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  • Carotids

    • < 50% => gray scale estimate

    • >50% => hemodynamic parameters

    • Distal stenosis => high resistive waveforms

  • Thyroid

    • Benign follicular adenoma

    • Papillary cancer

      • Lymphatic dissemination

      • 90-95% 20 year survival

      • Multifocal in 20%

      • Variants: mixed (papillary/follicular), microcarcinoma

      • Hypoechoic, solid

      • Ca++ in psammoma bodies

    • Follicular cancer

      • Hematogenous spread

      • No Ca++

    • Medullary cancer

      • MEN Type II

      • Microcalcifications are common

    • Anaplastic cancer

      • Large, solid, hypoechoic mass

    • Parenchymal disease

      • Hashimoto's thyroiditis

        • Enlarged, hypoechoic gland

        • Atrophic at end stages

      • Grave's

      • Subacute granulomatous (deQuervain's)

        • Poorly marginated area or areas of decreased echogenicity

  • Parathyroid

    • Parathyroid adenomas

      • Hypoechoic homogenous solid mass

      • May be confused with posterior thyroid septations

  • Pancreas

    • Pancreatitis

      • Enlargement

      • Hypoechoic

      • Heterogenous echogenicity

    • Focal pancreatitis can mimick mass

    • Pancreatic carcinoma

    • Islet cell tumors

      • Insulinomas (90% - 95% benign)

      • Gastrinomas (most are malignant)

    • Lymphoma

    • Metastases

    • Cystic pancreatic neoplasms

      • Microcystic adenoma = Serous cystadenoma = Glycogen rich cystadenoma

      • Macrocystic adenoma = Mucinous cystadenoma = Cystadenocarcinoma (premalignant or malignant)

    • Intraductal papillary mucinous tumor

  • Gallbladder

  • Liver

    • Echogenic ducts - periductal fibrosis (can be seen in PSC)

  • Bile ducts

    • Bile duct is usually slightly more prominent in its midportion. If distal and proximal bile duct is not dilated, it is probably not obstructed

  • Spleen

    • Cysts

      • Most are from trauma (hematomas which evolve into seromas)

      • Epidermoid (true) cysts are rare Þ Squamous cells in the walls

      • Parasitic cysts

      • Hydatid

      • Pseudoaneurysms, AVMs

      • Perisplenic cysts

    • Tumors

      • Hemangiomas

      • Hamartomas

      • Lymphangiomas

      • Lymphoma

      • Hemangiosarcomas

      • Metastases

    • Infection

      • Splenic abscesses are uncommon

      • Fungal abscesses

      • Granulomas

        • TB

        • Histoplasmosis

        • Sarcoid

    • Trauma

    • Infarction

      • Coarsened echotexture

  • Kidney

  • Scrotum

    • Extratesticular masses

      • Spermatocele

      • Hydroceles - potential space of tunica vaginalis

      • Varicoceles - veins

      • If unilateral on the right - retroperitoneal mass or situs inversus should be considered

      • Scars

      • Sperm cell granulomas

      • Chronic hematomas

      • Hernias

      • Scrotoliths

      • Adenomatoid tumor

      • Lipomas, liposarcomas, leiomyoma, leiomyosarcomas

    • Intratesticular

      • Simple testicular cysts

      • Tunica albuginea cysts

      • Tubular ectasia of rete testes

      • Germ cell tumors

        • Seminomas (homeogenous and hypoechoic)

      • Non-germ cell tumors (more likely to contain cystic regions and calcify)

        • Leydig cell tumors

        • Sertoli cell tumors

      • Mixed germ cell tumor

        • Combination of seminoma, teratoma, embryonal cell carcinoma, choriocarcinoma

      • Epidermoid cysts

      • Metastasis

      • Lymphoma

      • Leukemia

      • Testicular atrophy or fibrosis also produce hypoechoic regions

      • Testicular microlithiasis

        • Classic - 5 or more microliths on an image

        • Limited - less than 5 microliths on all images

  • Bladder

    • Primary neoplasms

      • TCC (90% of bladder tumors)

        • Smoking, analgesic abuse, industrial carcinogens

        • Posterior wall - trigone region

      • SCC (5%)

      • Adenocarcinoma (2%)

        • Usually in urachal remnants and in bladder extrophy

      • Pheochromocytoma

    • Invasion from adjacent structures and adjacent inflammation

    • Blood clots

    • Stones

    • Fungus balls

    • Bladder diverticula

    • Urachal diverticulum or cyst

    • Ureteroceles

  • Penis

    • Erectile dysfunction

      • Papaverine or prostaglandin E

      • Systolic velocities > 35 cm/sec considered normal < 25 cm/sec abnormal

    • Priapism

      • High-flow => AV fistula

      • Low-flow => thrombosis of the dorsal penile vein

    • Peyronie's disease

      • Lack of expansion of tunica albuginea in the area of fibrosis (plaque)

  • Prostate

    • Four zones

      • Peripheral

      • Central

      • Transitional

      • Fibromuscular stroma => anterior non-glandular tissue

    • 70% of prostate cancers are hypoechoic with respect to the peripheral zone

    • Benign prostatic hypertrophy => transitional zone

    • Prostatic cysts

      • Midline

        • Utricle cysts

        • Mullerian duct cysts

        • Ejaculatory duct cysts

  • Transplant

    • Draining vein thrombosis => reversal of diastolic flow

    • Thrombosis of feeding artery => decreased resistive indices and tardus et parvus waveform



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