Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 2013ries is to describe a new sonographic sign for perinatal torsion that has, toour knowledge, not been described previously.Methods—Five cases underwent grayscale, color, and pulsedDoppler evaluation for suspected torsion in the perinatal period during a26-month interval. The age of presentation ranged from birth to 30 days.The studies were performed using a Philips iU22 ultrasound machine. Alinear high-frequency transducer (17 MHz) was used for scanning. Thesecases were retrospectively analyzed with regard to clinical and sonographicfindings.Results—The grayscale appearance of the affected testicle wasquite abnormal in our cases (n = 5). We subdivided our cases into 2 groupsbased on the sonographic findings. The first group (n = 2) represented theearly phase of perinatal torsion, which we believe could have been potentiallysalvageable. The affected testicle in this group was markedly enlargedwith a heterogeneous echo texture. Linear hypoechoic striationswere seen, radially oriented from the mediastinum testicle, giving a characteristicappearance of a section in a kiwi fruit. The second group (n = 3)represented the nonsalvageable late phase of perinatal torsion, in which theaffected testicle was small and heterogeneous. Color Doppler assessmentin the affected testicle in both groups showed no flow.Conclusions—On the basis of the limited number of cases includedin our study and a review of the literature, we suggest that the “kiwisign” may become a useful finding representing the early phase of perinataltorsion. Future studies on a larger scale may prove that this sign canbe established as a reliable indicator to aid in surgical decision making.1515353 The Swollen Pediatric Scrotum: Ultrasound Technique andDifferential DiagnosisKelli Schmitz, 1 Kathryn Snyder, 1 David Geldermann, 2 RoyaSohaey 1 *1 Diagnostic Radiology, Oregon Health and ScienceUniversity, Portland, Oregon USA; 2 Colgate University, Hamilton,New York USAObjectives—Review the ultrasound protocol for performanceof scrotal ultrasound in pediatric patients and illustrate the ultrasound appearanceof conditions resulting in scrotal swelling. Provide a brief summaryof scrotal embryology.Methods—Retrospective review of an imaging database of pediatricpatients presenting with scrotal swelling who underwent diagnosticultrasound at a tertiary pediatric referral center. When available,surgical/pathologic correlation was obtained. Some cases were diagnosedin utero.Results—Causes for pediatric scrotal swelling include intravaginaland extravaginal torsion, epididymitis/orchitis, hydrocele (simple,inguinoscrotal, abdominoscrotal, iatrogenic, and spermatic cord), varicocele,inguinal hernia, trauma, adrenal rest, and testicular or paratesticularneoplasms.Conclusions—A variety of typical and atypical pathologicprocesses resulting in pediatric scrotal swelling will be presented in thispictorial review. Best-practice ultrasound technique will be reviewed.1515361 Suprarenal Masses in the FetusSarah Rogers, Karen Oh, Roya Sohaey* Diagnostic Radiology,Oregon Health and Science University, Portland, OregonUSAObjectives—Our objective is to review the imaging and differentialdiagnosis of fetal suprarenal masses.Methods—Prenatal ultrasound and magnetic resonance imagingof fetal suprarenal masses is presented, along with clinical informationand follow-up. Imaging pearls and differential considerations for each diagnosiswill be discussed.Results—Fetal suprarenal masses, diagnoses include congenitaladrenal hyperplasia (symmetric and asymmetric), extralobar pulmonarysequestration, neuroblastoma, partial multicystic dysplastic kidney, renalduplication, urinoma, gastric duplication cyst, and splenic cyst. Fetal adrenalmasses are often malignant, and every attempt should be made todifferentiate between them and other diagnoses. Recognizing the range ofmalignant and benign suprarenal fetal masses that can present on prenatalimaging can help guide patient counseling and management.Conclusions—The differential diagnosis of a suprarenal massis broad but can be narrowed by imaging characteristics. A pictorial reviewof suprarenal masses is presented along with technique and imaging pearlstoward accurate diagnosis.1518185 Extraovarian Adnexal Sonographic Findings in EctopicPregnancy: A ReappraisalMary Frates,* Peter Doubilet, Hope Peters, Carol BensonRadiology , Brigham and Women’s Hospital, Boston, MassachusettsUSAObjectives—To assess the frequency of extraovarian adnexalsonographic findings in patients with ectopic pregnancy using state-ofthe-artsonographic equipment.Methods—All patients with pathologic or sonographic confirmationof ectopic pregnancy between July 1, 2008, and August 31, 2011,who underwent transvaginal sonography (TVS) prior to treatment were included.The sonogram performed closest to the point of treatment was retrospectivelyreviewed for the presence of an extraovarian adnexal massand for a moderate-to-large amount of free fluid. In cases with an adnexalmass, the presence of a tubal ring, yolk sac, or embryonic cardiac activitywas recorded.Results—Our study population comprised 231 patients. A positivefinding—adnexal mass and/or free fluid—was present in 220 of 231patients (95.2%): adnexal mass in 218 of 231 (94.4%) and a moderate-tolargeamount of free fluid in 56 of 231(24.2%). Among our 231 studycases, sonography demonstrated a tubal ring in 75 (32.5%), a yolk sac in19 (8.3%), and embryonic cardiac activity in 17 (7.4%). In 140 cases(60.6%), TVS demonstrated a nonspecific adnexal mass (without tubalring, yolk sac, or cardiac activity).Conclusions—TVS demonstrates an adnexal abnormality in>95% of patients with ectopic pregnancy. The most common finding is anonspecific adnexal mass. A tubal ring is found in fewer than half of casesand a yolk sac and cardiac activity in