(BQ) Part 2 book Direct diagnosisin radiology urogenital imaging has contents: Prostate cancer, peyronie disease, penile malignancies, the female genitals, ovarian cystadenomas, ovarian cancer, ovarian fibromas,.... and other contents.
Definition ~ Anatomy Each tesris consists of lobules containing densely packed convoluted seminiferous tubules The straight terminal porrions of the seminiferous tubules join to form the rete testis enter the mediastinum testis and become the efferent ductules • The ductules pierce through the tunica albuginea to form the head of epididymis and then converge into the larger vas deferens in the body and tail The seminiferous tubules are composed of germ cells and Serroli cells Testosterone-producing Leydig cells are in the testicular interstitium Tunica albuginea: this is a dense fibrous capsule with an overlying mesothelial layer enclosing the testis Imaging Signs ~ Modality of choice Ultrasound May be supplemented by MRI ~ Ultrasound findings Testis: Ovoid organ Size: 4-5 x 2-3 x 2-2.5 cm • Volume: 15-20 mL • Intermediate echogenicity and fine granular echotexture • Infant testis: 1.5 x I cm in size and of lower echogenicity • Small amount of serous fluid should not be misinterpreted as hydrocele Tunica albuginea: Thin echogenic line surrounding the testis Best seen where it reflects into the testis as the mediastinum testis Mediastinum tesris: Echogenic • Located eccentrically Tubules coursing in a caudocranial direction Scrotal cavity: Thin anechoic rim representing fluid is often seen especially in the area adjacent to the head of epididymis Epididymis: Isoechoic or hypoechoic and somewhat coarser than the testis Pyramidal head at the upper pole of the testis 5-12 mm in length Width of the body lateral to the testis: 2-4 mm • Width of the tail at the lower pole: 2-5 mm Epididymal appendix: Pedunculated hydatid attached to the epididymal head Testicular appendix (hydatid af Margagni): Ovoid hydatid mm in size between the upper pole of the testis and the epididymis Isoechoic • Cystic Typically seen only when a hydrocele is present or in case of torsion Tesricularartery: Primary vascular supply to the tesris • Branch of the abdominal aorta Pierces the tunica albuginea at the mediastinum, forming capsular arteries • Capsular arteries give off centripetal branches An occasional variant runs directly within the mediastinum as a transmediastinal arrery • RI0.48-0.75 Further arteries: Cremasteric arrery (from the inferior epigastric artery) and deferential artery (from the vesical artery) • Supply the epididymis vas deferens and peri testicular tissue RI0.63-1.0 Pampiniform plexus: Venous drainage Part of the spermatic cord Opens into the ipsilateral testicular vein 148 Fig 3.1 Normal upper pole of the testis longitudinal ultrasound scan Higher echogenicity of the testis in the polar region com· pared with the adjacent pyramidal head of the epididymis (filled arrow) A small amount of fluid in the scrotum (open arrow) is normal Flg.3.2 Doppler ultrasound of the testis Normal biphasic arterial flow pattern 149 Scrotal Anatomy Flg.3.3a,b Normal testes MRimages a Axial T2·weighted image Testes with normal high signal intensity b Sagittal Tl-weighted image after intravenous contrast administration Testis with intermediate signal intensity Normal tail of epididymis (arrow) • MRI findings Testis: Homogeneous intermediate signal intensity on Tl-weighted images • High signal intensity on T2-weighted images Hypointense septa radially extending from the capsule to the mediastinum testis Tunica albuginea: Thin line of low signal intensity Epididymis: Isointense to testis on Tl-weighted images, hypointense on T2weighted images More marked contrast enhancement compared with the testis Differential Diagnosis Cryptorchidism - Undescended testis seen in 3% of newborns may descend spontaneously in the first year of life - Inguinal testes are followed up by ultrasound abdominal testes by MRI - Persistent undescended testis will atrophy and has a higher risk of testicular tumor Selected References Hricak H et al.lmaging of the Scrotum New York: Raven Press; 1995 150 o.~P?i!~?~ ~ Epidemiology Most common cause of painless scrotal swelling ~ Etiology Excessive accumulation of serous fluid in the scrotum Congenital: Patent processus vaginalis (communication with the abdominal cavity) in newborns Resolves spontaneously within the first year of life Spermatic cord hydrocele: Small fluid collection due to incomplete closure of the processus vaginalis • Acquired: Reactive hydrocele due to inguinal hernia, epididymoorchitis vascular obstruction trauma, or ascites Idiopathic hydrocele Imaging Signs ~ Modality of choice Ultrasound ~ Ultrasound findings Anechoic crescent-shaped fluid collection around the testis and epididymis Septa and scrotal wall thickening in chronic inflammatory hydrocele Internal echoes indicate high protein content Hydrocele may contain scrotoliths (scrotal pearls) seen as small echogenic calculi with posterior shadowing Clinical Aspects • Typical presentation Painless swelling and soft fullness within the scrotum The underlying testis cannot be palpated • Treatment options Treatment of the underlying cause Fenestration and plication of the tunica vaginalis • Tetracycline sclerotherapy Expectant management in newborns ~ What does the clinician want to know? Exclusion of a testicular tumor Differential Diagnosis Pyocele Hematocele Selected - Floating echoes within the fluid Signs of inflammation History of trauma Acute hematocele is more echogenic Organized hematocele is more complex and heterogeneous References Hricak H et al Imaging of the Scrotum New York: Raven Press: 1995 1S1 Hydrocele :;! ~ ~ ;;; ~ '" ;:;: Flg.3.4 Hydrocele Transverse ultrasound scan showing large hydrocele surrounding the left testis Q ;;; Flg.3.5 Small hy· drocele longitudi- nal ultrasound scan of the right testis Anechoic band around the inferior pole of the testis (filled arrows) Accessory finding: spermatocele in the epididymal head (open arrow) 152 ~~f?!~~?~ ~ Epidemiology Present in 10%or men Mostly spermatoceles • True epididymal and intratesticular cysts are rare Tunica albuginea cysts are more common Cystic transrormation or the rete testis (tubular ectasia) typically caused by obliteration or the errerent ducts in older men ~ Etiology Spermatocele: Cystic distention or the errerent ducts in the epididymis True cysts may occur anywhere in the epididymis Testicular cysts in older men Imaging Signs ~ Modality of choice Ultrasound ~ Ultrasound findings Spermatocele: Thin-walled anechoic cyst only accurring in the epididymal head Posterior acoustic enhancement Single or multilocular May contain internal echoes Septa and sediments in rare cases Cannot be differentiated rrom a true cyst in the epididymal head Testicular cysts and tunica albuginea cysts: Intratesticular cysts lacated near the mediastinum testis • Tunica albuginea cysts are subcapsular in location • Thin-walled Normal echotexture of surrounding testicular parenchyma Rare Tubular ectasia of the rete testis: Anechoic tubules and cysts are seen side by side in the mediastinum testis Clinical Aspects ~ Typical presentation Spermatoceles cause no symptoms Intratesticular cysts not palpable Tunica albuginea cysts palpable as focal masses Large cysts may cause a dragging sensation ~ Treatment options No treatment required ~ What does the clinician want to know? Dirrerential diagnosis especially or intratesticular cysts and testicular tumors Differential Diagnosis Testicular tumors - Especially Adenomatoid tumor - Solid tumor components and palpable mass - Solid benign tumor or the tail or epididymis Selected nonseminomas with cystic componenrs References Hricak H et al Imaging or the Scrotum New York: Raven Press; 1995 153 Testicular and Epididymal Cysts :;! Fig.3.6 •.• testicular and epididymal cysts ;s: Q Diagrammatic representation of Epididymal cyst ;;; •:l C'\ S· ;;:; Intratesticular cyst Tunica albuginea cyst fig.3.7 Longitudinal scan of the right testis Doppler ultrasound Anechoic spermatocele in the epididymal head (arrow) 154 ~~f~.i~~?~ • Epidemiology Prevalence of up to 9% in the USA Association with testicular tumors especially germ cell tumors • Etiology Calcifications of the seminiferous tubules Unclear etiology Imoging Signs • Modality of choice Ultrasound • Ultrasound findings Multiple hyperechoic foci in both testicles (diagnostic criterion: more than five microliths on at least one ultrasound image) • 1-2 mm in size Diffuse distribution • No posterior shadowing Incidental finding Clinical Aspects • Typical presentation Asymptomatic • Treatment options Some centers recommend annual sonographic follow-up to rule out tumor • What does the clinician want to know? Exclusion of a testicular tumor Diagnosis Differential Macrocalafications of the testis - After trauma - Teratoma Sertoli cell tumor - Burned-out Other macroca/afications tumor - Tunica albuginea plaque after trauma - Epididymal calcifications after granulomatous inflammation (tuberculosis) or trauma - Scrotoliths (scrotal pearls) within the scrotum Selected References Hricak H et al Imaging of the Scrotum New York: Raven Press; 1995 155 Testicular Microlithiasis Fig.3.8 Longitudinal ultrasound scan of the left testis Testicular microli· thiasis is indicated by the numerous echogenic foci scattered throughout the testis Three punctate calcifications are indicated by arrows Fig.3.9 Longitudi- nal ultrasound scan of the right testis Testicular microlithiasis is apparent only after magnification 156 Definition ~ Epidemiology Epididymitis is the most common cause of acute scrotum in 20% of patients with epididymitis Concomitant orchitis Isolated orchitis is rare and most cases are due to mumps ~ Etiology Nonspecific bacterial infection urethritis or prostatitis sis syphilis leprosy Imaging Ascending spread via the vas deferens e.g., in Granulomatous epididymitis in sarcoidosis tuberculo- Signs , ~ Modality of choice Ultrasound ~ Ultrasound findings Acute stage: Enlargement of the entire epididymis and testis or predominantly the epididymal tail in less severe forms Coarser and more hypoechoic echotexture Diffuse or focal (primarily at the upper pole of the testis) • Reactive hydrocele Pyocele: Internal echoes Scrotal wall thickening Hypervascularization • RI often < 0.5 Vm" > 15 cm/s Granulomataus epididymitis/orchitis: Hypoechoic nodules with hypervascular rim Virtually impossible to differentiate from tumor Epididymitis nodosa: Chronic Cystic inclusions Abscess: Hypoechoic lesion with irregular borders Internal echoes Hypervascular rim Clinical Aspects ~ Typical presentation Gradual increase in pain Pain becomes more severe with pressure and movement Positive Prehn sign-scrotal elevation and support relieves pain Testicular swelling Fever Complications: Abscess formation Fistula Infarction Infertility, e.g., due to occlusive azoospermia Testicular atrophy Sterility • Treatment options Identification of the causative microorganism Antibiotic treatment Antiinflammatory treatment Surgery if there are complications ~ What does the clinician want to know? Differential diagnosis of acute scrotum (torsion exclusion of tumor) 157 Definition About % of all ovarian tumors Arise from the nonspecialized mesenchymal ovarian stroma Fibroma must be differentiated from fibrosarcoma Ascites is present in 10%of patients with ovarian fibroma and hydrothorax in 1%.especially with tumors over 10 cm in size (Meigs syndrome) • Epidemiology Ovarian fibromas occur at any age but are more common in women over 50 Typically unilateral Imoging Signs • Modality of choice Transvaginal ultrasound for screening MRIfor tumor characterization • Transvaginal ultrasound findings Ultrasound is performed with a 7.5 MHz endoprobe • Good delineation of the ovaries Good evaluation of cystic components in most cases Solid tumor little or no growth over time • MRI findings MRI has 93% accuracy in tumor characterization Solid lesion of low signal intensity on Tl- and T2-weighted images Slight to marked contrast enhancement • CTfindings cr with multiplanar reconstruction capabilities in patients with suspected ovarian tumor Precontrast examination Postcontrast examination after intrave- nous and oral contrast administration with additional rectal opacification if needed Scan range from the diaphragm to the pelvic floor Solid well-defined tumor in most cases No or only small cystic component CT does not allow reliable differentiation from malignant tumors Clinical Aspects • Typical presentation Asymptomatic Often diagnosed in women undergoing • Treatment options Resection or follow-up • Course and prognosis Excellent prognosis • What does the clinician want to know? Signs of malignancy7 • Specific diagnosis if possible Z4Z cancer screening Ovarian Fibromas fig.4.37 Ovarian fibroma Axial T2weighted MR image showing an ovarian mass with hypointense areas Differential Diagnosis Granulosa-theca cell tumor - Similar in morphologic appearance estrogen- producing sex cord stromal tumor - Rare typically occurs after menopause Ovarian malignancy e.g fibrosarcoma - Inhomogeneous composition - At times difficult to separate from fibroma Tips and Pitfalls Do not biopsy an ovarian mass Selected References Outwarer EK et al Ovarian fibromas and cystadenofibromas: MRI features of the fibrous component J Magn Res Imaging 1997; 7: 465-471 Yamashita Yet al Adnexal masses: Accuracy of characterization with transvaginal US and precontrast and postcontrast MR imaging Radiology 1995; 194: 557-565 243 A abscess Bartholin 193 195 periurethral 185 renal 33-35.34.40.43.58.59 drainage 34 scrotal 157.163 accessory renal arteries 105 acquired cystic kidney disease 46 Addison disease 92 adenocarcinoma ovarian 239 prostatic 176 adenoma adrenal 75.76-80.77-78.82 cystic 93 lipid-poor 90 renal 58 adenomatoid tumor 153 adenomyoma 200 adenomyosis 199.200-202.201 diffuse 200 focal 200 adrenal gland adenoma 76-80.77-78.82 adrenocortical hyperplasia 73-75.74 calcification 91-92.92 calcified tumor 92 carcinoma 79.81-84.82-83.86 90.93 regressive 93 cysts 86 93-95 94 mesenchymal tumors 80 metastases 79 82 86 88-90 89 regressive 93 ampullary pelvis 110 angiomyolipoma 47-49.48-49.58 65.66.66 appendage torsion 165 Page numbers in italics refer to illustrations appendix epididymal 148 testicular 148 arcuate uterus 189.191 arteriovenous fistula 70 atherosclerosis 10 11 atrophy renal 27 28 B Bartholin abscess/empyema 193.195 Bartholin cyst 193.223 benign prostatic hyperplasia (BHP) 133.171-173.172.178 bicornuate uterus 189 bifid ureter 96.97.97 bladder blood clot 144 cancer 129-132 130-131 diverticulum 127-128.128 paraureteral 101 endometriosis 207.208 mucosal folds 132 neobladder creation 140.141 perforation 128 rupture 142-144 143 tumor 173 burned-out tumor 160 c calcification 155 adrenal 91-92.92 eggshell renal cyst 42 tuberculosis 37 prostatic 178 testis 155 vascular 121 see also calculus; urolithiasis calculus 111.118 radiolucent 125 staghorn 120 see also urolithiasis carbuncle renal 33 245 carcinoma adrenal 79.86.93 adrenocortical 81-84.82-83,90 regressive 93 bladder 129-132.130-131 cervical 215-128.216-218 staging 215.216 endometrial 204.210-214,211-213 staging 210,211 ovarian 238-241.239 penile 184 urothelial 101,117.124-126, 125-126,129-132,130-131 vaginal 219-221,220 vulvar 222-223.223 see alsa renal cell carcinoma (RCC) cervical cancer 215-218,216-218 staging 215,216 cervical glands 193 cervicitis 218 cervix 186, 187 metastasis 218 see also cervical cancer choriocarcinoma 160.162 contusion, renal 19,20 coproliths 121 corpus cavernosum fibrosis 179, 180 thrombosis 179,185 Cowper syringocele 185 cremasteric artery 148 cryptorchidism 150 Cushing syndrome 81,83,231 cyclosporin toxicity 72 cystadenocarcinoma 229.237 cystadenoma 43,59-61.241 ovarian 229.235-237.236 mucinous 235 serous 235 cystectomy 140 cystic adenoma 93 cystic lymphangioma 93 cystocele 224.225 cysts adrenal 86,93-95.94 Bartholin 193,223 246 dermoid 209 229 endometriotic 206.208 epididymal 153 154 Gartner duct 193 194 Nabothian 193, 194 ovarian 209.227-229.228,231, 234.237 see also polycystic ovaries paraurethral 137 paravesical 128 prostatic utricle 173 renal 38-43 acquired cystic kidney disease 46 atypical 40,41-43,42 complicated 40,41-43.42 cortical 38-40 echinococcal 43 infected 35,41.43,44 parapelvic 38-40, 110 simple 38-40.39,44 see also polycystic kidney disease seminal vesicle 101 testicular 153,154 urachal 128 see also polycystic kidney disease cytomegalovirus (CMV)infection 72 D deferential artery 148 dermoid 209, 229 distal renal tubular acidosis diverticulum, bladder 127-128,128 paraureteral 101 urethral 135, 136.137 double ureter 96 97 97 duplex kidney duplicated renal pelvis dysgenesis uterovaginal 189 E echinococcal cyst 43 ectasia renal tubular tubalar, of the rete testis 153 Index ectopia renal I crossed I 98 uteralorifice 96 edema scrotal 166 eggshell calcification renal cyst 42 tuberculosis 37 embolism 13 endometriosis 206-209,207-208 endometrium 186 carcinoma 199.204,210-214, 211-213 staging 210,211 hyperplasia 204,214 polyps 199,203-205,204.214 stromal sarcoma 214 epidermoid 163 epididymis 148,150 cysts 153.154 epididymitis 157, 165 granulomatous 157 nodosa 157 epididymoorchitis 157-159.158 extrarenal pelvis 110 F fibroids 196-199, /97-198 see also leiomyoma fibroma, ovarian 199,241 242-243,243 fibromuscular dysplasia 10 fibrosarcoma 243 fibrosis penile cavernosal 179, 180 prostatic 175.178 retroperitoneal 115-117.116 fistula arteriovenous 70 vesicorectal 138-139 vesicovaginal 138-139 forniceal rupture 109, 111 G ganglioneuroblastoma 84 ganglioneuroma 80,84 Gartner duct cyst 193, 194 germ cell tumors 160,162,241 Graafian follicles 231 granuloma 132 granulosa-theca cell tumor 243 gravel 118 H hamartoma 47 hematocele 151 scrotal 166 hematoma peritesticular 166 renal 19, 20, 21 following kidney transplant 70,71 retroperitoneal 144 subcutaneous 147 testicular 166,167 hemoperitoneum 144 hemorrhage adrenal calcification and 91 adrenocortical carcinoma 81 intrascrotal 166 prostatic 175.178 renal cysts 41,42,44,45,46,49,58 horseshoe kidney 1,3 hydatid of Morgagni 148 hydrocele 151,152,158,167 spermatic cord 151 hydronephrosis 28 hyperplasia adrenocortical 73-75, 74 endometrial 204,214 macronodular 79 hypoplasia, renal 28 247 Index incidentaloma 76, 77 infarction renal 13-15,14,25 trauma and 21 testicular 163 infection adrenal 79 calcification and 91 renal cysts 35,41,43,44 injuries see trauma K keratocyst 163 kidney transplantation 67-72,70, megaureter 99-100, 100 primary obstructive 99 primary renuxing 99 secondary 99 Meigs syndrome 242 metastases adrenal 75, 79, 82, 86, 88-90, 89 regressive 93 cervical 218 penile 184,185 renal 49,57 microlithiasis, testicular 155, 156 Mycobacterium tuberculosis 36 myelolipoma 80 myometrium 186 focal myometrial contractions 199,202 71,72 nephrologic complications 70 surgical complications 70 N nabothian cyst L laceration, renal 19,20,21 leiomyoma 196-199, 197-198,202 classification 197 submucosal 204 subserosa I 209,241 leiomyosarcoma 199 leukemia 161 Leydig cell tumor 161 lymphangioma cystic 93 Iymphocele 70, 71 lymphoma malignant 82 renal 15,25,30,58,62-64,63 testicular 161 M macronodular hyperplasia 79 malrotation, renal 1.2 Marchand rests 163 mediastinum testis 148 medullary sponge kidney 5-6,6-7 248 193, 194 necrosis following kidney transplantation 70 renal papillary nephritis 37 nephrocalcinosis 121 nephrolithiasis 118 nephronophthisis-medullary cystic kidney complex 46 nephroptosis neuroblastoma 84,86 neurofibromatosis type I 65 nonseminoma 160,162, 162 o oncocytoma 50, 52, 53, 58 orchitis 165 focal 163 granulomatous 157,163 Ormond disease 115 ovary cancer 238-241,239 cystadenomas 235-237,236 Index cysts 209.227-229.228.23 I 234.237 see also polycystic ovaries endometriosis 206 fibroma 199.242-243.243 neoplasia 209 polycystic 227 teratoma 232-234.233 p pampiniform plexus 148 papillary blush paracolpium 186 paraganglioma 85 parametrium 186 paraneoplastic syndrome 57 parapelvic renal cysts 38-40.110 pelvic kidney 1.2 pelvic organ prolapse 224-226.225 penis cavernosal fibrosis 179.180 fracture 145.146.179 malignancies 184- 185.185 metastases 184.185 Peyronie disease 181-183.182-183 phakomatoses renal involvement 65.66 pheochromocytoma 82.85-87 86-87 90 93 phlebolith 121 polycystic kidney disease 43.44-46 45 autosomal dominant (ADPKD) 44.46 autosomal recessive (ARPKD) 44.46 polycystic ovaries 227.230-231 23/ polyps adenomyomatous 203 endometrial 199.203-205.204.214 postoperative lower urinary tract 140-141.141 primary hyperparathyroidism prostate cancer 173.175.176- 178.177 prostatectomy 140 141 prostatic utricle cyst 173 prostatitis 174 175.178 pseudoaneurysm 70 pseudodiverticulum 127 pseudotumor 80 pyelonephritis 15 acute 23-25.24 chronic 26-28.27.114 granulomatous 28 with abscessformation 32 xanthogranulomatous 25.29-30.30 pyocele 151.157 pyonephrosis 30.31 -32 32 R rectocele 224.225 anterior 224 physiologic 226 rectovaginal fistula 138 139.218 rejection kidney graft 70 renal abscess see abscess renal anomalies 1-4.2-3 renal artery accessory 105 stenosis (RAS) 10- 12.11 following kidney transplant (TRAS) 70.71 72 renal cell carcinoma (RCC) 30.35.49 52.54-58,55-57,64,66.125 chromophilic 54 chromophobe 54 clear cell 54 collecting duct 54 cystic 40.43,59-61,60 hypovascular 50.51 metastasis 49 57 spindle cell 54 staging 55 renal cysts see cysts renal infarction 13- 15.14.25 trauma and 21 renal papillary necrosis renal transplant 67-72 renal tuberculosis 6.36-38.37.125 249 renal vein thrombosis 16-18.17-18 retroperitoneal fibrosis 115-117,116 retroperitoneal lymphadenopathy 117 sarcoma botryoides 219-220 endometrial stromal 214 scrotal anatomy 148-150,149-150 seminal vesicle cyst 101 seminoma 160,161,162 septate uterus 189, 192 5ertoli cell tumor 161 spermatocele 152.153.154 staghorn calculus 120 Stein-Leventhal syndrome 230 u Ureaplasma urealyticum 174 stenosis ureter renal artery (RAS) 10-12.11 following kidney transplantation (TRAS) 70,71 ureteropelvic junction 103, 104 syringocele Cowper 185 endometriosis 207 injuries 122-123,123 ureteral duplication anomalies 96-98.97 ureterocele 101-102.102 ureterolithiasis 118 ureteropelvic junction (UP]) anomalies 103-105,104-105 T teratoma 160,209 ovarian 232-234,233,241 testicular artery 148 testicular microlithiasis 155.156 testicular torsion 159.164-165 165 testicular trauma 166-168 167 testiculartumors 153,159,160-163, 161,162.168 testis 148, 149-150.150 cysts 153.154 macrocalcifications 155 rupture 166 thrombosis corpus cavernosum 179,185 renal 13,16-18 17-18 following kidney transplant 70,71 transplant renal artery stenosis (TRAS) 70, 71 72 250 transplant renal vein thrombosis 71 trauma 19-22.20-21, 25 bladder rupture 142-144.143 penile 145-147, 146 testicular 166-168,167 ureteral 122-123.123 urethral 145-147 146 tuberculosis see renal tuberculosis tuberous sclerosis 65 66 tunica albuginea 148 cysts 153 TURB 140 TURP 140 congenital stenoses 104 rupture 21 urethra diverticula 135.136,137 female pathology 135-137.136 rupture 133 stricture 133-134.134.147 surgery 140 trauma 145-147.146 tumor 133.135.137 urinary obstruction 106 acute 109-111.110-111,114 chronic 110.112-114.113 urinoma 70 urocystolithiasis 118 urolithiasis 118-121,119-120 urothelial carcinoma 101.117, 124-126.125-126 bladder 129-132,130-131 Index uterovaginal anomalies 189-192 190-191 arcuate uterus 189 191 bicornuate uterus 189 classification 190 dysgenesis 189 lateral fusion defects 189 septate uterus 189.192 unicornuate uterus vaginal septum 189 vertical fusion defects 189 189 uterus anatomy 186 187 endometriosis 206 postmenopausal 186 see also uterovaginal anomalies v vagina anatomy 186-188 187 carcinoma 219-221.220 endometriosis 206 see also uterovaginal anomalies vaginitis 221 varicocele 169-170.170 primary 169 secondary 169 vesicorectal fistula 138-139 vesicoureteral refiux (VUR) 106-108 107 grading 107 vesicovaginal fistula 138-139 von Hippel-Lindau disease 65 von Recklinghausen disease 65 vulva carcinoma 222-223.223 chronic innammation 223 251 Sectional Anatomy Pocket Atlas of Sectional Anatomy CTand MRI Third Edition Torsten Moeller MO and Emil Reif, MD Pocket Atlas of Sectional Anatomy returns in a new, three·volume edition Renowned for its superb illustrations practical information, the third edition and highly of these classic references reflects the very latest in state-of·the·art technology imaging The compact and portable books provide a highly specialized navigational tool for clinicians seeking to master ability to recognize anatomical structures and accurately the interpret (T and MR images Features • New (T and MR images • Didactic organization of the highest quality using two-page units with radiographs on one page and full-color illustrations on the next • Consistent color-coding structures to aid identification • Sectional enlargements for detailed classification of the anatomical ~ ~ ~ ~ 'jj " ~ ~ structure Vol2: Thorn, H$rt, Abdomen, and PeMs 2007/255 PfJ./ 443 illus./softcover American continents V~ 1: He;adand Neck 2007/272 PfJ./ 413 iIIus./softcover American continents 15BN97B-I-5889O-475-1/ 139.95 Europe Asia Africa and Australia 15BN978-3-13-125503-7/ 84.95 of individual ISBN 978-1-58890-577-2/ 139.95 Europe, Asia, Africa, and Australia ISBN 978-3-13-125603-4/ Vol 3: SpIne, Extremities, Joints 2007/341 PfJ./ 485 ilIus./softcover American continents 15BN978-1-58890-566-6/ 139.95 Europe:, Asia, Africa, and Australia ISBN 978-3-13-143171-41 £34.95 £34.95 Easy ways to order Visit our homepage www.thleme.com I\merIcMt contIItenb rr.\'I E-mail a customerserviceOthieme.Com rr.\'I E-mail , custservOthieme.de 'Thieme Fax • +1-212-947-1112 Fax • +49-711-8931-410 Urology Ultrasound of the Urogenital System Grant M Baxter, MD and Paul S Sidhu BSc MBBS MRCP FRCR DTM&H This book provides a comprehensive, multi·disciplined perspective regarding the use of ultrasound in managing renal-based problems It discusses the use of ultrasound in both the native and transplant kidney; in diseases of the collecting system and ureters; in the bladder and prostate; and in the penis and testes It also covers 20061286 pp.1 450 illus./hardcoverl American continents ISBN978·1·58890·237·51 USS 129.95 ~ " {; Europe, Africa Asia, Australia ISBN 978-3-13-137441-71 B €109.95 ,· v ultrasound imaging for interventional procedures and pediatric imaging Descriptions of adjunct imaging methods will help the clinician learn how to employ alternative modalities to reach an accurate diagnosis in any given clinical situation Both specialists and general radiologists will find a wealth of practical information in this outstanding introductory text Features B ~ ,; ~ o • Up-to-date highly targeted information guides radiologists sonographers and physicians at all levels in urology and renal medicine through the management of common problems ~ • Shaded text boxes offer convenient summaries of key points in each chapter-ideal for rapid reference and review · v ·0 · ".g ·Ii' -5 ~~~ ~ ~ Easy ways to order: ~ Visit our homepage www.thieme.com Europe._ As••••Austr.l ••• [-mail custserv@thleme.de Amerlcon continents customerservice@thieme.com t!JThieme • [-mall Fax +49-711·8931410 Fax • +1·212-947· 1112 Urology LJltrdsonoKfdphy In Urology ~',""M.I ~PI",.••", ,", ~.I \~,"" '" Ultrasonography in Urology A Practical Approach to Clinical Problems Second Edition Edward I Bluth MD FACR.Carol B Benson MD Philip W Ralls MD and Marilyn J Siegel MD Recognized experts in the field provide the latest recommendations in urology pp./ 403 illus./softcoverl 2008/192 ISBN 978- 1·SBB90-609-0/ US179.9S Europe Africa Asia, Australia ISBN 978·3-13-1291 '5 £69.95 B of ultrasound the diagnostic evaluation, reviewing the indications and American continents ~ ~ for clinical applications For each clinical problem, the book describes the benefits and limitations of ultrasound imaging It discusses the usefulness of ultrasound, nonimaging tests, or other imaging modalities such as CT and MR, for diagnosing such problems as flank pain, renal failure and 32-51 acute scrotal pain Features v v :s • Clear descriptions a ~ ~ of symptoms and differential diagnosis 'C • More than 400 high-quality 1i demonstrating ", images and photographs key points "g ~ !i' -6 ~ v -." ~ " ~ Easy ways to order: 'Thieme ~ Visit our homepage www.thieme.com Europe AfrIca Asia Australia E·mail custserv@thieme.de • Fax +49-711-8931-410 American E-mail customerservice@thieme.com • Fax +1-212-947-" 12 continents Urology Interactive Teaching Atlas of Urologic Imaging Robert A Older, MD Complete with 102 cases, this state-of-the-art CD-ROM tests the user's ability to interpret images and reach accurate diagnoses of common urologic disorders The CD-ROM guarantees a stimulating educational experience for practicing physicians residents and medical students seeking a firm understanding pertaining to urology 2006/CD-ROMI American continents ISBN978·1-58890·468-3{ U5S119.95 Features Europe Africa Asia, Australia ISBN 978-3-13·143291-9/ ~ '" of all radiologic concepts • 65 videos sequences of CT MRI, and ultrasound examinations, complete with slide bar feature that enables the user to control image sequence as if £99.95 • viewing the original study -6 • An interactive ~ ~ ~ ~ one-on-one program that recreates the traditional viewbox learning by providing feedback on the user's correct and incorrect answers • User-friendly menu with search function allows user to '0 review cases either as unknowns by specific diagnosis or in random order • High-quality color artwork illustrates key concepts in anatomy and pathology t '" ~ ~ ~ 'j; " ~ • Easy ways to order: ~ Visit our homepage www.thieme.com Europe Atricio AsNI Australia t!Thieme E-mail custserv@thieme.de Amertun E·mail continents customerservice@thleme.com • • fax +49-711-8931-410 fax +1-212-947-1112 ... AF1P.Tumors and tumorlike lesions or the testis: radiologic-pathologic correlation RadioGraphies 20 02: 22 : 189 -21 6 163 Definition Urologic emergency Rotation of the testis on the spermatic... in the USAin 20 06: 23 4460 cases • Staging T1: Tumor identified by prostate biopsy 120 : Tumor involves less than half of one lobe 12b: Tumor involves more than half of one lobe 12e: Tumor involves... hemarrhage: - First 24 hours: Intermediate signal intensity on Tl-weighted images Moderately hyperintense on T2-weighted images - 24 hours to days: Hypointense on Tl- and T2-weighted images -