Postoperative ileo-ileal intussusception following surgical resection of patent omphalomesenteric duct

A female neonate with patent omphalomesenteric duct was treated by ductal excision. Six days following surgery, she developed vomiting and abdominal distension. On plain radiographs, distended bowel loops with multiple, air-fluid levels consistent with an intestinal obstruction were evident. Sonography demonstrated an ileo-ileal intussusception. At surgery, a 3-cm, ileo-ileal intussusception was noted proximal to the previous Lembert suture site and was manually reduced. Awareness of the possibility of small-bowel intussusception following surgery was critical to ensuring prompt and successful treatment of this infant.     

Sonographic appearance of lipoma of the inferior vena cava.

Lipomas of the major central veins are rare, and their sonographic features have rarely been reported. We report a case in which a lipoma of the inferior vena cava (IVC) was incidentally identified during liver sonography in a 68-year-old man. Sonography of the upper abdomen revealed coarsening of the liver echotexture, with a relatively small liver and atrophy of the right hepatic lobe. A 2-cm hypoechoic hepatic nodule was visualized in segment IV. Sonography also showed a 2.2- x 1.8-cm, highly echogenic, homogeneous nodule in the hepatic segment of the IVC at its junction with the right atrium. The lumen of the IVC was partially occluded. The CT and MRI appearances of the IVC lesion were consistent with a lipoma, which was not treated because there was no clinical evidence of obstruction. Histopathologic analysis following a sonographically guided biopsy of the liver nodule revealed hepatocellular carcinoma, which was treated by percutaneous ethanol injection.     

Sonography of postpartum uterine inversion from acute to chronic stage

We report the sonographic appearance of postpartum uterine inversion progressing from acute partial to chronic stage after an 8-week interval. The delay in diagnosis was partly due to the patient's stable clinical condition except for minor vaginal discharge and bleeding. The diagnosis of chronic inversion on the follow-up sonographic examination prompted clinicians to undertake surgical repair. Our case shows that the prompt use of sonography during labor and in the peripartum should be sufficient to establish the diagnosis of this serious postpartum complication, which can result in shock or even death. Sonography findings can be considered characteristic and fairly accurate in this condition.     

Pseudoaneurysm of the gastroduodenal artery ruptured into the superior mesenteric vein in a patient with chronic pancreatitis

We report the case of a patient with chronic pancreatitis that was complicated by the rare occurrence of a pseudoaneurysm of the gastroduodenal artery that ruptured into the superior mesenteric vein. The patient, a 65-year-old alcoholic man, suddenly experienced hematemesis. Gastroesophagoscopy revealed bleeding from esophageal varices; the hemorrhaging was controlled with sclerotherapy. Sonography identified a 2-cm round anechoic mass at the pancreatic head, and color Doppler imaging revealed turbulent arterial flow within the mass, leading us to the diagnosis of the pseudoaneurysm. CT and angiographic findings generally corresponded with those of sonography and confirmed our diagnosis. The pseudoaneurysm was treated successfully with embolization, and the patient was discharged 10 days after therapy. Follow-up sonography performed 2 months later confirmed the absence of blood flow within the lesion. Color Doppler sonography was very useful for diagnosing the pseudoaneurysm and planning its treatment, and we recommend its routine use in patients with chronic pancreatitis to avoid delays in diagnosing and treating such vascular complications.     

The Fountain Sign

Objective. Acute idiopathic scrotal edema (AISE) is an important differential diagnosis in children presenting with an acute scrotum. Sonography plays an important role in excluding testicular torsion, epididymitis, and torsion of a testicular appendage and confirming the diagnosis of AISE. The purpose of this series was to evaluate the relevance of color Doppler sonography (CDS) in children presenting with AISE. Methods. Ten patients with AISE who underwent CDS during a 25‐month period were retrospectively analyzed with regard to typical sonographic findings distinguishing AISE from other causes of scrotal edema. Results. Marked bilateral scrotal wall thickening and hyperemia resembling a fountain were detected in the transverse plane on CDS in all patients. Conclusions. This report highlights the usefulness of CDS in diagnosing AISE by showing that the “fountain sign” is related to hypervascularity of the scrotal wall. In an acute scrotum, this sign may help differentiate AISE from other etiologies.     

Partial preoperative reduction of inguinal hernia through compression with an ultrasound transducer

Sonography and CT are effective tools in early diagnosis of asymptomatic inguinal hernia. Sonography can be used not only for the diagnosis of hernia but also for its treatment. Real-time sonographically guided hernia reduction may avoid tissue damage that can arise from misguided compression. We report a unique case in which an incarcerated omental hernia in a 50-year-old woman was diagnosed and subsequently reduced via compression with an ultrasound transducer.     

原发性甲状旁腺机能亢进症的影像诊断

目的：评价X线、B超及CT在原发性甲状穷腺机能亢进症诊断中的作用。材料与方法：回顾分析经手术病理证实的15例原发性甲状旁腺机能力进症的X线、B超及CT检查资料。结果：X线检查15例均有明显的骨质改变；颈部B超检查5例中4例结果与手术病理相符；颈部CT扫描3例，结果均与手术病理相符。结论；X线检查是本病影像诊断的基本方法．B超及CT具有进一步明确诊断及术前定位诊断价值。     

Intra-abdominal lymphangioma in a newborn

We report the case of a male newborn infant with an intra-abdominal cavernous lymphangioma that produced acute abdominal symptoms. Sonography showed a cystic mass with thin septations, which caused intestinal obstruction and stenosis of the iliac artery. The histologic findings after surgical resection reflected the sonographic appearance of the mass. The differential diagnosis of cystic abdominal lesions is discussed. Sonography is the preferred method of diagnosis. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:320–322, 1998.     

经阴道彩超对盆腔淤血综合征的诊断价值评估

目的探讨经阴道彩色多普勒超声（transvaginalcolorDopplersonography,TVCDS）在盆腔淤血综合征（pleviccongestionsyndrome）中的应用价值。方法应用TVCDS对73例盆腔淤血综合征（PCS）患者和50例健康妇女作为正常对照组进行盆腔静脉的二维及彩色频谱多普勒检查。结果73例病变组中,均有盆腔静脉曲张、增宽,流速减低。与正常组对照比较,有显著性差异,（P〈0．01）。结论经阴道彩色多普勒超声是诊断盆腔淤血综合征的一种有效方法。     

Value of chest sonography in the diagnosis and management of acute chest disease.

PURPOSE: The aim of this study was to investigate the value of chest sonography in the diagnosis and management of patients with chest radiograph opacities in an emergency department. METHODS: Seventy-eight patients with acute chest complaints whose chest radiographs showed opacities underwent chest sonography. The initial diagnosis (based on clinical manifestations and the chest radiograph), the sonographic diagnosis (before any invasive procedures), and the final diagnosis were compared. The impact of chest sonography on the management of patients with chest opacities was also analyzed. RESULTS: The initial diagnosis was in concordance with the final diagnosis in 60 (77%) of the 78 patients, while the sonographic diagnosis was in concordance with the final diagnosis in 75 (96%) of the patients. Chest sonography therefore significantly increased the rate of correct diagnoses from 77% (95% confidence interval, 67-87%) to 96% (95% confidence interval, 92-100%; p < 0.0001). Sonography provided new information in 52 patients (67%): a different diagnosis from the initial diagnosis in 18 patients and additional diagnostic information in 34 patients. New information gained from sonography affected the management of 35 patients. Sonography also provided help in guiding 42 (70%) of 60 invasive diagnostic procedures and 22 (73%) of 30 invasive therapeutic procedures for which chest radiography and physical examination had failed to or were unsuitable to provide guidance. Overall, sonography assisted in the management of 64 (82%) of 78 patients. Sonography was of no benefit in 14 patients (18%). CONCLUSIONS: We conclude that chest sonography can complement chest radiography and is of value in the diagnosis and management of emergency department patients with acute chest diseases presenting as opacities on chest radiographs.     

Suture granulomas: sonography enables a correct preoperative diagnosis

The purpose of this study was to examine if suture granulomas display distinct sonographic signs and if these signs enable an accurate preoperative diagnosis. In a retrospective and prospective study, the sonographic findings of 22 consecutive suture granulomas were investigated and correlated with subsequent operative results. The sonographic appearance of various surgical sutures in a water bath was also investigated. Sonography was performed with commercially available 5- to 13-MHz linear transducers. The sonographic findings of the suture granulomas included hypoechoic lesions in all cases and hyperechoic double or single lines within the hypoechoic lesions in 20 of 22 cases. Sonography enabled the correct preoperative diagnosis for the investigating radiologists in 20 cases. The sonographic appearance of sutures in a water bath was that of hyperechoic double or single lines. The sonographic signs of suture granulomas (hyperechoic double or single lines within hypoechoic lesions) indicate the correct preoperative diagnosis in a high percentage of cases.     

Sonographic findings of mesenteric panniculitis: correlation with CT and literature review

PURPOSE: To evaluate the sonographic findings of mesenteric panniculitis (MP) and correlate them with CT findings. METHODS: We retrospectively evaluated the clinical, CT, and sonographic findings in 26 cases of MP in our hospital between January 1997 and July 2003. We also reviewed the sonographic features of MP previously described in the literature. RESULTS: The sonographic findings were well correlated to CT in 24 of 26 patients (92%). In these 24 cases, abdominal sonographic examination revealed a hyperechogenic, well-defined fatty mass (corresponding to the pseudocapsule CT sign) in the root of the mesentery, displacing the bowel loops. We found a clear interface between MP and normal intra abdominal fat. Examination with color Doppler sonography revealed the nondeviated mesenteric vessels within the mass. The persence of MP improved sonographic transmission in 9 obese patients and enabled the retroperitoneal vessels to be clearly visualized. Sonography was unable to demonstrate the preservation of the fat nearest the mesenteric vessels corresponding to the "fatty halo" sign on CT. CONCLUSIONS: Sonography is useful in the diagnostic workup for MP. The characteristic sonographic features of MP (well-defined mass, homogeneous hyperechogenicity of the mass, nondeviated vessels within the mass, and displaced bowel loops) correlate well with CT findings.     

Primary ascaridial perforation of the small intestine: sonographic diagnosis

Ascaris lumbricoides is the most common helminth affecting humans. Ascariasis can result in serious complications, including intestinal obstruction and perforation. Early diagnosis and treatment of such complications reduces the risk of mortality. We present a case of sonographically diagnosed ascaridial perforation in a 5-year-old girl. On sonography, each ascarid appeared as 2 pairs of parallel lines, representing the worm's outer margins, flanking a central sonolucent line, representing its digestive tract. Sonography revealed ascarides in the peritoneal cavity and in some loops of the small bowel. Emergent laparotomy was performed to remove ascarides from the peritoneal cavity and terminal ileum, and the patient recovered well and was asymptomatic at a 3-month follow-up. Knowledge of the sonographic features described herein may aid in the evaluation of patients, especially children, in tropical countries who have clinical symptoms of ascariasis.     

Sonography in the diagnosis of rhabdomyolysis.

This case report describes the use of musculoskeletal sonography in the diagnosis of rhabdomyolysis. The case involved an episode of severe muscle lysis following a heroin overdose in an addict who lay comatose for an uncertain period. Sonography revealed multiple hyperechoic areas within the muscles examined, consistent with a recent injury. The clinical diagnosis of rhabdomyolysis may be difficult but is important in view of the attendant danger of acute renal failure, and sonography was instrumental in the diagnosis in this case.     

Sonographic demonstration of a pancreatopleural fistula

Pancreatopleural fistula is an uncommon complication of pancreatitis. The presence of a fistulous tract, although not mandatory for diagnosis of pancreatopleural fistula, has been documented previously with contrast-enhanced radiography and endoscopic retrograde cholangiopancreatography. We report the case of a pancreatopleural fistula with right pleural effusion demonstrated sonographically in a 13-year-old girl with a history of chronic pancreatitis and upper abdominal pain. Sonography also showed a pseudocyst of the pancreas with pleural effusion. The patient was treated conservatively with nutritional support and intercostal drainage of the pleural fluid. Her symptoms resolved and the pleural effusion gradually disappeared. Sonography is useful in confirming the presence of a suggested pancreatopleural fistula and can avoid the need for other, more technically challenging imaging modalities.     

Sonography of the acute abdomen in the pediatric patient.

OBJECTIVE: To review the causes and sonographic appearance of pathologic processes that result in abdominal pain in the pediatric patient and to understand the use and limitations of abdominal sonography in the acute pediatric abdomen. METHODS: A pictorial review of cases is presented. RESULTS: Sonography in conjunction with color and pulsed Doppler imaging is a valuable tool in the evaluation of the acute abdomen in the pediatric patient. This article reviews the use of sonography in the evaluation of the acute abdomen in the pediatric patient. CONCLUSIONS: The causes of the acute abdomen in children vary depending on the ages of the children. Sonography is a noninvasive modality and is useful for assessing these patients.     

Hydatid cyst of the liver presenting as an inferior vena cava obstruction

A 48-year-old woman presented with clinical features suggestive of an obstruction of the inferior vena cava (IVC). Abdominal sonography showed a 15- x 14-cm cystic mass involving the medial segment of the left hepatic lobe and the anterior segment of the right hepatic lobe. We visualized multiple intracystic floating membranes, a detached endocyst, and a daughter cyst within the main cyst. The cyst was compressing and effacing the intrahepatic portion of the IVC and the right atrium. Sonography of the right and left hepatic veins showed blood flow in the normal direction, but spectral analysis showed that the flow was continuous, possibly owing to extrinsic compression of the IVC at the site where the hepatic veins drained into the IVC. The patient responded well to percutaneous treatment of the hydatid cyst. This case represents a rare presentation of a hydatid cyst of the liver.     

Sonographic features of internal hernia.

OBJECTIVE: The purpose of this series is to describe the sonographic findings in 4 patients with intestinal obstruction due to internal hernia. METHODS: Four patients had clinical features of intestinal obstruction. Sonography was performed with broadband convex and linear array transducers in these patients. RESULTS: In all 4 patients, there were features of intestinal obstruction with a zone of transition between dilated and nondilated bowel. There was a cluster of crowded, compressed, and aperistaltic small-bowel loops, as if they were tightly packed within a sac, by the side of this zone in 3 patients. This appearance was due to obstruction of the afferent loop caused by compression. In the last patient, there were 2 loops of dilated bowel within a sac outlined by fluid due to obstruction of the efferent loop. All 4 patients had obstructed internal hernias at laparotomy. CONCLUSIONS: Sonographic features of internal hernia are described.     

多发性大动脉炎的彩色多普勒超声诊断价值

目的研究多发性大动脉炎的彩色多普勒超声诊断价值。方法回顾性分析66例多发性大动脉炎患者周围血管的彩色多普勒超声表现。结果多发性大动脉炎累及多支大血管,以头臂动脉最多。受累血管声像图表现为对称的管壁增厚,管腔狭窄或闭塞,彩色多普勒显示相应血流动力学改变。与血管造影比较,彩色多普勒超声敏感性79.2%。结论彩色多普勒超声可较准确、直观地显示多发性大动脉炎血管受累的性质和范围,是诊断多发性大动脉炎有效方法之一。     

Shrapnel lesion of the Achilles tendon: diagnosis by ultrasonography

A 25-year-old patient, a soldier in a fighting unit with shrapnel lesion of the Achilles tendon is described. Low kilovoltage radiography and xeroradiography only outline the silhouette of the tendon. Sonography of the Achilles tendon demonstrated the lesion. The purpose of this report is to investigate the usefulness of soft tissue real-time ultrasonography for diagnosis of injuries in the Achilles region with emphasis on detection of foreign bodies. Sonography is valuable in the diagnosis of various lesions of the Achilles tendon and is very useful in detecting foreign body lesions.