Echogenic fluid: a pitfall in the ultrasonographic diagnosis of cystic lesions

Although it is well known that biliary sludge can produce fine diffuse echoes within the gallbladder, it is less commonly appreciated that other cystic structures may contain echogenic fluid and therefore be mistaken sonographically for solid lesions. In this article three cases of splenic cysts and one case each of pyrometrocolpos, hydroureter, and pyonephrosis presented with diffuse fine echoes in the fluid. Three of these cases were misinterpreted as a result of this echogenic appearance. These cases serve to emphasize the need for awareness of the echogenicity of some types of fluid and the value of other signs of cystic lesions besides absence of internal echoes.