Reevaluation of Large Pelvic Masses after Inconclusive MRIs: A Case Report.

The lack of a classification system addressing the size of pelvic masses challenges their evaluation. The American College of Obstetricians and Gynecologists recommends using an ultrasound (US) as the first-line modality, followed by magnetic resonance imaging (MRI). However, these do not guarantee optimal assessment. We present a case of a 36-year-old woman with a large pelvic mass of unknown etiology, after being evaluated with US, a computed tomography scan, and MRI. A reassessment by a US-specialized radiologist found a stalk (≥2.0 cm) with internal bridging vessels at the uterine fundus. The mass was identified as a pedunculated myoma and removed en bloc during a total abdominal hysterectomy with a bilateral salpingectomy and an oophoropexy. A reassessment by a US-specialized radiologist could be beneficial for cases of pelvic masses with unknown etiology after an evaluation with multiple imagining studies. These specialists possess extensive knowledge and vast expertise, potentially allowing US evaluations to be more effective than MRIs.

Paratesticular Dermoid Cyst Mimicking a Torsed Supernumerary Testis: A Case Report.

BACKGROUND Paratesticular tumors are rare causes of scrotal masses; most are benign and arise from the spermatic cord. We present the case of a dermoid cyst, a rare benign paratesticular tumor mimicking a torsed supernumerary testis. CASE REPORT An 8-year-old male presented to the Emergency Department with intense pain and swelling in the left hemiscrotum. He reported severe stabbing pain in his left hemiscrotum, quantified as 10/10, and demonstrating no improvement with change in position. Ultrasonography of the scrotum showed an oval-shaped heterogeneous, predominantly hypoechoic structure observed immediately inferior and lateral to the left testicle, showing no internal vascularity. The right hemiscrotum showed no testicular structure. Based on the sonographic observations, the possibility of 2 adjacent testicles in the left hemiscrotum was raised; the one without vascularity and with hypoechoic texture suggested the presence of ischemic changes due to torsion. The differential diagnosis of a paratesticular mass includes a paratesticular tumor, mimicking of paratesticular neoplasms (i.e. polyorchidism and splenogonadal fusion) and metastases. Surgical exploration of the left hemiscrotum revealed a normal untorsed left testis with an adherent paratesticular mass. An intraoperative frozen biopsy of the mass offered the preliminary diagnosis of an epidermoid cyst. CONCLUSIONS Paratesticular tumors can clinically present variably as a mass, which can be painful. Dermoid cysts can present as a painful mass and the sonographic appearance varies from anechoic to hyperechoic according to the cyst contents. A dermoid cyst as the differential diagnosis of a painful paratesticular mass in boys is important along with the possibility of a torsed supernumerary testicle.

Sonographic Features of the Liver Among Females with Type 2 Diabetes.

The craniocaudal (CC) length of the right lobe of the liver (RLL), liver texture, size of the main portal vein, and hemodynamics of the hepatic artery, were sonographically evaluated in female diabetic and non-diabetic patients. A One-way ANOVA, a Tukey's post-hoc test, and a Kruskal-Wallis with post-hoc Dunn's test, were employed. Non-symptomatic differences in liver anatomy were detected among non-controlled type 2 diabetes patients. They exhibited the longest CC length of the RLL (p = 0.04) as well as an enlarged main portal vein (p = 0.04). Hepatic artery resistive index (RI) was higher among controlled type 2 diabetes patients (p = 0.04). These differences were not attributed to fatty infiltration. Non-controlled type 2 diabetes patients exhibited significantly higher alanine aminotransferase, lower high-density lipoprotein cholesterol, and higher triglyceride levels, than in non-type 2 diabetes patients. Longitudinal sonography may provide valuable diagnostic information in the management of type 2 diabetes.

Anatomical criteria to measure the adult right liver lobe by ultrasound.

INTRODUCTION: This study aims to establish objective anatomical criteria to obtain accurate and reliable measurements of the right liver lobe (RLL) length by ultrasound while considering sex and anthropometry of the patient. METHODS: Thirty-three (n = 33) adult participants underwent two-dimensional (2D) and panoramic (PAN) ultrasound imaging of the RLL in the anterior axillary region (AAR). Each measurement was performed in the standard oblique plane and in a tested craniocaudal (CC) plane by two independent observers. Pearson analysis was conducted to evaluate correlation between measurements and Intraclass Correlation Coefficient (ICC) for inter-rater reliability. Two-tail paired T test was used to compare groups. Statistical significance was attained at p < 0.05. RESULTS: The proposed craniocaudal 2D RLL length was 13.0 ± 1.5 cm for females and 14.1 ± 1.3 cm for males whereas PAN RLL size was 13.7 ± 1.8 cm for females and 15.0 ± 1.1 cm for males. A strong correlation between the proposed 2D CC measurement of the RLL length with PAN CC measurements was found (r = 0.87). Inter-rater reliability for 2D CC measurements showed high reliability (ICC 0.96). DISCUSSION: CC measurement of RLL by ultrasound in AAR is a precise and reliable measurement that may allow for the routine monitoring of RLL length across time.

A Case of Round Ligament Varices Presenting in Pregnancy.

BACKGROUND Round ligament varices (RLV) are rare and are almost exclusively seen in pregnant women. RLV may clinically resemble an inguinal hernia, inguinal mass, or other pathology involving the inguinal canal and round ligament. Ultrasound imaging is important to make the diagnosis of RLV. CASE REPORT A 34-year-old Hispanic woman, gravida 1 para 0, at 34 weeks gestation, presented to our outpatient department with a complaint of a small, painless, reducible right inguinal mass. Gray-scale sonography showed an asymmetric right inguinal anechoic mass composed of multiple serpentine tubular channels, which became more prominent when the patient performed a Valsalva maneuver. Color Doppler ultrasound imaging showed a hyper vascular structure with a venous flow pattern, consistent with RLV. The patient was treated conservatively and had an uneventful vaginal delivery at 38 weeks gestation. At two weeks postpartum, the RLV spontaneously regressed and her symptoms completely resolved. CONCLUSIONS RLV is a rare condition that should be recognized and diagnosed promptly to prevent patients from undergoing unnecessary surgical exploration. Ultrasound is the diagnostic imaging procedure of choice for the diagnosis of RLV, as well as for patient follow-up and to exclude possible complications associated with RLV.

Ultrasound Accuracy of Liver Length Measurement with Cadaveric Specimens.

The liver is one of the principal organs of our body involved in over 500 physiological functions related to metabolism, digestion, immunity, and storage of nutrients, which makes it an essential organ to preserve life. Given that there are a number of approaches to measure liver length through diagnostic 2D sonography, this work aims to determine the most accurate measurement of this organ. Cadaveric specimens (n = 21) were employed to assess measurements in midclavicular line (MCL) and midaxillary line (MAL). Each measurement was calculated in anteroposterior (AP) and craniocaudal (CC) planes. In addition, in situ measurements were obtained by accessing the organ through the anterior thoracoabdominal wall. Statistical differences were detected between MCL and MAL measurements (p < 0.05), a positive correlation between MAL CC and in situ anterior measurements were noted (r = 0.97). Liver size, as assessed through in situ measurements, varied as a funtion of BMI and waist circumference (p < 0.05). It is concluded that CC measurement of the RLL in MAL from the uppermost right hemi-diaphragm to the inferior tip of the right lobe through a horizontal line parallel to the anterior liver wall is the most accurate measurement of the organ by sonography.

Prenatal sonographic evaluation of two intracranial teratomas.

Prenatal sonographic evaluation is of utmost importance in the detection of congenital anomalies. At the Ultrasound Section of our Radiology service, we incidentally detected fetal intracranial neoplasms in two different patients using non-invasive imaging. Our presumptive diagnosis in both cases was a teratoma, the most common brain tumor in the perinatal period. Subsequent confirmation was provided with pathological samples obtained at autopsy in both patients, revealing immature teratomas. Fetal intracranial tumors are so rare and incredibly, these two unique cases presented in our section within just a few months of one another.

Prenatal sonographic evaluation of two intracranial teratomas

Prenatal sonographic evaluation is of utmost importance in the detection of congenital anomalies. At the Ultrasound Section of our Radiology service, we incidentally detected fetal intracranial neoplasms in two different patients using non-invasive imaging. Our presumptive diagnosis in both cases was a teratoma, the most common brain tumor in the perinatal period. Subsequent confirmation was provided with pathological samples obtained at autopsy in both patients, revealing immature teratomas. Fetal intracranial tumors are so rare and incredibly, these two unique cases presented in our section within just a few months of one another.

Asymptomatic carcinoma of the endometrium in a patient on adjunctive tamoxifen therapy for carcinoma of the breast

A case report of a 70 years old female, on tamoxifen for over five (5) years after a left mastectomy and with lymphadenectomy and radiotherapy in whom an asymptomatic adenocarcinoma of the endometrium is reported. Review of the literature suggests this association, however, definitive proof that tamoxifen causes cancer of endometrium has not been fully accepted. The best study in this regards is the one from Radiohemmet Oncologic Centre from Stockholm, Sweden. Patients with cancer of the breast that have been over two (2) years on tamoxifen should be screened with endovaginal sonograms for thickness of endometrium, thickness over 9mm and possibly over 5mm should be investigated with hysteroscopy and fractional uterine curetage