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Acute torsion of the uterine adnexal structures (ovary and fallopian tube) is a recognized surgical emergency, but rarely has the diagnosis been made preoperatively on the basis of imaging studies. This report describes 16 cases in which the diagnosis was suggested preoperatively on the basis of sonography and subsequently confirmed at surgery. In all of the patients studied, a pelvic or pelvoabdominal mass was present on sonography. These masses had a sonographic texture ranging from cystic to solid, depending on the presence and extent of internal hemorrhage and/or stromal edema. In the majority of patients (13 of 16), adnexal torsion was associated with a preexisting cystic adnexal mass. Eight of these had thin internal septae. The severity of symptoms was variable and did not correlate directly with the sonographic features of the pelvic mass. Consideration of this entity in the proper clinical setting and with the typical sonographic findings will facilitate prospective recognition of adnexal torsion, thereby improving the chances for salvage of the involved adnexal structures.

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In 28 fetuses studied during a 4 1/2-year period, the initial femur was below 2 standard deviations (SDs) of the mean when compared with the biparietal diameter. These fetuses were considered at risk for skeletal dysplasias and were followed up. Studies were performed at a mean gestational age of 26.7 weeks (range, 15.3-41.0 weeks). Group 1 had a femur length 1-4 mm below the 2-SDs line (range, -2.0 to -4.0 SDs); no other abnormalities were detected. Interval examination of 12 femurs showed that 10 either remained shortened to the same degree or had a growth spurt. At birth, all subjects were healthy except one with mild growth retardation and one with a chromosomal abnormality. Of the two subjects that failed to continue normal growth, one was healthy and the other was a heterozygous achondroplastic dwarf. Group 2 had greater femoral shortness; all measurements were more than 5 mm below the 2-SD line (range, -4.3 to -31.0 SDs). All had fetal abnormalities and significant skeletal dysplasias. The authors conclude that the number of millimeters below the 2-SDs line is an accurate, easy criterion for evaluation of femoral length.

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The use of scrotal ultmsonogmphy has been advanced with the development of high-resolution real-time equipment. A group of 284 consecutive patients referred for scrotal examination was studied ultrasonically and followed over a three-year period. Abnormal scrotal contents were accurately detected in 98.5 per cent of cases. Sepamtion of testicular from extratesticular pathology was 99 per cent accurate. While all malignant testicular lesions could be identified, there were examples which could not be differentiated from benign lesions prior to surgical exploration and biopsy. However, there are many examples where the ultrasound results can change clinical management of the patient. (Key words: scrotal ultrasonography; testicular ultrasound; testis, pathology)Prior to the use of ultrasound examination of the scrotum, accurate diagnosis of most testicular lesions required surgical exploration. The develop· ment of diagnostic sonography has permitted evaluation of testicular abnormalities since the tech-· nique was described in 1978. 1 Initially, scrotal examinations were performed using the contact B· scan technique that required a high degree of opemtor experience. With the recent development of high-resolution real-time small parts ultrasound equipment, scanning technique and the resolution of the image have improved significantly. ~-.f Smaller lesions can be identified, with detection of cancers less than 1 em reported. 3 · while some pre· liminary studies have suggested the benefits of scrotal ultrasonography, these have involved small numbers of subjects or a limited range of pathology, or were retrospective studies. 3 -9 We have undertaken a large, long•term prospective study to evaluate the use of scrotal ultrasonography in detecting and differentiating abnormalities prior to operative confirmation in an attempt to define the usefulness of this procedure.

Experience appeared to decrease discrepancy rates. Trainees were more likely to miss findings than to read normal scans as abnormal.

Ultrasound and x-ray mammograms were obtained in 8 patients with palpable breast masses, which were subsequently proven to be cystosarcoma phylloides. Histopathologic examination of the 8 tumors showed benign cystosarcoma phylloides in 5, recurrent benign tumor in 1, coexistent invasive papillary carcinoma in 1, and coexistent in situ duct cancer and in situ lobular cancer in 1. A retrospective review of the B-scan images was undertaken to list the descriptive ultrasound features of cystosarcoma phylloides. The ultrasound findings included low-level internal echoes, smooth walls, and good through transmission. The carcinomas were indistinguishable from the benign lesions, although ultrasound was able to distinguish the cystosarcoma phylloides lesions as predominantly solid lobulated masses.