparathyroidism underwent preoperative ultrasonography. Two groups were defined. Group 1 included the patients in whom the preoperative cervical ultrasound localized one abnormal parathyroid gland; these patients underwent unilateral surgical exploration of the neck under local anesthesia. Group 2 included the patients who had a bilateral neck exploration under general anesthesia when the preoperative examination was equivocal or failed to localize the lesion, when concomitant thyroid pathology indicated thyroidectomy, and when justified by the surgical findings. RESULTS: Sensitivity and positive predictive value of ultrasonography in detecting abnormal parathyroid gland were 96% and 98%, respectively. Cervical ultrasound correctly identified, 96% and 85% of abnormal glands in groups 1 and 2, respectively. The presence of thyroid nodular disease did not affect ultrasonographic accuracy. Sonographic examination decreased the operative time of parathyroidectomy to an average of 15 minutes. Mediastinal and retroesophageal localizations of abnormal parathyroid gland adversely affected the accuracy of the ultrasound. No cervical hematoma was noted. Transient recurrent laryngeal nerve palsy occurred in four patients. Twenty-three patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at follow-up. CONCLUSIONS: Cervical ultrasound is a reliable preoperative exploration allowing parathyroidectomy via unilateral approach under local anesthesia.

The multiple ultrasound patterns of ectopic pregnancy.

Ectopic pregnancy (EP) has a variable and misleading clinical presentation contributing to the confusion with medical or other gynecological disorders. The rapid recourse to diagnostic methods, human chorionic gonadotropin (beta-hCG) titers and transvaginal ultrasonography, represents the best approach not only in the early diagnosis but also in the management and monitoring of patients with diagnosed EP. The purpose of this article is to provide a pictorial essay about EP and its multiple ultrasound (US) patterns. We present a large spectrum of EP aspects diagnosed on US and confirmed by pathology. We also review miscellaneous gynecologic diseases that may mimic EP on US. Although endovaginal US combined with quantitative (beta-hCG) analysis is an excellent tool for identifying EP, it may be normal sometimes in early pregnancies. Knowledge of all these patterns is helpful in establishing an early correct diagnosis, therefore leading to elective and conservative management in stable patients and preventing tubal rupture or substantial hemorrhage.

Intrathyroid parathyroid adenoma in primary hyperparathyroidism: can it be predicted preoperatively?

INTRODUCTION: The role of cervical ultrasonography (US)-guided surgery for intrathyroid parathyroid adenoma in primary hyperparathyroidism is rarely reported. The aim of this study was to elucidate the role of cervical US in identifying this entity. METHODS: From 1996 to 2003, cervical explorations were performed in 178 patients (mean age 57 years) with primary hyperparathyroidism. High-resolution cervical US was performed in all of the patients. Patients' characteristics were reviewed to identify predictive factors for intrathyroid adenoma. RESULTS: Cervical US identified abnormal parathyroid glands in 163 of 178 patients, with a positive predictive value (PPV) of 100%. Six patients (3.4%) were found to have intrathyroid parathyroid adenomas (two in the superior parathyroid and four in the inferior parathyroid). Cervical US predicted this anomaly in four of six patients (67%) in whom the thyroid gland was not nodular and allowed total enucleation of the adenoma to be performed in three and subtotal thyroid loboisthmectomy in three; these operations were performed uneventfully and rapidly. The PPV in this anomaly was 80%. Thirteen patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at the time of the last clinic visit, with follow-up varying from 12 to 96 months. On multivariable analysis, no factor predicted intrathyroid localization of parathyroid adenoma. CONCLUSIONS: The PPV of high-resolution cervical US for identifying an abnormal parathyroid gland was 100% in this series. It was 80% for predicting intrathyroid localization of the adenoma. This method allows us to shorten the operating time by guiding the exploration immediately toward the thyroid gland.

Spontaneous detorsion of the ovary: can it be diagnosed by MRI?

PURPOSE: To determine whether recent progress in imaging has made it possible to diagnose spontaneous detorsion, which is an accepted concept in the gynecological literature but until now has been a presumptive diagnosis that could not be confirmed because of the lack of imaging proof. MATERIALS AND METHODS: We searched for patients who had a diagnosis of spontaneous detorsion on MRI between January 2000 and January 2003, and selected only patients who met a selection of strict criteria, including mainly enlargement and hyperintensity of ovarian stroma on T2-weighted (T2W) images, clinical findings compatible with torsion and detorsion, and return of the stroma to normal size on follow-up examinations. Other signs of torsion, such as tubal thickening, were appreciated but not mandatory. Clinical follow-up for at least three years was available. RESULTS: Four patients met the study criteria. No stabilizing procedure was performed in the ovaries. One patient recurred and lost her ovary. CONCLUSION: The diagnosis of torsion followed by spontaneous detorsion was made with high probability in a selected number of patients. The clinical management of such patients remains a matter of debate. Laparoscopy with oophoropexy would be useful for young patients in whom close follow-up cannot be achieved.

Variable MR findings in ovarian functional hemorrhagic cysts.

PURPOSE: To describe the magnetic resonance (MR) findings in ovarian functional hemorrhagic cysts (FHC). MATERIALS AND METHODS: A total of 21 patients with 22 FHC, proven by follow-up ultrasound (US) in 11 women and surgery in 10 women, had US and MR examinations within 24 hours. The study was limited to cysts with obvious an echogenic pattern. All patients had T2-weighted fast spin echo (FSE), T1-weighted spin echo (SE), and T1-weighted SE fat-suppressed sequences. RESULTS: Four cysts (18%) were hypointense on T1-weighted-images without and with fat suppression, and hyperintense on T2-weighted-images. Five cysts (23%) were hypointense on T1-weighted images without and with fat suppression but heterogenous on T2-weighted images. Five cysts (23%) were hypointense on T1-weighted images but showed intermediate signal intensity on T1-weighted fat suppression images and heterogenous signal intensity on T2-weighted images. Two cysts (9%) were entirely intermediate on T1-weighted images. Five cysts (23%) displayed high signal intensity occupying less than 30% of the cystic content on T1-weighted images and one cyst (5%) displayed high signal intensity occupying more than 30% of the cystic content. CONCLUSION: Despite an obvious echogenic pattern on US, 64% of FHC were hypointense on T1-weighted images and 18% were also hyperintense on T2-weighted images. Only 36% demonstrated intermediate or high signal intensity on T1-weighted images.

Adnexal torsion: magnetic resonance findings in the viable adnexa with emphasis on stromal ovarian appearance.

PURPOSE: To evaluate ultrasound (US) and magnetic resonance (MR) findings in the viable twisted adnexa. MATERIALS AND METHODS: Ten patients underwent US and MR studies before surgical detorsion. Corrected cross-sectional area of the ovary was defined as cross-sectional area minus areas of cysts and follicles superior to 1 cm. On T2-weighted images, signal intensity of the stroma was graded as type 1 when it was equal to that of urine and type 2 when it was less than that of urine but markedly more than the contralateral side. RESULTS: The tube was twisted in six cases and the ovary in nine cases. All adnexa were viable. The largest ovarian cross-sectional area and the largest corrected ovarian cross-sectional area of the twisted ovary were significantly larger than those of the contralateral ovary (P = 0.043 for US; P = 0.012 and 0.017, respectively, for MR). These ovaries contained types 1 and 2 hyperintensity in six cases and only type 2 hyperintensity in three cases. Tubal thickening was seen on MR in five cases. CONCLUSION: Tubal thickening, enlargement of ovarian stroma as reflected by the corrected cross-sectional area, and hyperintensity of this stroma on T2-weighted images probably related to edema were useful findings in these viable torsions.