The value of simethicone in abdominal preparation.

The effectiveness of simethicone in reducing the amount of gastrointestinal gas was investigated with abdominal radiographs in a double-blind study of 169 patients receiving either simethicone or a placebo randomly. There was no statistically significant difference between the two groups. Although simethicone may relieve clinical symptoms and accelerate the transit time of gas, it does not reduce the amount of gas in the gastrointestinal tract. This study indicates that simethicone is not helpful in preparing the patient for radiological examination of the abdomen.     

Contrast-enhanced sonography for diagnosis of ruptured abdominal aortic aneurysm

OBJECTIVE: We describe the contrast-specific sonography features of ruptured abdominal aortic aneurysm, and we hypothesize that this technique would be useful for emergency imaging of patients with suspected aneurysm rupture. CONCLUSION: We used contrast-specific sonography to assess eight patients with ruptured abdominal aortic aneurysm. Five of these cases were correlated with CT findings. We found that contrast-enhanced sonography can reveal features specific for ruptured aortic aneurysm without causing a significant delay in surgery. This technique may be as effective as CT but may allow a more rapid and noninvasive diagnosis, especially when sonography can be performed bedside.     

Value of abdominal pulsed duplex sonography

Pulsed duplex sonography is a routine method for evaluation of superficial vessels. Especially in the assessment of the extracranial vessels of the head and neck region duplex sonography proved to be the method of choice. Modern technology allows the investigation of deep vessels by pulsed Doppler sonography. This study tries to define the value of the combination of real time sonography and pulsed deep doppler sonography in the abdomen on the basis of the author's experiences. Value and limitations of this method will be discussed.     

Renal transplantation: Use of sonography

The use of sonography in renal transplantation will be reviewed.     

Comparison of conventional sonography, real-time compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography of abdominal and pelvic lesions

OBJECTIVE: The purpose of this study was to compare conventional sonography, real-time spatial compound sonography, tissue harmonic sonography, and tissue harmonic sonography merged with compound sonography for overall image quality, lesion conspicuity, and elimination of artifacts. SUBJECTS AND METHODS. In this study, 150 lesions in 122 randomly selected patients with various abdominal and pelvic lesions were evaluated. For each lesion, sonograms were obtained with four techniques: conventional sonography, real-time spatial compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography. All images were reviewed and graded independently by two observers for overall image quality, lesion conspicuity, and elimination of artifacts. RESULTS: Statistical analysis showed that for overall image quality, lesion conspicuity, and elimination of artifacts, tissue harmonic compound sonography was significantly superior to all of the other techniques; real-time spatial compound sonography was better than tissue harmonic sonography; and conventional sonography was the least valuable of all (p < 0.001). When data were analyzed separately according to lesion types, tissue harmonic compound sonography was significantly superior for revealing stone diseases, liver cysts, gallbladder polyps, and uterine myomas. For the remainder of lesion groups, spatial compounding was superior to tissue harmonic sonography for all aspects of evaluation, and conventional sonography was the least valuable (p < 0.05). CONCLUSION: In abdominal and pelvic scanning, tissue harmonic compound sonography provides the best overall image quality, best lesion conspicuity, and least artifacts of all the evaluated imaging modes. Spatial compound sonography is better than tissue harmonic sonography for the evaluation of lesions in general, despite some differences among lesion groups.     

Musculoskeletal sonography of the postoperative orthopedic patient

Musculoskeletal sonography has an important role in the evaluation of the postoperative orthopedic patient. One major advantage of sonography over magnetic resonance imaging and computed tomography is that artifact from metal, which is common after orthopedic surgery, is relatively limited. This allows a clear assessment of the soft tissues for abnormalities such as tendon tear, tenosynovitis, joint effusion, and soft tissue infection. Sonography also has a role in evaluation of recurrent soft tissue tumor, bone healing, and limb amputation. This article first discusses the basic technical aspects of musculoskeletal sonography and is followed by sonographic examples of normal anatomy. Common applications of musculoskeletal sonography in evaluation of the postoperative orthopedic patient are reviewed, including sonography after tendon surgery, assessment of soft tissues adjacent to orthopedic hardware, recurrent musculoskeletal soft tissue tumors, sonography of bone healing, and evaluation of limb amputation. Guidelines and pitfalls of these applications are reviewed.     

B-Mode sonography as a screening procedure for asymptomatic carotid bruits.

Sixty-five B-mode carotid sonograms were obtained at random on patients undergoing cerebral arteriography. A 5 mHz transducer was used. The results were correlated with magnified cervical carotid arteriograms obtained on these patients. B-mode sonography was accurate in evaluating the carotid arteries for surgical stenosis in 72 per cent of the cases. The feasibility of using B-mode sonography as a screening test in patients with asymptomatic carotid bruits is discussed.     

Use of a curved multi-hole catheter for abdominal and femoral arteriography

A single-curve 6.5 French polyethylene catheter with an endhole and multiple sideholes is routinely used by the authors for abdominal aortography and femoral arteriography. It allows excellent simultaneous visualization of both renal arteries and intrarenal vasculature. When withdrawn to the aorto-iliac bifurcation, it allows virtually selective bilateral femoral artery visualization in the evaluation of peripheral vascular disease.     

Role of abdominal sonography in excluding abdominal malignancy in the initial workup of patients with abdominal complaints.

OBJECTIVE: The objective of this study was to evaluate the diagnostic performance and role of abdominal sonography in excluding abdominal malignancy in the initial workup of patients with abdominal complaints. MATERIALS AND METHODS: The sonographic report and follow-up data of 494 patients who had undergone a primary sonographic examination were retrospectively reviewed. Sensitivity and specificity of sonography for the diagnosis of an abdominal malignancy-that is, a primary tumor or metastasis-were determined. Multivariate logistic regression analysis was performed to determine the incremental value of sonography, and a prediction rule was derived. RESULTS: An abnormality on sonography--that is, a mass, ascites, pleural effusion, hydronephrosis, or focal intraparenchymal heterogeneity suggestive of a mass--had a sensitivity for abdominal malignancy of 86% and a specificity of 94%. In the multivariate analysis, the sonographic findings were found to have significant incremental value (odds ratio = 74) after adjustment for the clinical determinants. In patients younger than 38 years with no previous malignancy, no palpable mass, normal liver function test results, and negative findings on sonographic examination, the risk of an abdominal malignancy was less than 1 in 500. CONCLUSION: Our results suggest that sonography may be useful in excluding an abdominal malignancy when used in a primary care setting in patients with abdominal complaints who are at low risk for a malignancy.     

Visceral injury without hemoperitoneum: A limitation of screening abdominal sonography for trauma

Abdominal sonography for the detection of hemoperitoneum has become increasingly popular as a screening test for visceral injury after blunt trauma. The purpose of this study was to determine the frequency, severity, and clinical significance (outcome) of abdominal organ injuries that occur without hemoperitoneum on the initial evaluation of blunt abdominal trauma patients.During a 12-month period, 3392 blunt trauma patients were admitted to our center. Sonographic studies were performed as an initial screening evaluation to determine the presence of hemoperitoneum in 772 (22.7%) of these patients. Abdominal visceral injuries were verified by computed tomography (CT) or surgery in 196 (5.8%) of all blunt trauma admissions. Sonography, CT, and operative findings were reviewed to determine the presence or absence of hemoperitoneum in patients with abdominal injury. Patients with abdominal visceral injury without hemoperitoneum were further analyzed to identify the type of injury and the management required.A total of 246 abdominal injuries were identified in 196 patients. Fifty (26%) patients with abdominal visceral injuries diagnosed by admission CT scan had no evidence of hemoperitoneum. Admission sonography performed in 15 (30%) of these 50 patients also showed no evidence of hemoperitoneum. Visceral injuries detected by CT in the patients without hemoperitoneum included 22 of 100 splenic injuries (22%), 18 of 91 hepatic injuries (20%), 12 of 26 renal injuries (46%), and 1 of 9 mesenteric injuries (11%). Surgery was required to manage injuries in 10 of these patients.Up to 26% of blunt trauma patients with abdominal visceral injuries do not have associated hemoperitoneum identified on admission abdominal CT or sonography. Dependence on hemoperitoneum as the sole criterion of abdominal visceral injury after blunt trauma will result in falsely negative examinations and will miss potentially significant injuries.     

Abdominal sonography in examination of children with blunt abdominal trauma

OBJECTIVE: The objective of our study was to evaluate abdominal sonography for the detection of fluid and organ injury in children with blunt abdominal trauma. SUBJECTS AND METHODS: Fifty-one consecutive children with blunt abdominal trauma requiring abdominal CT were prospectively examined with sonography. Sonograms and CTs were independently evaluated by two radiologists for fluid and organ injury; CT examinations were considered abnormal if either was identified. Differences in CT interpretation were settled by a third observer. Using CT as the truth standard, we calculated the sensitivity, specificity, and negative predictive value of sonography for both observers. Agreement of the sonographic interpretations was evaluated using kappa statistic. RESULTS: In 33.3% of patients, CT revealed fluid, organ injury, or both. The sensitivity and specificity of sonography when detection of fluid was the sole parameter evaluated was 58.8% and 79.4%, respectively, for observer 1 and 47.1% and 79.4%, respectively, for observer 2. In contrast, the sensitivity and specificity of sonography when detection of both fluid and organ injury was evaluated was 64.7% and 79.4%, respectively, for observer 1 and 70.6% and 70.6%, respectively, for observer 2. The negative predictive value of sonography was 79.4% and 75.0% with evaluation limited to detection of fluid and 81.8% and 82.8% with evaluation of fluid and organ abnormality for observers 1 and 2 , respectively. Agreement was excellent for sonographic identification of fluid (kappa = 0.82) but poor for detection of organ injury (kappa = 0.34). CONCLUSION: The low sensitivity and negative predictive value of sonography when assessing for either fluid alone or fluid and organ injury suggest that a normal screening sonography alone in the setting of blunt abdominal trauma fails to confidently exclude the presence of an intraabdominal injury.