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Laminaria, shortly after being placed in the cervix, appear as strongly, echogenic structures with acoustic shadowing. We have observed, however, that laminaria develop a different appearance when left in place for extended periods of time; they enlarge and become hypoechoic. We have developed a model that demonstrates the evolving ultrasonic characteristics of laminaria.Lamina ria digitata has been used for centuries to dilate the cervix prior to abortion.1 This method of abortion induction fell into disuse approximately 50 years ago due to problems with infection.2 However, with improvements in sterilization techniques, its use has been revived.Before a laminaria is inserted, a string is attached in order to facilitate withdrawal. When initially placed in the cervix, laminaria are dehydrated. However, due to their hygroscopic nature, they absorb fluid from sur· rounding tissue and subsequently expand.Ultrasound has been used to assist in placement and localization of displaced Jaminaria. 3 A To date, the literature has described Jaminaria only in the dehydrated state.In the following study, we report a case in which we noted a different appearance of Jaminaria than has previously been described. We have developed an in vitro model in order to clarify this observation and to under~ stand the transition in appearance from the unexpanded to the completely expanded state. Received February 26, 1987, MATERIALS AND METHODSReal-time ultrasound of the patient was performed with a 5-MHz sector scanner (Acuson, Mountain View, CA). A 5-MHz linear array scanner was used to scan the laminaria which were placed in a water bath. A saturated sponge was placed behind them in order to produce echoes, so that acoustic shadowing could be assessed. Of the three Jaminaria used, one was soaked for 24 h, another for 48 h, and one was not soaked at all. They were then scanned simultaneously in a single water bath. This allowed for comparison of the three laminaria under uniform conditions in dehydrated, partially hydrated, and saturated states. CASE REPORTA 24-year-old, gravida 1, para 0, underwent placement of laminaria for therapeutic abortion at an outside institution. Removal of the laminaria was attempted 1 day later, but one of them could not be removed because its string became detached. The patient was referred to the Brigham and Women's Hospital for assessment and management of this complication.As the cervical canal appeared traumatized, exploration of the canal was delayed for 1 week. Eight days after the initial placement, additional laminaria were placed in the cervical canal. Real-time ultrasound was performed at this time.The sonogram revealed the presence of a double uterus with a pregnancy in the left hom. The previously placed Jaminaria was noted in the nongravid hom, while the more recently placed Jaminaria were in the cervix (Fig. 1). The laminaria within the uterus produced low level echoes, even lower than those of the surrounding myometrium (Fig. 2).

Ultrasound has been shown to be an excellent modality in the evaluation of the jaundiced patient, proving extremely valuable in differentiating surgical (obstructive) from medical jaundice based on the presence or absence of ductal dilatation.1 The sonographic finding of intrahepatic dilatation has been termed the “double barrel,”2 “shotgun,”3, or “parallel channel”4 sign. This refers to visualization of dilated intrahepatic bile ducts with the normally visualized portal venous radicles. Subsequent to its initial description, this sign has also been observed in patients with increased hepatic arterial flow.5,6 In these patients, one of the components of the parallel channel sign represents the prominent intrahepatic artery. In the following case report, we demonstrate the use of pulsed Doppler to help make this distinction.

The sonographic appearance of epidermal inclusion cysts varies in accordance with the contents of the cyst, ranging from an anechoic lesion to a hyperechoic solid appearing mass. Supernumerary testes are an uncommon congenital abnormality, in which more than two testes are present. We present a rare case of a ruptured scrotal extratesticular epidermal inclusion cyst, which had the sonographic appearance of a supernumerary testicle with torsion.