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Objective The purpose of this study was to evaluate the lung computed tomography (CT) findings in fat embolism (FE) syndrome. Methods We retrospectively evaluated 19 CT examinations of 18 patients with FE syndrome, diagnosed clinically using the Gurd and Wilson criteria. Result Fat embolism syndrome showed 3 patterns: negative examination, bilateral interstitial-alveolar involvement, and adult respiratory distress syndrome like. Frequent findings included consolidations (17 patients), mostly with gravity dependent distribution, and ground-glass opacities (17 patients), mostly with patchy distribution. Fifteen patients showed an overlapping random nodular pattern. Less common findings included lobular ground-glass opacities and lobular consolidations, smooth septal thickening, thickening of the bronchial wall, and areas of crazy paving. The extension of the consolidations correlates with the duration of assisted ventilation. Conclusions In FE syndrome, pulmonary CT findings are ground-glass opacities and dependent consolidations, associated with other variably overlapping signs, such as lobular opacities, random nodules, septal thickening, and bronchial wall thickening.

The increased use of ultrasound in patients with urological and andrological symptoms has given an higher detection of intra-testicular nodules. Most of these lesions are hypoechoic and their interpretation is often equivocal. Recently, new ultrasound techniques have been developed alongside of B-mode and color-Doppler ultrasound. Although not completely standardized, contrast-enhanced ultrasound (CEUS) and tissue elastography (TE), added to traditional ultrasonography, can provide useful information about the correct interpretation of incidentally detected non-palpable testicular nodules. The purpose of this review article is to illustrate these new techniques in the patient management.

Contrast enhanced ultrasound (CEUS) is an innovative technique that employs microbubble contrast agents to demonstrate parenchymal perfusion. Although initial clinical application was focused on the liver pathology, a wide variety of clinical conditions can be assessed now with CEUS. CEUS is a well-tolerated technique and is acquiring an increasing role in the assessment of renal pathology because contrast agents are not excreted by the kidney and do not affect the renal function. CEUS demonstrated an accuracy similar to contrast enhanced multi-detector computed tomography (CEMDCT) in detecting focal lesions, with the advantage of the real-time assessment of microvascular perfusion by using time-intensity curves. The aim of this paper is to review the main indications of CEUS in the assessment of renal and urogenital pathology. Imaging examples are presented and described. Advantages and limitations of CEUS with reference to conventional US and CE-MDCT are discussed.

Granulomatous lung diseases include a large number of conditions among granulomas are the pathological hallmark. Some of these conditions are frequently encountered in clinical practice. Differentiating infectious from noninfectious forms is a priority for the different specialists approaching these diseases, given the different implications for management and treatment. However, differential diagnosis is not always straightforward and the diagnosis of granulomatous disease, considering separately the clinical, radiological and pathological aspects, is at times incomplete or uncertain and requires multidisciplinary assessment. In this paper, we propose a combined HRCT-pathological approach to assess both the topographical and morphological features of the lesions. Based on topography, we can distinguish between granulomatous lesions distributed along the lymphatic vessels, with random distribution or centred on the airways. The prototype of the disease with lymphatic granulomas is sarcoidosis. In contrast, diseases exhibiting a random distribution of granulomas are those with haematogenous spread, the most typical of which is miliary tuberculosis (TB). Many diseases have distribution along the airways including hypersensitivity pneumonia and granulomatous bronchiolitis (including infections with bronchial spread, especially mycobacteriosis). The anatomical approach is completed by the assessment of the morphological aspects of the lesions and associated signs, reflecting both the possible mechanisms of spread and the different types of pathological and/or reparative tissue related to the disease.

This study investigated the relationships between morphological changes in the vestibular aqueduct (VA) in different inner ear pathologies. Eighty-eight patients (34 males and 54 females, ranging from seven to 88 years of age; average age 49.2 years) with cochleovestibular disorders underwent temporal bone CT (with a 64-channel helical CT system according to temporal bone protocol parameters; 0.6 mm slice thickness, 0.6 mm collimation, bone reconstruction algorithm). All patients with cochleovestibular disorders who underwent temporal bone CT had been previously divided into six different suspected clinical classes: A) suspected pathology of the third window; B) suspected retrocochlear hearing loss; C) defined Meniere's disease; D) labyrinth lithiasis; E) recurrent vertigo. On CT images we analyzed the length, width and morphology of the VA, contact between the VA and the jugular bulb (JB), the thickness of the osseous capsule covering the semicircular canals, the pneumatization rate of the temporal bone and the diameter of the internal auditory canal. At the end of the diagnostic work-up all patients were grouped into six pathological classes, represented as follow: 1) benign paroxysmal positional vertigo (BPPV), 2) recurrent vertigo (RV), 3) enlarged vestibular aqueduct syndrome (EVAS), 4) sudden or progressive unilateral sensorineural hearing loss (SNHL), 5) superior semicircular canal dehiscence syndrome (SSCD), 6) recurrent vestibulocochlear symptoms in Meniere's disease. We evaluated 176 temporal bones in 88 patients. The VA was clearly visualized in 166/176 temporal bones; in ten ears the VA was not visualized. In 14 ears (11 patients, in three of whom bilaterally) we found an enlarged VA while in 31 ears the VA was significantly narrower. In 16 ears a dehiscence of the JB with the vestibular or cochlear aqueduct was noted. In all six patients with suspected EVAS we found a AV wider than 1.5 mm on CT scans; moreover CT identified four patients with large VA and ill-defined clinical symptoms. Most patients with BPPV (11 patients, Class 1) we did not find any VA abnormalities on CT scans, confirming the clinical diagnosis in ten patients; in the remaining patients we found an enlarged VA, not clinically suspected. In the RV class (eight patients, Class 2) we found three patients with negative CT scans, two patients with narrow aqueduct and subsequently reclassified as Meniere's disease patients, and three patients with ectasic JB dehiscence with the VA. In patients suffering from SNHL we found no statistically significant correlation with the morphological abnormalities. The clinical suspicion of SSCD was confirmed by CT in 11/13 patients (84.6 %); in addition another seven patients showed a thinning or dehiscence of the superior semicircular canals as the prevailing alteration on CT scans, and were reclassified in this group. Meniere's disease symptoms were correlated with a VA alteration in more than half of the cases; the most striking finding in this class was that the VA was significantly narrower (21 patients). Our study demonstrates that alterations of the VA morphology are not only related to EVAS but are also found in other inner ear pathologies such as Meniere's disease. Furthermore, MDCT may confirm the presence of correlations between the morphology of inner ear structures such as VA, semicircular canals or JB dehiscence, and alterations of vestibulocochlear function.

Ultrasound (US) is recognized as a useful first-line imaging modality, being esteemed its characteristics such as real-time scanning, no radiation, easy performance, and cost-effectiveness. However, it is regarded inferior to computed tomography and magnetic resonance because of its low ability to depict organ vascularization especially for tumor characterization.

Scrotum is a superficial anatomical structure and it can be easily assessed with clinical examination. Ultrasonography (US) is the initial imaging modality for evaluating pathologic conditions of the scrotum. However, magnetic resonance (MR) imaging is useful in case of equivocal sonographic findings.

Purpose Defining the site of recurrent disease early after definitive treatment for a localized prostate cancer is a critical issue as it may greatly influence the subsequent therapeutic strategy or patient management.

Scrotal cystic lesions are common incidental findings at ultrasonography. Most of them are located in the epididymis, but the testis and the cord are also involved. Testicular, albugineal, and epidermoid cysts; cystic dysplasia of the rete testis; cysts of the spermatic cord; and cystic appendages are easily detected at ultrasonography, which is the modality of choice to differentiate benign cysts from cystic tumors. Other imaging modalities such as CEUS and MR imaging may have a role for characterization of complex cystic lesions.

Penile traumas can result from penetrating or non-penetrating injuries. Diagnosis of albugineal disruption must be obtained as soon as possible since early surgical repair reduces significantly the rate of posttraumatic curvature and fibrosis. MR imaging is the modality of choice to investigate the integrity of the tunica albuginea. In expert hands, however, ultrasonography can be as informative as MR. It is able to detect the exact site of the tear as an interruption of the thin echogenic line of the tunica albuginea.

Ultrasound features of solid scrotal tumors are often nonspecific, and most of them have no special character to help identification of their nature. Ultrasonography, however, identifies lesions in virtually all cases. Moreover, it allows differentiation between intratesticular and extratesticular masses and gives an accurate estimate of their local extent and of the relationship with adjacent tissues.

Contrast-enhanced ultrasound (CEUS) is a new technique that employs microbubble contrast agents and complementary harmonic pulse sequences to demonstrate parenchymal perfusion.

In the clinical practice, there is an increasing incidence of small, non-palpable testicular lesions identified with an ultrasonographic investigation performed for other purposes. Many of these lesions are benign tumours or non-neoplastic conditions. In this context, the old axiom that every testicular mass should be considered a malignant tumour and the testis must be removed is no longer valid. Lesions can either undergo active surveillance or testis-sparing surgery, which allows maximal preservation of testicular parenchyma and its vasculature. To provide for the possibility of testis-sparing surgery for non-palpable nodules, precise intraoperative ultrasonographic localisation of the lesion is necessary. Our technique includes ultrasonographic localisation of the nodule within the exposed testicle and placement of a localising needle while the patient is on the operating table.

Digital radiography technology has replaced conventional screen-film systems in many hospitals. Despite the different characteristics of new detector materials, frequently, the same radiological protocols previously optimised for screen film are still used with digital equipment without any critical review. This study addressed optimisation of exposure settings for chest examinations with digital systems, considering both image quality and patient dose. Images acquired with direct digital radiography equipment and a computed radiography system were analysed with specially developed commercial software with a four-alternative forced-choice method: the most promising protocols were then scored by two senior radiologists. Digital technology offers a wide dynamic range and the ability to postprocess images, allowing use of lower tube potentials in chest examinations. The computed radiography system showed both better image quality and lower dose at lower energies (85 kVp and 95 kVp) than those currently used (125 kVp). Direct digital radiography equipment confirmed both its superior image quality and lower dose requirements compared with the storage phosphor plate system. Generally, lowering tube potentials in chest examinations seems to allow better image quality/effective dose ratio when using digital equipment.

We present the case of an 80-year-old man with two renal solid masses found at sonography, which were imaged by contrast-enhanced ultrasound, CT, and MRI and confirmed histologically. Contrast-enhanced ultrasound findings suggested a benign mass and a CT-guided biopsy yielded a diagnosis of extramedullary hematopoiesis.

The rate of resolution of a first episode of pulmonary embolism (PE) is uncertain. A baseline test indicating any residual PE is pivotal in aiding a more accurate diagnosis of recurrent PE. This study aimed to assess the rate and risk factors of residual PE with either multidetector computed tomography imaging (MDCT) or lung perfusion scan (LPS) using a cross-sectional study in which consecutive patients were enrolled with a first objectively documented episode of symptomatic PE, and who were considered for possible treatment withdrawal after at least 3 months of anticoagulation. A first cohort of patients (n = 80) underwent MDCT, while the subsequent cohort (n = 93) underwent LPS. The two cohorts had similar characteristics, and 98.3% of patients had non high-risk index PE. MDCT detected residual PE in 15% of subjects (12/80, 95% CI 8-25%) after a mean of 9 months of anticoagulation. No clinical characteristics were significantly associated with residual PE at MDCT. LPS detected residual PE in 28% (26/93, 95% CI 19-38%) of patients after a period of a mean of 9 months of anticoagulation with a significant association with increasing age and known pulmonary disease. Resolution of PE was high after a first episode of non high-risk PE treated with heparin followed by at least 3 months of anticoagulation. Age and coexistent pulmonary disease influence the presence of residual PE detected by LPS, but not by MDCT. Further studies are warranted in which the presence of residual embolism is detected by repetition of the same test that had been initially carried out.

To evaluate the use of contrast-enhanced ultrasonography (CEUS) in patients with blunt abdominal trauma.A total of 133 hemodynamically stable patients were evaluated using ultrasonography (US), CEUS and multislice Computer Tomography (CT) da eliminare.In 133 patients, CT identified 84 lesions: 48 cases of splenic injury, 21 of liver injury, 13 of kidney or adrenal gland injury and 2 of pancreatic injury. US identified free fluid or parenchymal abnormalities in 59/84 patients positive at CT and free fluid in 20/49 patients negative at CT. CEUS revealed 81/84 traumatic injuries identified at CT and ruled out traumatic injuries in 48/49 negative at CT. Sensitivity, specificity, positive and negative predictive values for US were 70.2%, 59.2%, 74.7% and 53.7%, respectively; for CEUS the values were 96.4%, 98%, 98.8% and 94.1%, respectively.The study showed that CEUS is more accurate than US and nearly as accurate as CT, and CEUS can therefore be proposed for the initial evaluation of patients with blunt abdominal trauma.Sommario INTRODUZIONE: Descrivere l’impiego dell’ecografia con mezzo di contrasto (CEUS) nella valutazione dei pazienti con trauma chiuso dell’addome. MATERIALI E METODI: 133 pazienti con trauma addominale chiuso emodinamicamente stabile sono stati esaminati con ecografia (US), CEUS e Tomografia Computerizzata multistrato (TC) da eliminare. RISULTATI: I 133 pazienti avevano alla TC 84 lesioni, di cui 48 spleniche, 21 epatiche, 13 renali o dei surreni e 2 del pancreas. L’US ha identificato versamento libero o alterazioni parenchimali in 59/84 pazienti positivi alla TC e versamento libero in 20/49 pazienti negativi alla TC. La CEUS ha riconosciuto 81/84 lesioni traumatiche identificate dalla TC e ha escluso lesioni traumatiche in 48/49 pazienti negativi alla TC. Sensibilità, specificità, valore predittivo positivo e negativo per l’US sono stati rispettivamente 70.2%, 59.2%, 74.7% e 53.7%; per la CEUS sono stati 96.4%, 98%, 98.8% e 94.1%. CONCLUSIONI: Lo studio ha dimostrato che la CEUS ha una accuratezza diagnostica maggiore dell’US e quasi sovrapponibile alla TC e può quindi essere proposta nella valutazione iniziale del paziente traumatizzato.

While acute scrotal pain is a common clinical problem in both children and adults, symptoms are often vague and clinical findings are nonspecific. Ultrasound (US) allows for accurate differentiation of many causes of scrotal pain, including prompt diagnosis of testicular torsion. Use of color Doppler US made US the ideal imaging modality for evaluation of the acute scrotum in urgency. The authors review proper US technique and anatomy for testicular studies and findings of the main pathologies causing acute scrotal pain presenting at emergency department.

The aim of the study was to evaluate the diagnostic capability of contrast-enhanced ultrasonography (CEUS) in a large series of patients with blunt abdominal trauma. We studied 133 haemodynamically stable patients with blunt abdominal trauma. Patients were assessed by ultrasonography (US), CEUS and multislice computed tomography (MSCT) with and without administration of a contrast agent. The study was approved by our hospital ethics committee (clinical study no. 1/2004/O). In the 133 selected patients, CT identified 84 lesions; namely, 48 splenic, 21 hepatic, 13 renal or adrenal and two pancreatic. US identified free fluid or parenchymal alterations in 59/84 patients with positive CT and free fluid in 20/49 patients with negative CT. CEUS detected 81/84 traumatic lesions identified on CT and ruled out traumatic lesions in 48/49 patients with negative CT. The sensitivity, specificity and positive and negative predictive values of US were 70.2%, 59.2%, 74.7% and 53.7%, respectively, whereas those of CEUS were 96.4%, 98%, 98.8% and 94.1%, respectively. Our study showed that CEUS is an accurate technique for evaluating traumatic lesions of solid abdominal organs. The technique is able to detect active bleeding and vascular lesions, avoids exposure to ionising radiation and is useful for monitoring patients undergoing conservative treatment.

The objective of this study was to evaluate the concordance of US and contrast-enhanced US (CEUS) with CT in the assessment of solid organ injury following blunt trauma. Patients underwent complete US examination, including free fluid search and solid organ analysis. CEUS followed, using low-mechanical index techniques and SonoVue. CT was performed within 1 h. Among 156 enrolled patients, 91 had one or more abnormalities (n = 107) at CT: 26 renal, 38 liver, 43 spleen. Sensitivity, specificity, and accuracy for renal trauma at baseline US were 36%, 98%, and 88%, respectively, after CEUS values increased to 69%, 99%, and 94%. For liver baseline US values were 68%, 97%, and 90%; after CEUS were 84%, 99%, and 96%. For spleen, results were 77%, 96%, and 91% at baseline US and 93%, 99%, and 97% after CEUS. Per patient evaluation gave the following results in terms of sensitivity, specificity and accuracy: 79%, 82%, 80% at baseline US; 94%, 89%, and 92% following CEUS. CEUS is more sensitive than US in the detection of solid organ injury, potentially reducing the need for further imaging. False negatives from CEUS are due to minor injuries, without relevant consequences for patient management and prognosis.

In the last 20 years the increasing use of Computed Tomography, Magnetic Resonance and Ultrasonography has decreased the role of conventional radiology in the assessment of acute abdominal diseases. Nevertheless, in clinical practice, serial plain abdominal film remains the first diagnostic procedure, providing important diagnostic information, extremely useful in the emergency setting, and still of value if correctly performed and carefully interpreted. In this paper the current fields of application of serial abdominal plain film are presented, starting from a correct technique of performance and some basic knowledge of its interpretation.

To evaluate the diagnostic performance of ultrasonography using second-generation contrast agent in the study of patients with focal prostate lesions and increased serum prostate-specific antigen (PSA) level.SIX CONSECUTIVE PATIENTS (AGE RANGE: 72-87 years) with increased PSA (≥4 ng/ml) underwent transrectal ultrasonography (TRUS) followed by contrast-enhanced ultrasonography (CEUS) with injection of second-generation contrast agent. All patients showed areas of abnormal echostructure suspicious for neoplastic lesions. On the basis of CEUS, a time/intensity curve of the suspected area was compared to that of a normal-appearing distant area of the gland and to the results of biopsy of the hypoechoic area.AT CEUS TWO DIFFERENT PATTERNS OF ENHANCEMENT WERE IDENTIFIED AND CONSIDERED TO BE SIGNIFICANT: pattern 1 characterized by a rapid rise in the time/intensity curve of the suspected area compared with the normal gland. Two out of six patients had this pattern and biopsy showed cancer in the biopsied area. Pattern 2 was characterized by a similar rise in the time/intensity curve of the suspected area compared with the normal gland. Four out of six patients had this pattern and biopsy showed prostatitis in the biopsied area.CEUS using second-generation contrast agent can on the basis of time/intensity curves show differences in vascularization in normal and pathological tissue. Evaluation of the two patterns seems to be useful for identifying areas requiring biopsy, particularly when peripheral hypoechoic areas are observed at TRUS. Our data need to be confirmed in a larger patient population.Sommario SCOPO: Determinare la performance diagnostica dell'ecografia con mezzo di contrasto di seconda generazione nello studio delle lesioni focali della prostata nei pazienti con elevati valori sierologici di antigene prostatico specifico. MATERIALI E METODI: Sei pazienti consecutivi (età 72–87 anni) con elevati valori di antigene prostatico specifico (≥4 ng/ml) sono stati sottoposti a ecografia transrettale tradizionale seguita da ecografia con mezzo di contrasto. In ogni paziente sono state identificate le aree periferiche di alterata ecostruttura sospette per lesione neoplastica. Queste aree sono state valutate con ecografia con mezzo di contrasto mediante curve di intensità/tempo. I dati ottenuti sono stati confrontati con la biopsia dell'area sospetta. RISULTATI: L'ecografia con mezzo di contrasto ha consentito di identificare due pattern distinti: pattern 1 caratterizzato da rapida elevazione della curva calcolata a livello della lesione rispetto all'intensità di impregnazione del parenchima adiacente. Due dei sei pazienti con questo pattern hanno dimostrato presenza di lesione neoplastica nell'area sottoposta a biopsia. Pattern 2 caratterizzato da scarsa elevazione della curva rispetto all'intensità dell'impregnazione del parenchima adiacente. I rimanenti 4 dei 6 pazienti esaminati avevano questo pattern e l'area bioptizzata ha dimostrato assenza di lesione neoplastica. CONCLUSIONI: L'ecografia con mezzo di contrasto di seconda generazione, attraverso le curve di intensità/tempo può identificare differenze di comportamento tra tessuto normale e patologico. Queste caratteristiche possono risultare utili soprattutto nel caso di aree ipoecogene all'ecografia basale per identificare le aree da sottoporre a biopsia.

Objective: To evaluate the inflammatory involvement of cervical interspinous bursae in patients with polymyalgia rheumatica (PMR) using magnetic resonance imaging (MRI). Methods: Twelve consecutive, untreated new patients with PMR were investigated. Five patients with fibromyalgia, 2 patients with cervical osteoarthritis and 6 patients with spondyloarthritis with neck pain served as controls. MRI of the cervical spine was performed in all 12 PMR case-patients and in 13 control-patients. Two of the 4 PMR patients with pelvic girdle pain also had MRI of the lumbar spine. Results: MRI evidence of interspinous cervical bursitis was found in all patients with PMR, and in 3 patients with fibromyalgia, in 2 with psoriatic spondylitis and 1 with cervical osteoarthritis. A moderate to marked (grade >2 on a semiquantitative 0-3 scale) cervical bursitis occurred significantly more frequently in patients with PMR than in control-patients (83.3% compared with 30.7%, p=0.015). In all patients and controls with cervical bursitis the involvement was found at the C5-C7 cervical interspaces. MRI of the lumbar spine showed lumbar interspinous bursitis at the L3-L5 lumbar interspaces in the 2 patients with PMR and pelvic girdle pain examined. Conclusions: Cervical interspinous bursitis is a likely basis for discomfort in the neck of patients with PMR. The prominent inflammatory involvement of cervical bursae supports the hypothesis that PMR is a disorder of prominent involvement of extra-articular synovial structures.

Acute renal failure is a sudden and sustained decrease in the glomerular filtration rate associated with a loss of excretory function and the accumulation of metabolic waste products and water. It leads to an increase in serum urea and creatinine, usually with a decrease in urine output. Although routine surveillance of patients by means of laboratory examinations has been well defined, very little is known about renal imaging. Modern technology has provided a large number of sophisticated monitoring systems. Ultrasonography with color-Doppler study of the kidneys may be indicated as a possible monitor of renal perfusion. Ultrasonography is often used as the initial imaging procedure in the examination of patients with renal failure. Aside from excluding hydronephrosis, it is well recognized in characterizing the type of renal disease, especially in an acute setting. This article describes the use of ultrasound to achieve the proper diagnosis of acute renal diseases and to enable the appropriate and early assessment of these patients in intensive care units.

New flat-panel direct digital radiography equipment has recently been installed in our Accident and Emergency Department; its characteristics and versatility are well suited to the work undertaken in this environment. The aim of this study was to compare radiation doses to patients undergoing standard radiographic examinations using conventional screen-film radiography, computed radiography and direct digital radiography; entrance surface dose and effective dose were calculated for six standard examinations (a total of 10 projections) using standard patient exposure parameters for the three imaging modalities. It was found that doses for computed radiography (all examinations) were higher than the doses for the other two modalities; effective doses for direct digital radiography were approximately 29% and approximately 43% lower than those for screen-film radiography and computed radiography, respectively. The image quality met the criteria in the European guidelines for all modalities.

Objectives Review the role of imaging in detecting, characterising, and staging renal cell carcinoma (RCC). The imaging features are described and the different diagnostic criteria are analysed based on the methodology used. Methods The techniques of urography, sonography, computed tomography (CT), and magnetic resonance imaging (MRI) are described and new advances reported synthetically. Results Currently, urography and angiography are rarely used in urologic practice in developed countries because the cross-imaging techniques have a higher sensitivity and specificity in detecting, characterising, and staging renal tumours. High attenuation values at CT, signal intensity not typical of water or adipose tissue at MRI, and the presence of septations, wall thickening, and nodularity are the main criteria used to define the nature of an expansive renal lesion. The use of ultrasound with and without contrast agents has great promise even if multidetector CT is widely used for the evaluation of the kidneys. Conclusion Imaging has a major role in detecting and staging of tumoural renal masses. The technical improvements have been associated with a decrease in size of the RCC at diagnosis and in down-staging of the lesions. In many cases the differentiation between a benign and malignant neoplasm is possible

Peyronie’s disease (PD) is a benign disease of the penis of unknown cause. First fully described almost 300 years ago by François de La Peyronie, although “nodus penis” has been already described centuries before by Fallopius and Vesalius (Fornara and Gerbershagen 2004). Peyronie’s disease is defined as an acquired disorder of the tunica albuginea with the development of a plaque of fibrous tissue, associated with progressive penile bending and shortening. Pain on erection can be the first symptom of the disease in about 10–15% of the patients. As the result of progressive penile deformity, difficulties of penetration can develop with impairment of erectile capacity

Testicular cancer accounts for about 1 % of all cancers in men. Malignant testicular tumors are divided into two main groups: germ cell tumors and non-germ cell tumors. Germ cell tumors are subdivided into two groups: seminomas and nonseminomatous germ cell tumors such as embryonal carcinoma, yolk sac tumor, teratoma, choriocarcinoma, and mixed germ cell tumor. Non-germ cell tumors consist of Leydig cell tumor, Sertoli cell tumor, granulosa cell tumors, fibroma–thecoma tumors, mixed sex cord–stromal tumors, lymphoma, leukemia, and metastases. Radiological evaluation of testicular tumors is mainly based on ultrasound findings. The main role of ultrasound examination is to distinguish intratesticular from extratesticular lesions, because the majority of the extratesticular masses are benign and intratesticular masses are more likely to be malignant. MRI has an advantage over ultrasound in distinguishing an intratesticular hematoma from a testicular neoplasm.

Rising life expectancy has swollen the ranks of men of middle age and beyond. These individuals have a 43 % risk of symptoms of benign prostatic hyperplasia (BPH) and a 9 % chance of being diagnosed with prostate cancer. Although not always life-threatening, prostate diseases are often associated with a significant reduction in quality of life not only for the sufferer but also for his partner. Men beyond middle age are increasingly reluctant to accept restrictions on their day-to-day activities as they grow older. As a consequence, prostate diseases are now acknowledged as an important determinant of men’s health and therefore worthy of proper scrutiny, treatment, and enhanced research. In this chapter, the role of imaging modalities in evaluation of prostate disorders in elderly is illustrated, with emphasis both on current clinical practice and on the evolving imaging modalities that will affect treatment in the future

Urethral cancer is a rare disease which may occur at any age but is observed more often during the seventh decade. It is usually considered more common in females, but a recent study shows in the United States an annual age-adjusted incidence rate of 4.3 per million men and 1.5 per million women. The incidence is higher in African Americans. Different histologic patterns of urethral tumors are recognized. The most common type of urethral malignancy is squamous cell carcinoma which accounts for about 80 % of cases in men and 60 % of cases in women. Transitional cell carcinoma is the second most common urethral malignancy in both sexes. In males, this lesion accounts for 15 % of total cases, in females for 20 % of patients. Other primary malignant tumors of the urethra are rare. Only sporadic cases of lymphoma, melanoma, and neuroendocrine tumors have been reported in the literature.

Ultrasonography (US) is the method of choice for the diagnosis of bladder disease. It is superior to other imaging techniques, such as urography and cystography, in depicting certain structures and abnormalities. US examination of the bladder should include a study of the ureterovesical junction and the structures round the vesical neck. The examination technique may be transabdominal, transrectal or transvaginal, or transurethral. The bladder pathology that can be studied by US includes cystitis, calculi, clots, diverticula, trauma and tumors. The sensitivity and the specificity of the method are very high and sometimes superior to cystoscopy. Sonography can be used to explore patients with stress incontinence and those with abdominal trauma. The ureterovesical junction may be clearly examined by US and the pathology of the papilla clearly defined.

Retrograde urethrography is the method commonly employed in the detection of anterior male urethra pathology. Ultrasonography and magnetic resonance imaging have been proposed recently as new methods that can replace conventional radiography. Normal urethral anatomy can be easily studied after saline distention of the urethra, which creates high contrast relative to adjacent structures such as mucosa and corpus spongiosum. Sonourethrography with high-frequency probes has a high spatial resolution and has proved to be sensitive, specific, and accurate in the diagnosis of anterior urethral pathologies such as strictures, syringocele, tumors, and trauma. It has a major role in the selection of therapy in patients with bulbar strictures. Magnetic resonance imaging with a surface coil with a small field of view can detect penile and bulbar stenoses and tumor extension. After contrast administration, the activity of the inflammatory process in the spongiosum can be assessed and used to modify the urethroplasty technique. The clinical use of the new imaging modalities in the male anterior urethra is limited despite their demonstrated accuracy in diagnosis and presurgical staging of different diseases.

Objective To establish by means of fast spin echo (FSE)–T2-weighted sequences with fat saturation if enthesitis of the flexor digitorum superficialis and profundus tendons is the primary lesion in spondylarthritis (SpA) finger dactylitis. Methods Eleven dactylitic fingers and their corresponding normal, contralateral fingers, belonging to 6 patients who met the Amor criteria for SpA, were studied by FSE–T2-weighted sequences with fat saturation. Results All dactylitic fingers showed moderate or severe fluid collection in the flexor tendon synovial sheaths. Involvement of the joint cavity was simultaneously present in at least one joint in 3 (27.3%) of the 11 fingers. A mild to moderate peritendinous soft tissue edema was observed in 5 (45.5%) of the 11 affected fingers. In no dactylitic finger was bone edema observed near the insertions of the flexor digitorum superficialis or profundus tendons or in other sites of the phalanges. No lesions were observed in the 11 contralateral, clinically normal fingers. Conclusion In SpA dactylitis there is no evidence of enthesitis of the flexor digitorum tendons and joint capsules.

Gastrointestinal perforation is diagnosed by demonstrating air or intestinal content in the peritoneum or retroperitoneum. The diagnosis of free air in the abdominal cavity is usually made with x-ray. However, in clinical practice, x-ray may not detect small amount of air on radiography and CT is often requested. Recently, ultrasonography has emerged as an useful diagnostic technique in patients with acute abdomen also for detecting pneumoperitoneum. US is routinely performed to investigate patients with abdominal pain, including those having gastrointestinal perforation as final diagnosis. In case of gastro-intestinal perforation, a correct interpretation of the artifact due to free air eventually present can lead to the correct diagnosis. Direct and indirect signs of pneumoperitoneum at US are reported with a short report of the commonest causes of gastro-intestinal perforation .

The scrotum is a superficial structure and clinical examination is frequently not enough for making a specific diagnosis. In acute scrotal pain US can confirm the presumptive clinical diagnosis and provide additional relevant information. In testicular torsion, color-Doppler imaging has a central role since it has become possible to identify it at early stage by showing absence of perfusion in the affected testis before any gray-scale abnormality. Scintigraphy remains a satisfactory alternative in evaluating testicular torsion and should be used when color Doppler is inadequate, raising doubts about the suspected torsion. Diagnosis of torsion of testicular appendages is particularly difficult. Ischemic infarction shows a characteristic pattern at gray-scale and color Doppler imaging, whereas hemorrhagic ischemia may require MRI. Inflammatory diseases of the scrotum can be easily investigated by echo color Doppler and conventional radiography, and CT can be particularly useful in the detection of gas bubbles. In scrotal trauma, scrotal hematoma, hematocele, intratesticular hematoma, and testicular rupture can be identified using gray-scale US with very good reliability. Magnetic resonance imaging is indicated when a small tear of tunica albuginea is suspected but not visualized on US.

Enthesitis is a distinctive pathological feature of spondyloarthropathy and may involve synovial joints, cartilaginous joints, syndesmoses and extra-articular entheses. This review focuses on peripheral extra-articular enthesitis which is a clinical hallmark of spondyloarthropathy. The entheses of the lower limbs are more frequently involved than those of the upper limbs, and heel enthesitis is the most frequent. Entheseal pain may be mild or moderate as well as severe and disabling. Peripheral enthesitis may be observed in all forms of spondyloarthropathy, including the undifferentiated ones, and may for a long time be the only long-standing clinical manifestation of the B27-associated disease process. Various imaging methods have been suggested for studying peripheral enthesitis. Ultrasonography and magnetic resonance imaging are the most useful because they may show alterations of the structures involved. Therapy of peripheral enthesitis consists of NSAIDs, orthoses and physical therapy. Steroid injections, second line drugs such as sulphasalazine and radiotherapy are reserved for more severe cases.

We report a 5-year-old child with pancreatic trauma from a blunt abdominal injury that was monitored with contrast-enhanced sonography. Unenhanced US failed to demonstrate the abnormality that was recognized by CT and MRI. The injury was well demonstrated by contrast-enhanced US which was therefore used for follow-up until its healing.

Contrast-enhanced ultrasound (CEUS) was recently applied in the setting of trauma. Second-generation contrast US media allow to detect lesions in solid organ with a sensitivity approaching CT. Technique for performing CEUS is easy to learn and US semeiology very intuitive, making lesions more evident than in B-mode conventional US. CEUS should be considered an additional tool for improving trauma management.

Objective. To establish by means of ultrasound and magnetic resonance imaging (MRI) the role of tenosynovitis and arthritis in determining the “sausage-like” aspect of finger dactylitis and to compare the results of the 2 examinations. Methods. Twelve dactylitic fingers and their corresponding normal contralateral fingers belonging to 10 patients who met the Amor criteria for the diagnosis of seronegative spondylarthropathy (SpA) were studied by ultrasonography and MRI. Results. MRI revealed a significant increase in the volar bone-to-skin distance in dactylitic fingers with respect to that of the normal contralateral fingers (P < 0.001). This increase was due to distension of the flexor synovial sheaths (P < 0.00001) by fluid collection. Peritendinous soft tissues were not involved, since these were found to be significantly thicker in the normal fingers (P < 0.05). Of the 36 joints of the 12 dactylitic fingers, only 1 showed capsule distension. Using MRI as the “gold standard,” ultrasonography showed a 100% sensitivity and specificity for flexor tenosynovitis, but lacked sensitivity for joint involvement because it failed to reveal joint capsule distension in the only joint involved. Similarly, physical examination showed a 100% sensitivity and specificity for flexor sheath involvement. Conclusion. Dactylitis is due to flexor tenosynovitis. Enlargement of the finger joint capsule is not an indispensable condition for the “sausage-like” feature. Physical examination is a sufficient method for the diagnosis of dactylitis.