2082745 Fat-Contained Hepatic Masses: US, CT, MR And Pathologic Correlation

Abstracts 2. Distinguish normal findings from pathology in renal sonography. 3. Provide a rationale for formulating a clinically relevant differential diagnosis. 4. Recommend appropriate further imaging when sonographic findings are inconclusive. Conclusions: Knowledge of the sonographic appearance of normal variants and pathology is essential for accurate interpretation of renal sonograms. 2082715 TACRD and VACTERL associations in a fetus: case report and review of the literature Ganqiong Xu, Qichang Zhou, Ming Zhang Ultrasonography, Second Xiangya Hospital, Malden, MA, United States Objectives: To confirm ultrasound examination can make prenatal diagnosis of tracheal agenesis. TA is a rare and potentially lethal congenital anomaly with an incidence of ,1/50,000. Methods: System ultrasound examination detected multiorgan anomalies in a fetus. Postmortem radiological examination and necropsy confirmed all sonographic findings. Results: Ultrasonographic findings led to suspicion of TA or tracheal atresia, left radial and fibular aplasia, left ulnar and tibial hypoplasia, hypoplastic left heart syndrome, duodenal atresia, spinal bifida, agenesis of the kidneys, diaphragmatic hernia, oligohydramnios, and a single umbilical artery. Postmortem radiological examination and necropsy confirmed all sonographic findings and revealed other malformations. Autopsy findings showed complete agenesis of the trachea and two mainstem bronchi connecting the right and left lungs. A TEF arising from the esophagus connected through the carina, from which the two mainstem bronchi originated. Floyd’s type II tracheal agenesis was diagnosed. We also observed imperforate anus, absence of the thumb and syndactyly on the left hand, and left foot hypoplasia. Radiographs confirmed left radial and fibular aplasia and left ulnar and tibial hypoplasia. Conclusions: TA is usually fatal in the neonatal period. Most infants with TA die during the first days of life. So prenatal diagnosis is very important, but Robert et al. suggested that it can be made only by magnetic resonance imaging. However, in our case, ultrasonographic examination led to the suspicion of TA associated with other congenital anomalies. Firstly, we found a single umbilical artery, which may be the first sign of congenital malformations. Secondly, we carefully examined the fetus for multiorgan anomalies, the presence of which warned of potential tracheal problems. Finally, we detected no trachea on three-vessel and trachea views, leading to a preliminary diagnosis of TA associated with other congenital anomalies. Few cases of infants with VACTERL or TACRD association have been reported to date. To our knowledge, this is the second reported case that demonstrated multiorgan anomalies consistent with the full ranges of VACTERL and TACRD associations in a fetus. 2082726 Scrotal Ultrasound In The Emergency Department: Untwisting The Differentials Nupur Verma, Radiology, University Of Washington, Seattle, WA, United States Objectives: 1. Appreciate the utility of scrotal ultrasound in the Emergency Department as a cost-effective portable exam that improves throughput. 2. Recognize common diagnosis seen on scrotal ultrasound performed for the indication of acute pain with suspected testicular torsion, including torsion itself. 3. Access management of patients seen in the ED setting for nontorsion findings, including further evaluation of testicular microlithiasis and newly diagnosed masses.

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Methods: We review cases performed in an urban Emergency Department for the specific indication of torsion. We present ultrasound images of positive cases of torsion and also of differential diagnosis, with common helpful diagnostic features and pitfalls. Results: As expected, majority of patients have negative ultrasound examination. However, the incidence of other findings is relatively high. The most common finding was epididymitis, followed by epididymoorchitis. Other common ultrasound findings included microlithiasis, and epididymal and testicular masses. Extra-testicular findings were also very common, including hydroceles and varicoceles. Conclusions: Ultrasound plays a key role in evaluating patients with acute scrotal pain. In most patients the indication suspected is acute torsion. However, testicular torsion is a rare diagnosis usually seen in younger males with acute onset of pain. There are factors that increased the likelihood of a positive ultrasound for torsion, for example the strong predictive value of loss of cremasteric reflex or history of previous torsion. In the ED setting other etiologies are much more likely, and familiarity with their findings is just as important due to their high prevalence.

2082745 Fat-Contained Hepatic Masses: US, CT, MR And Pathologic Correlation Yongsoo Kim, Sang hyuk Yim Radiology, Hanyang University Guri Hospital, Guri-si, Gyounggi-do, Korea (the Republic of) Objectives: There were various histologic types of hepatic masses that contained fat. Those masses had similar sonographic findings; hyperechoic nodules well circumscribed margin, and occasionally posterior attenuation. However, their CT and MR findings made it easy to diagnose among them. These radiologic findings are well correlated with pathologic findings and we can differentiate these fat-containing hepatic masses. Methods: We reviewed the many cases of fat-containing hepatic lesions (multifocal fatty infiltration, hepatic angiomyolipoma, nodular regenerative hyperplasia of the liver, hepatocellular adenoma, dysplastic nodules, hepatocellular carcinoma with fatty metamorphosis) and correlated between their radiologic and pathologic findings. Results: Nowadays we can easily detect fat-containing hepatic lesions by various image modalities. These radiologic and pathologic findings are well correlated each other, we can differentiate these fat-containing hepatic masses. Conclusions: Fat contained hepatic lesions were very diverse range from completely benign to malignant. To know the additional features of fat contained hepatic nodules, we could more precise diagnosis.

2082791 Difficulties In The Performance Of Ultrasound Elastography Of Thyroid Malignancies Alexander Sencha, Yury Patrunov, Helen Sergeeva, Mikhail Mogutov Yaroslavl Railway Clinic, Yaroslavl, Russian Federation Objectives: to analyze disadvantages, difficulties, and artifacts during ultrasound elastography of thyroid cancer. Methods: Ultrasound examinations with elastography of 141 patients with verified thyroid cancer were analyzed. The reference group with verified benign nodules included 432 persons. The scanners S2000 (Siemens-Acuson), SonixSP (Ultrasonix), DC-8 (Mindray) with linear 7.5-15MHz probes were utilized. Results: The efficacy of the combination of compression and sharewave elastography in diagnosis of thyroid cancer was characterized with sensitivity of 96.4% and specificity of 90.1%. Compression elastography was