Urothelial cancer of the renal pelvicaliceal system: unusual imaging manifestations.

Unusual imaging features of urothelial cancer of the renal pelvicaliceal system can be challenging for any radiologist. These manifestations include noncalcified and calcified focal infiltrative parenchymal masses, incidentally detected tumors in a hydronephrotic kidney due to ureteropelvic junction obstruction, transpelvic infiltrating solid masses extending through the retroperitoneum, and tumors primarily invading the perirenal fat. Less common manifestations include massive papillary frond-like projections within a large hydronephrotic sac, large multiloculated cystic masses with thick and irregular septa, tumors invading the renal vein, and paraaortic lymph node metastases as the only sign of an undetectable primary tumor of the renal collecting system. Radiologists should be aware that an eccentric, focal, infiltrative pelvicaliceal carcinoma that causes distortion of the renal contour may simulate renal cell carcinoma; when calcified, such a pelvicaliceal carcinoma may simulate chronic inflammatory renal disease. The radiologist should also be aware of the importance of a meticulous sonographic evaluation of a hydronephrotic kidney, particularly in older patients, to avoid missing a urothelial cancer. When a nonfunctioning and enlarged kidney is present, radiologists should always consider infiltrative hydronephrotic urothelial carcinoma as a diagnostic possibility. Familiarity with unusual imaging features of urothelial cancer of the renal pelvicaliceal system may facilitate making the correct diagnosis, thus enabling adequate therapeutic management.

New sonographic aspects of peyronie disease.

OBJECTIVE: The aim of this study was to evaluate the role of sonography in the identification of several types of lesions seen in patients with Peyronie disease (PD). METHODS: A total of 78 patients were examined. Penile lesions were counted, classified, and categorized according to their anatomic location and sonographic presentation. RESULTS: The classic sonographic presentation, as well as less common and novel findings, are described and correlated with clinically relevant data and physical examination findings. CONCLUSIONS: Sonography can precisely assess the size and location of the plaques found in PD and can also aid in treatment.

Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs.

Scrotal ultrasonography (US) is usually the initial imaging modality for evaluating patients who present with acute pathologic conditions of the scrotum. Acute epididymitis, acute epididymo-orchitis, torsion of the spermatic cord (TSC), and other acute scrotal abnormalities may have similar findings at clinical examination. Pain and swelling make the clinical examination difficult, sometimes practically impossible, potentially resulting in management delays. The objective of this review is to summarize the main clinical signs of the TSC and to illustrate and briefly discuss the US features of this entity, including gray-scale imaging, color Doppler with spectral analysis, and power Doppler sonography. Although TSC can occur at any age, it is most common in adolescent boys. The intensity of the symptoms and the US findings vary with the duration of the torsion, number of twists in the spermatic cord (degree of rotation), and how tightly the vessels of the cord are compressed. An enlarged, more spherical, and diffusely hypoechogenic testis without detectable arterial and venous testicular flow at color and power Doppler US is considered diagnostic of acute testicular ischemia. The presence of a color or power Doppler signal in one part of the testis does not exclude TSC. Positive blood flow but significantly diminished, usually near or inside the mediastinum, may be found, mainly in the partial or incomplete TSC. Identification of a large echogenic extratesticular mass distal to the site of the torsion, frequently misinterpreted as a chronic epididymitis, can be the key to the diagnosis of TSC. When a small arterial sign is found a low amplitude waveform is present with an increased resistive index on the affected side due to a diminished, absent, or reversed diastolic flow. Gray-scale imaging, color Doppler, power Doppler and pulsed Doppler with spectral analysis are very effective to make or exclude the diagnosis of TSC.

Testicular schistosomiasis caused by Schistosoma mansoni: a case report from Brazil.

Testicular schistosomiasis by Schistosoma mansoni is exceedingly rare, with only 11 cases reported in PubMed. We report a new case from Brazil. A 31-year-old man from the northeast region of the country presented with a 2 cm nodule in the right testis. Ultrasonography showed a well-delimited hypoechoic tumor, suggestive of a granulomatous lesion. Magnetic resonance imaging revealed an irregular tunica albuginea signal. A biopsy showed interstitial tissue with schistosome ova and granuloma formation. The nodule was excised, and the patient was treated with oxamniquine. He has remained symptom free for 10 years. A testicular nodule should raise suspicion of numerous pathologies, including schistosomiasis. Treatment should include therapy with oxamniquine or praziquantel, and nodule excision should be done whenever possible.

Testicular schistosomiasis caused by Schistosoma mansoni: a case report from Brazil

Testicular schistosomiasis by Schistosoma mansoni is exceedingly rare, with only 11 cases reported in PubMed. We report a new case from Brazil. A 31-year-old man from the northeast region of the country presented with a 2 cm nodule in the right testis. Ultrasonography showed a well-delimited hypoechoic tumor, suggestive of a granulomatous lesion. Magnetic resonance imaging revealed an irregular tunica albuginea signal. A biopsy showed interstitial tissue with schistosome ova and granuloma formation. The nodule was excised, and the patient was treated with oxamniquine. He has remained symptom free for 10 years. A testicular nodule should raise suspicion of numerous pathologies, including schistosomiasis. Treatment should include therapy with oxamniquine or praziquantel, and nodule excision should be done whenever possible.

Renal cell carcinoma: unusual imaging manifestations.

Unusual radiologic manifestations of a renal cell carcinoma (RCC) can present a diagnostic challenge. These manifestations include bilateral synchronous multifocal tumors, a small RCC with synchronous adrenal metastasis, and RCC associated with bulky abdominal lymphoma. Less common manifestations include multiseptated cystic carcinoma simulating a moderately complex renal cyst at ultrasonography (US), paraaortic metastatic adenopathy as the only sign of an undetectable primary renal neoplasm, RCC causing a large arteriovenous fistula, RCC simulating angiomyolipoma, and a nonfunctioning kidney due to transparenchymal renal propagation of cancer associated with a tumor thrombus occluding the renal vein. Radiologists should be aware of the possibility of tumor multifocality or of adrenal metastases from a high-grade small renal tumor, as well as of the association of RCC with lymphoma. They should also be aware of the importance of following up a multiseptated cystic mass found at US or a Bosniak category IIF renal cyst, since these lesions can serve as early indicators of cystic carcinoma. Because the clinical implications of and therapeutic strategies for RCC vary depending on imaging characterization of the nature and extent of the disease, familiarity with its more unusual radiologic manifestations facilitates accurate diagnosis and management.

Torsion of the spermatic cord: sonographic diagnosis.

This article describes the ultrasound guidelines for evaluating patients with spermatic cord torsion, including gray-scale, Doppler with spectral analysis, and color and power Doppler sonography. The sonographic and Doppler features of acute, subacute, and chronic torsion of the spermatic cord are demonstrated and discussed.

Amiloidose renal: correlaçäo histopatológico-ultra-sonográfica / Renal amyloidosis: histopathological-ultrasonographic correlation

Näo obstante ser a amiloidose uma entidade de graves conseqüências clínicas quando verifica-se acometimento renal, a literatura näo registra nenhum trabalho dirigido espcificamente à avaliaçäo ultra-sonográfica desta condiçäo. Este é o objetivo do presente estudo, em que foram avaliados seis pacientes com acometimento renal histologicamente comprovado, correlacionando os aspectos ultra-sonográficos com os achados histopatológicos. Os depósitos da substância amilóide (nos glomérulos, túbulos, vasos e interstício) foram quantificados e observou-se nítida correlaçäo entre o volume do depósito e a ecogenicidade do parênquima renal. As alteraçöes ultra-sonográficas encontradas - aumento inespecífico da ecogenicidade parenquimatosa com prevençäo da diferenciaçäo córtico-medular, regularidade dos contornos renais e modificaçöes (aumento ou diminuiçäo) nas dimensöes do órgäo -, embora näo específicas (säo semelhantes às evidenciadas em outras doenças parequimatosas renais), podem sugerir o acometimento renal em pacientes com amilidose

Contribuição da ultra-sonografia ao estudo dos Tumores testiculares / Contribution of ultrasonography to the study of testicular tumors

O presente trabalho teve como objetivo discutir e avaliar a contribuição do método ultra-sonográfico para o estudo de pacientes com neoplasia testicular. Através de estudo retrospectivo foram criteriosamente revisados 67 exames ultra-sonográficos de pacientes com diagnóstico anatomopatológico de neoplasia testicular, 57 deles com tumor primário e 10 com envolvimento secundário do testículo por neoplasia de outra sede. A eficácia do método na caracterização da morfologia e da constituição interna do tumor foi verificada. O autor também procurou testar a eficiência do método no estadiamento local das neoplasias primários do testículo. Os seminomas e os tumores não seminomatosos foram estudados com o objetivo de se detectar eventuais diferenças no padrão ultra-sonográfico apresentado. A ultra-sonografia mostrou ser método bastante útil no estudo dos tumores testiculares, contribuindo para a adequada caracterização textural da lesão e também para o seu estadiamento