Yersinia terminal ileitis: sonographic findings in eight patients

To determine the sonographic features of Yersinia terminal ileitis, we analyzed the sonograms of eight patients with acute terminal ileitis. Bacteriologic or serologic confirmation of Yersinia enterocolitica infection was available in six patients. In the other two, the clinical course and radiologic findings were compatible with the diagnosis. Radiographs and endoscopy showed edematous mucosa with small elevations in the terminal ileum in all the patients. Sonograms showed thickening of the wall of the ileum in all eight patients and enlarged mesenteric lymph nodes in six patients. Although the number of the patients is small, our experience suggests that sonography can be useful for the detection of acute terminal ileitis caused by Yersinia.     

Abdominal sonographic findings in patients with AIDS

The ultrasound findings of 58 patients with AIDS and ARC were analysed retrospectively. In 55% an enlarged liver, in 62% an enlarged spleen, partially with focal lesions, and in 21% enlarged abdominal lymph nodes were diagnosed. The typical focal segmental glomerulosclerosis of the kidney was observed in one case, and cholangitis in 2 patients. Abdominal ultrasound is the first diagnostic procedure to be performed in patients with AIDS and ARC when abdominal pathology is suspected. With US-guided thin needle puncture of the lesions, a histological verification of the pathologic findings is possible.     

Renal diseases in patients with AIDS: sonographic findings.

This essay illustrates the spectrum of sonographic findings of various renal manifestations of AIDS. The most common renal abnormality in patients with AIDS is nephropathy, which is manifested by deterioration of renal function and proteinuria. Acute tubular necrosis, intrarenal infections, focal nephrocalcinosis, hydronephrosis, and neoplasms also may occur.     

Mycobacterium genavense infection in AIDS: imaging findings in eight patients

This retrospective study included eight HIV-positive patients with a M. genavense infection. Seven of these patients had a CT scan of the abdomen and a US examination, whereas one patient with pulmonary symptoms had conventional chest radiographs and thin-section CT scan of the thorax. Multiple large retroperitoneal and mesenteric lymph nodes were demonstrated in seven patients; low-attenuation centers within enlarged nodes were identified in two patients. On CT scans two cases showed circumferential wall thickening of the proximal small bowel with a deep ulceration in one of these patients. Additional findings included focal lesions in the liver (n = 1), spleen (n = 2), splenomegaly (n = 6), and hepatomegaly (n = 4). The CT scans from the thoracic examination demonstrated multiple diffuse nodular infiltrates in both lungs. M. genavense infection should be considered in the differential diagnosis of AIDS patients with CD4 counts below 100 cells/mm³ presenting with abdominal lymphadenopathy, multinodular or homogeneous hepatosplenic enlargement and circumferential thickening of the small bowel wall. Received: 28 March 2000/Revised: 3 July 2000/Accepted: 6 July 2000     

Gallbladder perforation: correlation of cholescintigraphic and sonographic findings with the Niemeier classification

We retrospectively analyzed the cholescintigrams and sonograms of 36 consecutive patients with gallbladder perforation to (a) determine the sensitivity of each for the preoperative detection of gallbladder perforation and (b) correlate the findings with the modified Niemeier classification. Cholescintigraphic criteria of perforation (free spill, pericholecystic hepatic activity, and scintigraphic gallstone ileus sign) were detected in 14 of 28 (50%) cases, while sonographic criteria of perforation (pericholecystic fluid or pneumobilia with gallstones) were present in 18% (4 of 22) of patients (p less than 0.05). Cholescintigraphic patterns of perforation associated with the Niemeier classification were: Type I (acute free perforation), 3 of 7 scans demonstrated free spill; Type II (subacute pericholecystic abscess), 9 of 19 scans showed pericholecystic activity; and Type III (chronic cholecystoenteric fistula), 1 of 3 scans showed a scintigraphic gallstone ileus. Thus, although cholescintigraphy appears superior to sonography, both modalities are relatively insensitive for the detection of gallbladder perforation.     

MRI for evaluating congenital bile duct abnormalities

Congenital bile duct diseases consist of ductal plate development abnormalities and are genetically determined. These biliary abnormalities are encountered mainly in congenital fibrocystic diseases, represented by congenital hepatic fibrosis and different forms of Caroli disease. On the other hand, polycystic hepatic diseases also present cystic abnormalities, which could be confused with biliary dilatations, especially in the perihilar area. Further, intricate forms between Caroli and polycystic hepatic diseases are possible. In congenital bile duct paucity, which is extremely rare, the biliary tree, located on the opposite, is not visible. MRI modalities for the analysis of the biliary tree are mainly represented by T -weighted sequence, also known as MR cholangiography (MRCP), and T gadolinium-enhanced sequences. Familiarity with the most common appearances of congenital bile duct dilations, its variants, and related complex diseases facilitates accurate diagnosis and allows and helps avoid misinterpretation.     

Brain abnormalities in infants on extracorporeal membrane oxygenation: sonographic and CT findings

The findings of cranial sonography performed before and during extracorporeal membrane oxygenation (ECMO) in 50 near-term infants and CT findings after ECMO in 18 of those patients are reported. Hemorrhage is uncommon in patients being considered for ECMO: subependymal hemorrhage was seen in one case and subependymal cyst possibly due to in utero hemorrhage was seen in five cases. Hypoxic ischemic ischemic injury is more common: severe cerebral edema was seen in two cases, occipital hemorrhagic infarct in one case, and mild cerebral edema in 17 cases. During ECMO, sonograms showed that the hemorrhage in patients with small subependymal hemorrhage or cyst before ECMO did not extend while on ECMO. Typical germinal matrix/intraventricular hemorrhage was seen uncommonly (three cases). Unusual parenchymal hemorrhage did occur. Hypoxic ischemic brain injury was more common: parenchymal hemorrhage was seen in three cases, severe cerebral edema in three cases, and infarction in three cases. Hypoxic ischemic brain injury probably occurs before ECMO, with a delay in visualization. CT after ECMO detected additional abnormalities, particularly peripheral areas of hemorrhage and infarction not visible on sonograms, and is now being performed on all patients. More emphasis should be placed on better screening of infants being considered for ECMO treatment to identify irreversible anoxic brain injury, not just hemorrhage.     

Gastrointestinal lymphoma: sonographic findings in 54 patients

Between 1980 and 1990, 580 patients with known malignant lymphoma were referred for sonography for evaluation of abdominal masses as a part of the initial staging of the disease. In 54 patients, sonography showed different degrees of hypoechoic bowel wall thickening; gastrointestinal lymphoma was confirmed by histologic examination in all of these patients (non-Hodgkin lymphoma in 50, Hodgkin disease in four). Nineteen of the 54 patients had primary gastrointestinal lymphoma; the other 35 had widespread tumor with secondary gastrointestinal involvement. The portions of gastrointestinal tract involved included the stomach (38), small intestine (five), colon (seven), and multiple sites (four). Several sonographic patterns were found: 39 patients had circumferential involvement of the bowel wall, four had bulky tumors, and two had nodular extraluminal spread. Eight patients had segmental infiltration, and one had mucosal involvement. The results of this study indicate that sonography is of value for examining patients with gastrointestinal lymphoma and that several patterns of involvement can be detected.     

Omental infarction in pediatric patients: sonographic and CT findings

OBJECTIVE: Children with omental infarction typically present with abdominal pain and are diagnosed clinically as having acute appendicitis. Our purpose was to perform a retrospective review of the imaging findings in nine children with omental infarction as an aid to radiologists in distinguishing this entity from acute appendicitis. CONCLUSION: In pediatric patients with omental infarction, both CT and sonography show a heterogeneous mass characteristically situated between the anterior abdominal wall and the colon. It is important for radiologists to recognize the characteristic imaging findings seen with omental infarction.     

Gallbladder contractility in patients with spinal cord injuries: a sonographic investigation

Approximately 30% of all patients who have spinal cord injuries have gastrointestinal symptoms. One cause is gallstone disease; indeed the literature suggests that gallstones are more common in patients with spinal cord injuries because these patients have impaired contractility of the gallbladder with a reduced ejection fraction. To test this hypothesis, we obtained gallbladder sonograms in 30 patients with spinal cord injuries (16 quadriplegics and 14 paraplegics) and in 32 uninjured age-matched control subjects. Four patients and four asymptomatic control subjects had gallstones and were excluded. The remaining 26 patients and 28 control subjects fasted for 12 hr. Longitudinal and transverse sonograms of the gallbladder were made immediately before the ingestion of 25 g of fat, and at 10, 20, 30, 45, and 60 min thereafter. Gallbladder volumes were measured by using the ellipsoid method. Resting and residual volumes and the emptying times were determined and the ejection fractions were calculated. The ejection fractions were significantly lower (p = .003) in the patients than in the control subjects because the resting volumes were lower than in the control subjects (p = .013). However, the emptying times and residual volumes were the same in the two groups. We conclude that gallbladder contractility is normal in patients with spinal cord injuries and that the lower ejection fraction found in such patients is due to a smaller resting volume.     

Gallbladder and bile duct stones: percutaneous therapy with primary MTBE dissolution and mechanical methods

The authors describe percutaneous treatment of gallbladder or bile duct stones in 18 patients who were poor surgical candidates or in whom conventional therapy failed. Dissolution was performed in most cases with methyl tert-butyl ether (MTBE) because of its potent dissolution properties; other solvents used included monooctanoin or chelating solutions. Gallbladder stones were eliminated in 11 of 13 patients (six of seven with dissolution alone, four of four with dissolution and basket extraction, one with basket removal alone). In five patients with stones in the common bile duct (n = 3), cystic duct remnant (n = 1), and intrahepatic bile ducts (n = 1), stones were eliminated with dissolution alone in two and with dissolution plus basket extraction in one. In two patients percutaneous therapy failed due to complications (vagal hypotension with bile peritonitis and transient respiratory arrest) that occurred during catheter placement. Preliminary results suggest that MTBE is effective for dissolution of many gallbladder stones and some bile duct stones. Noncholesterol solvents and adjuvant mechanical maneuvers are valuable adjuncts to achieve complete stone elimination.     

MR imaging findings of early bile duct cancer

Purpose

To retrospectively evaluate the MR imaging features of early bile duct cancer and to correlate them with the clinicopathologic findings.

Materials and Methods

This retrospective study was approved by our institutional review board, and informed consent was waived. Seventeen patients with surgically proven early bile duct cancer who had undergone preoperative MR cholangiopancreatography with gadolinium‐enhanced MR imaging, were included in this study. Two, experienced radiologists evaluated the MR images in consensus regarding the following findings: tumor number and morphology; signal intensity of the tumor; sharpness of the outer border of the bile duct wall; enhancement pattern of the tumor; and the presence of enlarged peribiliary lymph nodes. Another radiologist measured the SNR of the tumor and bile duct wall on gadolinium‐enhanced MRI during the dynamic phases to evaluate the tumor enhancement degree.

Results

In all patients, MR imaging demonstrated single or multiple intraluminal bile duct masses showing a sharply defined outer margin. The most common enhancement pattern of the biliary lesions showed heterogeneous amorphous enhancement or heterogeneous enhancement with central, dot‐like structures or vascular structures (76.5%, 13/17 patients). The difference of SNR between bile duct and tumor was greatest in the equilibrium phase (P < 0.05).

Conclusion

MRCP combined with dynamic contrast‐enhanced MRI can be useful for detecting early bile duct cancers. Common MR findings of early bile duct cancer include one or more inhomogeneously enhancing intraductal masses with clear outer margins and preservation of the bile duct wall. J. Magn. Reson. Imaging 2008;28:1466–1475. © 2008 Wiley‐Liss, Inc.     

Gallbladder varices: imaging findings in patients with portal hypertension

A retrospective review of the medical and imaging records of 50 patients with portal hypertension examined in the authors' department during a 2-year period identified six patients with gallbladder wall varices. Imaging studies performed in these patients included computed tomography (CT) (four patients), duplex and color Doppler flow (five patients), and magnetic resonance (MR) (four patients). Five of six patients with gallbladder varices had portal vein thrombosis. Anechoic areas within the gallbladder wall detected with ultrasonography could be distinguished from intramural edema by using duplex or color Doppler flow imaging in all five patients in whom it was used. Contrast material enhancement of these varices was detected with CT in three patients, two of whom also had adjacent mesenteric collaterals. Gradient-echo MR imaging (fast imaging in steady precession/fast low-angle shot) showed flow-related enhancement within the gallbladder wall in two patients. The presence of gallbladder wall varices may imply the presence of portal vein thrombosis. Since these varices can be a source of major blood loss, surgeons must be made aware of them when operating on patients with portal hypertension.     

Is age associated with size of adult extrahepatic bile duct: sonographic study.

PURPOSE: To determine if the size of the extrahepatic bile duct increases with age in adults. MATERIALS AND METHODS: A total of 258 consecutive patients 18 years and older, without known biliary or pancreatic disease, who were fasting to undergo routine abdominal sonography were examined. The transverse and anteroposterior dimensions of the extrahepatic bile duct were measured proximally at the porta hepatis, at the middle above the head of the pancreas, and distally at the head of the pancreas. Simple linear regression of the average of these measurements against age tested the hypothesis of a slope of 1.0 mm per decade. RESULTS: The sample included a wide variety of ages: 55 years +/- 16 (mean +/- SD), with a range of 20-92 years, including 151 men and 107 women. One-tenth of the cohort were younger than 35 years old and one-tenth were older than 77 years old. The six measurements were proximal-transverse 3.5 mm +/- 1.0, proximal-anteroposterior 2.9 mm +/- 1.1, middle-transverse 3.9 mm +/- 1.2, middle-anteroposterior 3.4 mm +/- 1.2, distal-transverse 4.1 mm +/- 1.2, distal-anteroposterior 3.5 mm +/- 1.2. Least squares regression slope differed significantly from 0.1 mm per year (95% CI; -0.000703, +0.00110) and in fact contained zero. CONCLUSION: Findings were not able to help confirm an association between age and size of the extrahepatic bile duct in an asymptomatic adult population.     

Portal hypertensive gastropathy: radiographic findings in eight patients

OBJECTIVE: The purpose of our study was to determine the findings of portal hypertensive gastropathy on barium studies in eight patients and whether there are useful radiographic criteria for diagnosing this condition. CONCLUSION: Our experience suggests that portal hypertensive gastropathy may manifest on barium studies as thickened nodular folds in the gastric fundus. Although varices or various forms of gastritis can also produce thickened gastric folds, portal hypertensive gastropathy should be suspected when this finding is detected in patients with known portal hypertension.     

Testicular ischemia: color Doppler sonographic findings in five patients

We studied the findings on color Doppler sonography in five men with testicular ischemia (three with acute testicular torsion and two with testicular infarcts after herniorrhaphies). In all five cases, no intratesticular blood flow was identified on the symptomatic side, while normal blood flow was evident on the opposite side. In the three cases of acute torsion, no gray scale sonographic abnormalities were seen, and in the two cases of postoperative infarction, the abnormalities were nonspecific. These findings suggest that color Doppler sonography can be used to show decreased blood flow in cases of acute testicular ischemia and that it may have a role in evaluating patients with suspected testicular torsion.