Renal sonography is frequently employed to exclude obstructive uropathy in patients with uremia. Sonographic findings of moderate bilateral hydronephrosis were encountered in a dehydrated patient undergoing rehydration. Subsequent excretory urography and a follow-up renal sonogram were normal. To investigate the possibility that hydration and bladder distension in an otherwise normal and unobstructed collecting system could result in hydronephrosis detectable by ultrasound, 23 apparently normal volunteers underwent renal sonography in the hydrated and basal states. The filled urinary bladder in a patient undergoing hydration frequently results in the sonographic appearance of hydronephrosis.
Mucocele of the appendix refers to a dilated appendiceal lumen filled with mucus.1*2 We believe this report is the first description of the ultrasound findings of this rare lesion.
CASE REPORTA 60-yr-old man complained of gradually increasing abdominal distention for the year prior to admission. Physical examination revealed a firm, nontender mass extending from the left costal margin to the umbilicus. Plain film of the abdomen showed a curvilinear calcification delineating the caudal margin of the mass (Fig 1). Barium enema examination showed elevation of the transverse colon and mild lateral displacement of the descending colon. The appendix was not filled (Fig 2). Upper gastrointestinal examination showed a high transverse stomach but was otherwise normal. An ultrasound scan demonstrated a large cystic mass in the abdomen (Fig 3A and B).At celiotomy, the huge mass was well encapsulated and entirely within the retroperitoneal space. The predominantly left-sided mass communicated with the base of the appendix in the right lower abdominal quadrant. The mass and the appendix were removed intact. The mass was opened, and large amounts of gelatinous material were evacuated.The cyst wall was 1 cm thick. There were polypoid projections from the inner wall, and a large, serpiginous, loosely attached growth projected into the lumen. Microscopy revealed clusters of mucous-secreting cells among the dense fibrous stroma composing the wall. The polypoid intraluminal projections and serpiginous growth were due to varying degrees of proliferation
The typical sonographic appearance of a neoplasm of the luminal gastrointestinal tract is a single ring of sonolucency surrounding a dense central echogenic A similar appearance has been described for intuss~sception.~-~ Recently, Holt and Samuel suggested, on the basis of a single case, that a mass with double concentric rings of sonolucency surrounding a dense central echogenic focus is actually characteristic of intus~usception.~ We recently encountered a case of intussusception in which both single and double ring appearances were evident. The findings in this case provide a unifying explanation for the differing ultrasonic appearances described in the literature.
CASE REPORTA 61-yr-old man complained of intermittent vague periumbilical discomfort of two months' duration. No history of weight loss or melena was elicited. Physical examination revealed a fullness cephalad to the umbilicus. Abdominal ultrasound examination revealed a mass with an echogenic center and peripheral sonolucency at the level of the midtransverse colon (Fig 1). A section at the anticipated level of the ascending colon revealed a mass with double concentric rings of sonolucency (Fig 2). Barium enema revealed a classic intussusception at the midtransverse colon, which was slowly reduced by the hydrostatic pressure of the enema (Fig 3). A 4-cm polypoid mass at the medial aspect of the cecum was evident on the postreduction films.At surgery, the cecum and right colon were found to be suspended by a long mesentery. The
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