What are hyperechoic organs?

What are hyperechoic organs?

We say that an organ is hyperechoic when it returns a very large amount of ultrasound during ultrasound scans. As a result, it appears white and shiny on the screen.

What are hyperechoic organs?

Most organs are visible on ultrasound. But some shine brighter than others: they are said to be hyperechoic, a few naturally. Others become so or see hyperechoic areas appear in their matrix: this is not normal, but not necessarily serious.

Why are some organs hyperechoic?

Because they are strong, bones are hyperechoic. But, for a soft structure to be able to reflect ultrasound massively, whatever the angle of attack of the ultrasound probe, it must be able to present a smooth surface in all directions of space. A condition that only two organs naturally fulfill: the renal sinus (cavity inside the kidney) and the uterine lining in the second part of the menstrual cycle.

A constitutional change can cause other organs to become hyperechoic. Additional examinations will then be necessary to diagnose the cause.

In addition, when tumors form solid, rounded nodules with regular contours, they can appear hyperechoic in organs that are not. These lesions are most often benign, but ultrasound alone cannot confirm this. This is why, faced with these “shiny” spots, additional examinations are often prescribed to explore their nature: imaging, biopsy, puncture, etc.

The spots observed can also correspond to lithiasis, that is to say to solid stones formed from an accumulation of mineral salts – in the kidneys or salivary glands, for example.

What pathologies can there be behind hyperechogenicity?

The interpretation of hyperechogenity is different according to the organs. For example :

  • for the uterus: if the endometrium, i.e. the uterine lining, is hyperechoic during the second part of the menstrual cycle, this is normal. On the other hand, if it is also before ovulation, a biopsy may be indicated to explain it;
  • for the kidneys: except at the level of their sinuses, the kidneys are not hyperechoic. But kidney stones do. The observation of white dots in a kidney can therefore mark their presence, even if it is more often discovered during an episode of renal colic. Hyperechoic nodules can also correspond to tumors, which is why additional examinations may be indicated to verify that they are benign.
  • If it’s a whole kidney that shines, the patient may suffer from polycystic kidney disease, a genetic disease characterized by the formation of cysts in the kidneys, which can lead to their dysfunction. The diagnosis should be confirmed by computed tomography (CT), magnetic resonance imaging (MRI) and / or genetic testing;

  • for the liver: if this organ has a lighter area than the rest, localized and with well-defined contours, it may be an angioma of the liver, or hemangioma, that is to say a small mass blood vessels. Frequent and not serious, mostly asymptomatic, this vascular tumor is often detected incidentally, during an abdominal ultrasound. It is rare to have to operate. In case of doubt, other imaging examinations, with injection of contrast products, may nevertheless be requested.
  • If the entire liver is hyperechoic, we may be faced with hepatic steatosis, that is to say, an overload of the liver in fat, linked to alcoholism, to the taking of certain drugs or to being overweight. If the pathology seems advanced, with tissue inflammation, a biopsy may be requested to verify that it has not developed into cirrhosis;

  • for the thyroid: approximately 10% of the nodules observed in this gland are hyperechoic. In more than 95% of cases, they are benign. This is why, if they measure less than 20 mm, no puncture will be prescribed to analyze them;
  • for the pancreas: this organ is rarely hyperechoic, except in cases of edema in certain pancreatitis;
  • for the ovaries: if they have hyperechoic areas, they may be malignant lesions, but this cannot be confirmed without additional examinations.

What to do when an organ is abnormally hyperechoic?

Rarely is treatment offered directly, unless doctors are sure they have stones, or other associated abnormalities give them a good indication of the diagnosis. In some cases, for example a small nodule in the thyroid, the risk of malignancy is so low that simple monitoring will be offered.

On the other hand, as soon as there is any doubt, additional examinations are requested. In most cases, the hyperechoic lesions observed are benign, but the possibility that they indicate the presence of a malignant tumor cannot be ruled out. Only another imaging technique (scanner, MRI, etc.) and / or a tissue sample (biopsy, puncture) will allow this to be verified.

Case of hyperechogenicity of the fetus

During ultrasound monitoring of pregnant women, the observation of a hyperechoic intestine on the fetus (1% of cases) may be the sign of a mucous plug. Genetic tests are then conducted on the parents to verify that they are not carriers of the CFTR gene for cystic fibrosis. Hyperechogenicity could also be linked to infection.

The observation of a hyperechoic colon may be indicative of a rare genetic disease called cystinuria, linked to a failure in the reabsorption of cystine by the kidneys. Generally, this pathology is discovered in adulthood, during renal colic, but the diagnosis is more and more often made before birth: cystine, abnormally excreted by the fetal kidneys in the amniotic fluid, is reabsorbed by mouth and eventually build up in the colon.

A rare abnormality of renal development can also be diagnosed before birth, if this organ appears hyperechoic.

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