Fourteen patients are presented to illustrate the usefulness of ultrasonography in assessing masses of the neck. Included are five patients with primary tumors, two with metastasis to a cervical node, three with cervical adenitis, two with simple cysts, and two with hematoma related to endarterectomy for occlusive disease of the carotid artery.

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Abstract. Ultrasonography can be used to diagnose the presence of multiple gallstones, despite the fact that the gallbladder, per se, may not be demonstrated. The finding of many echoes in the area occupied by the gallbladder that cast a large acoustical shadow is strongly suggestive of gallstones.Key words: UltrasonographyGallstones --Oral cholecystography.Ultrasonography has proved successful in demonstrating the gallbladder in 80 to 92% of fasting patients [1][2][3]. The gallbladder that is not demonstrated by this technique may be small in size (less than 2.5 cm) [2], have an unusual shape or location, i.e., sharply angulated or situated high under the rib cage, or contain small stones that produce internal echoes which may render the gallbladder invisible against the background of echoes in surrounding tissue [2][3][4]. It has been suggested that nondemonstration of the gallbladder helps only to exclude the presence of an enlarged gallbladder [5].We recently encountered eight patients in whom cholelithiasis was correctly diagnosed ultrasonographically, despite the lack of demonstration of the gallbladder. The following two cases are selected to illustrate the observed findings.by the ingestion of fatty foods. Several members of her family had had gallstones. She had had no jaundice, dark urine, or clay-colored stools. Physical examination was unremarkable and results of laboratory studies, including liver function tests, were within normal limits.Ultrasonographic examination of the right upper quadrant disclosed a number of echoes embedded in the medial surface of the inferior aspect of the right lobe of the liver. Behind the echoproducing region was a large acoustical shadow, easily reproducible on both longitudinal and transverse scans (Fig, 1A and B).An oral cholecystogram confirmed the impression of multiple small stones within the gallbladder (Fig. 1 C). Case 2A 58-year-old man was evaluated because of tenderness in the right upper quadrant of his abdomen. Ultrasonography showed a prominent acoustical shadow that was situated posterior to a grouping of strong echoes in the region of the gallbladder fossa ( Fig. 2A). Oral cholecystography demonstrated a single, calcified gallstone in a septated gallbladder (Fig. 2B). This finding was confirmed surgically. Comment."The remaining six patients demonstrated similar ultrasonographic findings. In all cases a prominent acoustical shadow was seen posterior to a strong grouping of echoes located in the anatomic region of the gallbladder fossa. Multiple small gallstones which completely filled the gallbladder were present at the time of surgery or on subsequent radiographic studies in each case. Case Reports DiscussionBecause gallstones strongly reflect sonic emissions, sound waves are rapidly attenuated and create an acoustical "shadow." Whether the stones contain calcium seems to have little to do with ultrasonographic detectability [5]. A reproducible shadow behind an echo that is situated in the gallbladder lumen is convincing evidence that a gallstone is pre...

This report describes an unusual case in which a meningocele and a separate meningoencephalocele were diagnosed in a single fetus prepartum using B-scan ultrasonography . CASE REPORTThe patient is a 33-3'ear-01d(gravida 1, para 1, aborta 0) who had an uncomplicated prepartud course following a period of unexplained infertility. At 37 weeks of gesta! tion, palpation of the mother's abdomen disclosed the possibility of an abnormal fetus. A radiograph of the mother's abdomen showed possible hydrocephalus (Fig. 1). Ultrasonography revealed a large cystic mass and a smaller solid mass situated next to a normal-sized head ( Fig. 2A and B). The findings were interpreted as a meningocele and a separate meningoencephalocele without hydrocephalus.After an elective induction of labor the patient had an uneventful delivery. The fetus, an

Urographic, arteriographic and B-mode echographic findings in a four-year-old girl with tumefactive xanthogranulomatous pyelonephritis are reported. Review of our case and those that preceded it illustrates that when a localized mass in a functioning kidney is encountered radiographically in a child, xanthogranulomatous pyelonephritis should be included in the preoperative differential diagnosis. Nephrectomy may then be avoided.

A total of 150 patients with germinal testicular neoplasms treated at the University of California, San Francisco, were reviewed. The 5-year actuarial survival rate was 95% for 57 patients with seminoma and 56% for 75 patients with carcinoma. Treatment modalities were compared with respect to sites and causes of failure and complications. The most common sites of failure in the carcinoma patients were lung, and supraclavicular or mediastinal lymph nodes. Scrota1 orchiectomy , elevated gonadotropins, elements of choriocarcinoma, and bulky abdominal disease were all correlated with high treatment failure rate.

The role of contact B-mode ultrasonography in demonstrating prosthetic vascular grafts was assessed in 24 patients (27 grafts). All grafts were well delineated. End-to-side bypass grafts could be separated from end-to-end replacement grafts by their characteristic appearance. Patent and occluded grafts could not be distinguished either in vivo or in vitro. However, B-mode ultrasonography was ideally suited to the detection of other complications of vascular prosthetic grafts: hematoma, infection, and false aneurysm formation.

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