Hyper-Hypo-and-anechoicity: a guide!

I'm back in the blog game. Here is a nice piece from our ultrasonographers about ultrasound findings. Simple and straightforward. This is helpful for both practicing physicians and trainees. A refresher of sorts after the jump

Ultrasound terms:

• Hyperechoic – more echogenic (brighter) than normal
• Hypoechoic – less echogenic (darker) than normal
• Isoechoic – the same echogenicity as another tissue

Anechoic

Structures and areas which have no internal reflectors or from which no echoes are returned are said to be anechoic and they produce the black areas of the image.

Example: Bladder

Echogenic

In most contexts, interchangeable with hyperechoic (q.v.) which is the more correct term.

Example: dermoid calcifications

Hyperechoic

Structures are said to be hyperechoic when strong echoes are reflected from their internal contents.  In some contexts, hyperechoic may to refer to areas which produce stronger reflections than might be expected for that type of tissue. They produce the more white or bright parts of an image.

Hypoechoic

Structures are said to be hypoechoic when only low-level echoes are reflected from their internal contents, producing the darker grey areas of the image. In some contexts, hypoechoic may refer to areas which produce weaker reflections than might be expected for that type of tissue.  Areas in shadow  (q.v.) could be described as hypoechoic. 

  

On ultrasound, endometriomas can be variable but the great majority (about 95%) of patients present with a classic homogeneous, hypoechoic cyst with diffuse low level echoes.
Rarely is it anechoic, mimicking a functional ovarian cyst.
Endometriomas can be multilocular and have thin or even thick septations.

Example of an endometrioma that contains hyperechoic and hypoechoic areas: 

This mass would be described as a complex mass; most likely an endometrioma.