The sonographic findings in four patients with benign Brenner tumors of the ovary are described. Computed tomography (CT) was also obtained in one case. The neoplasms were solid, hypoechoic masses, usually exhibiting good through transmission of sound. Two neoplasms contained peripheral calcifications; one was inseparable from the uterus and was misdiagnosed as a leiomyoma; the other was well-demonstrated by CT but only in retrospect was the peripherally located calcification identified. Sonographically, Brenner tumors are similar to other solid ovarian neoplasms, particularly fibromas-thecomas, and can also be confused with pedunculated leiomyomas.

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The sonographic features of 40 pathologically proven endometriomas in 32 patients were reviewed to evaluate their sonographic spectrum. Acoustic enhancement was present in 88% and indeterminate in 10% due to technical factors. With respect to internal echo texture, the majority of endometriomas were predominantly anechoic (80%): 7 were totally anechoic; 4 contained septalions; 12 contained scattered internal echoes, with or without septations; and 9 contained dependent echoes, E ndometriosis is a common clinical entity in women of childbearing age with significant implications. It is defined as the presence of active, functioning endometrial tissue outside the uterus. When these foci become walled off and develop internal hemorrhage, endometriomas result. According to a study by Friedman et al, 1 small endometrial implants are difficult to demonstrate sonographically. Moreover, the demonstration of associated sonolucent areas in the myometrium, attributed to adenomyosis by Walsh et al, 1 has not been reproduced.3 Thus the only single reliable sonographic finding of endometriosis is the endometrioma. Several authors have reviewed the sonographic findings in endometriosis. 1 .2· 4 -6 and categorized the masses as cystic, complex (mixed), or solid, with occasional mention of other characteristics.In order to make this diagnosis more frequently, we with or without septations. Seven endometriomas con· tained diffuse, low·level internal echoes and were considered hypoechoic, but still fluid-containing masses. Only 1 was echogenic. The overall appearance frequently simulated that of hemorrhagic ovarian cyst, but in some cases endometriomas resembled tube-ovarian abscess, cystadenoma/cystadenocarcinoma, or ectopic pregnancy. KEY WORDS: ultrasonography, gynecologic, endometrioma. (/ Ultrasound Med 8:487, 1989) analyzed multiple sonographic characteristics in a series of 40 endometriomas, which is to our knowledge the largest single series to date. MATERIALS AND METHODSThe sonograms and clinical records on 32 patients with 40 surgically and pathologically documented endometriomas were reviewed retrospectively. These cases were accumulated via a system whereby the hospital charts of all patients with adnexal masses were reviewed for surgical confirmation. Most scans were performed with real-time equipment using either 3.5-or 5-MHz transducers. Static scans only were performed in some of the earlier cases. Techniques were adjusted to best analyze the internal architecture of each mass. The sonographic characteristics of the endometriomas that were assessed included size, shape, location, acoustic enhancement, wall thickness, and internal echogenicity, as well as the presence and characterization of septations. The presence of additional adnexal masses, uterine abnormalities, and free fluid was also recorded.Clinical data analyzed included age, race, parity, prior history of endometriosis, major symptoms, and results of pelvic examinations. Surgery and pathology reports

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