Thursday, December 30, 2010

Sonography of renal sinus lipomatosis

This middle aged patient presented with non specific complaints and we did a routine abdominal ultrasonography on him. This is what we found on ultrasound imaging of the kidneys:














Both kidneys showed echogenic matter within the region of the renal sinuses- and this was more prominent in the left kidney. The large echogenic mass like appearance in the lower part of the left renal sinus prompted us to think that this could be angiomyolipoma, one of the more common entities in the kidney. However, further imaging showed that this hyperechoic deposit was almost totally within the confines of the renal sinuses. Besides the lesions were bilateral.
 See ultrasound video clips below:
video 
Further observe the vessels within the renal sinus of the left kidney in this color Doppler ultrasound video clip below:
video 
The most obvious diagnosis based on these ultrasound images and video clips is renal sinus lipomatosis.
The uniformly homogenous appearance of the fatty tissue in the renal sinus suggests lipomatosis rather than any more ominous masses/ malignancies of the renal sinus. These ultrasound findings are suggestive of a grade -1 renal sinus lipomatosis of both kidneys.
References: http://www.jultrasoundmed.org/cgi/reprint/21/9/993 (free excellent article with images)
For more ultrasound/ color Doppler images of this case see:

Saturday, December 11, 2010

Subependymal cysts:

This neonate has a relatively large subependymal cyst close to the caudato-thalamic groove (ie the groove between the caudate nucleus and thalamus) of the fetal brain. Ultrasound videos taken in both the sagittal and coronal sections help confirm this diagnosis. The ultrasound video clip below shows a coronal section of the neonatal brain with the lesion displayed well.
video 
The ultrasound video clip below shows a sagittal section through the neonatal brain displaying the subependymal cyst. The video clip pans from the lateral to the medial aspect of the neonatal brain, with focus on the subependymal cyst.




video
Still ultrasound images of this same neonatal brain are shown below: (see coronal images below):


























This supendymal cyst is almost 7 to 8 mm. in dimension and needs careful follow up ultrasound imaging.
Parasagittal section image below shows another view of the subependymal cyst:













Visit:
http://www.ultrasound-images.com/pediatric.htm#Another_complication_of_subependymal_hemorrhage-_subependymal_cysts for more information and images of similar cases.

Saturday, December 4, 2010

Blunt trauma to testes with rupture:

This 25 yr. old male came to me with a history of severe blunt injury to the left scrotum. On inquiring further, he reported that the part of a heavy machine hit him squarely without causing any bleeding. However, the left scrotum was moderately swollen and markedly painful.
Ultrasound imaging of the scrotum revealed (see ultrasound video clip below):
video
 Observe the large hypoechoic (dark) inhomogenous area in the left testis. This is a typical appearance of an intratesticular hematoma. But is that all? The right half of the video shows partial rupture of the outer covering of the left testis (tunica albuginea). Do we see anything more? There is some spillage of the lateral part of the testicular parenchyma outside the confines of the testicular capsule.
See some more color Doppler ultrasound videos of this testicular trauma- below:
video
Observe normal vascularity (blood flow) of the main testicular tissue (in the above long section of the left testis). This is a good sign and shows that the injured left testis is viable and does not need to be removed surgically. However, the lower pole of the left testis does show vessels entering the tissue that has spilled out of the capsule of the testis. This confirms that seminiferous tubules from the testis have been pushed out of the rupture site (of the left testicular fibrous capsule). In addition, there is a moderately large hemorrhagic fluid collection in the left scrotum (left hematocele).
Visit this link to read more on this topic:
http://www.ultrasound-images.com/acute-scrotum.htm#Testicular_trauma_%28rupture_of_testes_or_fracture_testes%29:_
We have one more color Doppler ultrasound video (this time a transverse section of the left testis):
video 
Observe the linear strip of tissue hanging (or floating) within the hematocele in the left scrotum. This could be left testicular tissue with part of the body of the left epididymis.
Here are the ultrasound/ color Doppler images of this case of testicular trauma:















This last image is a transverse section section of the testis showing the site of rupture of the tunica albuginea, using Power Doppler imaging. The intratesticular hematoma is also seen.