Journal of Diagnostic Medical Sonography

Idiopathic chronic male pelvic pain is difficult to diagnose and treat. Currently, diagnosis relies on subjective symptoms; objective measures of neuromuscular mechanisms have not been investigated. Sonographic imaging has been used to investigate these neuromuscular mechanisms in the female pelvic floor, but neither research nor books describe sonography evaluation of the male pelvic floor. The purpose of this study was to develop and evaluate a perineal sonographic technique for the examination of the male pelvic floor muscles. Anatomic landmarks were identified with images collected from two subjects, one with intermittent reports of pelvic pain and one with no history of pain in the pelvic region. A description of the equipment settings, the examination protocol, and the resulting comparative image analysis is included. A validated protocol such as this may be useful in documenting differences in the soft tissue structures between asymptomatic individuals and patients with chronic pelvic pain to aid in diagnosis and treatment. This is the first known study to report sonographic findings of the individual muscles in the male pelvic floor, and additional research is needed to validate the techniques that have been deemed feasible.

A retroaortic left renal vein (RLRV) is an uncommon condition in which the left renal vein passes posterior to the abdominal aorta and anterior to the vertebrae. Retroaortic left renal vein may lead to left renal vein hypertension syndrome, also known as the nutcracker syndrome, a condition in which extrinsic compression of the left renal vein causes hypertension within the vessel. Retroaortic left renal vein and nutcracker syndrome are vascular anomalies considered to be of clinical importance, particularly during surgical procedures involving the renal vasculature directly or, in many cases, the abdominal aorta.

Focal nodular hyperplasia (FNH) is the second most common benign hepatic mass. The primary purpose of this article is to provide a relevant case study and offer a review of the recent literature related to FNH with a discussion of both the clinical and imaging findings of this classically benign hepatic lesion. Although magnetic resonance imaging is considered the gold standard of FNH imaging, the sonographic and computed tomography appearance also is offered in this article. Furthermore, contrast-enhanced ultrasound, which boasts a 96% success rate at differentiating FNH from other hepatic tumors, is analyzed. The historical treatment options, including medical and possible surgical intervention, are provided as well. Last, this article offers an analysis of the prognosis for the patient diagnosed with FNH.

Page kidney refers to the development of secondary hypertension due to compression of the kidney by an external source, most commonly a subcapsular hematoma. Compression of the renal parenchyma results in hypoperfusion and microvascular ischemia leading to activation of the renin-angiotensin system and elevation of blood pressure. Until the last decade, Page kidney was primarily diagnosed in young men with unexplained hypertension and a history of sports-related trauma and imaging studies demonstrating a subcapsular hematoma. Treatment varies from conservative, medical management to a nephrectomy, depending on how the patient’s blood pressure responds to treatment.

Various modalities of diagnostic imaging have been proven to be adequate in the characterization and diagnosis of ovarian neoplasms. This case study investigates a unique form of mucinous borderline ovarian tumor consisting of both intestinal and Müllerian types. Borderline tumors are considered an intermediate form of neoplasm between the benign and malignant form. Shortly after sonographic and magnetic resonance imaging, the large tumor was removed and the patient was determined to have an excellent prognosis. The utilization of sonography in diagnosing this tumor is discussed, demonstrating the significance of the technology.

Sialolithiasis is a rare condition characterized by the presence of stones within the salivary gland or duct. Salivary duct stones have an incidence of 1% at autopsy, but only 50 in 1,000,000 present symptomatically per year. Possible signs and symptoms include an upper neck or jaw mass that enlarges and recedes following meals and xerostomia, or dry mouth. Sonography has been used along with a number of other imaging modalities to diagnose this condition. The use of real-time sonographic imaging allows for identification and confirmation of the presence of stones within the salivary gland. Treatment of sialolithiasis generally begins conservatively but can result in surgery if not resolved. This case report demonstrates the use of sonography as an effective method of diagnosing sialolithiasis in a patient with classic symptoms.

The sonographic features of extrarenal manifestations of complicated acute pyelonephritis (APN) have rarely been reported. A case of severe APN in a young woman is presented with the imaging workup done exclusively by conventional sonography using color and power Doppler. Discussion places a focus on the imaging spectrum and clinical significance of the extrarenal manifestations. The hepatobiliary findings of APN appear to signify accompanying sepsis and gravity of the condition, and gallbladder wall thickening must not be misdiagnosed as acute cholecystitis.

Portal vein tumor thrombus (PVTT) is a complication of liver disease, specifically hepatocellular carcinoma (HCC). It occurs secondary to direct invasion of tumor into the portal venous system. PVTT is associated with a poor prognosis, therefore identification and differentiation of malignant from benign thrombus is very important in the treatment of the patient. Sonography can be a useful tool in the detection of malignant thrombus.

Bladder cancer is a rare finding in young adults. This case demonstrates a 17-year-old female with an incidental bladder mass seen during a first-trimester obstetrical sonogram. Sonographic examination revealed a nonmobile, echogenic mass in the inferior portion of the patient’s bladder. The patient subsequently went to surgery at 18 weeks’ gestation where a cystoscopic resection was performed. The tumor was found to be a low-grade papillary urothelial cell carcinoma. The patient delivered at term without further complications. Early diagnosis of this bladder carcinoma led to prompt diagnosis and treatment for the patient. This diagnosis may not have been possible without the bladder being fully distended.