Hypoechoic formation

Instrumental diagnostics by ultrasound scanning (ultrasound), also called ultrasonography, can detect areas with different acoustic densities in the internal organs and cavities - hyperechoic or hypoechoic formation.

What is gipoehogennoe education?

Local gipoehogennoe formation in this or that organ, in contrast to hyperechoic, is the result of lower echogenicity of tissues - in comparison with the parameters of acoustic density of healthy tissues of the organ. That is, this area weakly reflects the ultrasonic signal directed to it (in the frequency ranges 2-5, 5-10 or 10-15 MHz). And this is evidence that this education - in terms of its structure - either contains liquid, or has a cavity.

Hypoechoic formation on the screen is visualized in the form of gray, dark gray and almost black zones (in the case of hyperechoic zones, light, often white). For the decoding of the ultrasound image, there is a scale of six gray Gray Scale Imaging categories, where each pixel of the hypoechoic image obtained on the monitor image - depending on the strength of the ultrasonic signal returning to the sensors - is a specific shade of gray.

The results of ultrasound examination deciphered by ultrasound examiners (sonographs) are studied by physicians of a specific profile (endocrinologist, gastroenterologist, urologist, nephrologist, oncologist, etc.), compared with the indices of the patient's tests and the results of other studies.

In many cases, differential diagnosis is required, for which, in addition to ultrasound, other hardware methods for visualizing the pathology (angiography, color Doppler, CT, MRI, etc.) are used, as well as a histological examination of the biopsy specimens.

Causes of hypoechoic formation

As an indicator of ultrasonography, a hypoechoic formation can have any localization. The causes of hypoechogenic formation are also different and completely dependent on the etiology and pathogenesis of those diseases that develop in patients.

For example, hypoechoic formation in the pancreas is considered a diagnostic criterion for identifying pathologies such as cysts, hemorrhagic pancreatitis, mucinous cystadenoma (which is prone to malignancy), adenocarcinoma of the pancreas head, metastases in malignant tumors of other organs.

Hypoehogogenic formation in the liver and gallbladder

Healthy hepatic tissues are moderately hyperechoic, and hypoechoic formation in the liver can occur with cirrhosis; focal steatosis; cysts (including those with Echinococcus multilocularis); biliary abscess; hepatocellular adenoma; focal parenchymal hyperplasia; hepatoma and cholangiocellular adenocarcinoma of small size.

Hypoechoic formations are also visualized in cases of spreading to the liver of diffuse metastases of pancreatic cancer, ovaries, mammary glands, testis, gastrointestinal tract.

In the ultrasound diagnosis of gallbladder pathologies, the structure of its walls is of particular importance, since in the absence of organ damage they are visualized as three layers: external and internal hyperechoic and secondary hypoechoic.

Among the causes of hypoechoic formation in the gallbladder, we should mention polyps, adenocarcinoma (with an intact outer layer of the bladder), lymphomas (tumors of lymph nodes), angiosarcoma.

Hypoehogenous formation of the spleen

Normally, the echogenicity of the spleen is uniform, although slightly higher than that of the liver. But because of the high vascularization of the ultrasound, the spleen is carried out with a contrast agent that accumulates in the parenchyma and enables (at the end of the parenchymal phase) to visualize focal lesions and hypoechoic spleen formations.

Among such formations are:

• acute intraparenchymal hematoma with ruptured spleen (due to abdominal trauma);
• hemangiomas (benign vascular formations) with splenomegaly;
• spleen infarctions (infiltrative or hematologic);
• lymphoma of the spleen;
• metastases of various origin (most often sarcomas of soft tissue, osteosarcoma, kidney cancer, breast or ovaries).

As experts note, echinococcal, solitary and dermoid cystic spleen formations can have a mixed ehost structure.

Hypoehogogenic formation in the kidney, adrenal gland and bladder

Hypoehogenous formation in the kidney can be detected with inclusions to the parenchyma of cystic structures (including poor quality), hematomas (at the initial stages), pyogenic paranephalic abscesses (at the stage of necrosis) or cavernous tuberculosis of the kidney.

According to endocrinologists, to detect hypoechoic adrenal gland formation is not an easy task, and ultrasound, unfortunately, does not always cope with it. For example, the verification of the diagnosis of adenoma in primary aldosteronism, as well as abnormal proliferation of adrenal cortex cells in hypercorticism (Isenko-Cushing's disease) is based on symptoms. Ultrasound unmistakably detects a sufficiently large pheochromocytoma, as well as lymphoma, carcinoma and metastases. So, it's best to examine the adrenal glands with CT and MRI.

With the development of benign leiomyoma, transitional cell carcinoma of the bladder or pheochromocytoma (paraganglioma) of the bladder, which is accompanied by hypertension and hematuria, ultrasound examination in the urinary bladder is visualized on ultrasound.

Hypoehogenic formation in the abdominal cavity and pelvis

Pathologies localized in the abdominal cavity, particularly in the intestinal tract of the gastrointestinal tract, are unobstructed by ultrasound: the diseased empty intestine has thickened hypoechoic walls contrasting with the surrounding hyperechoic fatty tissue.

In a far from complete list of reasons that cause the hypoechoic formation visualized in ultrasound in the abdominal cavity, the following appear:

• a hernia protruding into the inguinal canal;
• intra-abdominal hematomas (traumatic or associated with coagulopathies);
• serous and purulent phlegmon of peritoneum or retroperitoneal space;
• abscess of terminal ileum for transmural ileitis (Crohn's disease);
• inflammation of mesenteric lymph nodes (lymph nodes of the mesentery);
• B-cell non-Hodgkin's lymphoma or Burkitt's lymphoma;
• metastasis in the visceral lymph nodes of the abdominal cavity;
• carcinoma of the cecum, etc.

With ultrasound of the pelvic organs and uterus, formation with low acoustic density is detected in women - in the presence of fibroids, adenomas, cysts or endometriosis of the uterus; functional or dermoid cysts of the appendages. A hypoechoic formation in the ovary occurs with a hemorrhagic cyst, as well as a tubo-ovarian abscess (purulent inflammation in the fallopian tubes and ovaries), follicular lymphoma and carcinoma.

In men, pathologies with such a diagnostic index are testicular cancer, testicular lymphocele, varicocele of the cord, and in the course of ultrasound of the prostate in patients with benign adenoma or cancer of this gland hypoechoic formation of the prostate gland is visualized.

Hypoechoic formation in the subclavian region

Identified during ultrasound hypoechoic formation in the subclavian area may be a sign:

• benign neoplasms and malignant lymphomas of the anterior mediastinum;
• chronic lymphocytic leukemia;
• lesions of peripheral lymph nodes with metastases of thyroid cancer, larynx, esophagus, milk jelly, lungs;
• osteosarcomas of thoracic localization;
• cysts and echinococcosis of the lungs;
• thymomas or carcinomas of the thymus (thymus gland).

Hypoehogenicity of structures in this area is noted by clinicians in patients with hyperplasia or parathyroid gland cyst, hyperparathyroidism or nodular adenomatosis.

Types of hypoechoic formations

In addition to the anatomical and topographic characteristics of the formation, ultrasonography reveals its shape (rounded, oval, irregular), its width (craniocaudal) and depth relative to the outer wall of the organ or cavity.

In this parameter, the main types of hypoechoic formation include:

• rounded hypoechoic formation or hypoechoic oval formation (these are various cysts, varicocele, adenomas, adrenal tumors of metastatic etiology);
• gipoehogennoe nodal formation (characteristic of hemangiomas, nodal biliary hypertrophy, uterine fibroids, nodular adenomatosis, etc.);
• hypoechoic focal formation (characteristic of cirrhosis and focal fatty liver, haematomas and spleen infarction, etc.).

In the conclusion of the ultrasound, the features of the image contours are noted:

• gipoehogennoe education with smooth contours (cysts, nodular hypertrophy of the liver, breast tumors );
• gipoehogennoe education with uneven contours (many tumors, most metastases);
• gipoehogennoe education with a clear outline (cysts, adenomas, abscesses, having on the ultrasound image hyperechoic rim);
• gipoehogennoe education with indistinct contours (cavernous hemangions of a liver, a cancer of a thyroid gland, metastases in a tissue of organs of any localization).

Further, the homogeneity / heterogeneity of the formation is assessed, that is, its internal structure:

• gipoehogennoe homogeneous education (carcinoma);
• gipoehogennoe heterogeneous formation (large adenomas, liver cancer, diffuse forms of carcinomas, etc.);
• hypoechoic formation with hyperechoic inclusions (renal cell carcinoma, ovarian adenoma, prostate cancer).

The description of the condition of surrounding tissues, distal acoustic effects (amplification, attenuation, acoustic shadow) and the feature of lateral shadows (symmetry, asymmetry, absence) are given without fail.

In addition, there is a presence / absence of vascularization (i.e., blood vessels) in nodular structures with the definition of such species as: hypoechoic formation without blood flow (avascular) and hypoechoic formation with blood flow.

Formations with blood vessels are divided into:

• hypoechoic formation with perinodular blood flow (subtype with perinodular, i.e., the surrounding vascularization);
• gipoehogennoe formation with a combined blood flow (the vessels are near the formation and inside it);
• hypoechoic formation with intranodular blood flow (the presence of vascularization is recorded only within the education).

As clinical practice shows, a hypoechoic formation with intranodular blood flow can indicate its malignant character.

Finally, the presence of calcium compounds in the structure of formation is taken into account. And gipoehogennoe education with kaltsinatami (kaltsinozom) is typical for encapsulated chronic liver abscess with amoebiasis, liver cancer, neoplasms in the thyroid and prostate gland, malignant tumors of the mammary gland, etc.

Treatment

Patients can ask the doctor what treatment for hypoechogenic education is necessary, and what medicines are prescribed for this ... But the abnormal areas not detected by ultrasound are treated, but the diseases that caused a pathological change in the density of tissue that weakly reflects ultrasonic waves.