J Clin Ultrasound

Duplex Doppler findings in splenic arteriovenous fistula.

Piscaglia F. Valgimigli M. Serra C. Donati G. Gramantieri L. Bolondi L.
Department of Internal Medicine and Gastroenterology, Universita di Bologna, Italy.
Splenic arteriovenous fistula (AVF) is a rare cause of portal hypertension. An early diagnosis is crucial because lethal complications may occur if the disease is not treated. We report a case of AVF in a noncirrhotic patient in whom the diagnosis was made by duplex sonography. This technique can differentiate between AVF and other, more common vascular abnormalities in the left upper quadrant in patients with portal hypertension. Duplex sonography can therefore be recommended as the first imaging approach in this population.

Congenital short-bowel syndrome: prenatal sonographic findings of a fatal anomaly.

Aviram R. Erez I. Dolfin TZ. Katz S. Beyth Y. Tepper R.
Department of Obstetrics and Gynecology, Sapir Medical Center, Kfar Saba, Israel.
The sonographic findings in a fatal case of congenital short-bowel syndrome are reported. Sonography at 11 weeks of gestation showed a 11 x 6 mm hyperechoic mass interpreted to be a midgut umbilical hernia. A repeat scan 2 weeks later showed an intact anterior abdominal wall, no umbilical herniation, and appropriate fetal growth. Forty-eight hours after full-term, vaginal delivery, the infant began vomiting bile and passing blood rectally. Imaging studies showed distended bowel loops without air-fluid levels and incomplete bowel obstruction. Laparotomy showed malrotation and short small bowel without volvulus. The infant died at 9 weeks of age. When delayed return of the midgut to the abdominal cavity is noted on prenatal sonograms, follow-up sonograms should be done throughout the second trimester, especially in patients with a family history of short-bowel syndrome, to search for dilated short bowel loops. If such loops are found, patients should be given options for pregnancy termination.

Superior mesenteric artery blood flow in patients with small bowel diseases: evaluation with duplex Doppler sonography.

Erden A. Cumhur T. Olcer T.
Department of Radiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
PURPOSE: This study was conducted to determine how the hemodynamic parameters of the superior mesenteric artery are affected in small bowel diseases. METHODS: One hundred thirty-seven patients whose clinical symptoms suggested an intestinal abnormality were evaluated with duplex Doppler sonography. The control group comprised 42 subjects recruited from the medical staff or from patients referred for renal sonography. RESULTS: In 38 patients with diverse small bowel diseases, mean blood flow volume to the superior mesenteric artery territory (1.115+/-0.470 l/min) was significantly greater (p < 0.01) and the mean resistance index (0.82+/-0.06) was significantly lower (p < 0.05) than the mean values in the control group (0.692+/-0.250 l/min and 0.85+/-0.04, respectively). The mean peak systolic velocity and end-diastolic velocity in bowel disease patients were higher than the mean values in the control group. CONCLUSIONS: Various intestinal abnormalities share common Doppler findings, eg, increase in blood flow volume, increase in both peak systolic and end-diastolic velocities, and decrease in resistance index. However, the absence of these findings does not exclude the possibility of small intestinal disease because of the overlap of the measurements in diseased and healthy subjects.

Spontaneous enterourachocutaneous fistula in Crohns disease: sonographic diagnosis.

Artigas JM. Blasco A. Mota J. Macho J. Gracia AI.
Department of Diagnostic Radiology, Hospital Miguel Servet, Zaragoza, Spain.
Spontaneous abdominal wall fistulas are rare in Crohn's disease. We report a case of enterourachocutaneous fistula in a woman with Crohn's disease and present the sonographic, computed tomographic, and sinographic findings.

Sonographic diagnosis of small intestinal anisakiasis.

Year 1998
Ido K. Yuasa H. Ide M. Kimura K. Toshimitsu K. Suzuki T.
Department of Surgery, Nagoya Tokushukai General Hospital, Aichi Prefecture, Japan.
PURPOSE: We studied the utility of sonography in the early diagnosis of anisakiasis of the small intestine. METHODS: The imaging findings and clinical data of 12 patients with proven small intestinal anisakiasis were retrospectively reviewed. RESULTS: Dominant sonographic findings were ascites, small bowel dilatation, and focal edema of Kerckring's folds. CONCLUSIONS: Patients who have acute abdomen after recent ingestion of seafood and in whom ascites, small bowel dilatation, and focal edema of Kerckring's folds are seen by sonography should be suspected of having small intestinal anisakiasis and should be treated conservatively without laparotomy.

Doppler study of fasting and postprandial resistance indices in the superior mesenteric artery in healthy subjects and patients with cirrhosis.

Year 1998
Taourel P. Perney P. Dauzat M. Gallix B. Pradel J. Blanc F. Pourcelot L. Bruel JM.
Service d'Imagerie Medicale, Hopital Saint-Eloi, Montpellier, France.
PURPOSE: We assessed the resistance index (RI) in the superior mesenteric artery under fasting and postprandial conditions in healthy subjects and in patients with cirrhosis to determine whether the amount of change in the RI reflects the presence or severity of liver dysfunction. METHODS: Fifteen subjects with normal livers and 27 patients with cirrhosis underwent Doppler sonography of the superior mesenteric artery before and after ingesting a standard meal. The RI at baseline (fasting state) and the postprandial RI were compared between the 2 groups. The fasting RIs and post postprandial RIs changes in cirrhotic patients were correlated with the severity of disease. RESULTS: No difference was found between the baseline RIs in healthy (RI = 0.85) and cirrhotic subjects (RI = 0.84), nor was there a difference in baseline RIs between subgroups of cirrhotic patients according to the severity of liver disease. The RI decreased significantly (p < 0.05) after the meal in both the healthy (13%) and cirrhotic (8%) subjects, but the postprandial decrease was significantly less pronounced (p < 0.05) in cirrhotic patients than in healthy subjects. Among cirrhotic patients, there was no correlation between the postprandial decrease of the RI and severity of liver disease. CONCLUSIONS: The marked decrease in the postprandial RI in the SMA in healthy subjects is generally not seen in patients with cirrhosis, and changes in the postprandial RI do not reliably predict the severity of liver dysfunction.

Hemodynamic changes in hepatic artery after glucose ingestion in healthy subjects and patients with cirrhosis.

Year 1998
Numata K. Tanaka K. Kiba T. Mitsui K. Saito S. Sekihara H.
Third Department of Internal Medicine, Yokohama City University School of Medicine, Japan.
PURPOSE: The purpose of this study was to investigate hemodynamic changes in the hepatic artery after glucose ingestion. METHODS: We used color Doppler sonography to measure hemodynamic changes in the right hepatic artery and the right portal vein in response to glucose ingestion (225 ml, 300 kcal) in 25 healthy subjects and 25 patients with cirrhosis. RESULTS: In healthy subjects, the peak systolic and end-diastolic velocities in the right hepatic artery decreased (33 +/- 3% and 53 +/- 3%) from baseline velocities measured in the fasting state. The resistance index of the right hepatic artery and the velocity in the right portal vein in these subjects significantly (p < 0.01) increased (14 +/- 2% and 32 +/- 2%) from baseline values after glucose ingestion. Glucose ingestion produced significantly (p < 0.01) smaller changes in cirrhotic patients. The maximum decrease in the peak systolic and end-diastolic velocities in the right hepatic artery were 13 +/- 2% and 25 +/- 3% from baseline velocities, and the maximum increases in the resistance index of the right hepatic artery and the velocity in the right portal vein were 6 +/- 1% and 10 +/- 3% from baseline values. CONCLUSIONS: The decrease in blood flow velocity in the right hepatic artery after glucose ingestion is presumably a homeostatic mechanism to maintain constant hepatic perfusion. This reciprocal response was reduced in cirrhotic patients.

Sonographic features of mucinous biliary papillomatosis: case report and review of imaging findings.

Year 1998
Khan AN. Wilson I. Sherlock DJ. DeKretser D. Chisholm RA.
Department of Diagnostic Imaging, North Manchester General Hospital, United Kingdom.
Because of its indolent course, high recurrence rate, and risk of malignant transformation, mucinous biliary papillomatosis is an important consideration in the differential diagnosis of bile duct obstruction. We report a case of mucinous biliary papillomatosis and review the sonographic and other imaging findings previously reported in the literature. On sonography, these tumors appear as nonshadowing intrabiliary masses that are clearly defined and associated with proximal biliary dilatation. They may be multiple and associated with mucoid sludge. The imaging findings reflect the macroscopic appearance of a doughy papilliferous tumor of a bile duct. Associated findings include cholelithiasis, choledocholithiasis, and gallbladder dysplasia.

Epigastric pain and sonographic assessment of the pancreas in dengue hemorrhagic fever.

Year 1998
Setiawan MW. Samsi TK. Wulur H. Sugianto D. Pool TN.
Department of Pediatrics, Sumber Waras Hospital, Faculty of Medicine, Jakarta, Indonesia.
PURPOSE: This study reports the sonographic features of the pancreas in children who have dengue hemorrhagic fever (DHF) with epigastric pain, evaluates pancreatic abnormalities as the source of this pain, and relates sonographic findings, DHF status, and serum levels of amylase and lipase. METHODS: Over 3.5 years, real-time sonographic examination of the pancreas was prospectively performed in 148 children (age range, 5 months-14 years) who had DHF with epigastric pain. The DHF diagnosis was confirmed by serologic examination and viral isolation. RESULTS: Of the 142 children included in this study, 72 had mild DHF (grade I or II) and 70 had severe DHF (grade III or IV). An enlarged pancreas was found in 41 patients (29%), 10 (14%) of whom had mild DHF and 31 (44%) of whom had severe DHF. The pancreas was hyperechoic relative to the liver in 36 patients (25%), isoechoic in 98 (69%), and hypoechoic in 8 (6%). CONCLUSIONS: The majority of patients with DHF and epigastric pain do not have an enlarged pancreas, different echogenicity of the pancreas compared with the liver, or a dilated pancreatic duct. Thus, pathologic changes of the pancreas cannot be the only cause of epigastric pain in DHF patients. Increased serum levels of amylase and lipase are commonly seen in patients with severe DHF and an enlarged pancreas.

Urethral complications of urinary catheterization presenting as primary scrotal masses: sonographic diagnosis.

Year 1998
Parvey HR. Patel BK.
Department of Radiology, Veterans Administration Medical Center, St. Louis, Missouri 63106, USA.
We report on 2 debilitated male patients who had penile urethral complications of transurethral catheter drainage. One patient had a urethral diverticulum, and the other had a Foley catheter misplaced through a urethral perforation. Both lesions mimicked primary intrascrotal masses on physical examination and were therefore evaluated by scrotal sonography. The correct diagnosis of each lesion required careful examination of the mass and its anatomic relationship to the adjacent urethra. Penile urethral complications of catheterization in debilitated patients must be included in the differential diagnosis of scrotal cystic masses. These cases also emphasize the necessity of a thorough sonographic examination that extends beyond the specific area of presumed clinical interest.

Carcinoma arising from ectopic pancreas in the stomach: endosonographic detection of malignant change.

Year 1998
Ura H. Denno R. Hirata K. Saeki A. Hirata K. Natori H.
First Department of Surgery, Sapporo Medical University School of Medicine, Japan.
We present a case of a submucosal tumor in the stomach that was suspicious for malignancy on preoperative endosonography. The resected tumor was histologically diagnosed as a ductal adenocarcinoma that originated in ectopic pancreatic tissue in the gastric wall. Although malignant transformation in ectopic pancreas is extremely rare, it remains an important consideration in the differential diagnosis of gastric submucosal masses.

Preoperative sonographic diagnosis of sealed-off perforated gastric ulcer.

Year 1998
Tsai KC. Wang HP. Huang GT. Wang SM.
Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei.
Perforated peptic ulcer (PPU) is a common surgical emergency. Early diagnosis and intervention are necessary to reduce the morbidity and mortality. Radiographic or sonographic detection of free air is neither sensitive nor specific for PPU. We report a case of sealed-off PPU with direct sonographic demonstration of the perforation tract within the anterior wall of the gastric antrum. The diagnosis was confirmed at laparotomy.

Effervescent gallbladder: sonographic findings in emphysematous cholecystitis.

Year 1998
Wu CS. Yao WJ. Hsiao CH.
Department of Radiology, Military General Hospital, Kaoshiung, Taiwan.
We report a case of emphysematous cholecystitis with the sonographic appearance of an "effervescent gallbladder"--a large amount of gas bubbles rising like bubbles in a glass of champagne from the dependent part of the gallbladder and floating to the nondependent part. The etiology of this finding was acute obstruction of the distal common bile duct by a stone and purulent cholangitis. Short-term follow-up sonography is important to confirm the diagnosis of cholecystitis.

Value of contrast-enhanced color Doppler sonography in diagnosing hepatocellular carcinoma with special attention to the color-filled pattern.

Year 1998
Tanaka S. Kitamra T. Fujita M. Yoshioka F.
The Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
PURPOSE: The purpose of this study is to evaluate the effectiveness of contrast-enhanced color Doppler sonography in the diagnosis of hepatocellular carcinoma (HCC), with special attention to the value of a "color-filled pattern." METHODS: Contrast enhancement with Levovist was performed on 30 liver tumors, including 21 HCCs, as part of phase II and III clinical trials. Detection of a "feeding artery" or a "color-filled pattern" with color Doppler sonography was interpreted as a positive finding for HCC. Angiography was also performed. RESULTS: A feeding artery was detected in 9 HCCs before contrast enhancement and 20 HCCs after. A color-filled pattern was seen in 14 HCCs after enhancement. A feeding artery was seen in only 1 non-HCC tumor, and a color-filled pattern was not seen in any non-HCC. The sensitivity and specificity of a feeding artery for the diagnosis of HCC were 95% and 89%, values similar to those of hepatic angiography. The sensitivity and specificity of a color-filled pattern were 67% and 100%, respectively. CONCLUSIONS: Contrast enhancement increases the detectability of a feeding artery and improves the sensitivity of color Doppler sonography for diagnosing HCC. A color-filled pattern is a highly specific finding in the diagnosis of HCC.