Testicular microlithiasis: sonographic and clinical features.

Eleven cases of bilateral diffuse microlithiasis of the testes were evaluated sonographically. The presence of testicular microlithiasis was coincidental to the presence of testicular neoplasms (n = 2), nontesticular malignant lesion in the abdomen or chest (n = 2), subfertility (n = 2), varicocele (n = 1), epididymitis (n = 1), testicular maldescent (n = 1), scrotal trauma (n = 1), and transient scrotal pain (n = 1). Clinical follow-up suggested that testicular microlithiasis is an asymptomatic nonprogressive condition. Sonographic examination of testicular microlithiasis shows diffuse hyperechoic nonshadowing foci measuring 1-2 mm in diameter throughout both testes. The diagnosis of testicular microlithiasis was pathologically proved in five cases. In six cases, the diagnosis was made on the basis of the sonographic appearance (n = 6), clinical information and follow-up (n = 6), and radiologic demonstration of testicular microcalcifications (n = 3). The sonographic appearance of testicular microlithiasis is specific, and we believe that biopsy or orchiectomy in these cases is unnecessary.

The safe intercostal approach? Pleural complications in abdominal interventional radiology.

Six serious pleural complications (three empyemas, two hemothoraces, and one bilious effusion) have occurred after use of the right intercostal approach to the upper abdomen in 230 interventional radiologic procedures performed over the last 3 years. The anatomy of the pleural reflection in the right costophrenic sulcus is reviewed and correlated with a dissection study of the course of right intercostal needle punctures in three cadavers. The pleural reflection reaches the level of the 10th rib in the midaxillary line, and in the cadaver study, all 9th- 10th interspace punctures clearly traversed pleura, diaphragm, and peritoneum to reach the liver. The widely held belief among radiologists that the pleura can be deliberately avoided in transhepatic cholangiography and biliary drainage is shown to be false. It is believed that most needle punctures traverse the costophrenic sulcus, through pleura but below lung, despite the low incidence of reported pleural complications. a left subxiphoid approach avoiding the pleura is recommended in patients with abscesses, ascites, emphysema, anxiety, and, in the case of biliary drainage, benign or purely left-sided disease. When using the intercostal approach, the minimum number of needle passes, careful route planning, antibiotic prophylaxis, and postprocedural chest radiography are strongly recommended.

The effects of tissue velocity changes on acoustical interfaces.

Three case reports illustrate the changes in a distal acoustic interface after transmission of an ultrasonic beam through a tissue containing two different tissue velocities. The "break" created in the distal interface should be recognized and should not be interpreted as representing a pathologic change.

Sonographic demonstration of air-fluid levels in abdominal abscesses.

Abdominal sonograms were obtained for three patients who had clinically suspected abscesses. There were abnormal fluid collections that, when viewed from a posterior position, demonstrated a horizontal line representing an air-fluid level. Abdominal abscesses containing air were confirmed by both horizontal beam radiography and surgery. Since ultrasound examination is frequently performed before radiography in patients thought to have abscesses, it is important to look for and recognize the sonographic appearance of an air-fluid level.

The effect of doxapram on fetal breathing in the sheep.

In five ewes of 105 to 120 days gestation intravenous doxapram (1.8 to 3.85 mg/kg) administered to the mother produced a dose-related increase in fetal breathing. This effect of doxapram might prove useful as a test of human fetal health. Fetal breathing movements could be a sensitive indication of the effects of drugs on the human fetal respiratory system.