Objective. To evaluate the association of the onion skin sign as a sonographic marker for appendiceal mucocele. Methods. The sonographic onion skin sign was considered specific for the preoperative diagnosis of appendiceal mucocele. Therefore, detection of this sign in a mass located in the right lower abdomen, unrelated to the female reproductive organs, indicated surgical intervention with a presumptive diagnosis of appendiceal mucocele. From 1998 through 2001, female patients who were found to have atypical cysts containing this sign underwent surgery. The cases were closely followed, and intraoperative findings and final histologic diagnoses were recorded. Results. Appendiceal mucocele was the final diagnosis in all 7 patients in whom the onion skin sign was observed. One additional patient had an appendiceal mucocele with a sonographic picture of a clear tubular cystic structure. Conclusions. A sonographically layered cystic mass in the right lower quadrant of the abdomen in the presence of a normal ovary strongly suggests the diagnosis of appendiceal mucocele. Recognition of the sonographic onion skin sign in a cystic mass in the right lower quadrant may facilitate the accurate preoperative diagnosis of appendiceal mucocele. Key words: appendix; echogenic layers; mucocele; onion skin; sonography. ppendiceal mucocele (AM) denotes an obstruction of the appendiceal lumen and the accumulation of mucus distal to the obstruction. 1Appendiceal mucocele is quite rare, with a prevalence of 0.25% among appendectomies.2 The anatomic location of AM in the right lower quadrant of the abdomen includes it in the differential diagnosis of masses in this region. The sonographic features of AM should be familiar to anyone who performs pelvic sonography.The sonographic markers of AM are considered nonspecific, making preoperative diagnosis inaccurate. 3,4 Recently, Dgani et al 5 reported an unusual sonographic marker, onion skin, in AM, which may be specific for this entity, assisting in preoperative diagnosis. 5 The aim of this study was to evaluate the association of this specific marker with AM in a larger series of patients.

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Our objective was to define a subset of women with postmenopausal bleeding in whom the accepted practice of endometrial sampling could be safely omitted. Vaginal endosonographic measurements were compared to the histological findings of curettings following diagnostic dilatation and curettage in 129 women with post-menopausal bleeding who were not receiving hormonal therapy. Atrophy was diagnosed in 49%, slight proliferation in 10%, endometrial polyps in 11%, hypoplasia in 12%, and adenocarcinoma in 12%. Endometrial atrophy was associated with a mean sonographic thickness of 2.6 mm of the double layer (range 0-6.5 mm). Of the women with a final histological diagnosis of atrophy, 92% had an endometrial thickness of 3 mm or less. Furthermore, all women with a sonographic endometrial thickness of 3 mm or less had atrophic endometrium (p < 0.0001). An endometrial thickness of 3 mm or less would have reduced the number of dilation and curettage procedures by 45% and no cases of endometrial pathologies would have been missed. In women presenting with postmenstrual bleeding, meticulous scanning of the endometrium can select a group where endometrial sampling can be omitted from the protocol.

Objective To propose, in cases with coiling of the ovarian vessels, a classification of severity of torsion based on