The significance of contrast-enhanced ultrasonography in the characterization of liver tumors, the features of contrast agents, and the characteristic enhanced patterns of various kinds of liver tumors are described.

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We describe considerations for carrying out ultrasound examinations in cases of common urologic emergency diseases. Urologic diseases requiring emergency surgery or treatment are limited and infrequent and comprise such conditions as trauma of the urogenital organ, rupture of a renal neoplastic mass, rupture of a renal aneurysm, renal infarction, and testicular torsion. On the other hand, those requiring palliative surgery or treatment include stones in the upper urinary tract, acute pyelonephritis, acute renal failure, acute orchitis and epididymitis, bladder tamponade, renal arteriovenous fistula, and urinary retention. When US examination is performed by a US technician or physician, the specific characteristics of pathogenesis and the ultrasonographic features of these emergency diseases should be understood. Moreover, differential diagnosis to distinguish gastrointestinal, hepatobiliary, and gynecologic emergency diseases from urologic diseases is also important.

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Ultrasound (US) is a simple and noninvasive modality, but it is susceptible to interference from gas echoes, and the ability of US depends on the level of diagnostic skill of the sonographer. It is also important that the sonographer know about the characteristics of artifacts and how to remove their influence. Gallbladder lesions are arbitrarily classified into three types including pedunculated, broad based and wall-thickened (flat) types. This classification is very important not only to make a differential diagnosis but also to evaluate the depth of cancer invasion; the pedunculated lesion can be diagnosed as an early gallbladder carcinoma. In addition, we should evaluate their size, surface structure, internal echo texture, and structural changes of the gall bladder wall. These findings are also useful to discriminate carcinomas from other lesions. Furthermore, abnormal US findings of the gallbladder, which include distension with or without debris and impaired fullness, are also useful to detect occult lesions of the extrahepatic biliary tract.

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Purpose: To diagnose benign and malignant breast lesions using elastography, which has proven useful and found increasing use in tumor diagnosis. Lesions with heavy blood flow must often be approached as possibly malignant. Elastography has also been used to evaluate potentially benign lesions, which are usually hypervascular. In this study, we examined such cases retrospectively to determine what points should be kept in mind during examination and testing. Subjects and Methods: Of patients who had undergone ultrasound evaluation from April to June 2007, whose B-mode ultrasound evaluation was category 3 or higher, and whose color Doppler ultrasound findings indicated heavy blood flow, those with an elastography score of 3 or lower served as subjects, and their ultrasound and histologic findings were studied. Results: Twelve of the 17 subjects had breast cancer; the remaining 5 had benign lesions. Eight of the subjects had an elastography score of 1 or 2: 4 had ductal carcinoma in situ; 1, papillotubular carcinoma; 1, fibrocystic breast disease; 1, intraductal papilloma; and 1, a phyllodes tumor. Of 9 subjects with an elastography score of three, 4 had ductal carcinoma in situ; 1, scirrhous carcinoma; 1, solid-tubular carcinoma; 1, papillotubular carcinoma; 1, fibrocystic breast disease; and 1, a phyllodes tumor. Of the 12 cases of breast cancer, 8 were cases of ductal carcinoma in situ and 4 were cases of invasive cancer. In 3 of the 4 cases, the invasive portion was relatively small and accounted for the image. Conclusion: Further study seems warranted by the fact that in cases that were potentially malignant according to B-mode and color Doppler ultrasound findings, lesions with an elastography score of 3 or lower were either non-invasive cancer or benign lesions.

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Purpose: This article describes an investigation of the detectability of breast microcalcifications by ultrasound imaging. Methods: Two kinds of experiments were performed to evaluate the spatial and contrast resolution of microstructures in an agar graphite phantom and to analyze human perception of tiny spots. Results: The results showed that most of the difficulties in finding microstructures were not only due to lower echo levels but also to obstructions in the surrounding texture of the image. Based on these results, a new image processing method was proposed to emphasize microcalcifications in mammary glands. This method utilized statistical analysis of the echo signals and also considered the structural pattern of the mammary gland. Processed images from some clinical cases showed adequate extraction of the microcalcifications with efficient cancellation of the mammary gland structure. Conclusion: The results suggested that the perception of microcalcifications could be improved by the proposed method.

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The patient was a 37-year-old man with end-stage renal disease. He was diagnosed with hyperuricemia and chronic kidney disease when he was 11 years old. He had a family history of gout in his mother and grandmother. He was suffering from anomalies of uric acid transport and renal function with a c860 G>A mutation in exon 4 of the uromodulin gene, resulting in a substitution of tyrosine for an evolutionary conserved cystine. Hemodialysis was initiated. Abdominal ultrasonography revealed renal atrophy and calyceal dilatation. Past ultrasonography showed renal stone and calyceal dilatation. In this case, ultrasonography offered advantages in terms of studying the mechanism of kidney damage.

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A 79-year-old man with hypertension and diabetes mellitus had systolic ejection murmur that was auscultated over the right parasternal area when admitted for interferon therapy for chronic type C hepatitis in February 2008. The echocardiogram revealed a right atrial mass involving the tricuspid valve and the free wall of the right ventricle. A large mass occupied the right atrium, and a dilated right atrium and ventricle were revealed. Enhanced computed tomography and positron emission tomography showed two abnormal masses in the mediastinum and extending from the right atrium to the ventricle. Although no symptoms were presented, we considered the possibility of malignant tumors and had the patient transferred to this institution. Specimens of the mediastinal mass obtained by mediastinoscopic biopsy indicated malignant lymphoma (diffuse large B-cell). Mass size had clearly decreased after eight courses of chemotherapy with rituximab plus CHOP. Treatment of cardiac lymphoma is not established, but rituximab plus chemotherapy for malignant lymphoma improved the prognosis of this patient. These findings suggest the usefulness of echocardiography in evaluating malignant cardiac tumor and judging response to treatment.

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