Lactating adenoma: US features and literature review.

PURPOSE: To describe the ultrasonographic (US) features of adenoma in a lactating breast. MATERIALS AND METHODS: The US scans of 11 lactating adenomas in nine patients aged 25-36 years examined in 1991-1996 were retrospectively reviewed. In all lesions, diagnoses were cytologically or histologically proved after US-guided fine-needle aspiration biopsy (eight lesions) or core biopsy (three lesions). Six patients were lactating, and three patients were in the third trimester of pregnancy. The US features analyzed were shape, orientation to the chest wall, border characteristics, echogenicity, homogeneity, enhancement or shadowing, and depth within the breast. RESULTS: Most lesions had benign US features such as ovoid shape with the long axis parallel to the chest wall (10 of 11), well-defined margins (eight of 11), homogeneous echotexture (eight of 11), and posterior acoustic enhancement (10 of 11). Four lesions had US features that resembled malignant lesions, such as irregular margins, heterogeneous echotexture, and posterior acoustic shadowing. CONCLUSION: The US features, although generally benign, are not specific. Tissue sampling with fine-needle aspiration biopsy is recommended. Core biopsy is necessary if a diagnosis cannot be made with the aspirate but is not performed initially because of the possibility of milk fistula formation.

Palisading granulomas of the prostate associated with prior prostatic surgery.

We report a case of a unique granulomatous lesion of the prostate and recurrent bladder neck obstruction. The lesion was histologically identical to a rheumatoid nodule and it has only been seen in patients who have undergone prior prostatic surgery. There appears to be no clinical correlation with connective tissue disease, and the lesion differs clinically and morphologically from other types of granulomatous prostatitis.

The ultrasonic appearance of intravascular gas in fetal death.

Real-time ultrasonography permits an accurate diagnosis of intrauterine fetal death by documenting absent cardiac motion. Occasionally, intravascular and/or intracardiac gas arises from maceration following fetal demise. The presence of gas in the heart and circulatory system alters the ultrasonic appearance of the fetal body. What may appear to be technically poor visualization of the fetus secondary to tissue maceration, oligohydramnios, or maternal factors may, in fact, be due to reverberation artifacts produced by intravascular gas. These characteristic echogenic foci have been radiographically proven to represent intrafetal gas. Recognition of the appearance of gas in the circulatory system is important since gas is a pathognomonic sign of fetal death.

Klatskin tumors of the bile ducts: sonographic appearance.

The authors present 3 cases of surgically proved Klatskin tumor diagnosed by ultrasound alone. Sonographic features of these tumors include (a) dilatation of the intrahepatic biliary ducts but not the extrahepatic duct, (b) non-union of the right and left hepatic ducts, and (c) small, solid masses at the hepatic hilus. Local spread to the liver may also be seen. If the pancreas appears normal and no primary tumor can be found, Klatskin tumor can be diagnosed with a high degree of accuracy.

Ultrasonographic evaluation of the gallbladder in mucocutaneous lymph node syndrome.

Hydrops of the gallbladder was diagnosed by ultrasonography in five out of ten consecutive patients with mucocutaneous lymph node syndrome (MLNS). Certain signs and symptoms were correlated with the development of hydrops. Follow-up ultrasonography revealed the return of the gallbladder to normal size in four out of four patients. One patient was lost to follow-up. Hydrops of the gallbladder in patients with MLNS appears to be a self-limiting condition with a benign course.

Biliary tract dilatation in the nonjaundiced patient.

The significance of intra- or extrahepatic biliary distension (or both) in 33 anicteric patients was investigated. The entire biliary tree and pancreas were sonographically evaluated. Correlation with the biochemical profile, cholangiography, endoscopy, and surgery were obtained when available. Fourteen patients had common bile duct stones, nine had partially obstructing masses, four had papillary stenosis, and three had common bile duct strictures. Two postcholecystectomy patients had dilatation without obstruction. Two patients had mild intrahepatic biliary tract distension without other evidence of biliary tract disease. Sonography is a more sensitive indicator of partial obstruction of the biliary tract than the serum bilirubin. If biliary distension exists, further investigation is warranted, unless an obstructing lesion is clearly defined by the sonogram.

The nonspecificity of the thyroid halo sign.

In a series of 28 patients with solitary solid thyroid masses, 10 of the patients had a mass surrounded by a rim of decreased echoes or by an echo-free rim, previously termed the halo sign. Eight of these lesions were benign, being either adenomas or benign nodules; however, two halos were also demonstrated surrounding proven carcinomas. The presence of the halo in both benign and malignant disease is illustrated, and the possibility of pericapsular inflammatory infiltrate as its underlying anatomic correlate is suggested.

Ultrasonography of pancreatic lithiasis.

The ultrasonograms of 13 patients with pancreatic lithiasis associated with chronic alcoholic pancreatitis were reviewed and compared with the abdominal radiographs. Although plain radiographs were sufficient to establish the presence of pancreatic calcifications, in many cases ultrasound provided the additional information concerning duct dilatation and lithiasis in the main duct. The progressive formation of stones with extrusion into the duct of Wirsung was observed in one case. Ultrasound enabled assessment of pancreatic size and detection of focal enlargement or associated carcinoma. Ultrasound serves as a useful guide to appropriate clinical management in patients with this disease.

Ultrasonic detection and aspiration confirmation of intra-abdominal collection of fluid.

In patients clinically suspected of possessing intra-abdominal abscesses, ultrasonic imaging is an effective way of detecting suspicious localized fluid collections. However, definitive diagnosis depends upon sampling the fluid collections, which can be most easily performed by percutaneous fine needle aspiration of the collection under ultrasonic guidance. Sixty-six patients suspected of having intra-abdominal abscesses had localized fluid collections demonstrated by ultrasonic scanning. The composition of the fluid was proved in 40 patients by percutaneous aspiration; in 26, by surgical drainage alone, and in 30, by both methods. The aspiration procedure is relatively painless, rapid and free of complications.

Ultrasonic characteristics of pancreatic tumors.

The ultrasonic features of 40 pancreatic tumors were analyzed. The tumors were categorized by texture, attenuation, shape, size, and location. Secondary effects of pancreatic duct visualization, biliary stasis, splenic vein involvement, metastases, and ascites were reviewed. Thirty of thrity-one adenocarcinomas had a similar ultrasonic texture consisting of a background of faint, low-level echoes with varying amounts of superimposed coarse echoes. Tumors are detectable prior to enlargement or distortion of the pancreas. Secondary features were present in 94% of the adenocarcinomas. Significant information regarding the possibility and complexity of resection can be provided.

Ultrasonography of biliary tract dilatation without jaundice.

The significance of intrahepatic biliary distension in the nonjaundiced patient was studied. Biochemical profiles and endoscopic and surgical findings were evaluated. Biliary tract disease was proven in 11 of 12 patients, with nine of the 11 having concurrent pancreatic disease. Ultrasound proved a more sensitive indicator of partial biliary obstruction than the serum bilirubin levels. The biliary tract of nonjaundiced patients with ultrasonographic evidence of biliary distension should be evaluated by additional studies regardless of the biochemical profile.

Ultrasonic demonstration of the pancreatic duct: an analysis of 41 cases.

Ultrasonically visualized pancreatic ducts seen in patients over two and a half years were reviewed. Pancreatic ducts ranging from 2 to 16 mm were identified in 41 patients. All proved to have pancreatic disease. Of these, 25 had inflammatory disease, including acute pancreatitis, chronic pancreatitis, and pancreatolithiasis, and 16 had ampullary or pancreatic head tumors. There was no correlation between the pancreatic duct diameter and the underlying pathology. A careful search for tumor must be made in all patients in whom the pancreatic duct is demonstrated, using current gray-scale instrumentation.

Ultrasonography of hemorrhagic splenic cysts.

Cysts arising from the spleen are much less common than those arising from other organs such as kidney, liver, and ovary (1). Hemorrhagic cysts of the spleen are rare (1), but we have encountered two patients with this entitiy. The ultrasonograms in each patient demonstrated gravity-dependent layering of two fluids of distinctly different echogenicity. The fluids were contained within a spherical mass. Acoustic enhancement was exhibited behind the mass in each case. This suggested the diagnosis of hemorrhagic cyst.

Ultrasonically guided antegrade pyelography.

Guided by ultrasound percutaneous antegrade pyelography can be accomplished with great ease in patients with obstructive hydronephrosis. The exact location and the depth of the dilated renal pelvis can be determined accurately with the use of ultrasound and the procedure is similar to that of a cyst puncture. Antegrade pyelography provides significant diagnostic information on the nature of the obstructive lesion and can be performed as an adjunct to a retrograde study or as an alternative to a retrograde pyelogram. Ultrasound is considered a most advantageous aid to the performance of antegrade pyelography.

Ultrasound guided fine-needle aspiration biopsy of abdominal masses.

Twenty-six cases of ultrasonically guided percutaneous fine-needle aspiration biopsies of abdominal masses are reported. Included are masses in the pancreas, retroperitoneum, liver, kidney, and pelvis. Aspiration biopsies accurately diagnosed or excluded malignancy in 21 patients (81%). The procedure, performed under local anesthesia, is rapid, simple and almost painless. No complications occurred; specifically, there was no hemorrhage, peritonitis, or spread of tumor along the needle tract.