Sonographic demonstration of the aberrant left hepatic artery

An aberrant left hepatic artery, arising from the left gastric artery, was found running transversely through the lesser omentum into the liver in 10 per cent of a series of 100 consecutive real-time abdominal ultrasound examinations. The characteristic appearance on sagittal scans is of a round vessel in the middle of the normally continuous echogenic line of the groove for the ligamentum venosum anterior to the caudate lobe of the liver; on transverse scans, a vessel is seen in its long axis running from the cardia of the stomach anterior to the lesser sac in the lesser omentum. This typical appearance has not been illustrated previously. Awareness of its significance should avoid mistaken diagnosis of a portosystemic venous collateral or other abnormality.     

Sonographic anatomy of the caudate lobe veins

Because of their small size, the caudate lobe veins (CLV) are not routinely imaged with ultrasonography. We recently examined 4 patients with elevated central venous pressure in whom the CLV were easily identifiable. To our knowledge this is the first report of sonographic visualization of these veins. We suggest that visualization of the CLV may not be as rare as previously presumed, and based on our experience, we will propose a nomenclature system for these veins.     

Disproportionate left hepatic lobe size in the fetus: ultrasonic demonstration

The lateral segment of the left lobe of the liver is a useful window for abdominal sonography. An autopsy series suggested relative enlargement of the left lobe in infants and fetuses. The authors evaluated the relative size of the lateral segment of the fetal left lobe (L) compared with the remainder of the liver (R) in 89 obstetric ultrasonograms; the mean ratio L:R was 1.04. The same ratio was determined for 50 adults undergoing abdominal computed tomography, and the mean L:R was 0.76, which differs significantly from that in the fetus (P < 0.001). Normal values for L:R in fetuses and in adults may be useful in detecting a variety of hepatic diseases and possibly intrauterine growth retardation.     

Sonographic characterization of 271 hepatic hemangiomas with typical appearance on CT imaging

Purpose  

Hepatic hemangioma is the most frequent benign solid tumor that requires differentiation from hepatic malignancy on ultrasonography. Useful ultrasound findings are therefore required for diagnosis.     

Serum immunoreactive beta-glucuronidase determined by an enzyme-linked immunosorbent assay in patients with hepatic diseases.

An enzyme-linked immunosorbent assay (ELISA) was developed for human beta-glucuronidase, using a specific polyclonal antibody raised against the purified enzyme. beta-Glucuronidase from human liver consisted of three subunits with molecular mass of 76, 64 and 18 kDa. The assay offered a specific, sensitive and convenient means of measuring immunoreactive beta-glucuronidase in human sera. beta-Glucuronidase activity determined by the conventional method appeared to be extremely low, indicating that in human sera beta-glucuronidase exists in an enzymatically inactive form. The sensitivity of the assay permitted the detection of 1-100 ng of purified beta-glucuronidase. A mean serum level in normal subjects was 108 +/- 25 ng/ml (mean +/- S.D.). A high level of beta-glucuronidase was found in sera of patients with severe hepatocellular necrosis, including liver cirrhosis (152 +/- 130 ng/ml) and chronic active hepatitis (220 +/- 99 ng/ml), whereas no significant increase of the enzyme protein was observed in chronic persistent hepatitis (102 +/- 42 ng/ml). beta-Glucuronidase was also increased in sera of patients with primary hepatoma (156 +/- 125 ng/ml). The immunoreactive beta-glucuronidase determined in this assay was thought to be a supplementary serological indicator for hepatocellular necrosis.     

Sonographic appearance of extensive hepatic arterial calcification mimicking pneumobilia.

Pneumobilia appears sonographically as intrahepatic linear echogenic regions that often produce distal acoustic shadowing. We present a case in which extensive hepatic arterial calcification mimicked the sonographic appearance of pneumobilia. In the appropriate clinical setting, extensive hepatic arterial calcification should be considered when intrahepatic linear echogenic regions are found sonographically.     

Sonographic diagnosis and follow-up of idiopathic hepatic artery aneurysm, an unusual cause of obstructive jaundice.

Hepatic artery aneurysms are rare. We report an idiopathic hepatic artery aneurysm causing obstructive jaundice in a case in which the common hepatic artery arose from the superior mesenteric artery. The diagnosis of hepatic artery aneurysm was suggested by gray-scale sonography, which showed that the common bile duct and intrahepatic biliary radicles were dilated with no obvious intraluminal abnormality and showed no evidence of a mass in the head of the pancreas. A papillotomy of the papilla duodeni major was performed to relieve the cholestasis. Repeat sonography 2 weeks later showed dilatation of the common bile duct and a cyst-like lesion at the porta hepatis impressing the anterior part of the common bile duct. Doppler sonography confirmed pulsatile flow within the cyst-like lesion. Helical CT showed a well-circumscribed lesion with a density similar to that of the abdominal aorta, and mesenteric angiography showed a 3-cm, smooth aneurysm arising from the common hepatic artery, which originated from the superior mesenteric artery. The aneurysm was successfully treated with transcatheter embolization.     

Sonographic detection of stones in poorly opacified left intrahepatic ducts.

Intrahepatic duct (IHD) stone is a common disease in Taiwan. In some cases, left IHD stones cannot be demonstrated by endoscopic retrograde cholangiography (ERC) or even by percutaneous cholangiography (PTC). This study was designed to evaluate the efficacy of sonography in demonstrating left IHD stones in poorly opacified left IHD by either ERC or PTC. Of 109 patients with hyperechoic nodular lesions in either the dilated left IHD or atrophic left lobe of the liver, with or without acoustic shadows, 49 patients were excluded because they refused further study. Among the remainder (60 patients), 33 patients had good opacification of left IHD in ERC or PTC. Stones were seen in 31 patients, and tumor obstruction in 2 patients. Twenty-seven patients had complete or partial absence of the left IHD in cholangiograms. Stones were found at surgery in 23 patients and by CT scan in 3 patients. Mucin-producing cholangiocarcinoma was found in 1 patient. The positive predictive value of the demonstration of stones in left IHD by ultrasound was 95% (57/60). Only 15% of patients with atrophy of the left hepatic lobe and stones were demonstrated by sonogram in this series. We conclude that the detection of left IHD stones by ultrasound in patients with poor opacification of the left IHD in cholangiograms is reliable procedure.     

Sonographic appearance of an appendiceal diverticulum.

The increasing use of sonography for evaluating acute abdomen has brought greater recognition of appendicular abnormalities. We present an incidental finding of an appendiceal diverticulum during a sonographic examination of a 4-year-old child with acute appendicitis. Abdominal sonography showed an enlarged, swollen appendix with a diameter of 1.1 cm and a small, fingerlike lateral projection approximately 2.0 cm from its tip. The specimen, resected during an appendectomy, was 5.5 cm long and 1.0 cm in diameter and had a 0.3-cm outpouching. Microscopic examination revealed a pseudodiverticulum composed of mucosa and muscularis mucosa.     

Hypertrophied muscular bands in the region of the foramen of Bochdalek as a cause for an accessory fissure within the liver

Within the right lobe of the liver a linear echogenic band with two parallel sonolucencies within it (accessory fissure) was noted on both real time and static scans of 11 patients over a one-year period. Examination of 27 cadavers was performed to ascertain the etiology of this band and demonstrated three with diaphragmatic bands. In two cadavers the band occurred in a location compatible with the echogenic line noted on ultrasound. The embryonic origin of the diaphragmatic band is presumed to be the anterior edge of the foramen of Bochdalek.     

Sonographic texture characterization of salivary gland tumors by fractal analyses

The purpose of this study was to quantify the sonographic images of salivary gland tumors. The study population consisted of 21 pleomorphic adenomas, seven Warthin's tumors and 15 malignant tumors. We selected the region-of-interest within the lesion. We made a contour map and evaluated the complexity of the contour lines using the 2-D box-counting (BC) method. We also evaluated the 2-D distribution of the pixel values by the 3-D BC method and the fractional brownian movement (F BM) model. The fractal dimension by the 2-D BC method of pleomorphic adenoma was significantly larger than that of malignant tumors. The FD by the 3-D BC method of pleomorphic adenoma was significantly larger than both that of Warthin's tumors and that of malignant tumors. The Hurst index obtained by the F BM model of pleomorphic adenoma was significantly lower than that of the malignant tumor.     

副肝静脉分布规律及其血流状态的超声表现

目的：探讨超声检查显示副肝静脉（AHV）的分布规律及其血流状态。方法：随机选健康查体者800例行超声检查，取剑突下纵切、右腋前线纵切、横切和中上腹部横切、肋间斜切，观察AHV的汇入部位、走向、数量、内径及其与下腔静脉（IVC）轴线的夹角及多普勒波形、流速等。结果：800例体检者超声检查490例显示568支AHV，平均（0.80±0.38，0～3）支/例，平均内径（0.35±0.16）cm。检出一支者343例，占70％，检出两支者120例，占24.5％，检出三支者27例，占5.5％。230例显示较粗大的肝右后静脉298支，平均内径（0.40±0.19）cm，多为右或右前走行；尾状叶静脉270支，平均内径（0.26±0.18）cm，均为左走行或左前走行。AHV与IVC夹角多呈直角或近似直角（505/568，89%），平均内径（0.36±0.17）cm；63例与IVC夹角呈锐角（11%），平均内径（0.26±0.12）cm。彩色多普勒显示为与心动周期相符的双向三峰波，平均流速（12±4）cm/s。结论：超声检查可显示健康人生理状态下的部分AHV。临床检测AHV可为肝外科手术策略的制定及Budd-Chiari综合征的分型、治疗提供指导意义。     

Sonographic detection of multiple Staphylococcus aureus hepatic microabscesses mimicking Candida abscesses.

We report the sonographic, CT, and clinical findings in a patient presenting with clinical sepsis and multiple Staphylococcus aureus hepatic microabscesses. Although contrast-enhanced CT has had a higher sensitivity than sonography in detecting hepatic microabscesses in some studies, this examination was negative in our patient. On sonography, numerous small hypoechoic lesions were present. Some target-like lesions had a striking similarity to Candida albicans microabscesses. The hepatic lesions were believed to be pyogenic liver microabscesses, as several blood cultures were positive for S. aureus. Following prolonged intravenous antibiotic therapy, all the hypoechoic hepatic lesions disappeared, along with the clinical and biochemical signs of sepsis.     

右肝发育不全的超声诊断及其临床意义

本文回顾性分析35例右肝发育不全患者的超声影像资料,报道如下. 1 材料与方法 我院1997年9月-2004年3月超声检查发现右肝发育不良患者35例,其中男19例,女16例,年龄23～67岁,平均年龄39.76岁.10例为体检发现,无明显症状、体征;剑下或右上腹不适、隐痛13例;右上腹疼痛、畏寒、发热、黄疸12例;白蛋白降低6例;血小板降低12例.35例中,33例经过造影剂增强CT检查,13例经过DSA检查,诊断与超声检查基本一致.19例经手术证实.