Urachal remnants in asymptomatic children: gray-scale and color Doppler sonographic findings

PURPOSE: We undertook this study to evaluate the frequency of visualization and the sonographic appearances of urachal remnants (URs) in asymptomatic children. METHODS: One hundred eighty-two children without any urachus-related symptoms underwent sonography of the prevesical region and urinary bladder with high-frequency transducers. RESULTS: A UR was visualized in 180 (99%) of the children. The URs had a mean length +/- standard deviation of 13 +/- 5 mm. Most of the URs were ovoid, and most demonstrated a moderate protrusion into the bladder cavity. The URs with a central echogenic area were larger than those without central echogenicity. In 36 (61%) of the 59 URs that were evaluated with color Doppler sonography, vascular signals were demonstrated within the lesion. The URs with internal vascular signals were significantly larger than those without internal vascular signals. CONCLUSIONS: The gray-scale and color Doppler sonographic characteristics of URs seem to be related to their size and their degree of involution rather than to the age of the child. We think that URs are present in almost all children. URs should be considered normal findings if they are asymptomatic and their length is not significantly greater than 22.5 mm, the 95th percentile in our study.     

Posterior mediastinal arteriovenous malformation with atypical color Doppler sonographic findings

An arteriovenous malformation (AVM) is an anomaly of capillary development that results in a direct connection between branches of an artery and veins, with no intervening capillary network. A definite diagnosis of AVM is usually made with angiography. We report the case of a posterior mediastinal AVM found on routine sonography in a 64-year-old woman with neglected hypertension and severe back pain. Color Doppler imaging showed 2 adjoined vascular structures without a typical mosaic-like flow pattern, and spectral Doppler analysis showed low-resistance flow and arteriovenous shunting in 2 adjoined vascular structures. The diagnosis was subsequently confirmed by angiography. Because disastrous bleeding could result if needle biopsy were performed inadvertently in the case of a suspected mediastinal AVM, we suggest that color Doppler sonography be attempted if there is an adequate acoustic window.     

小儿胃食管反流的护理进展

从胃食管反流发生的相关危险因素、不同年龄段患儿临床表现及护理干预措施方面,综述了小儿胃食管反流的护理研究进展。     

含餐3h食管pH监测诊断胃食管反流病的研究

目的提出含餐3hpH的监测方法,并以常规24hpH检测为标准验证含餐3h监测方法的灵敏度及特异度。方法患者共221例,均行食管测压和pH监测。计算24h食管内pH监测方法pH<4.0的时间百分比,以>4.0作为胃食管反流病的诊断依据。选择患者晚餐开始共计3h的监测数据,计算食管内pH<4.0的时间百分比,同样的标准诊断胃食管反流病。比较两种方法的一致性。结果221例患者经常规24hpH监测诊断胃食管反流病114例,正常107例,含餐3hpH监测方法诊断胃食管反流病115例,正常106例。经Kappa及Mc-nemar检验两种方法具有良好的一致性。结论含餐3h监测法和24hpH监测法具有良好的一致性,可以提高患者依从性,有望用于胃食管反流病特别是非糜烂性反流病的诊断。     

Transabdominal sonography of the normal gastroesophageal junction in children.

PURPOSE: Because sonography identifies abnormalities of the gastroesophageal junction, it is essential to understand the normal sonographic anatomy. The aim of this study was to determine the normal sonographic appearance of the gastroesophageal junction and its variations and to provide measurements of the abdominal esophagus in asymptomatic, healthy children. METHODS: In this prospective study, 124 healthy children (75 boys and 49 girls), aged 2 days-12 years, underwent abdominal sonography. With the patient in a supine position, the transducer was placed under the xiphoid and the ultrasound beam was directed cephalad through the window of the left lobe of the liver. The length of the abdominal esophagus was measured from the point at which it penetrated the diaphragm to the gastroesophageal junction. The thickness was measured on the anterior wall at the midpoint of the abdominal esophagus. RESULTS: The gastroesophageal junction was identified by sonography in all of the children. The mean length of the abdominal portion of the esophagus ranged from 18 mm in the newborns to 34 mm in children older than 6 years. The wall thickness ranged from 2.4 mm to 5.7 mm. CONCLUSIONS: Our results indicate that visualization of the gastroesophageal junction and measurement of the abdominal esophagus are readily achievable with real-time sonography in healthy children.     

Iatrogenic carotid-jugular arteriovenous fistula: color Doppler sonographic findings and treatment with covered stent

We describe the case of a 68-year-old woman who presented with an arteriovenous fistula (AVF) between the common carotid artery and internal jugular vein following several failed attempts of right jugular catheter insertion. Sonographic examination revealed an AVF between both vessels with a high-velocity turbulent flow inside and an arterialized waveform in the jugular vein. Angiography confirmed the sonographic findings, and endovascular treatment was performed with a covered stent.     

Color Doppler sonographic findings in penile fracture

We performed color Doppler sonographic examination on 4 patients, 3 of whom had preliminary diagnoses of penile fracture and 1 of whom had undergone an operation due to penile fracture a year previously. Color Doppler sonography helped evaluate the relationships between the hematoma and the vascular structures and aided in differential diagnosis of the vascular injuries that may accompany tunical rupture (or have similar clinical presentations) and Mondor's disease; thus, this method has a crucial role in choosing the treatment approach. Color Doppler sonography may also assist in the follow-up of patients after surgical or conservative treatment.     

Gray-scale and color Doppler sonographic findings in a case of subacute granulomatous thyroiditis mimicking thyroid carcinoma

Subacute granulomatous thyroiditis is a common disease of unknown cause and is usually self-limiting, with complete resolution of symptoms occurring spontaneously or after steroidal treatment. We report a case of subacute granulomatous thyroiditis in a 62-year-old woman whose clinical presentation was consistent with thyroid carcinoma. Gray-scale and color Doppler sonography revealed marked enlargement of the left lobe of the thyroid and markedly hypoechoic, ill-defined focal areas in both lobes. No flow was noted on color Doppler sonographic examination. Fine-needle aspiration of the thyroid was performed, and histopathologic examination of the specimen confirmed the diagnosis of subacute granulomatous thyroiditis. The patient received prednisolone therapy (20 mg/day) for 2 weeks and recovered well. This case report is the first to describe the gray-scale and color Doppler sonographic appearances of subacute granulomatous thyroiditis. This disease should be included in the differential diagnosis of patients with clinical signs and symptoms of thyroid carcinoma. Histopathologic examination is necessary to confirm the diagnosis.     

Ultrasound diagnosis of gastroesophageal reflux and hiatal hernia in infants and young children

In 30 young children suspected of gastroesophageal reflux (GER), the G-E junction was examined with ultrasonography directly after a feeding while these children were on overnight extended esophageal pH monitoring (EEpHM) (32 simultaneous ultrasound/EEpHM studies). The two tests showed 81% to 84% agreement in the detection of the presence or absence of GER, depending on whether the whole period of EEpHM or only the part of it covering the ultrasound observation period were used as the standard. The discrepancies between the two tests were explained by the much longer monitoring period of EEpHM compared to ultrasonography and the inability of EEpHM to show reflux of neutralized gastric contents directly after milk feedings. The two studies probably measure different aspects of clinically significant reflux and must be correlated with the clinical symptoms. Morphological findings associated with significant reflux were (1) a short intra-abdominal part of the esophagus, (2) a rounded gastroesophageal angle, and (3) a "beak" at the gastroesophageal junction. Barium meal findings confirmed these sonographic signs, indicating a sliding hiatal hernia of the distal esophagus, either fixed or intermittent. Ultrasonography can be recommended as a useful and physiological screening test to demonstrate clinically significant GER and a predisposing hiatal hernia of the esophagus in symptomatic children.     

Pseudoaneurysm of the dorsalis pedis artery: color Doppler sonographic and angiographic findings

Pseudoaneurysm of the dorsalis pedis artery is an uncommon condition that is usually caused by a traumatic injury or an iatrogenic intervention. The patient usually complains of an enlarging painless, pulsatile mass. A tentative diagnosis may be made by palpation of the pulsatile mass and detection of an associated systolic bruit. Color Doppler sonographic and arteriographic examinations can be used to confirm the diagnosis. We report the case of a 17-year-old patient with a posttraumatic pseudoaneurysm of the dorsalis pedis artery. Sonographic examinations revealed pulsatile flow into and out of a cystic structure surrounded by a thick hypoechoic wall and a "to-and-fro" pattern in the neck of the vascular mass; these findings were consistent with the diagnosis of a pseudoaneurysm. Angiography confirmed the diagnosis. The patient was treated with ligation of the artery and resection of the pseudoaneurysm. He recovered well after surgery and remained free of symptoms 3 months postoperatively. We believe that color Doppler sonography should be the procedure of choice for use in diagnosing pseudoaneurysms; arteriography can then be used to evaluate the alternative blood supply before surgery is undertaken.     

Borderline cystic tumors of the ovary: gray-scale and color Doppler sonographic findings

PURPOSE: The aim of the study was to determine the value of gray-scale and color Doppler sonography in distinguishing borderline cystic tumors (BCTs) from benign cysts and malignant tumors of the ovary. METHODS: The gray-scale and color Doppler sonographic features of 383 ovarian lesions in 374 nonpregnant women were retrospectively studied. Sonography was performed transvaginally for all but 7 lesions, which were imaged suprapubically. All of the lesions were surgically resected via laparoscopy or laparotomy. RESULTS: The histopathologic diagnoses were 27 BCTs, 35 ovarian carcinomas, and 321 benign cysts. Sonography diagnosed 24 (89%) of 27 BCTs as malignant lesions. Patients with BCTs, were younger than those with ovarian cancer (p < 0.001). BCTs showed intracystic papillae in 17 cases (63%), diffuse internal echoes in 11 (41%), intracystic septa in 8 (30%), a heterogeneous echo pattern in 7 (26%), and a solid pattern in 4 (15%). BCTs showed blood flow in 24 cases (89%) and lower pulsatility and resistance indices (RI) compared with benign lesions (p < 0.001 for both). Multivariate analysis revealed intracystic papillae as the only independent predictor of BCTs (p < 0.001). CONCLUSIONS: When a cystic mass has papillae, this is the only abnormal finding detected by gray-scale transvaginal sonography, and color Doppler imaging shows low RI values within the mass, a BCT should be suspected.     

Thyroid metastasis from rectal carcinoma coexisting with hashimoto's thyroiditis: Gray-scale and power Doppler sonographic findings

We present the gray-scale and power Doppler sonographic findings in a case of rectal carcinoma metastasis to the thyroid that mimicked a primary thyroid neoplasm and coexisted with Hashimoto's thyroiditis in a 67-year-old man. Gray-scale sonography revealed a hypoechoic mass with ill-defined borders in the left lobe of the thyroid; the mass extended through the isthmus to the right lobe. Sonography also showed multiple enlarged cervical lymph nodes. Power Doppler sonography showed increased flow in the nontumorous thyroid gland and decreased flow in the tumor. This contributed to the differentiation between the tumor and the remainder of the thyroid, which was involved with Hashimoto's thyroiditis. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:361–365, 1998.     

从心身角度认识胃食管反流病

胃食管反流病(GERD)为一组疾病症候群,包括典型症状如反酸和烧心,以及不典型症状如胸痛、嗳气,还有食管外症状如咳嗽、哮喘等。其定义不断进行更新,最新定义为胃内容物反流入食管或口腔、咽喉、肺部引起的症状和并发症。GERD发病机制包括滑动性食管裂孔疝、一过性食管下括约肌松弛、酸囊、食管清除能力下降、胃排空延迟、十二指肠胃食管反流等。焦虑、抑郁等心理因素可导致食管的敏感性增高,而后者可产生GERD相关症状。心理应激对食管敏感性的影响主要通过外周及中枢机制,即外周致敏和中枢致敏,而后者起主要作用。对GERD患者的治疗中应根据每位患者的具体情况采取个体化原则,应重视心理因素。     

Portal hypertension in children and young adults: sonographic and color Doppler findings

Portal hypertension is a relatively uncommon pathologic condition in children and young adults in contrast with older adults. The aim of this study is to evaluate the utility of sonography and color Doppler sonography in the diagnosis of portal hypertension in children and young patients and to evaluate the sonographic pattern of each disease. We reviewed 25 such patients who were younger than 30 years old and obtained the following sonographic findings: (1) liver cirrhosis: (a) multiple intrahepatic venovenous shunts in patients with primary Budd-Chiari syndrome and (b) intrahepatic vascular narrowing and nodular coarse parenchymal texture, with multiple very-high-echo spots along the portal vein in patients with Wilson disease; (2) congenital hepatic fibrosis: marked and developed collaterals, wide periportal echogenic band, and a heterogeneous parenchymal texture comprised of multiple high echoes but without portal thrombus; and (3) extrahepatic portal thrombosis: invisible portal lumen except as an echogenic band. Sonography and color Doppler sonography are very useful in diagnosing these portal hypertensive diseases. However, there are no specific sonographic findings, and the role of sonography is limited to follow-up observation of associated secondary hepatobiliary changes in patients with congenital biliary atresia. Received: 1 May 1995/Accepted: 24 June 1995     

Liver tumors in children and young patients: sonographic and color Doppler findings

BACKGROUND: Liver tumors are a relatively rare pathologic condition in children and young patients. The aim of the present study was to categorize the sonographic (US) and color Doppler results of liver tumors in these patients. METHODS: We retrospectively reviewed the US findings of 23 such cases: malignant tumor (13 cases)-hepatoblastoma (four cases), hepatocellular carcinoma (HCC; four cases), and hepatic metastasis (five cases); benign tumor (10 cases)-hepatocellular adenoma (four cases), focal nodular hyperplasia (two cases), mesenchymal hamartoma (two cases), cystadenoma (one case), and hemangioendothelioma (one case). RESULTS: There was no specific US findings for each tumor type. HCC usually developed on a normal liver and was imaged as multiple nodules. Color Doppler US helped in differentiating multiple metastatic nodules (hypovascular) from multiple HCC nodules (hypervascular). Presence of intratumoral cystic areas was usually suggestive of benign tumors. Follow-up US was useful for detecting small nodules in high-risk groups (congenital biliary atresia, glycogen storage disease). Color Doppler US helped in diagnosing portal thrombus or intratumoral shunt. CONCLUSION: Although there were no highly specific findings, US and color Doppler results contributed, to a certain degree, to the diagnosis of liver tumors in children and young adults by showing intratumoral cystic areas or vascularity.