[The Achilles tendon: echography at different frequencies. Comparative study]

The authors report their experience with a comparative US study employing different-frequency probes (7.5, 10, 13 and 15 MHz) in Achilles tendon conditions. The study population included 49 patients, 37 of them athletes. All patients complained of the same symptoms: achillodynia in the middle third (group A, 29/49 cases), achillodynia in the lower end (group B, 16/49 cases), suspected partial rupture in the middle third (group C, 2/49 cases) and suspected distal rupture in the upper third (group D, 2/49 cases). In group A, the different frequencies yielded different results. 7.5 MHz frequencies yielded negative results in 13/29 patients, versus 3/29 with higher frequencies, which demonstrated peritenon inflammation in 10/29 cases. In the remaining 16 cases, where 7.5 MHz frequencies had shown tendon inflammation and degeneration, the higher frequencies confirmed the findings, even though their accuracy was greater. On the contrary, in the cases of distal achillodynia where pain was mainly due to inflammation of the retrocalcaneal bursa, the different frequencies yielded similar results, even though the higher ones proved more accurate in revealing tendon abnormalities--i.e., thickening, focal hypolucencies, spotty microcalcifications, irregularity of the bone lining. In group B, the different frequencies once again exhibited similar results showing a focal hypoechoic discontinuity which was correctly diagnosed on the basis of clinical history. Finally, as for group C, the lower frequencies gave better results because of the deeper location of the region of interest. In both cases a small blood collection was visible, between gastrocnemius and soleus, in the absence of clear-cut tendon lesions. No matter what the condition, the higher frequencies were extremely valuable since they allowed excellent demonstration of tendon anatomy. The tendon is enveloped by the peritenon, made of two macroscopically distinct sheaths the distinction of which is allowed by higher frequencies when a minimal amount of fluid is present. From the peritenon, the intratendon septa originate circumscribing spaces containing tendon fiber bundles. The vessels, which run longitudinally, are located within the confluence of the septa. On US images, the septa appear as thin hypoechoic stripes or small hyperechoic spots depending on the type of scan (longitudinal/axial). As to tendon fibers--i.e., tenocytes, collagen and elastic fibers--their pattern is homogeneous and hypoechoic since devoid of interfaces.

[Echography in neoplasms of the mesopharynx and the larynx]

Laryngeal and mesopharyngeal cancers are usually diagnosed by means of endoscopy which, however, fails to demonstrate tumor spread to adjacent structures. Aim of the present work is to assess the role of US in the evaluation of these lesions, relative to the demonstration of both the primary tumor with its local spread and metastases. This could help choose the correct therapeutic approach and select the patients ineligible for surgery to treat with chemo-/radiotherapy. Twenty-seven patients underwent US: 9 had mesopharyngeal and 5 supraglottic cancers, 11 had glottic and 2 subglottic lesions. With the only exception of subglottic cancers, US always demonstrated the primary tumor and its spread to anterior and posterior perilaryngeal structures. Moreover, node involvement could be studied. US proved uninformative in demonstrating the posterolateral laryngeal walls, the subglottic area, the presence of deep lymph nodes and the retrocartilaginous structures when associated with calcifications of the thyroid cartilage. In summary, we believe that US can be useful as the first-step imaging modality to stage laryngeal and mesopharyngeal cancers and to follow the patients submitted to chemo-/radiotherapy.

[Hemophilic arthropathy: echography and radiology]

Our experience is reported with the combined use of radiology and US in the study of 210 joints of hemophilic patients. The study was carried out considering that in hemophilia the classification of the grades of disease generally relies upon X-ray findings which, although reliable in the advanced stages of the disease, appear inadequate in the early stages. In fact, synovial hypertrophy, cartilage erosions and initial subchondral cysts are most often missed on X-ray films. In the examined cases, US was employed to evaluate: 1) the degree of synovial hypertrophy, 2) the status of the explorable cartilage, 3) the presence of effusions and 4) the status of bone linings--whenever erosions, even of minimal extent, were suspected, X-rays were always performed and the results employed as the reference standard. The examined joints did not exhibit the same grade of involvement: the knee, elbow and ankle had advanced arthropathy in 85% of cases, corresponding to > or = 7 according to Pettersson score. On the contrary, the shoulder and hip were found to be equally involved either by initial (Pettersson score: 0-6) or by advanced arthropathy (Pettersson score: > or = 7). Moreover, in nearly 10% of the cases, hemarthrosis was found which showed no correlation with the grade of joint involvement. Our results indicate that: 1) US appears very useful in the early stages of the disease when the X-ray picture is negative or poorly significant. The demonstration of early alterations is useful mainly in those cases in whom synoviectomy is considered (for prevention); the latter is useful only if performed before cartilage erosion appear; 2) US appears equally useful in hemarthrosis cases, especially in those of limited extent in which the clinical therapeutic management may be difficult; 3) US appears unnecessary in the cases of advanced arthropathy in which X-rays serve as the reference standard.

[Echography in the study of lipomas of superficial soft tissues]

High-resolution sonography (US) was used to evaluate 47 superficial soft tissue lipomas. Forty-one lesions were found in subcutaneous tissues and 6 in superficial muscles. The lipomas were classified by location, shape, echotexture, homogeneity and US beam attenuation values. Moreover, 21 lipomas underwent histology and histologic patterns were correlated with echogenicity. Most lesions were elongated and their greatest diameter was parallel to the skin. Eighty-four percent exhibited well-defined margins. Twenty-six percent of the lipomas were hypoechoic, 24% were isoechoic, 34% hyperechoic and 16% exhibited a mixed pattern. In 27% of cases, a hypoechoic capsule was present. Superficial soft tissue lipomas exhibit unsteady echotexture: most of them are hyperechoic. The correlation between echotexture and histology showed that no typical and steady patterns can be identified, since lipomas vary from a histologic point of view. The clinical diagnosis of superficial lipomas is based on clinical history and the palpation of a well-defined, mobile and soft superficial mass. When palpation is not diagnostic, US can be used to rule out a cyst. An elongated isoechoic or hyperechoic mass in the subcutaneous tissue should suggest a lipoma, whereas a hypoechoic mass is associated with a broader range of differential diagnoses, including malignant tumors. However, malignant masses are not likely to have an elongated or flattened shape. Even though tissue characterization is less specific with US than with CT and MRI, the former method is quick, easy and less expensive and, thanks to high-frequency transducers, is also well-suited to diagnose soft tissue lipomas.

[Percutaneous alcoholization of a small hepatocarcinoma]

Twenty-nine small hepatocellular carcinomas (sHCCs) less than 5 cm in diameter were treated with percutaneous ethanol injection (PEI) under US guidance in 24 cirrhotic patients. The nodules were treated on an outpatient basis with 6-18 ethanol injections; the total amount of alcohol delivered to each lesion was 10-103 ml. Twenty-seven of the 29 HCCs (93.1%) showed no evidence viable neoplastic tissue at a dynamic CT scan combined with multiple fine-needle biopsies performed one month after the end of treatment; in 10 cases MR confirmed the presence of necrosis showing marked hypointensity of the lesions in T2-weighted images. None of the 27 necrotized sHCCs recurred locally during a 4-44 months' follow-up period (mean 18 months). Two lesions larger than 4 cm showed incomplete response to treatment. No complications occurred after a total number of 264 alcohol injections. The 1-year survival rate in the 16 patients with a follow-up longer than 12 months was 93.7%. PEI proved to be a safe and effective treatment for sHCCs. In particular, PEI can be viewed as a reliable alternative to surgery in the management of nodules less than 3 cm in diameter, considering the operative hazards and the high risk of new lesions occurring in resected livers.

[The echographic aspects of prostatic carcinoma before and after radiation treatment]

The authors evaluated the US patterns of 50 prostatic carcinomas before and after radiation therapy, analyzing the correlation of US patterns with histologic (bioptic) findings and with treatment outcome. Before radiation therapy, 28 tumors were hypoechoic, 8 were isoechoic and 14 mixed. In 18 of 28 hypoechoic carcinomas, the lesion showed a progressive increase in echogenicity, becoming completely isoechoic 9-18 months after the end of treatment. In this group of patients the final response to treatment was complete in 17 cases and partial in 1; during the follow-up (24-90 months, mean 48 months) neither local recurrences nor distant metastases were observed. In 10 of 28 hypoechoic carcinomas, a hypoechoic area of variable size was still clearly recognizable within the lesion after a minimum period of 18 months since the end of treatment. Nine of these patients underwent histology and persistent carcinomas were found in 8 of them; one patient developed distant metastases. In the group of isoechoic and mixed carcinomas, no significant differences were observed in the US patterns relative to treatment outcome. Persistent prostatic carcinoma after radiation therapy seems not to affect its US pattern. If the tumor is hypoechoic before treatment, the persistence of a hypoechoic area within the lesion 18 months after the end of treatment must be regarded as a possible therapeutic failure and histologically verified. On the contrary, the evolution of the lesion toward isoechogenicity is usually related to a favorable outcome. If the tumor is isoechoic or mixed before treatment, a reliable US evaluation is not possible and the correct assessment of the response to treatment can only be made with multiple biopsies.

[Ultrasound-guided biopsy of small abdominal lesions. Methodology implications]

In the present study the diagnostic accuracy of US-guided fine-needle biopsy was evaluated in a series of 219 abdominal lesions < or = 3 cm in diameter (21 between 0.6 and 1 cm; 83 between 1.1 and 2 cm; 115 between 2.1 and 3 cm). One-hundred-eighty-three of them were located in the liver and 36 in other abdominal organs (pancreas, 10, adrenals 9, lymphnodes 9, kidney 5, spleen 3). Biopsies were performed with "free-hand" technique using up-to-date ultrasound equipment. The demonstration of the correct location of the needle tip at the time of sampling was looked for with great care. The sensitivity rate was 93%, with a progressive improvement with the increase of the lesion size (83.3% between 0.6 and 1 cm; 91.1% between 1.1 and 2 cm; 95.4% between 2.1 and 3 cm). The specificity rate was 100%. In 207 cases in which the location of the needle tip was clearly demonstrated, the sensitivity reached 97.3% and the negative predictive value 93%. No noteworthy complications were observed. Ultrasonography is a highly reliable guidance modality also in biopsies performed on small abdominal lesions; if the correct location of the needle tip is clearly shown, even a diagnosis of benignity can be confidently made.

[The diagnostic imaging of complex breast nodules]

This study was aimed at determining the role of high-frequency (7.5 MHz) US combined with cytology in the diagnosis of complex breast nodules (complex cysts--cystic tumors). The study population included 60 patients presenting with complex breast nodules selected on the basis of US patterns among 3,000 cases. All patients were also submitted to US-guided fine-needle aspiration biopsy (FNAB). Cytology of nipple discharge was always performed when discharge was present (15 cases), mammography was performed in 50 cases and pneumocystography in 10. US allowed the identification of the lesion in all patients and the diagnosis of nature in 73%; with FNAB the figure reached 96.7%. Mammography identified the lesion in 95% of patients, but failed to reveal the complex nature of the nodule. In a small number of cases mammography proved to be a useful complementary tool demonstrating malignant features not recognizable on US images. On the contrary, pneumocystography yielded no further information with respect to US. Diagnostic control was obtained by means of surgery in 30 patients and of clinical-US follow-up in the extant 30 cases. On the basis of their US features the lesions were classified into two groups: I) nodules having a mainly liquid component--i.e., hemorrhagic, septic, multilocular cysts, papillary cystadenoma; II) nodules having a mainly solid component--i.e., solitary intraductal papilloma, intracystic carcinoma, mixed carcinoma, phylloid adenoma, sarcoma. As to the former group, US proved reliable in making a diagnosis in the cases with typical hemorrhagic, septic and multilocular cysts. In the atypical cases, FNAB of the solid component of the nodule was necessary to differentiate irregular clots, thick septa or inflammatory thickening from different conditions. As to the latter group, FNAB of the solid component and/or mammography proved useful in making a diagnosis, even though to this aim US revealed peculiar patterns which were highly suggestive. In our experience, combined US and FNAB are of basic importance in the diagnosis of breast lesions, thus replacing pneumocystography which has been widely employed so far. As regards mammography, its role seems limited to pointing out the peculiar characters of malignancy which could not be demonstrated otherwise.

[Small nodules of adenomatous hyperplasia in the cirrhotic liver. Treatment with percutaneous alcoholization]

Small adenomatous hyperplastic nodules (AHNs) are now detected with increasing frequency in cirrhotic livers thanks to the widespread use of ultrasonography (US) in patients with chronic liver disease. The management of these lesions, which are commonly considered as likely to evolve into hepatocellular carcinomas (HCCs), is difficult: indeed, the surgical resection of a questionable neoplastic lesion does not seem advantageous, if surgical hazards are considered; on the contrary, the simple US/bioptic follow-up may be untimely in the detection of the malignant transformation. Percutaneous ethanol injection (PEI) under US guidance, already employed in the treatment of small HCCs, was recently proposed as a viable therapeutic alternative for AHNs. Our experience includes 16 AHNs submitted to PEI over a 2-year period. The size of the lesions ranged between 0.7 and 2.3 cm. Each nodule was treated on an outpatient basis with 6 weekly ethanol injections; the total amount of alcohol delivered to each lesion was 8-17 ml. No complications occurred. PEI induced volumetric reduction and/or structural modifications of the lesions; 10 of them were hardly differentiable from the surrounding parenchyma at the end of treatment. One month after PEI, CT allowed the detection of 13/16 AHNs; all of them resulted hypodense and showed no contrast enhancement. Repeated biopsies produced necrotic material in all cases. During the follow-up (10-33 months, mean 18.3) no recurrences were observed. At the moment, PEI seems to be the most appropriate therapeutic approach for small AHNs.

[Atkinson prosthesis in esophageal carcinoma. Radiologic study: when CT?]

The endoscopic palliative treatment of esophageal and esophagocardial neoplastic stenoses is generally performed in the patients in whom surgery is not indicated for oncological and general reasons and endoscopic dilatation is uneffective. Our experience is reported concerning 92 patients submitted to palliative therapy through placement of Atkinson prostheses; the patients underwent radiologic studies--i.e. (a) plain chest radiographs (before and after intubation), (b) esophagogastric studies with iodate cm, and (c) CT (performed in the last 20 cases only). The mortality rate at 30 days was 6.5% (6 cases), in no case due to specific complications related to intubation. The mean survival was 3.6 months (range: 1-12). As to the complications specifically related to intubation, they were basically 3: perforation, dislocation, and obstruction (of the prosthesis). As to the methods allowing best demonstration of the same: a) CT proved to be superior in revealing perforation, which usually occurs early after intubation. However, considering its low incidence (2 cases only, in our series), the routinary use of CT does not seem justified. CT should be reserved to selected patients in whom the shape of the neoplasm or peculiar anatomical conditions make intubation difficult, with high risks of perforation--e.g., kiphoscoliosis, hiatal hernia, previous surgery or radiotherapy, angulation of the prosthesis, neoplasm of scirrhous or necrotic type or causing luminal deviation; b) if dislocation occurs, as it more often happens (9 cases in our series) in the presence of soft neoplastic tissue or in cases of mild or asymmetrical stenosis, CT seems likewise unnecessary. Conventional radiology proved superior thanks to its more comprehensive view, and therefore sufficient to suggest the correct treatment--e.g. repositioning of the prosthesis by means of fiberoscopy, or withdrawal after gastrostomy; c) CT appeared useless in the cases due to alimentary causes (easily detectable from the clinical history), but proved useful in the cases due to neoplastic overgrowth. In the latter, CT can yield information as to the site and size of the neoplasm, as well as to its relationship to surrounding tissues, and thus help suggest proper treatment--e.g. dilatation and repositioning of the prosthesis, gastrostomy, recanalization by means of NdYAG laser, no treatment at all.

[Computerized tomography of the orbit in Graves' ophthalmopathy. New observations]

In order to evaluate Graves' ophthalmopathy new CT parameters have been introduced such as: the diameters of the five extraocular muscles, the value of their addition, the grade of apical crowding, the enlargement of optic nerve sheaths and of the superior ophthalmic vein, and the anterior displacement of the lacrimal gland. On this subject we report our further experience after reviewing 68 cases in which the new ocular parameters were correlated with altered ocular motility and optic neuropathy. The results confirmed our previous study, dealing with several groups of patients, which at the moment seem to be 2, instead of 3 groups: a) patients with increase in both muscular and fatty tissue (54/68 cases); b) patients with main or exclusive increase in fatty tissue (14/68 cases). Relevant clinical signs were present only in the first group of patients, where the medial, inferior and superior muscles were affected in 53/55, 53/55 and 50/55 cases respectively. A muscle increase by nearly 50% was more frequently found in cases with altered ocular motility, an increase by 90% was often associated with optic neuropathy. In case of optic neuropathy apical crowding was often observed, mainly in coronal scans, together with significant enlargement of the optic nerve sheath and of the superior ophthalmic vein. As to proptosis, preseptal area and anterior displacement of the lacrimal gland, they demonstrated lower correlation with the reference symptoms, even though their occurrence was high in symptomatic patients.

[Echography in gynecologic emergencies]

The authors report their experience with US in gynecologic emergencies through a retrospective study on 105 patients presenting with acute abdomen of suspected gynecologic nature. The series included 3 groups of patients: Group I: 59 patients all submitted to immediate surgery. The following pathologic conditions were observed: ectopic pregnancy (23 cases), torsion or hemorrhage from ovarian cysts (13 cases), pyosalpinx or tubo-ovarian abscess (9 cases), torsion of pedunculated uterine leiomyoma (7 cases), intraperitoneal bleeding from hemorrhagic corpus luteum (6 cases), hematocolpos and hematometra from imperforate hymen (3 cases). Two false positives, not included in this group, resulting from appendicular abscesses and misinterpreted as ovarian, were submitted to surgery in a gynecologic unit. Group II: 19 patients treated with medical therapy for the following conditions: torsion or hemorrhage from hyperstimulated ovary (10 cases), pyosalpinx or tubo-ovarian abscess (9 cases). Group III: 25 patients in whom neither US nor clinical examination revealed positive gynecologic findings. Both US and clinical follow-up were negative in these patients. The study was aimed at evaluating the role of US in identifying both lesion and peritoneal involvement, and in the diagnosis of nature. US proved a valuable tool in the first two diagnostic steps, allowing to confirm/dismiss active pathologic conditions, to indicate the medical/surgical treatment (immediate or delayed), to detect associated pathologies to study with further examinations. As for lesion nature, US alone proved poorly useful if not correlated with an accurate clinical history.

[Prostatic carcinoma: the importance of echographic monitoring of gland volume after radiotherapy]

Prostatic volume modifications were retrospectively analyzed by means of serial endorectal US in 50 patients affected with prostatic adenocarcinoma previously submitted to external radiotherapy. A progressive reduction in glandular volume (of low, medium, and high grade) was observed in 48/50 patients respectively within 3 months, between 3 and 6 months, and 6-9 months after treatment. After 9 months only lesser modifications were observed. A statistically significant correlation (p less than 0.05) was found between volume decrease percentage and histologic grading of the tumor, but not with its stage. Within the groups of patients affected with similar-grade neoplasms, a statistically significant difference (p less than 0.05) was observed, relative to the decrease rate of prostatic volume, between the patients with complete response and those with partial or no response. US monitoring of prostatic volume after radiotherapy, if correlated with histologic grading, can yield early predictive elements as to treatment outcome, thus contributing to select non-responsive patients to submit to biopsy and, if necessary, to therapeutic alternatives or combinations. Longer-term studies are needed to prove its effectiveness, to prognostic purposes, in the single patient.

[The significance of echographic signs in pathology of the rotator cuff]

Fifty-two patients, 17 acute and 35 chronic, underwent US of the shoulder. The first class of patients had clinical history of blunt trauma occurred 2 to 30 days before examination. The second class of patients included 15 patients with history of trauma occurred 3 months (or more) before examination and 20 patients affected with impingement syndrome. As to the US signs of rotator cuff tear reported in the literature, the results of the study, supported by arthrographic (21 cases), MR (2 cases) and surgical (24 cases) findings, indicate that their presence and significance differ in the acute and in the chronic patient and that: 1) Focal discontinuity, appearing as a hypoechoic area, is demonstrable only in the acute patient. The sign is due to a tear filled with blood and/or bursal liquid and holds high diagnostic accuracy. It is rare that an acute lesion appears as a hyperechoic linear density--which has doubtful diagnostic accuracy. 2) Non-visualization of the cuff is observable in both the acute and the chronic patient and indicates rupture in both of them. This sign has high diagnostic accuracy. 3) Thinning of the cuff is also observable both in the acute and in the chronic patient. Nevertheless, while in the former the sign can be regarded with confidence as indicating a tear in almost all cases, in the latter it may be due either to a tear or to degeneration. Arthrography or MR Imaging are therefore advisable in this group of patients, especially if surgical treatment is considered.

[Solitary intraductal papilloma of the breast. An echographic study of 12 cases]

Solitary intraductal papillomas (SIP) of the breast are relatively common lesions (incidence: 2-3%) originating from proximal ducts or from retroareolar lactiferous ducts. This work was aimed at evaluating the diagnostic reliability of US in the diagnosis of this condition and at discussing the differential diagnosis with similar focal lesions. Twelve cases of SIP were diagnosed with US among 31 selected female patients (aged 16-35 years) who had been referred for serohematic discharging breast and/or palpable nodules. All cases had surgical confirmation. US patterns typical of SIP were: 1) solid hypoechoic nodules with peripheral anechoic areas (7 cases); 2) small papillary excrescences within a cystic cavity, corresponding to papillary cystadenocarcinoma (4 cases); 3) periareolar overdistended ducts filled with dense material (1 case). Surgery was performed directly in 8 patients with positive cytology while mammography, ductography and fine-needle biopsy were performed in the extant 4 patients with negative or questionable cytologic findings. US combined with cytologic samples allowed the correct diagnosis to be made in 8 of 12 cases (66%): this is noteworthy when considering the low reliability of mammography in young patients and the poor tolerance to ductography in general. US allows the differential diagnosis with other focal lesions and subsequently helps shorten the diagnostic route.

[Inflammatory aneurysms of the abdominal aorta: US and CT characteristics]

The authors report their experience with US and CT in 31 cases of inflammatory aneurysms out of a study population of 200 patients with abdominal aortic aneurysms. The work started with a case that had not been diagnosed at US, either due to the operator's poor knowledge of this pathologic condition or because of improper examination technique. The authors stress the importance of a high-frequency probe and proper gain settings which are often necessary for a good visualization of the anterior aortic wall. The correct diagnosis of the inflammatory nature of the aneurysm has been assessed by US ever since, in all cases except for very obese and meteoric patients. In our series, US diagnostic accuracy was 78%, versus 33% reported in literature. US was not accurate in evaluating adjacent structures involvement within fibrous tissues (ureteral narrowing, caval narrowing)--which CT did. Neither US nor CT exhibited reliable diagnostic accuracy in demonstrating enteric involvement within fibrous tissues.

[Computerized tomography in post-operative recurrence of bronchial carcinoma]

The authors describe the different types of postoperative carcinoma recurrences, as seen on CT examinations of the chest, in 38 patients who underwent different surgical procedures for bronchogenic carcinoma (12 pneumonectomies, 22 lobectomies, 2 segmentectomies, and 2 atypical resections). The recurrences were classified as follows: 1) recurrence in the bronchial stump; 2) lymph node enlargement; 3) recurrence in the thoracic wall; 4) recurrence in the residual lobe; 5) pleural effusion; 6) nodule in the contralateral lung. The CT findings, correlated with those from plain chest radiographs and clinical symptoms, indicate a higher incidence of recurrences in the hilar region, either in the bronchial stump or as node enlargement. In the discussion, the problems faced after total and subtotal resection are separately analyzed. While after pneumonectomy plain chest radiographs fail to demonstrate the recurrence in most cases, so that CT is nearly always mandatory, after subtotal resection the diagnostic accuracy of conventional radiology appears higher since the residual parenchyma offers good natural contrast. Nevertheless, after subtotal resection, greater difficulties arise at a deeper radiological analysis due to lobar reassessment, the features of which are to be known.

[CT of the orbit in Graves' ophthalmopathy]

Fifty patients suffering from Graves' disease underwent CT examination of the orbit. The medical rectus width was measured, together with the degree of proptosis and the value of the preseptal area, in order to evaluate the volumetric increase in both the muscle and the fatty tissue. The three parameters were correlated with disorders of ocular motility and with optic neuropathy. The results indicate the presence of 3 classes of patients; a) with main or exclusive increase of muscular tissue; b) with main or exclusive increase of fatty tissue; c) with increase of both muscular and fatty tissues. Only in patients from class c) disorders of ocular motility and optic neuropathy were seen to occur.

[Use of echography in pathology of the maxillary sinuses]

Sonography has recently gained attention as a non-invasive technique improving the diagnostic accuracy of conventional radiology as regards the pathologic conditions of the maxillary sinus. Eighty-two patients with various pathologies of the maxillary sinus--i.e. acute/chronic sinusitis, mucocele, mucopyocele, polyp, and carcinoma--were submitted to US after preliminary conventional radiographs and before CT and surgical treatment (both performed in selected cases only). US proved useful in detecting liquid exudate, mucosal hypertrophy, and lesions of the anterior wall, while it was not as accurate in detecting lesions of the posterior wall (unless fluid was present) and in establishing the nature of a solid lesion. The last two conditions are those where CT is mainly indicated.

[Renal amyloidosis. An echographic study of 7 cases]

Seven patients suffering from renal amyloidosis (2 primitive and 5 secondary) underwent US examination. The results show a strict correlation between US findings and the pathologic changes produced by this condition. US proves to be especially useful in the early stages of the disease: its results, together with the clinical data, may in fact be highly suggestive of the correct diagnosis. On the contrary, in the late stages of renal amyloidosis, when pathologic changes lead to progressive nephrosclerosis, US findings appear aspecific, since they are undistinguishable from the patterns observed in other renal medical disorders.

[Current role of echography in the study of thoracic pathology]

Echotomographic examinations were performed in 64 patients suffering from thoracic wall, pleural, pulmonary and mediastinal diseases, after preliminary examinations using standard radiographic techniques. The value of echography in the detection and evaluation of the location and extent of the lesion is assessed. Particular stress is placed on the physical difficulties involved in the detection and correct evaluation of the relationship with the adjacent organs. The importance of echography in detecting the type of the lesion is under-lined and the semeiological criteria for its correct location are given.