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The great variability in the sonographic appearance of ovarian cystic teratomas poses difficulties for their diagnosis and classification. To overcome such difficulties, we have proposed a simplified classification of the pathognomonic echo patterns of ovarian cystic teratomas based on three basic types of echo pattern. In a prospective study of 118 echogenic adnexal masses, with postoperative histological confirmation, this classification enabled the correct diagnosis to be made in 115 cases (accuracy rate, 97.45%). In the three cases misdiagnosed preoperatively as ovarian cystic teratoma, the tumors proved to be benign and included a serous cyst adenoma, a serous cyst adenofibroma and a Brenner tumor. We suggest that, with our proposed classification of the echo patterns of ovarian cystic teratomas, sonography can become a quick and accurate tool in the recognition of this condition.

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.