N Clinical manifestations

• Livid, localized nodular swelling

• An infected varix is hard, extremely tender, and surrounded by erythematous skin.

n Diagnosis: compression sonography of the veins of the lower extremity; conventional venography is rarely necessary (see p. 212). n Sonographic findings:

• Easily compressible, anechoic nodule

• CDS demonstrates blood flow. A normal flow velocity excludes thrombosis and an arteriovenous fistula (following left-heart catheterization or dilatation therapy).

n Accuracy of sonographic diagnosis: A varix located close to the transducer can be positively identified.

Sonographic Findings Varicose Veins
Fig. 141a, b Recanalized umbilical vein, CDS. a The vessel is easily traced to the abdominal wall. b The palpable, nodular mass beneath the abdominal wall is identified as a varix by CDS. The patient presented clinically with alcoholic cirrhosis of the liver

E o n Clinical manifestations: swelling, no systemic manifestations n Diagnosis:

• Palpation: doughy, mobile, nontender

• Gradual enlargement may occur; doubts are resolved by FNAB.

Round or elliptical mass n Sonographic findings: ^

• Smooth, well-defined margins

• Hypoechoic rim may form as a result of tumor expansion "jj

• Lipoma tends to be echogenic. ¡j» n Accuracy of sonographic diagnosis: Sonography can clearly demonstrate the individual features of these tumors, but it is prudent to evaluate the lesion by FNAB. If the findings are equivocal, a local excision is indicated.

Fig. 142 Lipoma (cursors): rubbery, mobile mass that is hyperechoic to the neck muscles (M)

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