Echogenic inclusions in the kidneys. Hyperechoic inclusions (structures) what is it? Concepts - hyperechogenicity and acoustic shadow

The article is under development.

The mammary gland is located on the anterior surface of the chest from 2-3 to 6 ribs. The parenchyma of the gland has a complex-groin-like structure: many vesicles (alveoli) are collected into a lobule, the lobules are combined into a share. The lobules and lobes do not have a capsule, the voids between the glandular tissue are filled with loose connective tissue. In a small mammary gland there are 6-8, and in a large one - 15-20 lobes. The lobes are arranged radially with respect to the nipple.

From each glandular lobule, a milk duct departs - a galactophore of the first order - a diameter of up to 1 mm; intralobar duct - galactophore II order - diameter up to 2 mm; extralobar duct - galactophore III order - diameter up to 3 mm. Inside the nipple, the milk ducts expand spindle-shaped - the milk sac - up to 5 mm in diameter.

At rest, the mammary gland is a system of blindly ending ducts, the alveoli appear only during pregnancy and lactation, and after the end of breastfeeding they atrophy.

Click on pictures to enlarge.

The parenchyma of the gland is enclosed in a connective tissue case and surrounded by pre- and retromammary fatty tissue. Adipose tissue around the mammary glands has a lobular structure. From the anterior and posterior sheets of the split fascia, connective tissue strands - Cooper's ligaments - gradually grow in the direction of the skin.

After the cessation of lactation or termination of pregnancy, the processes of fatty involution of the mammary glands are launched - adipose tissue appears inside the glandular layer. In menopause and obesity, fat lobes replace glandular tissue.

Ultrasound of the mammary glands

For all patients, ultrasound is performed on the 9-10th day of the menstrual cycle. For ultrasound of the mammary glands, a linear probe of 8-15 MHz is most suitable. The 5-10 MHz transducer may be useful for examining large breasts and for better visualization of deep structures.

The position of the patient during ultrasound of the mammary glands

• When examining the middle sections of the chest, the patient lies on his back, hand behind his head;
• When examining the lateral sections of the chest, the patient lies on the opposite side, hand behind the head;
• When examining the lower chest, the patient lies on his back, the chest is lifted if necessary;
• Sometimes the superficial areas of the chest are better seen in the patient's sitting position.

How to do a breast ultrasound

The chest is examined with an overlap to ensure that the entire gland is covered. Inspection goes vertical (1) and horizontal (2) planes, followed by radial (3) and anti-radial (from the periphery to the nipple) scanning.

If the transducer is positioned directly over the nipple (1), the nipple is pressed into the gland and produces shading, making it difficult to view the peripapillary area. Scanning along the border of the areola (2) is more suitable, in this position the ducts and milk sacs under the areola are better visible. It is sometimes useful to support the breast on the opposite side of the sensor (3) in order to optimize the geometry of the nipple.

Additional glandular tissue is often located in the axillary region, in rare cases - under the collarbone, in front of the sternum. If the glandular tissue is connected with the main gland, they speak of a process. When the glandular tissue is isolated, this is an additional share.

If focal changes are determined in the mammary gland, pay special attention to the axillary space; Other zones of regional lymph drainage from the mammary gland are subclavian, supraclavicular, and retrosternal.

Localization of the focus in the mammary gland

The localization of the focus can be described by quadrants: upper outer, lower outer, upper medial, lower medial (1). The areola (SA), nipple (N) and axillary region (AX) are isolated separately. For precise radial localization use the dial (2). The three concentric zones around the areola are numbered 1, 2 and 3 (3).

The M(3) lesion will be described as R/10/3, which means right breast, at 10 o'clock, in zone 3. Some authors measure the distance from the nipple to the lesion, then the lesion is described as R/10/distance from the nipple 20 mm. Assess the size and depth of the focus. On the photo it is useful to indicate the position of the sensor: horizontal (H), vertical (H), radial (R) or anti-radial (AR).

The review stage of the study of the breast ends with an analysis of the state of the regional zones of lymphatic outflow. There are four areas to explore:

• Axillary zone - from the outer border of the pectoralis minor muscle to the posterior edge of the axillary region;
• Subclavian zone - from the lower edge of the clavicle along the vascular bundle to the axillary region;
• Supraclavicular zone - from the upper edge of the clavicle to the medial edge of the digastric muscle;
• Anterosternal zone - from the lower edge of the clavicle along the midclavicular line to the border with the breast.

In most cases, lymph nodes do not differentiate from surrounding tissues; sometimes it is possible to distinguish a normal lymph node - an oval shape with a hypoechoic rim around the echogenic center; horizontal dimension up to 10 mm; you can see axillary lymph nodes more than 10 mm - benign hyperplasia.

Normal breasts on ultrasound

On ultrasound of the mammary glands, the structures are assessed as hyper-, iso-, or hypoechoic in relation to subcutaneous fat.

Leather- the central hyper- or isoechogenic band above and below is limited by even more hyperechoic lines. The width of the three-layer complex is less than 2 mm, slightly thicker above the areola. Under normal conditions, skin visualization is carried out in the form of a smooth hyperechoic line up to 7 mm thick. Due to fat deposits, the skin may take the form of two hyperechoic lines separated by a thin hypoechoic layer. Between the dermis and the underlying tissues, the border is never detected, in contrast to the mammary gland.

Pre- and retromammary fiber- The fat around the mammary glands is hypoechoic compared to fat in any other area and has a lobular structure, each lobule is surrounded by a thin hyperechoic film.

We did not find big differences in the description of the retromammary region in almost all authors working with the mammary gland: the latter consists of fatty tissue, ribs, intercostal muscles and pleura. Adipose tissue is visualized as hypoechoic lobules between the hyperechoic lines of the posterior leaflet of the split fascia and the anterior fascial sheath of the pectoralis major muscle. S. Willson (2007) considered such a constitution to be the term “false gynecomastia”.
The pectoral muscles (large and small) are visualized as multidirectional hypoechoic layers parallel to the skin with a transverse hyperechoic septum. They are bordered by hyperechoic lines of fascia. It is very easy to visualize the ribs as oval formations of high echogenicity with persistent acoustic shadowing. Between the ribs, the operator always marks hypoechoic arrays with a typical muscle pattern - the intercostal muscles. The deepest hyperechoic line can visualize the pleura.

Parenchyma of the mammary gland- hyperechoic diffusely heterogeneous layer between subcutaneous and retromammary fat. Layers of high echogenicity represent the supporting stroma, and layers of low echogenicity are loose connective tissue around the alveoli and ducts. Ultrasound cannot differentiate glandular tissue (alveoli and ducts) from periglandular stroma. The severity of the periglandular stroma (layers of low echogenicity) surrounding these structural elements is proportional to the development of glandular tissue.

The thickness of the glandular tissue is normal (Trofimova T.N. and Solntseva I.A., 1999): up to 35 years old - 9.2-15.6 mm, 35-44 years old - 6.7-13.9 mm, 45- 54 years old - 5.2-11.6 mm, over 54 years old - 4-7.2 mm. The change in the thickness of the parenchymal layer of the breast reflects age-related involution: partial and then complete fatty transformation of the glandular tissue. The echogenicity of the glandular tissue increases with age, which is associated with fibrosis of the connective tissue components of the fibroglandular zone.

milk ducts- Normally, at the base of the mammary gland, the diameter of the duct is up to 1 mm, and in the peripapillary region - up to 3 mm. Ducts less than 1 mm in diameter are not visible; normally, they begin to be clearly identified in the form of tubular structures at the end of the pregnancy period and especially during lactation. In 50% of women under the age of 50, ultrasound shows dilated ducts - anechoic tubular structures up to 5-8 mm in diameter.

cooper ligaments- hyperechoic processes of the superficial fascia, interlobular layers that stretch from the parenchyma through the premammary fatty tissue to the deep layers of the skin. Cooper's ligaments and Durret's ridges normally appear after 30 years, up to 30 years - one of the symptoms of fibrotic changes.

The ratio of glandular, connective and adipose tissue in the breast depends on age and hormonal status. In young women, glandular tissue predominates, which is good to evaluate with ultrasound, but is problematic with mammography. In older women, adipose tissue predominates, which is easy to assess by mammography, but problematic by ultrasound.

Picture. On ultrasound, the normal breast of a woman of reproductive age: the skin is superficially located, a hyperechoic glandular layer is enclosed between the hypoechoic pre- and retromammary tissue, in the background the pectoralis major and minor muscles, as well as the pleura. The hyperechoic component of the glandular tissue is represented by the supporting stroma, and the hypoechoic cells are the periglandular stroma around the alveoli and ducts. The severity of the periglandular stroma increases markedly in the second half of the cycle, during pregnancy and lactation, due to hyperplasia of the glandular tissue.

The nipple is defined as a rounded, delimited formation of low echogenicity. Behind the nipple, the operator can observe the acoustic shadow. Subareolar structures are always hyperechoic

Before the onset of puberty in girls and boys, the structure of the gland is the same - it is represented by adipose tissue, fragments of the ductal and glandular systems are in their infancy; on ultrasound, a hypoechoic structure in the posterior nipple region. During puberty, the mammary glands of girls actively develop - the ducts lengthen, branch and end lobular units are formed. By the age of 15, the mammary gland of a teenage girl resembles the structure of the gland of an adult woman.

Until the age of 25, there are no significant changes in the structure of the mammary glands. At 25-40 years old, the structure of the mammary glands is very diverse. The whole variety of ultrasound pictures can be grouped according to ultrasound morphotypes. Even in one woman, the morphotype is constantly changing depending on age, phase of the cycle, pregnancy, onset and completion of lactation.

Types of the structure of the mammary gland according to Kelly Fray

The juvenile morphotype is small, behind the nipple or next to the nipple right under the skin, the glandular layer is highly echogenic, the structure throughout the entire section is homogeneous fine-grained, pre- and retromammary tissue is practically absent. In the second phase of the cycle, the lactiferous ducts can be seen.

Early reproductive morphotype - small hypoechoic cells of the same size appear, premammary tissue is present fragmentarily, more in the lateral sections, retromammary tissue is completely absent, connective tissue structures are poorly differentiated.

With an increase in age and the number of pregnancies, fatty transformation of the glandular tissue occurs, the anterior contour of the gland becomes more wavy due to protrusions at the attachment sites of Cooper's ligaments.

Type of reproductive flowering - the number and size of hypoechoic areas increases, a mesh pattern appears, premammary tissue is in a continuous layer, retromammary tissue is absent.

Mature morphotype - fatty lobules appear in the glandular layer, 1-2 cm in size, retromammary fiber can be fragmentary or continuous.

Premenopausal morphotype - there is no layered structure, almost complete replacement of the parenchyma with adipose tissue, the remains of glandular tissue are represented by a thin homogeneous hyperechoic strip, there is no mesh pattern, premammary fatty tissue with many fascial septa.

Postmenopausal morphotype - fat lobes and connective tissue occupy the entire volume of the mammary gland, you can see small hyperechoic areas of rounded shape, small sizes (3-5 mm) - islands of glandular tissue.

Lactation morphotype - the entire gland is represented by a layer of medium echogenicity of coarse-grained glandular tissue, against the background of which multidirectional hypoechoic tubular structures 2-2.5 mm appear closer to feeding - dilated ducts; Premamarny fat is almost absent, fat lobules are not defined.

In fact, in different parts of the gland, the structure may differ, therefore Zabolotskaya N.V. depending on the ratio of glandular and adipose tissue, it allocates:

• The glandular type of the structure of the mammary gland is an early reproductive type;
• Fatty type of the structure of the mammary gland - postmenopausal type;
• Mixed type (with a predominance of glandular tissue, with a predominance of adipose tissue) - normally, most of the glandular tissue is located in the upper outer quadrant - the reproductive flowering type, in the center - the mature type;
• Specific type of structure of the mammary gland against the background of lactation.

Picture. On ultrasound, a normal breast: a girl in prepuberty (1) - a juvenile morphotype, nulliparous (2) and multiparous (3) women in the reproductive period - a morphotype of the reproductive prime, a postmenopausal woman (4) - a premenopausal morphotype. With age, the thickness of the glandular layer gradually decreases and the proportion of adipose tissue increases.

With the onset of menstruation, under the influence of sex hormones, cyclic changes occur in the mammary gland: 1-3 days - resorption of the secret from the ducts, 4-8 days - tubuloacinous involution (rest period), 9-16 days - proliferation of the ductal epithelium, hypervascularization of the connective tissue, 17 -28 day - acinar proliferation, glandular hyperplasia and a gradual decrease in connective tissue vascularization. In the second phase of the cycle, in response to the secretion of progesterone, the milk ducts and blood vessels of the parenchyma expand.

Picture. Echostructure of the mammary gland in phases I and II of the cycle: in phase II, Duret's crests and Cooper's ligaments are pronounced, since the surrounding adipose tissue accumulates fluid makes the image more contrast, and tubular anechoic structures also appear - galactaphores of 2-3 orders accumulate the secretory component.

At the end of pregnancy, the mammary gland acquires a large mesh structure due to the development of glandular tissue. With hypogalactia, the mesh pattern is preserved, with well-defined lactation, the mammary gland loses its mesh structure and is a zone of reduced echogenicity, against which dilated ducts can be determined. In the areolar areas during lactation, groups of significantly dilated ducts are revealed. After the completion of lactation, the mesh structure of the mammary glands is restored again.

Picture. On ultrasound, the breasts of a nursing woman: pre- and retromammary fatty tissue are not expressed; the parenchyma is abundant, low echogenicity, thin-walled anechoic tubular structures are determined - dilated ducts (1); milk sacs in the nipple area (2, 3).

At the age of 40-50 years, there is an increase in the proportion of adipose tissue, a decrease in the degree of development of the glandular tree, the number of glandular lobules. At the age of 50-60, compared with the previous period, no significant changes in the structure were revealed, but the strengthening of the processes of fibrosis of the intralobular stroma attracts attention. At the age of 60-70 years, the mammary gland is represented by fat lobes with low echogenicity, against the background of which stringy structures of high echogenicity are determined, which are thinned glandular tissue and compacted supporting stroma, located in the mass of adipose tissue.

The mammary gland is under compression against the background of endoprosthesis replacement.

breast skin

breast fat

Accessory mammary glands on ultrasound

Often in the armpit, in rare cases on the face, neck, chest, back, buttocks and limbs, additional breast tissue may be located. Scattered glandular tissue without an excretory duct is called an accessory lobe, and a formed structure with an areola and a nipple is an accessory gland.

Accessory nipples are easily confused with birthmarks. During puberty or pregnancy, pigmentation increases, swelling and even lactation appear. Tumors, mastitis and fibrocystic changes can form here. Rarely, the uncomfortable extra tissue is removed.

Regional lymph nodes of the mammary glands on ultrasound

Intramammary lymph node in children on ultrasound

There may be a lymph node in the breast parenchyma, most often in the upper outer quadrant. It is important to distinguish an enlarged lymph node from a tumor. On ultrasound, the lymph node has a characteristic appearance: an oval formation, a hypoechoic rim on the periphery and a hyperechoic central scar - vessels surrounded by fat.

Regional zones of lymphatic drainage - axillary, supraclavicular, subclavian, retrosternal lymph nodes. The tumor process is characterized by the absence of differentiation into a hypoechoic zone along the periphery, a hyperechoic central scar.

Dopplerography of the breast

When analyzing blood flow, it must be remembered that the blood supply to the mammary glands depends on:

• the age of the patient;
• hormonal status;
• individual structural features of the circulatory system of the glands;
• peripheral arterial pressure;
• on the severity of sclerosis of parenchymal arteries and arterioles, etc.

With ultrasound of the vessels of the mammary glands, you can evaluate:

• number of vessels;
• spectral Doppler parameters (RI, A/B ratio, PI);
• the size and number of individual color spots in one tumor;
• type and characteristics of the parameters of the Doppler curve itself;
• to compare the blood supply of symmetrical areas in healthy and affected mammary glands.

The blood flow in the thoracic arteries is symmetrical. PSV up to 11.2 cm / s, EDV up to 4.2 cm / s (velocity indicators correspond to the 2nd phase of the cycle).

Signs of a malignant process - the blood flow in the tumor node is locally increased in the form of a feeding arterial vessel with PSV above the background.

To study the peripheral blood supply to the mammary glands, the condition of the medial and lateral branches of the adducting thoracic arteries is assessed. To obtain data on blood flow in the medial mammary arteries, the transducer is placed in the 2nd or 3rd intercostal space near the sternum. To obtain information about the lateral group of the thoracic arteries, the sensor is moved along the lateral thoracic line from the 2nd to the 6th intercostal space.

Table 1. Normal indicators of blood flow velocity in the thoracic arteries of the mammary glands (M. Barta, 1999).

Table 2. Normal indicators of blood flow velocity in the arteries of the mammary glands (V.A. Sandrikov, 1998).

Both normal parenchymal vessels and vessels formed as a result of neoangiogenesis have a very small lumen and, accordingly, velocities. In this regard, the most effective technique for assessing such vessels is the power Doppler technique. After the vessels are identified, their number is determined and a spectral assessment is carried out. The results obtained correlate with data on the contralateral mammary gland.
The literature provides various indicators of blood flow velocities in the vessels of benign and malignant tumors. Most authors emphasize the higher average systolic velocity in malignant tumors (17.6 cm/sec) compared to benign tumors (13.9 cm/sec).
Data on the value of the resistance index (IR) of the vessels of malignant tumors are contradictory.
According to J. Folkman, one of the most significant criteria for malignancy is vascular asymmetry of the mammary glands. Pathological tumor vessels are characterized by uneven caliber, tortuosity of the course, lacunar extensions. In this regard, to identify these criteria, great hopes are placed on the technique of spatial three-dimensional reconstruction.

Take care of yourself, Your Diagnostician!

In the ultrasound examination protocol, a conclusion is often found - hyperechoic inclusions in the kidneys. This medical formulation means that foreign formations have been found in the kidneys, which have a structure different from the tissues of the organ itself. It is wrong to consider such a conclusion as an independent diagnosis.

On the screen of the ultrasound machine, pathological inclusions look like light or almost white dots reflecting ultrasonic waves. They may indicate various diseases, the diagnosis of which is the task of the attending physician.

Ultrasound scanning is used to diagnose hyperechoic changes. The term "hyperechoic inclusion" means that the detected elements have a brighter structure compared to the native tissue of the parenchyma. The hyperechoic structure is due to various degenerative processes that change it. In other words, hyperechogenicity implies that due to the presence of various foreign inclusions in the examined organ, the wave is reflected too strongly.

Attention! Any detected hyperechoic formation in the kidney indicates the development of a pathological process in the organ.

It directly affects their full functioning and can cause negative symptoms, which then manifest themselves in the entire urinary system. The foreign inclusion is usually located in the parenchyma or pyramidal layer of the kidneys.

All hyperechoic formations in the kidneys are divided into:

• large, casting an acoustic shadow (inflammation of the kidneys and the appearance of stones in its tissues);
• large, without a shadow: cyst, vascular atherosclerosis, benign or malignant tumor, sand or small stones;
• small, without acoustic shadow: microcalcifications or psammoma bodies.

Hyperechoic inclusions in the kidneys differ in size and shape: point or linear, multiple and single, voluminous or small. If echogenic formations do not have an acoustic shadow, then these are definitely not stones.

It is important that the sizes of such centers have valuable diagnostic value. Sometimes ultrasound reveals several varieties of such inclusions. With single formations without reflecting the acoustic shadow, the doctor prescribes an additional examination for clarification, namely, urine and blood tests, x-rays with contrast, MRI. If cancer is suspected, a biopsy is ordered.

Forms of manifestation of pathology

Normally, the kidneys have a uniform structure, smooth shape and are arranged symmetrically. But under the influence of various damaging factors, their appearance and structure change. On an ultrasound scan, normal kidneys cannot reflect ultrasound waves, but when degenerative changes occur, ultrasound conduction becomes worse. In the presence of sand or stones, as well as neoplasms, the echogenicity of such areas changes, since the density of the hyperechoic inclusion is significantly increased.

If foreign inclusions are calcifications, then this indicates that the pathology has been formed and has been developing for a long time, since this is a process of salt deposition, and it lasts for many months. They are usually deposited in tissues damaged by inflammation.

Ultrasound reveals the syndrome of hyperechoic pyramids of the kidneys, but it is not dangerous for the patient. This is a sign of a certain disease that requires differential diagnosis using laboratory tests. If as a result deviations are revealed, it is necessary to confirm or refute the presence of nephropathy or renal failure.

The presence of hyperechoic inclusions in the kidneys is almost always accompanied by specific symptoms, since each disease has its own specific signs. The general symptoms of pathological changes in the kidneys are characterized by the following manifestations:

• increase in body temperature;
• chills and fever;
• vomit;
• bouts of nausea;
• renal colic;
• cloudy urine with an unpleasant odor;
• back pain radiating to the abdomen and groin.

Such manifestations are characteristic of the acute stage of the disease and the period of exacerbation of chronic pathologies.

It is possible to detect on ultrasound a hyperechoic kidney in a fetus during a woman's pregnancy. Such a finding is being closely studied, since it indicates multiple anomalies in the intrauterine development of the unborn child.

Possible diseases

The detection of large-sized inclusions according to the results of ultrasound indicates an inflammatory process or urolithiasis. With single inclusions without a shadow, the following violations can be assumed:

• scar tissue;
• vascular sclerosis;
• the presence of small and fragile stones;
• hematomas;
• cyst;
• sand and stones;
• fat seals;
• neoplasms.

When bright glimpses without a shadow are detected on ultrasound, the doctor concludes that psammoma bodies are present in the renal parenchyma, and this often indicates the development of cancer. An excessive amount of calcifications and the presence of areas of sclerosis also speak of a similar nature of the pathology.

If there is a cyst, then the echogenicity of the tissue increases dramatically due to cystic formations. According to ultrasound, an increase in the size of the kidney is also noted, but the acoustic shadow is not present in this case. With tumors in the parenchyma, the normal structure and shape of the organ changes. Often, hyperechoic inclusions in the kidneys turn out to be malignant neoplasms.

A common renal pathology is acute pyelonephritis. This disease is also visualized on ultrasound with increased echogenicity and is characterized by the development of a pyramidal symptom. If the pyramids have weak echogenicity, but at the same time areas of hyperechogenicity appear in the tissue of the organ, then this indicates glomerulonephritis.

Unilateral or bilateral kidney stone formation or nephrolithiasis is clearly manifested by ultrasound scanning, especially if the inclusions are up to 3 mm in size. Difficulties arise with the identification of smaller concretions. Usually they do not have an acoustic shadow, and in order to determine them, it is necessary to carry out differential diagnostics. As for the hematoma, it can be detected when the blood in it begins to clot.

Regardless of what inclusions are supposed in the kidneys, additional examination methods are required to make an accurate diagnosis. As a rule, these are laboratory and other instrumental methods. The detection of hyperechoic inclusions inside the kidneys is a basis for a thorough examination, but does not act as an independent diagnosis.

On ultrasound hyperechoic inclusions visualized as dotted, linear or volumetric structures of high echogenicity, determined within the formation tissue; some of the 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 " macrocalcifications"- hyperechoic areas with a characteristic acoustic shadow. The presence of "microcalcifications" in the node is regarded by most researchers as one of the most likely 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 identified morphologically in malignant tumors: 1) psammoma bodies (50%), 2) calcifications(30%) and, most often, 3) areas of sclerosis(about 70%). Unlike malignant neoplasms, psammoma bodies were not morphologically determined in benign nodes; 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 Garretti L. et al. and Leung C. S. et al. about 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 dots ;

2) 3D without acoustic shadow;

3) 3D with acoustic shadow.

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

Rice. 171. Papillary carcinoma (histopathological preparation): A- psammoma bodies (histopathological preparation - cit. according to T. I. Bogdanova, fragment); AT- calcification (histopathological preparation - cit. by Rubin E., fragment).

psammoma bodies(Fig. 172) are a special kind of calcifications. These structures are extremely important in the ultrasound diagnosis of papillary carcinomas. “A distinctive feature of papillary carcinoma is the presence psammoma bodies, resembling a cut of a tree trunk with characteristic rings, increasing from the center to the periphery. Psammoma 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, and also in metastases of papillary carcinoma to the lymph nodes. According to most researchers, they are formed at the site of destruction of papillae, which is why they are often referred to as "tombstones" of dead papillae. Psammoma bodies should not be confused with calcifications that are observed in any thyroid pathology, and not only in papillary carcinoma ”(cited by Bogdanova T.I.,).

Psammoma 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 already at sizes that are slightly more than half the wavelength at a frequency of 7.5 MHz (from 100 μm). The size of psammoma bodies is variable, but usually does not exceed the ultrasonic wavelength (200 µm). Sonographically significant (visualized) are separate structures with a size of 100 - 150 microns, as well as clusters smaller bodies of 30 - 50 elements ("bunch of grapes"), the total size of which can reach 500 - 600 microns.

Rice. 172. Psammoma body(pathohistological specimen) [cit. according to Yamashita S., 1996].

On ultrasound, psammoma bodies are visualized as multiple, very bright, punctate hyperechoic structures without acoustic shadowing(Fig. 173). The described ultrasonic feature corresponds only to these structures. The degree of hyperechoicity of psammoma 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.

Rice. 173. Bright point hyperechoic inclusions. Education size 39 mm, irregular shape, without clear boundaries, unevenly reduced echogenicity. In the tissue of the node, multiple bright dotted hyperechoic structures without an acoustic shadow are determined. Point hyperechoic inclusions are localized mainly in isoechogenic areas of the tumor. PTHI is a non-encapsulated papillary carcinoma of papillary-solid structure with the presence of numerous psammoma bodies.

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

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

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

The greatest 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 neoplasm tissue, but also throughout almost the entire volume of the thyroid gland, as well as in enlarged regional lymph nodes. The noted ultrasonic feature is consistent with the results of morphological studies of Bogdanova T. I. et al. , which emphasizes that psammoma bodies are formed at the site of destruction of papillae in malignant papillary tissue, tumor metastases to the lymph nodes, as well as lymphatic capillaries of the surrounding thyroid tissue, especially in the diffuse sclerosing variant of papillary carcinoma.

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

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

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

Rice. 175. Volumetric hyperechoic structure without acoustic shadow. Isoechoic formation of the correct form, with a hydrophilic border, contains separate small cystic cavities. In the tissue of the node, a large hyperechoic structure without an acoustic shadow is determined. PTGI is a heterogeneous adenoma with sclerotic and cystic changes.

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

Rice. 176. Pseudofibrosis. The isoechoic node of the correct form, with a discontinuous hydrophilic border, contains multiple small slit-like cystic cavities, along the posterior surface of which hyperechoic amplification of the echo signal is noted.

For papillary carcinomas pronounced fibro-sclerotic changes from the side of the stroma are characteristic (Fig. 177).

Rice. 177. Sclerosis(histological specimen, scheme) . Papillary thyroid carcinoma, diffuse sclerosing variant. Signs of diffuse tumor growth, severe sclerosis(histological preparation - cit. according to 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).

Rice. 178. Volumetric hyperechoic structures without acoustic shadow. Hypoechoic formation 24 mm in size, irregularly shaped with preservation of the contour, indistinct border, the presence of tortuous vascular structures. The node contains multiple hyperechoic areas without acoustic shadowing. PTGI is an encapsulated papillary carcinoma with severe sclerotic changes.

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

Volumetric hyperechoic inclusions with acoustic shadowing correspond to areas of sclerosis and large calcifications in a morphological ratio of approximately 3: 1. This ultrasonic sign can also be observed with large accumulations of psammoma 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.

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

Rice. 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). PTGI is a heterogeneous adenoma with isolated calcifications.

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

Rice. 180. Volumetric hyperechoic structures with acoustic shadow. Education size 25 mm, irregular shape, without clear boundaries, unevenly reduced echogenicity. Multiple hyperechoic structures with acoustic shadowing are identified. PTGI is a non-encapsulated papillary carcinoma of a follicular-solid structure with severe stromal sclerosis.

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

Rice. 181. Combination of various hyperechoic inclusions. Education size 47 mm, irregular shape, without clear boundaries, unevenly reduced echogenicity. Multiple point and volumetric (with acoustic shadow) hyperechoic inclusions, as well as various tortuous vascular structures, are determined. PTGI is a non-encapsulated papillary carcinoma, predominantly of a papillary-solid structure with pronounced fibrous-sclerotic changes, an abundance of calcifications and psammoma bodies.

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

Ultrasound examination is one of the most progressive, reliable and fast methods of visualization of the organs of the human body, which, moreover, is financially accessible to almost every person. The very principle of ultrasound - different degrees of reflection of sound waves from objects with different densities has been used for more than a hundred years in the navy, industry, military affairs, and only recently has been used in medicine.

Over the past fifty years, they have become so wide that modern obstetrics, cardiology, gynecology, urology, surgery and many other branches of medicine cannot be imagined without the use of this indispensable method for studying the human body.

During the examination of the patient, the doctor of ultrasound diagnostics sends high-frequency sound waves through the thickness of the human body through the thickness of the human body to the organ of interest and receives the reflected signal with the same sensor, which is subsequently amplified, decoded by a powerful computer and displayed on the screen in the form of a black and white two - or three-dimensional image.

• echogenicity

  Darker areas of the ultrasound image are called. These are the areas through which ultrasound passes practically without reflection - cysts, blood vessels, adipose tissue. Lighter areas reflect sound much more strongly and are called areas of high acoustic density or hyperechoic areas. Most often these are stones, calcifications or bone formations and structures.

  In most cases, the ultrasound picture of individual organs and structures is more or less, therefore, the identification of hypo- or hyperechoic inclusions unusual for the organ very often indicates pathology and requires particularly careful analysis.

  Inclusions of increased echogenicity in various organs

  Let's try to figure out which hyperechoic inclusions most often a specialist in ultrasound diagnostics has to deal with. Most often, areas of high acoustic density can occur in the uterus, prostate, spleen, kidneys, gallbladder and bladder.

  

  soft tissues

  In the form of a bright dense formation in the thickness of the soft tissues, chronic hematomas are most often visualized, which did not get out, but became sclerosed and became a place for the deposition of calcium salts. Often, cephalohematomas of newborns look like this. Basically, such formations can be an accidental find and do not cause any concern. In case of detection of calcification, it is necessary to contact the surgeon for observation, and sometimes for the appointment of resolving therapy.

  Uterus

  They may turn out to be calcifications that form after abortions, curettage, miscarriages, the introduction of contraceptive coils, as well as the outcome of a number of chronic inflammatory diseases. After intrauterine surgery and manipulation, and in the postpartum period, hyperechoic blood clots can sometimes be detected. It should not be forgotten that polyps, fibroids, and even may look like echo-dense nodes and inclusions. Therefore, if they are found, you should not postpone a visit to the gynecologist.

  

  Prostate

  Light, bright inclusions in the prostate are the stones of this organ, formed from calcium and phosphorus salts. Such a formation can be different in size (from 2 mm to 20 mm) and shape. Most often, prostate stones are a sign of chronic prostatitis or adenoma, but sometimes they can also become an accidental find. To a greater or lesser extent, calcification of the prostate occurs in 75% of men over the age of 50 years. Contribute to the occurrence of calcifications of the prostate sedentary lifestyle, physical inactivity and prolonged lack of sexual activity. By itself, calcification does not cause discomfort and does not require treatment (unless accompanied by symptoms of prostatitis). The only contraindication for calcium deposits in the prostate is its massage due to the high risk of injury.

  

  Gallbladder and bladder

  And the bladder can be not only stones, but sometimes parietal polyps. Polyps are usually less echogenic, rarely exceeding 8-10 mm in size. Gallbladder stones have a high echo density, leaving an acoustic shadow behind them. Their sizes can vary from barely noticeable to filling the cavity of the gallbladder. For differential diagnosis, the patient is asked to change his position. The stones will roll down, and the polyps will remain in the same place.

  

  Spleen

  Small, usually up to 3 mm - calcifications. Most often found as an accidental find. Larger inclusions with clear contours, usually triangular in shape, are signs of chronic injuries and splenic infarcts. Neither one nor the other require special treatment. Special attention should be paid to echo-dense formations of the spleen, which have fuzzy boundaries, heterogeneous structure, or cast an acoustic shadow. This is how abscesses of the spleen and metastases of malignant tumors look like.

  

  kidneys

  Hyperechoic ones are of particular interest, as they can be signs of a fairly wide range of diseases.

  

  Ultrasound of the kidneys

  Types of echo-dense renal formations

  Let's divide echo-dense formations into three main types:

  Large echo-dense formations that give an acoustic shadow

  In the vast majority of cases, kidney stones (stones, macrocalcifications) look like this. A similar picture can also be given by a sclerosed, due to the inflammatory process, lymph node. Chronic renal hematomas can also calcify and mimic the ultrasound signs of nephrolithiasis. Kidney stone disease is treated by nephrologists and urologists. Most often, a special diet is prescribed, a number of medications for dissolving stones, spa treatment. Periodic ultrasound monitoring is performed, which displays the dynamics of the state of hyperechoic inclusions in the kidneys. Surgery is prescribed only in extreme cases - with obstruction of the urinary tract, recurring excruciating pain, infection.

  Large evenly echo dense formations without acoustic shadow

  Most often, benign kidney formations look like this - fibromas, hemangiomas, oncocytomas. After a thorough examination of the patient and a series of laboratory tests, they are surgically removed by resection or partial excision, followed by a mandatory biopsy of the surgical material.

  Bright point hyperechoic inclusions in the kidneys that do not have an acoustic shadow

  In this case, there are two options. The first is multiple harmless calcifications, small kidney stones, kidney “sand”. The second option is small inclusions, up to 3 mm in size with very high echo density - psammoma bodies, which I would like to dwell on in more detail.

  

  Isoechoic formation

  Psammoma (or psammous) bodies

  Psammoma (or psammous) bodies are multiple hyperechoic inclusions in the kidneys of a rounded shape, most often in size from 0.5 mm to 3 mm. The structure of the bodies is layered, they consist of a protein-lipid component encrusted with calcium and phosphorus salts. Normally, such a formation can be determined in the meninges and some vessels, however, their location in the renal tissue may (but not always) indicate the presence of a malignant formation, most often papillary carcinoma. Observation and treatment of this pathology is carried out by a nephrologist or urologist.

  On ultrasound, psammoma bodies are a scattering of small bright dot structures that do not have an acoustic shadow (a symptom of the starry sky). These formations have the highest acoustic density among all tissues of the human body, so they are clearly visible against the background of any organ. Psammoma bodies are located not only in the tumor tissue (although their concentration in it is much higher), but also on the periphery of it and in the nearby lymph nodes.

  

  Determination of a large number of bright small dot echostructures in the renal tissue is one of the most reliable ultrasound signs of an oncological neoplasm. In the case of their visualization, a particularly thorough study of the renal tissue and nearby structures is necessary.

  Differential diagnosis of psammoma bodies is carried out with an echo signal of the “comet tail” type.

  If hyperechoic inclusions are found in the kidneys, consultations of such specialists as a urologist, nephrologist are shown. Only these doctors, taking into account the history of the disease, data from ultrasound and other research methods, as well as laboratory data, will be able to make the most accurate diagnosis and prescribe adequate treatment. The doctor of ultrasound diagnostics makes an ultrasound report, but does not make a diagnosis!

  In conclusion, I would like to note that any pathology detected during ultrasound or any other examination? is not a judgment. This is rather a hint to you to pay attention to your own lifestyle and attitude to the most expensive and hard-to-renew resource that we have - our own health.

Complete collection and description: hyperechoic structures in the kidneys without a shadow and other information for human treatment.

Hyperechoic inclusions are most often detected at the time of ultrasound of the kidneys. They look like areas of tissue with large acoustic seals. This may indicate the presence of stones of the onset of urolithiasis or be formations in the form of a tumor.

Such inclusions have a denser structure compared to the surrounding tissues, they respond well to ultrasound, thereby creating increased echogenicity. On the monitor of the ultrasound machine, they appear as white spots.

Hyperechoic inclusions Type and structure

On an ultrasound machine examining the kidneys, these neoplasms are shown as small linear, dotted or volumetric structures with a high echogenicity index. They can be seen within the renal tissue.

In the practice of medicine, it is noticed that the data hyperechoic inclusions are calcifications, point particles are isolated from them without accompanying an acoustic shadow, called microcalcifications. If there is a microcalcification in the nodular formation, then it is possible to declare the development of a malignant tumor that has begun.

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

• Half of the echogenic formation is made up of psammoma bodies.
• Only 30% is calcified.
• Sclerotic areas - 70%.

If a benign tumor of the kidney is detected during ultrasound, then there are no psammoma bodies at all, calcifications are also rare. Most often, sclerotic areas are noted.

Types of hyperechoic inclusions, their diagnosis

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

1. Point inclusions, which are visible to the naked eye, since they do not have an acoustic shadow and are small.
2. Formations also with no acoustic shadow only big size. They are rarely localized in the kidneys, they are found by ultrasound of the kidneys. They appear in both malignant and benign tumors.
3. Large formations with acoustic shadow. They correspond to the sclerotic parts.

Ultrasound can most accurately detect hyperechoic inclusions in the kidneys. In addition, their presence can be suspected for a number of symptoms. These may be:

• Elevated temperature.
• Change in color of urine.
• Frequent colic in the region of the kidneys.
• Severe pain in the abdomen or below the belt or constant pain in the groin.
• Vomiting and nausea.

These symptoms are universal and similar to the manifestations of many other diseases, therefore, if kidney stones are suspected need to see a doctor immediately y. To avoid the progression of the disease, a complete diagnostic examination should be carried out every six months with the delivery of blood, urine, and feces tests. In this way, the development of diseases can be prevented and some diseases can be avoided.

Prevention of stones in the stomach is frequent consumption of fluids in the form of water, infusion of wild rose, tea with herbs (mountain ash, oregano, mint and others). Thanks to it, the body will be cleansed of toxins and salts, which occurs during each urination.

Treatment of hyperechoic kidney formation

Hyperechoic inclusions, as a rule, appear in the form of:

• Scar tissue.
• Kidney stone disease.
• Inflammatory process, for example, kidney abscess, carbuncle.
• Growths in the form of cysts that contain fluid.
• Hemorrhages in the kidney. Kind of a hematoma.
• Tumors of the kidneys of benign (with lipoma, fibroma, adenoma, hemangioma) or malignant orientation.

If the ultrasound revealed suspicions of these diseases, then the doctor advises the patient a comprehensive examination using MRI. Sometimes, in severe cases, a kidney biopsy may be needed.

Hyperechoic inclusions can be cured, but this will not be an easy treatment. Stones are removed in several ways. The basis of the first method is frequent urination, which is caused by various diuretic herbs or drugs prescribed by a doctor. This method treats small formations up to 5 mm.

Abdominal surgery is indicated for sufficiently large stones. The alternative is removal of stones with a laser, which crushes and then removes. Stones can also be removed using ultrasound.

Tumor pathologies of malignant or benign content are removed surgically. Hyperechoic formations and cysts are removed by partial excision (resection). If the malignant disease is advanced, the tumor is removed along with the kidney, and then treatment with chemotherapy drugs is prescribed. In such a radical case, constant dieting is required.

Remember that only a qualified specialist can make an accurate diagnosis. Treatment is based on renal ultrasound and test results. Self-medication is not worth it, as this often leads to an aggravation of the situation.

During an ultrasound examination of the kidneys (ultrasound), dense solid formations in these organs can be detected - hyperechoic inclusions in the kidneys. Ultra high frequency acoustic waves are not reflected by healthy kidneys. Areas with high acoustic density indicate the presence of seals in the renal tissue, which is a good reason for additional examination of the patient.

Types of hyperechoic inclusions

For the most part, hyperechoic inclusions in the kidneys are represented by non-cellular structures in the form of fibrous-sclerotic areas, frame elements of connective tissue, or calcifications. They do not contain liquid.

There are several types of acoustically determined formations in the kidneys:

1. Kidneys with small hyperechoic inclusions - have pronounced point inclusions of small sizes, without the formation of an acoustic shadow.
2. There are also volumetric hyperechoic inclusions without acoustic shadows in the kidneys - if they are large enough, they are rare in the kidneys, more often such visual changes are found in the thyroid gland.
3. Huge hyperechoic inclusions in the kidneys with echoes may indicate the presence of malignant neoplasms (tumors) in the organs.

What does the presence of renal hyperechoic inclusions indicate?

Volumetric or linear hyperechoic inclusions in the kidneys may indicate the presence of urolithiasis, and areas with increased acoustic density are renal calculi (stones). The absence in this case of the echo of shadows excludes urolithiasis.

Kidneys with small hyperechoic inclusions, if they are dashed, are not considered by doctors as a pathology, since these can also be vessels. In the worst case, these are foci of fibrosis.

To exclude the possibility of developing oncological diseases, doctors must prescribe additional studies:

• blood test for tumor markers;
• biopsy of kidney tissue;
• daily analysis of urine for the presence of mineral salts;
• general blood analysis.

The final diagnosis is established only by the doctor, comparing the results of ultrasound with the clinical manifestations of the disease, additional laboratory tests.

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. Normal kidneys are round, symmetrical and do not reflect ultrasonic waves. If there are deviations, a change in the size and shape of the kidneys, their asymmetric location, as well as various formations that reflect ultrasound can be detected.

Hyperechoic inclusions in the kidneys are new formations or foreign bodies that do not contain liquid, 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 are reflected from them during the study and create the phenomenon of hyperechogenicity.

What is hyperechogenicity and acoustic shadowing

The kidney casts an 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 beyond anything, in our case - beyond the usual echogenicity of kidney tissue. A hyperecho 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 pays attention to whether the detected inclusion casts an acoustic shadow, that is, a bunch of ultrasonic waves that have not passed through it. An 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 of the development of pathology inside the kidney.

Clinical picture: symptoms and signs

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

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

Types of inclusions and possible diseases

What does a hyperechoic formation look like on ultrasound

If in the cavity of the kidney, and more often both, seals of a large volume (0.5-1.5 cm3) are found, casting an acoustic shadow, they indicate stones inside the kidney. Volumetric formation with a fixed shadow may indicate a sclerotic lymph node, which was 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:

• 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 compaction in the renal tissue;
• hemorrhages with the presence of hematomas;
• the development of tumors, the nature of which needs to be clarified.

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

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

Calcifications are calcium salts that precipitate into soft tissues affected by chronic inflammation.

The study may reveal a combination of several varieties of hyperechoic inclusions with or without a shadow.

The composition of malignant tumors in 30% of cases includes calcifications, in 50% of cases - psammoma bodies, in 70% of cases sclerotic areas are fixed.

There is a high probability of seeing hyperechoic inclusions in the kidneys in the presence of urolithiasis, foci of infection, chronic or recurrent inflammatory diseases: glomerulonephritis, hydronephrosis, paranephritis.

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 test is prescribed, which determines the composition of mineral salts in it, as well as a blood test to determine the weak links in the body's metabolism.

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

If oncology is suspected, a blood test for tumor markers and a biopsy of organ tissues are necessary. When the quality of the tumor is in doubt, it is desirable to conduct sonoelastography (a type of ultrasound), which detects cancer in the initial stages, determines the location and size of the tumor, even of a microscopic size. A highly qualified specialist can visually differentiate the quality of the neoplasm.

The discovery of hyperechoic bodies is not a reason for confusion or inaction, it is necessary to immediately examine, establish a diagnosis and begin treatment.

Prevention and treatment

Surgery to remove a kidney tumor

Preventive measures usually include the use of traditional methods of treatment. 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 crushed with a laser or ultrasonic radiation, followed by removal by lithotripsy. Inflammatory kidney disease is treated with antibiotics.

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

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

Hyperechoic inclusions in the kidneys are usually found during ultrasound. This means that ultrasound reveals separate areas in which the structure has changed towards a higher density.

On the screen, they appear as lighter spots. The reasons for this deviation may be different.

The procedure for examining the kidneys with ultrasound is often used. This is a completely harmless method that is not contraindicated even during pregnancy.

This technique helps to determine the degree of integrity of the organ, the possibility of its functioning, to detect various formations and the tumor process.

What could such a picture mean?

The concept of echogenicity includes the ability to reflect ultrasonic waves. All organs and tissues that exist in the human body have this ability to varying degrees.

A term such as hyperechogenicity implies the most powerful reflection, which is characteristic of very dense structures.

The following structures can give a similar picture:

• calcifications;
• fibro-sclerotic changes;
• inclusions of protein-lipid nature.

Hyperechoic inclusions are divided into several main types:

1. Formations that have a three-dimensional appearance and an acoustic shadow. These are quite large changes that give calculi, areas of calcification, lymph nodes prone to sclerosis.
2. The formation is voluminous, but without the presence of an acoustic shadow. Such a picture occurs in the presence of a neoplasm of any nature, small stones, cysts, sclerosis of the kidney vessels.
3. Bright, small inclusions are pronounced, without acoustic shadow detection. Perhaps their appearance in a diffuse form of cancer, or the presence of psammoma bodies.

What diseases should be suspected?

If a specialist describes the presence of hyperechoic inclusions, then the attending physician may suggest the following diseases:

• inflammatory kidney disease (nephritis);
• abscess;
• hematoma;
• cicatricial changes;
• benign and malignant tumors;
• cyst.

The very description of such formations is not a diagnosis, but their detection should be the reason for contacting a doctor to clarify the true nature of this deviation. If necessary, the patient undergoes a standard abdominal operation.

What to do next?

After receiving the results of the ultrasound, the doctor conducts additional diagnostics. This necessarily includes general tests, as well as blood for tumor markers, a study of urine for the presence of salts in it, in some cases a biopsy is performed.

The diagnosis also includes the clinical picture of a particular disease. The patient may complain of back pain, dysuric phenomena, general weakness, attacks of renal colic, fever, often worried about frequent and painful emptying of the bladder, urinary incontinence, nausea and vomiting.

Hyperechoic formation in the kidney is treated in two main areas:

• impact on the cause of this pathology;
• symptomatic therapy.

When confirming urolithiasis, conservative treatment is first applied. It includes taking diuretic herbs and drugs, following a certain diet (depending on the qualitative composition of the stones), normalizing metabolic processes.

In the absence of effect and the presence of large formations, lithotripsy with ultrasound or laser is recommended.

In some cases, KSD will require surgery. The most modern technique is the removal of the stone using endoscopic techniques.

Detection of a malignant tumor process requires immediate surgery. If the cancer is at an inoperable stage, then doctors resort to palliative methods to slow its growth and spread.

For the prevention of diseases and the treatment of the kidneys and urinary system, our readers recommend Cirrofit Drops, which consist of a set of medicinal herbs that enhance each other's actions. Drops can be used to cleanse the kidneys, treat urolithiasis, cystitis and pyelonephritis.
Doctors opinion...

Pain relief is carried out by prescribing analgesics, narcotic and non-narcotic effects.

Sometimes the neoplasm is removed along with the kidney, after which radiation and chemotherapy are applied.

If hyperechoic inclusions are the result of diffuse dystrophic processes in the absence of an acute or chronic disease, then treatment is not required.