With ultrasound examination hyperechoic inclusions are visualized as point, linear or volumetric structures of high echogenicity, determined within the tissue of formation; some hyperechoic structures may be accompanied by an acoustic shadow (see Fig. 120).

The traditional interpretation of hyperechoic inclusions is “ calcifications", While they are subdivided into" microcalcifications "corresponding to point hyperechoic particles without acoustic shadow, and " macrocalcates»- hyperechoic areas with a characteristic acoustic shadow. Most researchers regard the presence of "microcalcifications" in the node as one of the most probable signs of its malignancy.

We observed hyperechoic inclusions much more often in malignant tumors (75%) than in benign (5%) nodes. At the same time, three types of structures were revealed morphologically in malignant tumors: 1) psammary bodies (50%), 2) calcifications (30%) and, most often, 3) areas of sclerosis (about 70%). In contrast to malignant neoplasms, in benign nodes, psammological bodies were not morphologically determined, in rare cases, the presence of calcifications (5.13%). The most frequently identified areas of sclerosis (more than 60%).

The results obtained are consistent with the data of L. Garretti et al. and Leung C. S. et al. on the presence of psammoma bodies in the tissue of 25 - 50% of papillary carcinomas, as well as the works of Kuma K. et al. , Zaccheroni V. et al. and Bruneton J. in which it is noted that, in addition to malignant tumors, calcifications are morphologically detected in nodular goiter and follicular adenomas.

In accordance with the ultrasound characteristics and morphological content, hyperechoic structures of thyroid neoplasms can be divided into three types:

1) bright spot ;

2) volumetric without acoustic shadow;

3) volumetric with acoustic shadow.

Bright point hyperechoic inclusions are the predominant ultrasound sign of psammotic bodies, less often of small calcifications (Fig. 171). In the presence of an ultrasound sign, the morphological ratio of these elements is approximately 4: 1.

Fig. 171. Papillary carcinoma (pathological specimen): А - psammomy bodies (pathohistological preparation - cited according to TI Bogdanova, fragment); IN - calcification (pathological specimen - cited after Rubin E., fragment).

Psammary bodies (Fig. 172) are a special type of calcifications. These structures are extremely important in the ultrasound diagnosis of papillary carcinomas. “A distinctive feature of papillary carcinoma is the presence of psammous bodiesresembling a cut from a tree trunk with characteristic rings increasing from the center to the periphery. Psammary bodies can be found in the stroma of the tumor and the surrounding tissue of the thyroid gland, in the lymphatic capillaries, especially in the diffuse-sclerosing variant of papillary carcinoma, as well as in metastases of papillary carcinoma to the lymph nodes. According to the majority of researchers, they are formed at the site of destruction of papillae, due to which they are often called "gravestones" of dead papillae. Psammomnye bodies should not be confused with calcifications, which are observed in any thyroid pathology, and not only in papillary carcinoma "(cited by TI Bogdanova).

Psammary bodies and calcifications have the highest acoustic density of all structures of the thyroid gland and thyroid neoplasms. This feature makes it possible to visualize these elements even at sizes slightly more than half the wavelength at a frequency of 7.5 MHz (from 100 μm). The size of psammotic bodies is variable, but usually does not exceed the ultrasonic wavelength (200 μm). Echographically significant (visualized) are separate structures with a size of 100 - 150 μm, and congestion smaller bodies of 30 - 50 elements each ("grape bunch"), the total size of which can reach 500 - 600 microns.

Fig. 172. Psammom(pathological specimen) [cit. by Yamashita S., 1996].

Ultrasound examination of psammomnye bodies is visualized as multiple, very bright, point hyperechoic structures without an acoustic shadow (fig. 173). The described ultrasonic feature corresponds only to these structures. The degree of hyperechoicity of psammotic bodies is the highest of all hyperechoic structures; they are clearly defined against the background of tissue of any echogenicity. In some cases, this feature is of decisive importance in the ultrasound diagnosis of isoechoic carcinomas.

Fig. 173. Bright point hyperechoic inclusions... Education 39 mm in size, irregular shape, without clear boundaries, unevenly reduced echogenicity. Multiple bright point hyperechoic structures without an acoustic shadow are determined in the tissue of the node. Point hyperechoic inclusions are localized mainly in isoechoic areas of the tumor. PTHI is an unencapsulated papillary carcinoma of a papillary-solid structure with numerous psammotic bodies.

In quantitative terms, microcalcifications in papillary carcinomas are less common than psammomnye bodies. They are visualized as single bright echoes without an acoustic shadow (Fig. 174). The same ultrasound sign can be observed in the presence of separate groups of psammological bodies.

Fig. 174. Bright point hyperechoic inclusions... Education 13 mm in size, irregular shape, without clear boundaries, unevenly reduced echogenicity. In the tissue of the node, separate bright point hyperechoic structures without an acoustic shadow are determined. PTHI is non-encapsulated papillary carcinoma of typical papillary structure with the presence of single calcifications.

Bright punctate hyperechoic inclusions were detected only in papillary carcinomas (65%). In the presence of an ultrasound sign, morphologically in the structure of the tissue of these tumors, psammom cells (80%) were most often detected, less often - small calcifications (20%) and areas of sclerosis (6.5%).

The highest severity (number) of point hyperechoic inclusions is observed in the papillary-solid structure of papillary carcinomas, especially in the diffuse-sclerosing variant of the tumor. In these cases, multiple bright point echoes are determined not only within the tissue of the neoplasm, but also practically throughout the volume of the thyroid gland, as well as in enlarged regional lymph nodes. The noted ultrasound feature is consistent with the results of morphological studies Bogdanova T.I. et al. , which emphasize that psammomnye bodies are formed at the site of destruction of papillae in malignant papillary tissue, tumor metastases to lymph nodes, as well as lymphatic capillaries of the surrounding thyroid tissue, especially in the diffuse-sclerosing variant of papillary carcinoma.

Thus, visualization of multiple bright point echoes is one of the most significant independent ultrasound features. malignant papillary tissue... It is necessary to differentiate bright point hyperechoic inclusions with the echo signal "comet tail".

Volumetric hyperechoic inclusions without acoustic shadow are determined both in benign and malignant formations, in an approximate ratio of 1: 7. They are the predominant ultrasound sign of fibro-sclerotic areas, which are detected in more than 80% of cases during the pathological examination of these nodes.

In patients with benign formations, volumetric hyperechoic inclusions without an acoustic shadow are visualized mainly as single structures and are observed in all types of benign nodular pathology (Fig. 175).

Fig. 175. Volumetric hyperechoic structure without acoustic shadow... Isoechoic formation of regular shape, with a hydrophilic border, contains separate small cystic cavities. A large hyperechoic structure without an acoustic shadow is determined in the tissue of the node. PTHI is an adenoma of a heterogeneous structure with the presence of sclerotic and cystic changes.

Often, linear hyperechoic echo signals visualized in the tissue of benign nodes containing multiple small cystic cavities are interpreted as "fibrous foci" (Fig. 176). These echoes arise due to the usual acoustic effect of strengthening the posterior wall of the hydrophilic cavity (cystic, vascular) and are not morphologically fibrous structures.

Fig. 176. Pseudofibrosis... The isoechoic node of the correct shape, with an intermittent hydrophilic border, contains multiple small slit-like cystic cavities, along the posterior surface of which there is a hyperechoic amplification of the echo signal.

For papillary carcinomas characterized by pronounced fibrosclerotic changes from the stroma (Fig. 177).

Fig. 177. Sclerosis(histological specimen, scheme) ... Papillary thyroid carcinoma, diffuse sclerosing variant. Signs of diffuse tumor growth, severe sclerosis(histological preparation - cited by T.I. Bogdanova).

On ultrasound examination of these tumors, single volumetric hyperechoic areas without an acoustic shadow can be observed, but multiple structures are more often visualized (Fig. 178).

Fig. 178. Volumetric hyperechoic structures without acoustic shadow... Hypoechoic formation of 24 mm in size, irregular shape with preservation of the contour, indistinct border, the presence of convoluted vascular structures. The node contains multiple hyperechoic areas without acoustic shadow. PTHI is an encapsulated papillary carcinoma with pronounced sclerotic changes.

We observed hyperechoic inclusions without acoustic shadow in all anaplastic, 35% papillary, 25% medullary and 10% follicular carcinomas.

Volumetric hyperechoic inclusions with acoustic shadow correspond to areas of sclerosis and large calcifications in a morphological ratio, approximately 3: 1. This ultrasound sign can also be observed with large accumulations of psammotic bodies.

Volumetric hyperechoic inclusions with an acoustic shadow are determined mainly in the tissue of malignant nodes (83%) and much less often in benign ones.

When benign of nodal pathology, hyperechoic inclusions with an acoustic shadow are observed quite rarely, they were noted by us only in 4% of patients, while in all cases they were echographically determined single structures (fig. 179).

Fig. 179. Volumetric hyperechoic structure with acoustic shadow... Isoechoic formation 46 mm in size, regular shape, with a uniform hydrophilic border, the presence of multiple different-sized cystic cavities. In the tissue of the node, a single large hyperechoic structure with an acoustic shadow is determined (c). PTHI is an adenoma of a heterogeneous structure with separate calcifications.

In patients with malignant tumors, an ultrasound sign was observed in a third of cases, more often it was determined multiple structures (Fig. 180). The presence of volumetric hyperechoic inclusions with an acoustic shadow was noted in a quarter of patients with papillary carcinomas and a third of patients with medullary carcinomas.

Fig. 180. Volumetric hyperechoic structures with acoustic shadow... Education 25 mm in size, irregular shape, without clear boundaries, unevenly reduced echogenicity. Multiple hyperechoic structures with an acoustic shadow are identified. PTHI - non-encapsulated papillary carcinoma of the follicular-solid structure with severe stromal sclerosis.

More than half of the patients noted combination various hyperechoic inclusions: with benign nodes, hyperechoic structures with acoustic shadows and without them were observed, which morphologically corresponded to the presence of fibrosclerotic areas and calcifications; in patients with malignant neoplasms, various combinations of bright dotted with volumetric ones were determined, which corresponded to the presence of psammotic bodies, foci of sclerosis and calcifications (Fig. 181).

Fig. 181. Combination of various hyperechoic inclusions... Education 47 mm in size, irregular shape, without clear boundaries, unevenly reduced echogenicity. Multiple point and volumetric (with an acoustic shadow) hyperechoic inclusions, as well as variegated convoluted vascular structures are identified. PTHI is non-encapsulated papillary carcinoma, predominantly of papillary-solid structure with pronounced fibro-sclerotic changes, an abundance of calcifications and psammotic bodies.

Thus, hyperechoic inclusions are much more often observed in carcinoma tissue than in benign nodules. Availability multiple hyperechoic structures of any kind, especially bright punctate ones, is a significant independent ultrasound sign of thyroid malignant tumors.

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The procedure for ultrasound examination of the kidneys allows you to determine the features of the functioning of this organ, the integrity of its structure and the absence of any possible pathologies in the form of malignant or benign formations. The kidneys in a normal state have a rounded shape, are located symmetrically and do not reflect ultrasonic waves. In the presence of deviations, a change in the size and shape of the kidneys, their asymmetric location, as well as various formations reflecting ultrasound can be detected.

Hyperechoic inclusions in the kidneys are new formations or foreign bodies that do not contain fluid, have low sound conductivity and high acoustic density. Since the density of foreign structures is higher than the density of the renal tissue, ultrasonic waves during the study are reflected from them and create a hyperechoic phenomenon.

What is hyperechoicity and acoustic shadow

Echogenicity is the ability of solid and liquid physical bodies to reflect sound waves. All internal organs are echogenic, otherwise ultrasound would be simply impossible. "Hyper" - means above anything, in our case - above the normal echogenicity of kidney tissue. A hyperechoic signal means that something has appeared inside the kidney that can powerfully reflect ultrasonic waves.

The doctor on the screen determines the inclusion by a light, almost white spot, and immediately draws attention to whether the detected inclusion casts an acoustic shadow, that is, a bunch of ultrasonic waves that have not passed through it. The ultrasonic wave is slightly denser than air, so only a very dense object can prevent it from passing through itself.

Hyperechoic inclusions are not an independent disease, but a signal about the development of pathology inside the kidney.

Clinical presentation: symptoms and signs

It is almost impossible to determine the presence of neoplasms without an ultrasound scan, however, as a rule, they are accompanied by the following symptoms:

• increased temperature against a background of pain in the lower back;
• changed color of urine (it becomes brown, bright or dark red);
• colic (solitary and paroxysmal) in the renal region;
• persistent pain (sharp and / or aching) in the groin;
• constipation alternating with diarrhea;
• nausea and vomiting.

Types of inclusions and possible diseases

If in the cavity of the kidney, and more often both, seals of large volume (0.5-1.5 cm3) are found, casting an acoustic shadow, they indicate stones inside the kidney. A volumetric mass with a fixed shadow may indicate a sclerosed lymph node that formed after a purulent-inflammatory process or during a chronic inflammatory disease.

Sclerosis is a pathological replacement of healthy functional elements of an organ with connective tissue, followed by a violation of its functions and death.

If a single formation is found inside the kidney that does not cast an acoustic shadow, it can be a signal:

• a cystic cavity filled with fluid or empty;
• sclerosis of the vessels of the kidney;
• small, not yet hardened calculi (stones);
• sand;
• inflammatory process: carbuncle or abscess;
• fatty lumps in the kidney tissue;
• hemorrhages with hematomas;
• development of tumors, the nature of which needs to be clarified.

If hyperechoic formations are small (0.05-0.5 cm3), are reflected on the screen with bright sparkles, and there is no acoustic shadow, these are echoes of psammotic bodies or calcifications, which often, but not always, indicate malignant tumors.

Psammous (psammous) bodies are layered formations of rounded forms of protein-fat composition, inlaid with calcium salts. They are found in the joints of blood vessels, meninges, and some types of tumors.

Calcifications - calcium salts precipitated into soft tissues affected by chronic inflammation.

The study can reveal a combination of several types of hyperechoic inclusions with or without a shadow.

The composition of malignant tumors in 30% of cases includes calcifications, in 50% of cases - psammom cells, in 70% of cases sclerosed areas are fixed.

There is a good chance to see hyperechoic inclusions in the kidneys in the presence of urolithiasis, foci of infection, chronic or recurrent inflammatory diseases: glomerulonephritis, hydronephrosis, paranephritis.

Making an accurate diagnosis and additional procedures

Under the guidance of a doctor who analyzes the clinical picture of your disease, you should undergo further examinations to clarify the nature of the formations.

If stones, sand, hematomas in the kidneys are suspected, a general and daily urine analysis is prescribed, which determines the composition of mineral salts in it, as well as a blood test to determine the weak links of the body's metabolism.

If the kidney was injured, a hemorrhage occurred in it, a fatty deposit or a cyst formed, the vessels became hardened and an operation was required, an MRI scan was performed to determine the exact location of the inclusions.

If oncology is suggested, a blood test for tumor markers and a biopsy of organ tissue is required. When the quality of the tumor is in doubt, it is advisable to perform sonoelastography (a type of ultrasound), which detects cancer of the initial stages, determining the localization and size of the tumor, even of a microscopic size. A highly qualified specialist can visually differentiate the quality of the neoplasm.

Detection of hyperechoic bodies is not a reason for confusion or inaction, it is necessary to immediately be examined, diagnosed and start treatment.

Prevention and treatment

Preventive measures usually include the use of traditional treatments. So to remove sand or small stones, various diuretic herbal preparations and medicines prescribed by the attending physician are effectively used. Larger stones (more than 5 mm) are either removed, or they are crushed with a laser or ultrasonic radiation, followed by removal by lithotripsy. Inflammatory kidney disease is treated with antibiotics.

Upon detection of malignant and benign tumor pathologies, surgical intervention is performed. Benign neoplasms and cysts are removed by resection or partial excision. With malignant tumors, the entire kidney is removed using chemotherapy and various radiation methods.

An accurate diagnosis and treatment program is possible only when contacting a qualified and experienced specialist: a nephrologist or urologist.

moipochki.ru

Hyperechoic inclusions

Type and structure

On an ultrasound machine that studies the kidneys, these neoplasms are shown as small linear, point or volumetric structures with a high echogenicity. They can be seen within the kidney tissue.

In the practice of medicine, it is noticed that the data hyperechoic inclusions are calcifications, from them point particles are emitted without accompanied by an acoustic shadow, called microcalcifications. If there is a microcalcification in the nodular formation, then one can declare the beginning of the development of a malignant tumor.

Since hyperechoic formations begin to manifest themselves clearly only in malignant tumors, the following types of structures are distinguished in a malignant tumor:

• Half of the echogenic formation is made up of psammary bodies.
• Only 30% is removed by calcification.
• Sclerosed areas - 70%.

If ultrasound reveals a benign kidney tumor, then there are no psammom cells at all, calcifications are also rare. Sclerotic areas are most often noted.

Types of hyperechoic inclusions and their diagnosis

These inclusions in the kidneys can only be detected by a specialist during the diagnostic procedure. The conclusion may speak of kidney stones and the presence of sand. Today, there are several types of inclusion data:

With the help of ultrasound, it is possible to most accurately identify hyperechoic inclusions in the kidneys. In addition, their presence can be suspected by a number of symptoms. These can be:

• Elevated temperature.
• Discoloration of urine.
• Colic in the kidney area is frequent.
• Severe pain in the abdomen or below the waist, or persistent pain in the groin.
• Vomiting and nausea.

These symptoms are universal and similar to many other diseases, so if kidney stones are suspected you must immediately consult a doctorat. To avoid the progression of the disease, you should undergo a full diagnostic examination every six months with blood, urine, and feces tests. Thus, the development of diseases can be prevented and some diseases can be avoided.

Prevention of stones in the stomach is frequent drinking of liquids in the form of water, rosehip infusion, tea with herbs (mountain ash, oregano, mint and others). Thanks to her, the body will be cleansed of toxins and salts, which happens during each urination.

Treatment of hyperechoic renal formation

Hyperechoic inclusions, as a rule, manifest themselves as:

If an ultrasound scan reveals suspicions of these diseases, then the doctor advises the patient examination using MRI... Sometimes, in severe cases, a kidney biopsy may be required.

It is possible to treat hyperechoic inclusions, but it will not be an easy treatment. Stones are removed in several ways. The first method is based on frequent urination, which is caused by various diuretic herbs or medications prescribed by a doctor. This method treats small formations up to 5 mm.

Abdominal surgery is indicated for large enough stones. An alternative is removal of stones with a laser, which is crushing and then removing. You can also remove stones using ultrasound.

Tumor pathologies of malignant or benign content are removed by surgery. Hyperechoic formations and cysts are removed by partial excision (resection). If a malignant disease is advanced, the tumor is removed together with the kidney, and then chemotherapy is prescribed. In such a radical case, constant adherence to the diet is required.

Remember that only a qualified specialist can make an accurate diagnosis. Treatment is prescribed on the basis of an ultrasound of the kidneys and test results. Do not self-medicate, as this often leads to an aggravation of the situation.

pechen.guru

With ultrasound examination hyperechoic inclusions are visualized as point, linear or volumetric structures of high echogenicity, determined within the tissue of formation; some hyperechoic structures may be accompanied by an acoustic shadow (see Fig. 120).

The traditional interpretation of hyperechoic inclusions is “ calcifications", While they are subdivided into" microcalcifications "corresponding to point hyperechoic particles without acoustic shadow, and " macrocalcates»- hyperechoic areas with a characteristic acoustic shadow. Most researchers regard the presence of "microcalcifications" in the node as one of the most probable signs of its malignancy.

We observed hyperechoic inclusions much more often in malignant tumors (75%) than in benign (5%) nodes. At the same time, three types of structures were revealed morphologically in malignant tumors: 1) psammary bodies (50%), 2) calcifications (30%) and, most often, 3) areas of sclerosis (about 70%). In contrast to malignant neoplasms, in benign nodes, psammological bodies were not morphologically determined, in rare cases, the presence of calcifications (5.13%). The most frequently identified areas of sclerosis (more than 60%).

The results obtained are consistent with the data of L. Garretti et al. and Leung C. S. et al. on the presence of psammoma bodies in the tissue of 25 - 50% of papillary carcinomas, as well as the works of Kuma K. et al. , Zaccheroni V. et al. and Bruneton J. in which it is noted that, in addition to malignant tumors, calcifications are morphologically detected in nodular goiter and follicular adenomas.

In accordance with the ultrasound characteristics and morphological content, hyperechoic structures of thyroid neoplasms can be divided into three types:

1) bright spot ;

2) volumetric without acoustic shadow;

3) volumetric with acoustic shadow.

Bright point hyperechoic inclusions are the predominant ultrasound sign of psammotic bodies, less often of small calcifications (Fig. 171). In the presence of an ultrasound sign, the morphological ratio of these elements is approximately 4: 1.

Fig. 171. Papillary carcinoma (pathological specimen): А - psammomy bodies (pathohistological preparation - cited according to TI Bogdanova, fragment); IN - calcification (pathological specimen - cited after Rubin E., fragment).

Psammary bodies (Fig. 172) are a special type of calcifications. These structures are extremely important in the ultrasound diagnosis of papillary carcinomas. “A distinctive feature of papillary carcinoma is the presence of psammous bodiesresembling a cut from a tree trunk with characteristic rings increasing from the center to the periphery. Psammary bodies can be found in the stroma of the tumor and the surrounding tissue of the thyroid gland, in the lymphatic capillaries, especially in the diffuse-sclerosing variant of papillary carcinoma, as well as in metastases of papillary carcinoma to the lymph nodes. According to the majority of researchers, they are formed at the site of destruction of papillae, due to which they are often called "gravestones" of dead papillae. Psammomnye bodies should not be confused with calcifications, which are observed in any thyroid pathology, and not only in papillary carcinoma "(cited by TI Bogdanova).

Psammary bodies and calcifications have the highest acoustic density of all structures of the thyroid gland and thyroid neoplasms. This feature makes it possible to visualize these elements even at sizes slightly more than half the wavelength at a frequency of 7.5 MHz (from 100 μm). The size of psammotic bodies is variable, but usually does not exceed the ultrasonic wavelength (200 μm). Echographically significant (visualized) are separate structures with a size of 100 - 150 μm, and congestion smaller bodies of 30 - 50 elements each ("grape bunch"), the total size of which can reach 500 - 600 microns.

Fig. 172. Psammom(pathological specimen) [cit. by Yamashita S., 1996].

Ultrasound examination of psammomnye bodies is visualized as multiple, very bright, point hyperechoic structures without an acoustic shadow (fig. 173). The described ultrasonic feature corresponds only to these structures. The degree of hyperechoicity of psammotic bodies is the highest of all hyperechoic structures; they are clearly defined against the background of tissue of any echogenicity. In some cases, this feature is of decisive importance in the ultrasound diagnosis of isoechoic carcinomas.

Fig. 173. Bright point hyperechoic inclusions... Education 39 mm in size, irregular shape, without clear boundaries, unevenly reduced echogenicity. Multiple bright point hyperechoic structures without an acoustic shadow are determined in the tissue of the node. Point hyperechoic inclusions are localized mainly in isoechoic areas of the tumor. PTHI is an unencapsulated papillary carcinoma of a papillary-solid structure with numerous psammotic bodies.

In quantitative terms, microcalcifications in papillary carcinomas are less common than psammomnye bodies. They are visualized as single bright echoes without an acoustic shadow (Fig. 174). The same ultrasound sign can be observed in the presence of separate groups of psammological bodies.

Fig. 174. Bright point hyperechoic inclusions... Education 13 mm in size, irregular shape, without clear boundaries, unevenly reduced echogenicity. In the tissue of the node, separate bright point hyperechoic structures without an acoustic shadow are determined. PTHI is non-encapsulated papillary carcinoma of typical papillary structure with the presence of single calcifications.

Bright punctate hyperechoic inclusions were detected only in papillary carcinomas (65%). In the presence of an ultrasound sign, morphologically in the structure of the tissue of these tumors, psammom cells (80%) were most often detected, less often - small calcifications (20%) and areas of sclerosis (6.5%).

The highest severity (number) of point hyperechoic inclusions is observed in the papillary-solid structure of papillary carcinomas, especially in the diffuse-sclerosing variant of the tumor. In these cases, multiple bright point echoes are determined not only within the tissue of the neoplasm, but also practically throughout the volume of the thyroid gland, as well as in enlarged regional lymph nodes. The noted ultrasound feature is consistent with the results of morphological studies Bogdanova T.I. et al. , which emphasize that psammomnye bodies are formed at the site of destruction of papillae in malignant papillary tissue, tumor metastases to lymph nodes, as well as lymphatic capillaries of the surrounding thyroid tissue, especially in the diffuse-sclerosing variant of papillary carcinoma.

Thus, visualization of multiple bright point echoes is one of the most significant independent ultrasound features. malignant papillary tissue... It is necessary to differentiate bright point hyperechoic inclusions with the echo signal "comet tail".

Volumetric hyperechoic inclusions without acoustic shadow are determined both in benign and malignant formations, in an approximate ratio of 1: 7. They are the predominant ultrasound sign of fibro-sclerotic areas, which are detected in more than 80% of cases during the pathological examination of these nodes.

In patients with benign formations, volumetric hyperechoic inclusions without an acoustic shadow are visualized mainly as single structures and are observed in all types of benign nodular pathology (Fig. 175).

Fig. 175. Volumetric hyperechoic structure without acoustic shadow... Isoechoic formation of regular shape, with a hydrophilic border, contains separate small cystic cavities. A large hyperechoic structure without an acoustic shadow is determined in the tissue of the node. PTHI is an adenoma of a heterogeneous structure with the presence of sclerotic and cystic changes.

Often, linear hyperechoic echo signals visualized in the tissue of benign nodes containing multiple small cystic cavities are interpreted as "fibrous foci" (Fig. 176). These echoes arise due to the usual acoustic effect of strengthening the posterior wall of the hydrophilic cavity (cystic, vascular) and are not morphologically fibrous structures.

Fig. 176. Pseudofibrosis... The isoechoic node of the correct shape, with an intermittent hydrophilic border, contains multiple small slit-like cystic cavities, along the posterior surface of which there is a hyperechoic amplification of the echo signal.

For papillary carcinomas characterized by pronounced fibrosclerotic changes from the stroma (Fig. 177).

Fig. 177. Sclerosis(histological specimen, scheme) ... Papillary thyroid carcinoma, diffuse sclerosing variant. Signs of diffuse tumor growth, severe sclerosis(histological preparation - cited by T.I. Bogdanova).

On ultrasound examination of these tumors, single volumetric hyperechoic areas without an acoustic shadow can be observed, but multiple structures are more often visualized (Fig. 178).

Fig. 178. Volumetric hyperechoic structures without acoustic shadow... Hypoechoic formation of 24 mm in size, irregular shape with preservation of the contour, indistinct border, the presence of convoluted vascular structures. The node contains multiple hyperechoic areas without acoustic shadow. PTHI is an encapsulated papillary carcinoma with pronounced sclerotic changes.

We observed hyperechoic inclusions without acoustic shadow in all anaplastic, 35% papillary, 25% medullary and 10% follicular carcinomas.

Volumetric hyperechoic inclusions with acoustic shadow correspond to areas of sclerosis and large calcifications in a morphological ratio, approximately 3: 1. This ultrasound sign can also be observed with large accumulations of psammotic bodies.

Volumetric hyperechoic inclusions with an acoustic shadow are determined mainly in the tissue of malignant nodes (83%) and much less often in benign ones.

When benign of nodal pathology, hyperechoic inclusions with an acoustic shadow are observed quite rarely, they were noted by us only in 4% of patients, while in all cases they were echographically determined single structures (fig. 179).

Fig. 179. Volumetric hyperechoic structure with acoustic shadow... Isoechoic formation 46 mm in size, regular shape, with a uniform hydrophilic border, the presence of multiple different-sized cystic cavities. In the tissue of the node, a single large hyperechoic structure with an acoustic shadow is determined (c). PTHI is an adenoma of a heterogeneous structure with separate calcifications.

In patients with malignant tumors, an ultrasound sign was observed in a third of cases, more often it was determined multiple structures (Fig. 180). The presence of volumetric hyperechoic inclusions with an acoustic shadow was noted in a quarter of patients with papillary carcinomas and a third of patients with medullary carcinomas.

Fig. 180. Volumetric hyperechoic structures with acoustic shadow... Education 25 mm in size, irregular shape, without clear boundaries, unevenly reduced echogenicity. Multiple hyperechoic structures with an acoustic shadow are identified. PTHI - non-encapsulated papillary carcinoma of the follicular-solid structure with severe stromal sclerosis.

More than half of the patients noted combination various hyperechoic inclusions: with benign nodes, hyperechoic structures with acoustic shadows and without them were observed, which morphologically corresponded to the presence of fibrosclerotic areas and calcifications; in patients with malignant neoplasms, various combinations of bright dotted with volumetric ones were determined, which corresponded to the presence of psammotic bodies, foci of sclerosis and calcifications (Fig. 181).

Fig. 181. Combination of various hyperechoic inclusions... Education 47 mm in size, irregular shape, without clear boundaries, unevenly reduced echogenicity. Multiple point and volumetric (with an acoustic shadow) hyperechoic inclusions, as well as variegated convoluted vascular structures are identified. PTHI is non-encapsulated papillary carcinoma, predominantly of papillary-solid structure with pronounced fibro-sclerotic changes, an abundance of calcifications and psammotic bodies.

Thus, hyperechoic inclusions are much more often observed in carcinoma tissue than in benign nodules. Availability multiple hyperechoic structures of any kind, especially bright punctate ones, is a significant independent ultrasound sign of thyroid malignant tumors.

studopedia.org

What does the term itself mean?

The prefix "hyper", which is part of complex medical terms, translated from Greek means "over", "increased over the norm."

The second part of the word - "echogenicity" - comes from the well-known word "zho" and means the ability of someone or something to reflect sound waves. Since we are talking about ultrasound research, the word "echogenicity", in this case, means the ability of an object to reflect ultrasonic waves.

Now, understanding the meaning of each part of this complex medical term, you can guess the meaning of the whole word.

The phrase "hyperechoic formation in the gallbladder" means that in the gallbladder there is a certain formation with an excessively increased ability to reflect ultrasonic waves. On the screen, such a formation looks very light, almost white.

What kind of education is it?

Without hesitation, we can say with confidence that this formation is very dense. Because only very dense formations reflect ultrasound with increased zeal.

So, in the gallbladder there is a still unknown formation, quite dense, perfectly reflecting ultrasonic waves. Much stronger than the surrounding tissue.

The next thing the doctor of ultrasound diagnostics pays attention to is whether there is a shadow behind this formation. Does this formation give the so-called "acoustic shadow"?

Why is it important?

Because the presence of an acoustic shadow behind any object indicates that the object under study is so dense that it does not transmit ultrasonic waves at all.

What could it be?

Gallbladder stone

If the doctor sees an acoustic shadow behind a dense formation in the gallbladder, he first of all thinks about a gallbladder stone.

Agree, a stone is a very dense formation, so dense that ultrasonic waves are not able to penetrate it. That is why a dark track or "acoustic shadow" forms behind it.

1 - stone

2 - gallbladder

3 - acoustic shadow

4 - liver

But, unfortunately, not everything is so simple.

Gallbladder polyps

Some gallbladder polyps have the same high density. These are polyps "impregnated" with cholesterol, the so-called cholesterol polyps.

Polyp by its nature is a soft tissue formation, and therefore it usually reflects only part of the ultrasonic waves. The rest of the waves pass through it.

In such cases, it is displayed on the screen of the ultrasound device as a formation of medium echogenicity, that is, as a gray formation. These polyps never give an acoustic shadow behind them.

And only when the polyp tissue is replaced by cholesterol, the polyp becomes as dense as the gallbladder stone. In this case, it is rather difficult to distinguish a polyp from a stone.

How to tell a stone from a polyp?

Difficult, but quite possible.

Mobility

After all, a polyp is a benign tumor emanating from the wall of the gallbladder, and therefore, closely, inextricably linked with it. The polyp is motionless.

No matter how the patient turns, no matter what body movements he makes, the polyp will not move from its place. He is always in the same place. That is why it can be seen not only on the lower wall of the gallbladder (like a stone), but also on the upper or side walls.

Stone is quite another matter! It is formed from bile, inside the cavity of the gallbladder and is not associated with its wall. He is free in his movements.

Free from connection with the walls of the gallbladder, but not from the law of gravity. Therefore, when the patient turns from side to side or lies on his back, the stone rolls over and always ends up on the lower wall. On the wall that is "closer to the ground."

This is the main difference between a gallbladder stone and a polyp.

There are, of course, cases when a stone is almost indistinguishable from a gallbladder polyp. Such difficulties arise when the stone is very small, 1-2 mm. So small and light that it does not sit on the bottom, but "floats" in bile. Or it “sticks” to the upper wall of the gallbladder and stays there for some time due to its very low mass.

But even in these cases, with careful and repeated examination of the patient, it is possible to quite accurately distinguish a stone from a gallbladder polyp.

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When carrying out an ultrasound of the kidneys, neoplasms can sometimes be found in them, which do not contain fluid.

A stably functioning organ has a normal structure, and the ultrasound scan does not show the reflection of ultrasound waves from the kidneys.

When the organ reflects sound waves during the ultrasound scan, we can talk about the presence of hyperechoic inclusions in the kidneys.

Echogenicity is the property of various objects to reflect sound waves from themselves. An ultrasound machine works according to the principle of echogenicity. All human organs have this property. When sound waves are passed through them, they reflect them from themselves with varying degrees of intensity.

Echogenicity is normal and natural. But if the degree of reflection of ultrasonic waves by the organ is exceeded, we can talk about malfunctions in its work.

When examining the kidney, an ultrasound scan gives a signal in the form of a white spot on the organ that there is any foreign body or neoplasm inside it.

Small hyperechoic inclusions

An ultrasonic wave, falling on a similar body, is reflected from it in the form of a clot. This clot is called an acoustic shadow. According to the acoustic shadow, the specialist determines the type of neoplasm inside the kidney. It can be:

• voluminous;
• point;
• hyperechoic linear inclusions in the kidneys.

Since the ultrasound wave has a higher density than air, only an object with a very dense structure cannot pass it. You should not classify such inclusions as a separate type of disease. They only clearly indicate the presence of any pathology.