Color Doppler sonography was performed in 32 patients with a painful scrotum in whom testicular ischemia from torsion or postherniorrhaphy was clinically suspected. Surgical correlation was available in 15 patients, and scintigraphic correlation was available in 17 patients. Seven of the 32 patients were diagnosed as having testicular ischemia from torsion. Color Doppler flow imaging demonstrated a lack of intratesticular flow in six of the seven testes with torsion and relatively normal intratesticular flow in one of the patients with acute torsion. Normal or increased intratesticular flow was demonstrated by color Doppler in all 57 of the nonischemic testes. Using the single criterion of presence or absence of identifiable intratesticular flow, the authors found that color Doppler was 86% sensitive, 100% specific, and 97% accurate in the diagnosis of torsion and ischemia in the painful scrotum. Color Doppler sonography is an accurate, noninvasive means of rapidly assessing perfusion of the testis in the painful scrotum.

In the medical literature, Gerota fascia is frequently used as a general term to describe both the anterior and posterior pararenal fascia. However, Zuckerkandl's name is also often used to describe either the anterior or posterior fascia. To resolve this confusion, the authors reviewed the original works by Gerota and Zuckerkandl. In 1883, Zuckerkandl described the posterior renal fascia but did not recognize the presence of the anterior renal fascia. In 1895, Gerota documented the presence of the anterior renal fascia and clearly assigned Zuckerkandl's name to the posterior renal fascia. Thus, the terms Zuckerkandl fascia and posterior renal fascia are synonymous, as are Gerota fascia and anterior renal fascia.

We report a case of a bulbous urethral cyst in a man. This rare lesion, probably arising from Cowper's gland, was treated successfully by endoscopic excision of the cyst wall.

The frequent presence of small echogenic foci within the inner myometrium in women who have had prior uterine instrumentation is reported. Bright foci were observed in 35 of 80 patients who had had prior dilatation and curettage or endocervical biopsy and in only 2 of 174 patients who gave no history of either procedure (P < 0.005). These foci tend to be small (3 to 6 mm), linear, usually nonshadowing, single or multiple, and located immediately adjacent to the endometrium anywhere along the length of the endometrial cavity; they can be seen many years after the D uring pelvic sonography, we have occasionally noted the presence of small, brightly echogenic foci within the inner layer (junctional zone) of the myometrium, close to the myometrialendometrial junction (Fig. 1). We were initially uncertain as to the cause of these foci but, through patient inquiries, we anecdotally found these foci likely to be related to prior uterine instrumentation. The present study was undertaken to confirm that the presence of these foci is statistically related to prior uterine instrumentation. PATIENTS AND METHODSDuring a five month period, all women referred for nonobstetrical pelvic sonography were asked to comReceived September 17, 1990 from the Departments of Radiology and Clinical Investigation, Naval Hospital, San Diego, California. Revised manuscript accepted for publication February 8, 1991 .Address correspondence and reprint requests to LCDR Z. N. Balsara: c/o Clinical Investigation Department, Naval Hospital. San Diego, CA 92134-5000.The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. procedure was performed. The histopathologic features of these foci are unconfirmed, but we suspect they represent calcification or fibrosis at sites of mechanical injury to myometrium. The presence of these foci serves as a marker of prior instrumentation and probably has no clinical significance. However, sonographers who are aware of their possible occurrence, can avoid mistaking them for leiomyoma calcifications or for air in the endometrium or myometrium in patients with suspected endometritis. plete a patient questionnaire relevant to their obstetrical and gynecologic medical history (Table 1). Of the 407 women referred for pelvic sonography during this time, questionnaires were completed and returned by 68% (277 patients). Twenty-three of these women had had hysterectomies and were excluded from analysis. The study group consisted of the remaining 254 patients.Transabdominal pelvic sonography with a full bladder technique was performed on all patients and many also underwent transvaginal sonography. All transab· dominal scans were obtained with a 3 MHz, 3.5 MHz, or 5 MHz transducer (Acuson, Mountain View, CA, and Advanced Technology Laboratories, Bothell, WA), and all transvaginal scans were obtained with a 5 MHz transducer. The presence or absence of small echogenic foci within the inner myome...

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Sonography has a primary role in the evaluation of a variety of complkations that follow renal trans~ plantation. Specifically, sonography has an important role in the detection of perirenal masses, fluid collections, and hydronephrosis. 1 -5 Hematomas , lymphoceles, seromas, urinomas, and abscesses are well known causes of perirenal transplant masses and their sonographic features have been de· scribed. 1 • 3 • 5 \Ve present a case of small bowel hernia that occurred in proximity to the renal transa plant that had a diagnostic sonographic appearance. REPORT OF A CASEA 36-year-old wonmn wa~ admitted for epigastric pain followed by intermittent vomiting of four hours' duration. The patient had unde rgone a cadaveric renal transplant to the right iliac fossa one month prior to her admission. Her immediate postoperative course was complicated only by serum sickness and her transplant kidney had been functioning well. There was no hematcmesis with the vomitin~ and the patient had a normal bowel movement several hours before the abrupt onset of the abdominal pain. U rinc output had been good. On physical examination she was observed to be in moderate pain with temperature 98.6°F. pulse 80 beats/min, blood pressure 190/ll8, and respirations 16/min. There was modemte epigastric tenderness and diminished bowel sounds. There was no sign of peritoneal irritation. Palpation of the right lower qundrant revealed "a prominent transplant kidney" that wns slightly tender. Stool guaiac test was negative. Pertinent admission laboratory tests revealed creatinine 1. 7 mg!dl, BU N 63 mgf dl, bilirubin 0.1 mg!dl, amylase 131 IU/L, white hlood cell count 12,300!cm 3 , and hematocrit 31 per cent.Flat and upright abdominal radiographs on admission showed no dilated howe!. An abdominal real~tim e sono· graphic examination on the day f<1llowing admission showed a normal gallbladder, liver, and pancreas and smnll.. echo~ genic native kidneys. Ascites was present. A 5 x 5 x 6· em fluid collection containing a loop of peristalsing small howel was identified in the perinephric space anterior to the transplant kidney and a perinephric bowel hernia was diagnosed ( figs. 1 and 2). The diameter of the loop of bowel was less than 3 em and the wall tl1ickness was less than 5 mm. The characteristic appearing valvulae conniventes projecting into the bowel lumen were also seen. An upper CI and small bowel follow-through (SBFT) obtained im-