OBJECTIVE: The present study was aimed at sonographically determining the liver size in healthy newborns, infants and children under 7 years of age, correlating results with age, sex, height, body weight and body mass index. MATERIALS AND METHODS: A total of 584 healthy children subdivided into 11 age groups were evaluated with measurements of the left lobe craniocaudal diameter at the midsternal line, and the craniocaudal diameter of the right lobe posterior surface at the midclavicular line. The following tests were utilized for statistical analysis: a) Pearson's correlation coefficient (correlation study); b) non-paired Student's t-test (comparison of measures between sexes); c) nonlinear regression models (nomograms). RESULTS: The liver size presented a progressive growth from the birth up to the age of 7, proportionally lower than the body growth, in correlation with age, height and body weight (r > 0.70). Correlation with the body mass index was not observed (r < 0.11). There was no significant difference in liver size between male and female individuals. CONCLUSION: Liver size was sonographically determined in healthy children under the age of 7 by means of a standardized method, demonstrating a strong correlation with age and anthropometric indicators. Nomograms demonstrate the typical variations of the liver size in the population evaluated with a different growth pattern for each hepatic lobe.

Keywords: Liver, Liver size, Biometry, Child, Ultrasonography

OBJECTIVE: To describe ultrasonographic findings of localized cutaneous scleroderma and correlating them with clinical findings. MATERIALS AND METHODS: Twenty-three lesions of localized cutaneous scleroderma in 21 patients were evaluated with a Logiq 700 equipment coupled with a 6-14 MHz linear transducer. The disease stage (athrophic or inflammatory) was evaluated by a dermatologist, and the ultrasonographic findings (skin thickness and echogenicity) for both the affected and adjacent healthy regions were evaluated by a radiologist. Seven of the cases underwent post-treatment follow-up. RESULTS: All the affected regions presented loss of the normal ultrasonographic pattern of the dermis. Cases with clinically atrophic lesions (52.2%; 12/23) corresponded to reduction in the thickness and increase in the echogenicity of the dermis, and clinically inflammatory lesions (47.8%; 11/23) corresponded to decrease in echogenicity and increase in the thickness of the dermis. Post-treatment follow-up demonstrated alterations in the dermis thickness. CONCLUSION: The ultrasonographic findings allow the correlation between increase in the thickness/decrease in echogenicity of the dermis with the inflammatory phase of the disease, and decrease of the thickness/increase in echogenicity of the dermis with the atrophic phase. Also, it could be observed that it is possible to quantify the thickness of the dermis, utilizing this information associated with the clinical evaluation in the post-treatment follow-up.

Keywords: Localized scleroderma, Ultrasonography, Dermis

OBJECTIVE: To correlate the isolated sonographic finding of umbilical cord cyst with fetal anomalies such as chromosomopathies and structural changes. According to the medical literature, the clinical implications of the sonographic finding of umbilical cord cyst in the second and third trimesters of pregnancy are well established; however, the meaning of this finding in the first trimester still remains controversial. MATERIALS AND METHODS: A retrospective study was developed with consecutive, pregnant women with single living fetuses presenting with umbilical cord cyst as an isolated finding, over a 10-year period (1996-2006). Ultrasound studies were performed in all cases for screening of fetal anomalies after the diagnosis of umbilical cord cyst. Neonates and umbilical cords were evaluated after delivery for the presence of abnormalities. RESULTS: Nine cases presenting umbilical cord cyst as a sole finding with no other sonographic marker for fetal abnormality were evaluated. Two cases were detected in the first pregnancy trimester and seven cases in the second and third trimesters. Fetal cytogenetic study was done by means of amniocentesis in two cases. No newborn presented with structural anomalies or aneuploidy. CONCLUSION: Isolated sonographic finding of umbilical cord cyst did not imply increased risk for fetal structural anomalies or aneuploidies.

Keywords: Fetus, Umbilical cord, Cysts, Ultrasonography, Chromosome aberrations

OBJECTIVE: The present field research was aimed at identifying sonographic and hemodynamic findings indicative of the presence of schistosomiasis mansoni in endemic areas. MATERIALS AND METHODS: Doppler sonography was performed in 554 patients with schistosomiasis in three areas with different endemicity levels: low (n = 109), medium (n = 255) and high endemicity (n = 190). The World Health Organization (Niamey Working Group, 2000) protocol was adopted for sonographic evaluation. Doppler study included portal vessels, hepatic and splenic arteries, hepatic veins and collateral vessels. RESULTS: A significant correlation was observed between the frequency of sonographic findings, except for left lobe hypertrophy, and the areas endemicity levels. Altered hepatic veins flow pattern was observed in 23.7% of cases, such abnormality being related to the presence and intensity of periportal thickening. Hepatic arteries did not present any alteration as related to the evaluated parameters. Collateral vessels were identified only in the patients from the high-endemicity area. The splenic artery presented alterations (increase in caliber, flow velocity and resistive index), most frequently in the high-endemicity area, with significant difference between groups. CONCLUSION: Doppler sonography has shown to be a relevant auxiliary tool in the study of the morbidity related to schistosomiasis mansoni, contributing for a more accurate description of the disease profile in endemic areas.

Keywords: Schistosomiasis mansoni, Doppler sonography

OBJECTIVE: To evaluate, by means of ultrasonography, the spatial parameters of the hyolaryngeal complex in the deglutition dynamics as well the correlation between age and effects. MATERIALS AND METHODS: The present prospective and quantitative study included 39 healthy men and women in the age range between 20 and 70 years (mean, 45.56; standard deviation, 14.53). The swallowing biomechanics corresponding to the measurement of the distance between the upper portion of the hyoid bone and the upper rim of the thyroid cartilage at the moment of maximum laryngeal elevation was evaluated. Measurements were performed with the ingestion of pasty or liquid food. RESULTS: The variation of the distance between the hyoid bone and the larynx presented a positive association with aging only in the swallowing of pasty food that requires a higher lingual propulsive activity than liquid food does. CONCLUSION: An increase in the distance between the hyoid bone and the larynx, corresponding to a poorer laryngeal elevation, may occur during the deglutition of pasty food as a result of aging, a process where a decrease in functional reserves is observed even in healthy individuals. Ultrasonography can detect the swallowing behavior related to foods consistency, demonstrating the diagnostic potentiality of this method in the evaluation of the deglutition.

Keywords: Ultrasonography, Swallowing, Cervical, Dysphagia, Biomechanics, Larynx

Chronic autoimmune thyroiditis is currently considered as the main cause for hypothyroidism and its diagnosis is based on clinical manifestations and laboratory tests results. The most significant laboratory marker for this disease is the presence of anti-thyroperoxidase and anti-thyroglobulin antibodies, the latter being the most sensitive one. Aspiration biopsy shows high sensitivity and specificity but, considering the invasiveness of this method it is reserved for cases of suspected nodules or fast growing goiter. Scintigraphy is unnecessary for the diagnosis, considering its low specificity and sensitivity. Both B-mode and duplex color Doppler ultrasonography have rapidly evolved, becoming a simple, noninvasive and reproducible method with high sensitivity for the diagnosis of chronic autoimmune thyroiditis. Echogenicity is a relevant parameter at B-mode ultrasonography because of the close correlation with cytopathological findings besides the high sensitivity in the diagnosis of the disease. Although this is not a specific parameter for chronic autoimmune thyroiditis, considering that it may also be found in Graves' disease, postpartum thyroiditis and subacute thyroiditis, such disorders can be easily differentiated both by clinical-laboratory and duplex color Doppler findings. Thus, the present study is aimed at evaluating the significance of thyroid echogenicity in the diagnosis of chronic autoimmune thyroiditis.

Keywords: Ultrasonography, Echogenicity, Thyroiditis, Chronic, Autoimmune

OBJECTIVE: The aim of this study was to evaluate sonographic features of thyroid gland in patients with thyroiditis. MATERIALS AND METHODS: During a nine-month period, 38 patients previously diagnosed with thyroiditis by the Ultrasound Unit of "Instituto de Radiologia da Faculdade de Medicina da Universidade de São Paulo", São Paulo, SP, Brazil, were studied. Thirteen-six of these patients were women in the age range between 17 and 78 years. The following variables were observed and studied: thyroid volume, echogenicity, echotexture, and the presence of level VI chain lymph nodes (pre-tracheal, the preferential site of thyroid drainage), besides the gland dimensions. RESULTS: Thirteen patients had goiter; 37 of 38 thyroid glands presented heterogeneous echotexture and diffuse hypoechogenicity. Thyroiditis was diagnosed by laboratory tests in all patients. Level VI chain (pre-tracheal) lymph nodes were observed in 28 cases, all of them with reactional features. Of these cases, ten patients were submitted to fine needle aspiration biopsy, and the cytological result indicated inflammatory reaction. No case of nodule-simulating focal thyroiditis was found. CONCLUSION: The thyroid gland sonographic hypoechogenicity and heterogeneity, in association with the presence of cervical chain lymph nodes, constitute findings of great importance in the diagnosis of thyroiditis when correlated with clinical and laboratory tests findings.

Keywords: Ultrasound, Thyroid, Thyroiditis

Laryngoceles are fairly unusual diseases defined as anomalous saccular dilatation of the laryngeal ventricles. The usual classification divides laryngoceles into internal, external and mixed types. Internal laryngoceles are those located medially to the thyrohyoid membrane and usually compress the false vocal cords causing hoarseness or airway obstructive symptoms. External laryngoceles extend through the thyrohyoid membrane, presenting as cervical masses; and mixed laryngoceles present both the internal and external components with their respective symptoms. Diagnosis is usually defined by computed tomography and/or laryngoscopy. This is a report of a case of mixed laryngocele diagnosed by ultrasonography in a patient referred for investigation with a history of palpable cervical mass.

Keywords: Laryngocele, Cervical mass, Ultrasonography, Laryngoscopy

Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive interventional procedure that consists of placement of an auto expandable metallic stent in the hepatic parenchyma via transjugular. It is used to treat the complications of portal hypertension, particularly digestive bleeding of gullet varices and refractory ascites. Although TIPS is an efficient procedure with low rate of failure some complications such as stenosis are frequent. Early diagnosis of stenosis is mandatory since it interferes with the type of treatment and the reappearing symptoms can be serious. Doppler sonography is used in the follow-up of this patients and many parameters indicating TIPS stenosis are described in the literature such as the minimum and maximum velocity flow inside the stent, the velocity flow in portal vein, the velocity gradient between different sites of the stent, among others. Unfortunately there is no consensus on which parameter or group of parameters is more efficient for diagnosis because the evaluation protocols varied among institutions. The authors reviewed the parameters of stenosis reported in literature and other important aspects for comprehension of this procedure including indications, contraindications and physiopathology of stenosis.

Keywords: Portal hypertension, Transjugular intrahepatic portosystemic shunt, Doppler ultrasonography

Ultrasonography and Doppler ultrasonography have dramatically improved the diagnosis of portal hypertension thanks to the noninvasive visualization of the liver, spleen and splanchnic blood flow. In this article the authors discuss some important issues raised by the use of ultrasound and Doppler in the evaluation of portal hypertension.

Keywords: Portal hypertension, Liver, Ultrasound, Doppler

The thymus is a small gland which is responsible for the production of T-lymphocytes. This organ is larger during the gestation period and can extend into the neck and present different anatomic variants. Ultrasound can identify the thymus via suprasternal, parasternal and sternal approaches, and through the neck when its position is atypical. During adolescence, ultrasound evaluation of the thymus is more difficult due to its involution and reduction in size, and interposition of the lung. The appearance of normal thymus is typical on the ultrasound and produces a unique echo pattern that is less echogenic than the normal thyroid gland with multiple echogenic lines and foci, representing a cross section of either a connective-tissue septum or a blood vessel within a septum. Recognition of normal thymic tissue can be very important in order to avoid unnecessary investigations or surgery of a normal thymus mimicking an abnormal mass.

Keywords: Thymus, Ultrasound, Neck ultrasound

Unlike supraclinoid aneurysms, true aneurysms of the extracranial internal carotid artery are extremely rare (less than 4% of the peripheral aneurysms). The commonest presentation is a pulsatile neck swelling below the angle of the jaw associated with hoarseness, dysphagia and pain (neural compression). Concomitance with other peripherical aneurysms is frequent and caused by atherosclerosis. The morphological and hemodynamic features are very well evaluated by Doppler ultrasound, when the acoustic window is satisfactory. Identification and evaluation of these aneurysms are very important to prevent thrombosis, rupture, dissections, massive strokes and embolic brain infarcts, besides helping in the decision of the best treatment.

Keywords: Aneurysm, Extracranial internal carotid artery, Ultrasound, Doppler ultrasound, Color duplex Doppler ultrasound

Ultrasound assessment of neck lymphadenopathy can be difficult as sometimes the same pattern is seen both in inflammatory (specific or not) and neoplastic diseases (lymphoproliferative or metastatic). An adequate follow-up of these lymphadenopathies requires evaluation of some important ultrasound features, and relies on the ability of localizing these nodes. We reviewed the literature with the aim of establishing the most significant ultrasonographic features on gray-scale ultrasound and Doppler ultrasound that can help in the study of the lymph nodes of the neck. We also describe the localization of lymph nodes based on computed tomography anatomic landmarks. The aspects analyzed on B-mode were: number (isolated nodule or conglomeration), shape, echotexture/echogenicity, calcification, cystic necrosis and/or hemorrhagic necrosis, size, contours and extra nodal extension. Doppler aspects reviewed were color mapping and spectral analysis (pulsatility index and resistive index). Some patterns usually described for malignant nodes are round morphology, marked hypoechoic, peripheral vascularization and high pulsatility index and resistive index. We concluded that an accurate diagnosis requires the evaluation of multiple aspects seen on B-mode and Doppler ultrasound.

Keywords: Lymph nodes, Neck, Ultrasound, Color duplex-Doppler ultrasound

OBJECTIVE: To assess the hemodynamic changes considered normal after transjugular intrahepatic porto-systemic shunt (TIPS) placement and the efficacy of TIPS parameters suggestive of stenosis using Doppler sonography. MATERIALS AND METHODS: Sixteen patients were prospectively evaluated from December, 2001 to March, 2003 after TIPS placement. Evaluations were performed 24 to 48 hours after the procedure and then at intervals of 30 days, three months, six months and one year using B mode, color Doppler, power Doppler and spectral Doppler in different TIPS related sites. Angiography was performed only to confirm Doppler findings and treatment. RESULTS: To date the only statistically significant parameters for diagnosis of TIPS stenosis were continuous flow pattern in the proximal third of TIPS and the velocity gradient between the two sites (p < 0.001). Different non-statistically significant parameters were also observed. CONCLUSION: Doppler sonography is an efficient tool for the diagnosis of shunt patency and TIPS related complications such as stenosis. However, it is necessary to study a larger number of patients in order to determine a group of parameters that would help in the follow-up of these patients, thus using portal angiography only for indicated treatment.

Keywords: Portal hypertension, Transjugular intrahepatic portosystemic shunt, Ultrasound, Doppler ultrasound studies, Stents and prostheses

OBJECTIVE: Longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes. MATERIALS AND METHODS: Twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum. RESULTS: Findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients. CONCLUSION: Alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant.

Keywords: Pregnancy; Pyelocaliceal dilatation; Nephrolithiasis; Cholelithiasis; Portal vein; Right hepatic vein.

The elastic properties of tissue have always been of interest in clinical practice. In the past, the identification of structures that were stiffer on physical palpation would raise the suspicion that "there was something wrong". With the development and advancement of medicine, there proved to be a true correlation in the prediction of malignancy of a lesion: malignant disease tends to stiffen the affected tissue, either by increased cell proliferation or fibrosis. Palpation is the oldest method for the detection of thyroid nodules, which is informed by the knowledge that malignant thyroid lesions tend to be much harder than benign ones. Unfortunately, palpation is a highly subjective method that is dependent on the size and location of the lesion, as well as on the skill of the physician. In cases where these nodules are very small or are located in deep regions, their detection by palpation is difficult or even impossible. In addition, although a malignant lesion differs in terms of elasticity, it may not have echogenic properties, preventing its detection by conventional ultrasound. Imaging that indicates the stiffness or deformation of tissues, through the use of ultrasound elastography techniques, adds new information related to their structural formation. In this article, we review the basic physical principles of elastography and the evolution of the method for the evaluation of thyroid nodules, as well as the limitations of and future perspectives for its use.

Keywords: Thyroid gland; Elasticity imaging techniques/methods; Ultrasonography/methods; Thyroid nodule/diagnostic imaging; Shear wave elastography.